Week 7: Orthopaedic Surgery Flashcards
What is the purpose of bones?
Architectural framework
Anchor for other structures
Protects internal organs
What are causes of fractures?
Falls Crush injuries Sporting Violence Pathology: osteoporosis
What are types of fractures?
Subluxation Dislocation Fracture/dislocation Simple/closed or complex/open Comminuted Compression/burst Avulsion Depression Oblique Spiral Incomplete Transverse
How are fractures classified?
Anatomical positioning Description/exposure Fracture line/type and appearance Classical nomenclature Alignment- displaced, undisplaced, angulated, rotated
What are different types of proximal femoral fractures?
Subcapital neck Transcervical neck Intertrochanteric Subtrochanteric Greater trochanter Lesser trochanter
What is compartment syndrome?
“Increased pressure within the limited space of a muscle compartment”
This causes decreased blood flow to tissues below the level of the injury
CS should be considered in patients who have sustained a significant orthopaedic or vascular injury
If untreated, irreversible necrosis and permanent loss of function to the limb can occur
Signs and symptoms develop slowly
They may not appear until increased pressure becomes critical
What are the 6 P’s for assessing compartment syndrome?
Pain (severe) Pressure (swollen tense limb) Paraesthesia (loss of sensation) Paralysis (loss of movement) Pallor (late sign!) Pulses (present until very late stages)
What are injuries at risk of compartment syndrome?
Severe crush injuries Vascular injuries Fractures Severe contusions Swollen limbs beneath casts/splints
What is the treatment for compartment syndrome?
Fasciotomy
An incision is made releasing the muscle compartments in the affected limb
How do you recognise a fracture?
Pain on movement Loss of function Deformity Abnormal motility Crepitus Bruising / swelling Spasm
What are the altered vital signs in response to a haemorrhage?
Tachycardia (early)
Weak pulse (reduced SV)
Altered LOC (decreased brain perfusion)
Delayed cap refill (systemic vasoconstriction)
Normal or increased BP (compensation, vasoconstriction), decreased BP late sign
Pale cool peripheries (vasoconstriction), sweating (catecholamine release)
Decreased UO
How do you apply a plaster?
Apply under-cast padding. Remove excess water. Start at proximal end of limb. Smooth layers. Allow room for swelling. Inspect localised areas of pain by cutting window
Why is traction used?
Reduce fracture and realign bone fragments
Reduction and treatment of dislocations
Immobilise to prevent further soft tissue damage
Relieve muscle spasms occurring as a result of musculoskeletal trauma in absence of a #
Rest a diseased joint
What are the signs of carpel tunnel syndrome?
Numbness
Tingling
Weakness
Pain
What are the causes of joint disorders?
Osteoarthritis
Rheumatoid arthritis
Post traumatic arthritis
Avascular necrosis
What is the ideal patient for a knee hemiarthroplasty?
Not too old; not too young. Low demand (couch potato). Not obese. Structurally sound. Understands limitations
What is the purpose of a tourniquet?
Restrict arterial blood flow to limb;
Provide relatively blood-free surgical site
What are the risks of using a tourniquet?
Nerve injury; Blood vessel injury – ischaemia; Chemical burns related to prep solutions; Without correct exsanguination - > risk of intravascular thrombosis
What is a neurovascular assessment?
Evaluation of the neurological and vascular integrity of the limb
How do you prepare for neurovascular assessment?
Remove dirt, nail polish, blood or surgical antiseptics;
Ensure good lighting;
Ensure your hands are not overheated;
Rest patient prior as ankle pulse may be difficult/unable to be detected;
Always assess the unaffected limb for comparison;
How do you do a peripheral neurovascular assessment?
Checking sensation and motor function of extremity
Always compare affected to unaffected
Sensation
Ask pt to close their eyes.
Lightly touch extremity in course of nerve asking “where am I touching you?” rather than “do you feel this?”
Have pt describe limb sensation to determine if burning, pins/needles or numbness are present
Movement
Assesses the pts ability to perform normal movements of muscles in the course of a nerve innovation
Assess movement distal to injury
What does a vascular assessment examine?
Colour Swelling Temperature Capillary refill Peripheral pulse
What is a fracture?
Loss of continuity of the bone
What are the components of a screw?
Hemispherical head: internal hex width
Thread diameter
Thread type
Screw length
What are the types of bone?
Epiphysis: cancellous bone
Diaphysis: cortical bone
What is cortical bone?
Compact Bone Hard Can be thin Will accept a fine thread Similar in composition to metal
What is cancellous bone?
Spongiosa Bone Soft, compressible Can have defects Will accept a course thread Similar in composition to wood
What are the differences in screws between cancellous and cortical bone?
Thread diameter of cancellous screw is generally larger than that of cortical
Thread on the cortical screw is finer than the thread on the cancellous
Cortical screws are fully threaded, where as cancellous screws can be partially threaded
Cortical screws can be self tapping or non-seft tapping
Cancellous screws seldom require a tap
What does a screw do?
Compress a fracture
Act as an anchoring point in bone
What is tapping?
A Tap is a sharp instrument designed to cut threads into bone.
Taps are made from high carbon stainless steel (hard, sharp edge)
Hard but Brittle (can easily break)
Taps have flutes cut into them to aid in clearing bone debris
The std method for tapping is 2 turns forward & a ½ turn in reverse (to clear bone debris)
What is a washer?
Washers fit between the screw head and the bone and increase the contact area and allow more compression force to be exerted across the fracture
Greater surface area for contact reduces the risk of sinking, or collapsing into the bone
How do you insert a screw?
Drill
Measure
Tap
Insert the Screw
