Orthopedics & Fractures

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

Orthopedic Exam
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BONES
Major Functions: 1. Support for bodys 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 bones outer layer, what we can see. It is dense, strong, and heavy - Spongy Bone bones inner layer; self- organizes in response to the direction of weight put on it

http://training.seer.cancer.gov/module_anatomy/unit3_4_bone_classifica tion.html

Associated Structures
Joint anytime 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.

Quiz
Can you feel some of these bones in your own body? - where would you feel flat bones? - where would you feel a sesmoid bone (and its associated tendon)? - where would you feel short bones - where would you feel irregular bones?

FRACTURES

Types of Fractures
Open Closed Complete Incomplete Comminuted Segmental Chip Slab Pathologic

Open Fracture

Closed Fracture

Complete Fracture

Incomplete Fracture

Comminuted Fracture

Segmental Fracture

Chip Fracture

Pathologic Fracture
Fracture secondary to another disease process

Bone Re-Modeling
Osteoblasts secrete a matrix made up of calcium phosphate crystals Osteocytes retired osteoblasts; found within bony wall that they have deposited around themselves Osteoclasts break down bone; release acids to dissolve crystals and enzymes to break down matrix

Bone Reacts to Stresses Put on It

Greater physical stress placed on a bone at a particular site results in more bone deposition by osteoblasts at that site Another theory suggests electrical field change created by physical stress stimulates osteoblasts & matrix formation

Fracture Healing
Primary Bone Healing occurs when there is an anatomic reduction with compression fixation Secondary bone healing occurs with a fibrous connective tissue bridge that is replaced by bone

Normal Fracture Healing

What Is Necessary to Get Normal Healing?

Abnormal Fracture Healing

Mal-union a fracture that heals with abnormal alignment Non-union fracture healing has STOPPED before completely healed - elephant foot hypertrophic non-union - tapered atrophic non-union Sequestrum a dead bone fragment separated from the rest of the bone Osteomyelitis infection of bone

Malunion

Sequestrum

Non-union

Osteomyelitis

Treatment Options
Fracture Reduction - Closed * temporary (until surgery) * permanent (cast or splint) - Open (orthopedic surgery) Intramedullary Fixation Cerclage External Fixation Devices

Fracture Reduction Goals

Get bones close enough to heal Proper alignment - avoid mal-union + loss of function Avoid additional trauma - further fracture - infection

Closed Fracture Reduction

Open Fracture Reduction

Intramedullary Fixation

Pin Insertion

Cerclage

External Fixators

External Fixators

(view video)

TITAN continued
Treatment: Surgery - Wedge osteotomy of femoral condyles, plate applied - Deepening of patellar groove - Tibial crest movement back to cranial, pins applied - Patella was sutured medially to fixate in groove - Extra joint capsule on medial surface of joint was removed

Follow-Up
Re-Check in 2weeks for range of motion Re-check in 4weeks for progress of healing Recheck in 10weeks for further progress of healing STRICT CAGE REST DURING THIS TIME!!

Surgery Tools

Animal Orthopedics as Human Model

Animals are frequently used as models in clinical studies or experiments in the development of surgical procedures & drugs in veterinary medicine to be used in human medicine!
1st hip replacement surgery was developed in military dogs

Jeopardy!

Questions???

END
All images used from government websites as indicated OR with permission from Dr. Sharon Kerwin & Dr. Ben Young, Texas A&M University College of Veterinary Medicine