WCS33 Introduction To Orthopaedic Surgery

Question 1

Orthopaedic subspecialties

Answer 1

1. General
2. Trauma
3. Spine
4. Joint replacement
5. Hand and foot
6. Paediatrics
7. Sports
8. Oncology
9. Rehabilitation

Question 2

Musculoskeletal system

Answer 2

1. Bone
2. Joint
3. Soft tissue
   - Muscles
   - Tendons
   - Ligaments
   - Nerves

Chief complaints:

• Pain
• Deformity
• Stiffness
• Instability
• Weakness
• Numbness

Question 3

Form vs Function

Answer 3

Form:

• Normal
• Abnormal: Deformity

E.g. Genu valgum/varus, Kyphosis/Scoliosis

Function:
- Activities of Daily Living (ADL)

Question 4

Diseases

Answer 4

1. Congenital / Developmental
   - e.g. Congenital Talipes Equinovarus, CDH
2. Trauma
   - e.g. Fracture, Dislocation
3. Infection
   - e.g. TB spine, Necrotising fasciitis
4. Neoplasm
   - e.g. Osteochondroma (benign bone tumour), Osteosarcoma (malignant)
5. Inflammation
   - e.g. RA, Ankylosing spondylitis
6. Metabolic
   - e.g. Gouty arthritis, Diabetic foot
7. Neurovascular
   - e.g. Carpal tunnel syndrome, Avascular necrosis of femoral head
8. Degeneration
   - e.g. Osteoarthritis of knee, Lumbar spondylitis
9. Idiopathic
   - e.g. Idiopathic adolescent scoliosis

Question 5

Management principles

Answer 5

Aims:

1. Relieve pain
2. Improve function
3. Correct deformity

Principles:

1. Conservative
   - Closed reduction + Plaster of Paris
   - Bracing to hold spine straight
2. Operative
   - Open reduction + Internal fixation
   - Instrumentation / Spinal fusion

Goal (***5Rs):

1. Repair
   - e.g. bones (fracture fixation), tendons / ligaments, neurovascular
2. Reconstruct
   - e.g. joint (knee replacement), ligament (ACL reconstruction), toe-hand transfer
3. Rehabilitate
   - Preserve function
   —> Restore function (e.g. Splints, Orthotics, Prosthetics)
   —> Enhance function (e.g. Training, home environment modification)
4. Remove
   - e.g. loose bodies, synovitis, torn meniscus, prolapsed IV disc, tumour, amputation
5. Release
   - e.g. trigger finger, Carpal tunnel syndrome, contracted soft tissues (equinus deformity of ankle)

Question 6

Multidisciplinary team in Orthopaedics

Answer 6

1. Doctors: Anaesthesiologist, Radiologist, Physician, Rheumatologist, Pathologist, Oncologist
2. Nurse: ward, outpatient department, OT
3. Physiotherapist, Occupational therapist, Prosthics and Orthotics, Podiatrist
4. Clinical psychologist, Medico-social worker
5. Engineers, Material scientist
6. Patient family members