Week 7: Orthopaedic Surgery

Question 1

What is the purpose of bones?

Answer 1

Architectural framework
Anchor for other structures
Protects internal organs

Question 2

What are causes of fractures?

Answer 2

Falls
Crush injuries
Sporting
Violence
Pathology: osteoporosis

Question 3

What are types of fractures?

Answer 3

Subluxation
Dislocation
Fracture/dislocation
Simple/closed or complex/open
Comminuted
Compression/burst
Avulsion
Depression
Oblique
Spiral
Incomplete
Transverse

Question 4

How are fractures classified?

Answer 4

Anatomical positioning
Description/exposure
Fracture line/type and appearance
Classical nomenclature
Alignment- displaced, undisplaced, angulated, rotated

Question 5

What are different types of proximal femoral fractures?

Answer 5

Subcapital neck
Transcervical neck
Intertrochanteric
Subtrochanteric
Greater trochanter
Lesser trochanter

Question 6

What is compartment syndrome?

Answer 6

“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

Question 7

What are the 6 P’s for assessing compartment syndrome?

Answer 7

Pain (severe)
Pressure (swollen tense limb)
Paraesthesia (loss of sensation)
Paralysis (loss of movement)
Pallor (late sign!)
Pulses (present until very late stages)

Question 8

What are injuries at risk of compartment syndrome?

Answer 8

Severe crush injuries
Vascular injuries
Fractures
Severe contusions
Swollen limbs beneath casts/splints

Question 9

What is the treatment for compartment syndrome?

Answer 9

Fasciotomy

An incision is made releasing the muscle compartments in the affected limb

Question 10

How do you recognise a fracture?

Answer 10

Pain on movement
Loss of function
Deformity
Abnormal motility
Crepitus
Bruising / swelling
Spasm

Question 11

What are the altered vital signs in response to a haemorrhage?

Answer 11

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

Question 12

How do you apply a plaster?

Answer 12

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

Question 13

Why is traction used?

Answer 13

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

Question 14

What are the signs of carpel tunnel syndrome?

Answer 14

Numbness
Tingling
Weakness
Pain

Question 15

What are the causes of joint disorders?

Answer 15

Osteoarthritis
Rheumatoid arthritis
Post traumatic arthritis
Avascular necrosis

Question 16

What is the ideal patient for a knee hemiarthroplasty?

Answer 16

Not too old; not too young.
Low demand (couch potato).
Not obese.
Structurally sound.
Understands limitations

Question 17

What is the purpose of a tourniquet?

Answer 17

Restrict arterial blood flow to limb;

Provide relatively blood-free surgical site

Question 18

What are the risks of using a tourniquet?

Answer 18

Nerve injury;
Blood vessel injury – ischaemia;
Chemical burns related to prep solutions;
Without correct exsanguination - 
> risk of intravascular thrombosis

Question 19

What is a neurovascular assessment?

Answer 19

Evaluation of the neurological and vascular integrity of the limb

Question 20

How do you prepare for neurovascular assessment?

Answer 20

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;

Question 21

How do you do a peripheral neurovascular assessment?

Answer 21

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

Question 22

What does a vascular assessment examine?

Answer 22

Colour
Swelling 
Temperature
Capillary refill
Peripheral pulse

Question 23

What is a fracture?

Answer 23

Loss of continuity of the bone

Question 24

What are the components of a screw?

Answer 24

Hemispherical head: internal hex width
Thread diameter
Thread type
Screw length

Question 25

What are the types of bone?

Answer 25

Epiphysis: cancellous bone
Diaphysis: cortical bone

Question 26

What is cortical bone?

Answer 26

Compact Bone
Hard
Can be thin
Will accept a fine thread
Similar in composition to metal

Question 27

What is cancellous bone?

Answer 27

Spongiosa Bone
Soft, compressible
Can have defects
Will accept a course thread
Similar in composition to wood

Question 28

What are the differences in screws between cancellous and cortical bone?

Answer 28

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

Question 29

What does a screw do?

Answer 29

Compress a fracture

Act as an anchoring point in bone

Question 30

What is tapping?

Answer 30

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)

Question 31

What is a washer?

Answer 31

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

Question 32

How do you insert a screw?

Answer 32

Drill
Measure
Tap
Insert the Screw