INTRODUCTION TO ORTHOPAEDICS

Dr Sandeep Kumar
Head
Department of Orthopaedics
HIMSR & HAHC Hospital
New Delhi
 ORTHOPEDICS
Developed as a subspeciality of General Surgery
in 17th – 18th century.
Initial case load was mainly infection and
metabolic diseases.
 20th CENTURY – WWI AND WWII
• World wars I and II saw a phenomenal increase
in battle wounds (Gunshots/ Skeletal injuries).

• Emphasized the need to become a separate

Orthopedic Specialty
Hallus valgus
 Descriptive Orthopaedic Terms
• Valgus: part of body
distal to joint directed • Hallus
away from midline • Genu varus
• Varus: Part of body • Genu valgus
distal to joint directed • pes varus
toward midline
• metatarus valgus
• metatarus varus
 ORTHOPEDICS

TRAUMA SYSTEMIC
(HOT) (COLD)
 ORTHOPAEDIC DISORDERS
• Locomotive system
– Bone
– Joints
– Tendons
– Nerves
– muscles
 WHAT CONDITIONS AFFECT THESE
STRUCTURES
1. Injuries and mechanical derangement
2. Congenital and developmental anomalies
3. Infection and inflammation
4. Arthritis and inflammatory disorders
5. Metabolic dysfunction
6. Tumors and tumor like condition
7. Sensory and motor disorders
Orthopaedic Trauma
- General Principles -
 Orthopaedic Trauma
The care of fractures
and soft tissue injuries
of the extremities either
in the setting of
multiple trauma or
isolated injuries
 Trauma
• Field Triage
– Airway
– Breathing
– Circulation
– Extrication of Patient
– Shock Management
– Fracture Stabilization
– Transport
 Trauma
• Golden Hour of Trauma
– Rapid transport of a severely injured patient to a
trauma center for definitive care. Initial treatment
has a significantly higher chance for survival
during this period.
 Trauma Evaluation
• ATLS- Advanced Trauma and Life Support
– A standardized protocol for the evaluation and
treatment of victims of trauma
– Developed by an Orthopaedic surgeon, Dr James
K. Styner (1976) who was involved in a trauma and
was not satisfied with the care for such patients.
 ATLS
• A- establish an Airway
• B- Breathe for the pt. (if
they aren’t)
• C- assess and restore
Circulation
• D- assess neurologic
Disability
• E- Expose entire patient
 Primary Survey
• Rapid assessment of ABC’s and addressing life
threatening problems (ie establishing airway and
ventilation, placing chest tubes, control active
hemorrhage)
• Place large bore IV’s and begin fluid replacement for
patients in shock
• Obtain Xray of Chest, Pelvis, and Lateral C-Spine
 Secondary Survey
• Assessing entire patient for
other non-life threatening
injuries.
• Orthopaedist assesses
skeleton and splints
fractures and reduces
dislocations
• Also evaluate distal pulses
and peripheral nerve
function
• Obtain Xray or CT of
affected areas when pt is
stable
 EMERGENT SKELETAL ISSUES
• Hemorrhage control from Pelvis Fractures in pt with
labile blood pressure (shock)
– Close pelvic volume
• Hemorrhage control from open fractures
– Direct pressure
• Restore pulses by realigning fractures and
dislocations
 URGENT SKELETAL ISSUES
• Irrigation and Debridement of open fractures
• Reduction of dislocations
• Splinting of fractures
• Fixation of femur fractures
• Addressing compartment syndromes
ORTHOPAEDIC BASICS

- History and Physical Exam

- How to Read an X-Ray
- Principles of Casting/Splinting
- Fracture Fixation
 ORTHOPAEDIC HISTORY
• A good general orthopaedic history contains:
– Onset, Duration, and Location of a problem
– Limitations and debilitation attributed to the
problem
– Good surgical history, especially with regards to
orthopaedic surgeries and prior anesthesia
– Co-morbid conditions that contribute to the
problem or will preclude healing in some manner
COMPONENTS OF ASSESSMENT
• Chief Complaint
– Why seeking care
•Pain
– Acute and chronic problem
• History taking; its
significance
• Pain characteristics
– location
– character
– what effects
• Associated conditions Complications!
 PRINCIPLES OF ASSESSMENT
• Normal first
• Bilateral comparison • Test your skills
– Changes with age
• Inspect then gentle
– Nutritional status
palpation
– Skin integrity
– shape, size , contour
– Rashes
– signs inflammation,
ecchymosis – Color changes, esp
with cold; arterial vs.
– muscle condition venous
– deformity – Character of joints
– Bruises, swelling
 PHYSICAL EXAM BASICS
• NVI What does this mean?
1. Neurologic exam- Always document the
neurologic status. Some fractures are
associated with nerve injuries and knowing
the status of the nerve is critical
2. Vascular exam- Always check for pulses distal
to the fracture sight. Missed vascular
injuries can be devastating
 PHYSICAL EXAM
• NEVER trust someone else’s exam. ALWAYS
put your hands on the patient and see for
yourself
• Always trust your exam- you WILL pick up
something that someone else has missed at
some point
IMAGING
 READING X-RAYS
1. Say what it is- what anatomic structure are
you looking at and how many different views
are there
2. Condition of the soft tissue- Open vs Closed
3. Regional Location- Diaphysis (rule of 1/3),
Metaphysis, Epiphysis including intra and
extra-articular, and Physis (pedi)
4. Direction of the fracture line- Transverse,
Oblique, Spiral
 READING X-RAYS
5. Condition of the bone- comminution (3 or
more parts), Segmental (middle fragment),
Butterfly segment, incomplete, avulsion,
stress, impacted
6. Deformity-Displacemtent (distal with respect
to proximal), angulation (varus, valgus),
rotation, shortening (in cm’s), distraction
 FRACTURE PATTERN
• Transverse
• Produced by a
distracting or tensile
force
 FRACTURE PATTERN
• Spiral
• Produced by a torsional
force
 FRACTURE PATTERN
• Butterfly
• Produced by pure
bending force
 Fracture Pattern
• Comminuted
• Broken into many
pieces- high energy
with combined forces
 DISPLACEMENT
• Characterized by % of bone
contact on either view
 ANGULATION
• Distal fragment relative to
proximal
– Varus, Valgus, Anterior, Posterior
• Apex of angle formed by
fragments
– E.g., Apex Anterior, Apex Medial,
Apex Ulnar
 LOCATION
• Commonly described in thirds of affected
bone
– ie distal third of tibia
– ie junction of proximal and middle third of femur
– If fractured at two levels describe as segmental
 LOCATION-DIAPHYSIS
• Shaft portion of bone
 LOCATION-METAPHYSIS
• The ends of the bone (if
the fracture goes into a
joint it is described as
intra- articular)
 NOW ALL TOGETHER
• Transverse fracture of
the femur at the middle
third- distal third
junction with 100%
displacement and varus
(or apex lateral)
angulation
WHAT DO YOU SEE?
WHAT DO YOU SEE?
WHAT DO YOU SEE?
 SYSTEMIC (COLD ORTHOPEDICS)
1. Congenital and developmental anomalies
2. Infection and inflammation
3. Arthritis and inflammatory disorders
4. Metabolic dysfunction
5. Tumors and tumor like condition
6. Sensory and motor disorders
CONGENITAL ANOMALIES
CONGENITAL ANOMALIES
CONGENITAL
INFECTION
NODULES
ARTHRITIS
ARTHRITIS
ARTHRITIS
METABOLIC DYSFUNCTION
TUMOURS
TUMORS
NEUROMUSCULAR DISORDERS
NEUROMUSCULAR DISORDERS
NEUROMUSCULAR DISORDERS