Welcome to your Orthopedic surgery

Course requirments
Attendance: 5%
presentations: 5%
Mid term Exam:30%
Final Exam:60%
Total mark: 100%

Reference : Tronto Notes, Bailey & Love`s, Short practice of

surgery, Current Diagnosis and treatment Orthopedics, Lange Mc
Graw Hill
Introductions and Clinical
examination of orthopedic
patients

Dr.Abdirahman Adan
Orthopedics
“Orthopedics” is:

that branch of surgery which is specially concerned

with the preservation and restoration of the function
of the skeletal system, its joints, and associated
structures like ligaments and tendons
Orthopedics
In general:
to restore and preserve the normal function of
musculoskeletalsystem
Orthopedic surgeons use both surgical and nonsurgical
means to treat musculoskeletal trauma, sports
injuries, degenerative diseases, infections, tumors, and
congenital disorders
Goals
 At the end of the course you should be able to:
1. Read basic x-rays appropriately
2. Perform an orthopaedic history and physical
3. Recognize common fractures, their classification, and
know how to acutely manage them
4. Understand basic patient care for the Orthopaedic
patient
5. Be able to diagnose common musculoskeletal
problems
Musculoskeletal system
Bones
Joints
Cartilages
Ligaments
Muscles
Tendons

Function:
 provide support for the body
 protect vital organs
Facilitate easy Movement of joints
BONES
Major Functions:

1. Support for body’s vital organs (ie. skull protects the

brain, rib cage protects the heart & lungs)

2. Serve as levers in conjunction with joints, tendons,

ligaments, and muscles for movement

3. Production of blood cells in bone marrow

4. Storage site for calcium & phosphorous

Anatomy of a Typical Bone
Types of Bone
- Compact Bone – bone’s outer layer, what we can see. It is
dense, strong, and heavy
- Spongy Bone – bone’s inner layer; self- organizes in response
to the direction of weight put on it
 Bone Structure

Periosteum
 Diaphysis
Epiphysis
Endosteum
Epiphyseal plates;
bone growth,
injury
Associated Structures
Joint – where 2 or more bones come together
Articular Cartilage – cartilage covering the ends of
bones that are in contact with adjacent bones to create
smooth movement and shock absorption
Tendon – connects muscle to bone
Ligament – connects bone to bone
Classification of Bones
Long Bones – long! Bones of limbs
Short Bones – short! Small bones of hands & feet
Flat Bones – flat!
Sesamoid Bones – small bones embedded in
tendon as it crosses a bony prominence.
Irregular Bones – jutting processes give these
bones an irregular shape.
Orthopedic surgery
Needs
 Diagnostic evaluation
   Preoperative evaluation
 Surgery
 Postoperative care
 Rehabilitative period
History
 Introduce yourself
 Ask an open question:(What is your problem?
 When did it start? How did it start?
What were you doing? Sudden /gradual onset
Associated symptoms.
Ask about pain swelling, instability, mechanical symptoms,
loss of power, altered sensation
Difficulties in daily living?
– Eating, washing, walking
Past medical history
– Diabetes, asthma, heart attack, stroke
 Past surgical procedures
Medications
Anticoagulants, steroids, aspirin,
immunosuppressants
Social conditions
Work, accomodation, home help
Hopes and expectations of care?
Musculoskeletal examination

Look
Feel
Move
Look
How does the patient walk? Walking aid?
Limping?
How does the patient stand?
Skin:scars,bruising, erythema, sinuses etc.
Soft tissues: swelling, lumps, muscle wasting
Bones: deformities, alignment
Feel 
Areas of tenderness: try to determine anatomical
structure
Sensory loss and patern(dermatomal, glove)
 Lumps; what kind of a lump? Hard or soft, mobile
or attached to the surrounding structures
Peripheral pulses
Move
Active movement: ask patient to move a limb
 Passive movement: move ajoint yourself.
Record a range of movement
Stability
Muscle power
Peripheral nerve examination: motor testing,
reflexes,tone
Direction of movement
 Flexion
   Lateral flexion
   Extension
   Abduction
   Internal rotation
   External rotation
   Supination
   Pronation
   Inversion
   Eversion
   Retraction
Grading muscle power
o 0–no movement
o 1–flicker of movement
o 2–movement with gravity elimination
o 3–movement against gravity
o 4–movement against resistance but power less
than normal
o 5–normal power
Body positions
Supine
Prone
 Right lateral
Left lateral
Trendelenburg
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
 X-Ray Rule of 2s
2 sides = bilateral
2 views = AP + lateral
2 joints = joint above + below
2 times = before + after reduction
Diagnostic Tests
CT Scan
Bone Scan
MRI
Dual-Photon Absorptiometry
Arthrography
Arthrocenthesis
Arthroscopy
Orthopaedic Interventions!
Traction
Casts
External Fixators
External fixators:
Pin, plates and
screws
Crutch-walking
The end