Alloy
Substances that are mixtures of pure metals.
Aponeurosis
A tendinous sheet that separates muscles or attaches a muscle to bone.
Arthodesis
Surgical fusion of a joint.
Bioactive implant
An orthopedic implant that releases calcium to enhance healing.
Biocompatibility
A term that describes a material that is compatible with tissue (i.e., causes no toxic or inflammatory effect).
Biomechanics
The relationship between movement and biological or anatomical structures.
Broaches
Fin-shaped rasps used to enlarge the medullary canal for insertion of an implant. The broach is the same shape as the implant.
Cannulated
A device having a hollow core; for example, an instrument with a central channel that can be fitted over a guidewire or pin.
Casting
A method of immobilizing a limb by the application of rigid or semirigid material along the length of the limb. A cast can be fully or partially circumferential.
Closed reduction
Alignment of bone fragments into anatomical position by manipulation or traction.
Comminuted
A fracture in which there are multiple bone fragments.
Compartment syndrome
Extreme tissue swelling within a closed compartment of the body or closed external device such as a cast. Edematous tissue can exceed the capacity of the space it is held in, causing sufficient pressure to cause tissue necrosis.
Compression
Mechanical force in which a structure is compacted or pressed together. Compression is used to repair tissue. A compression injury (e.g., compression fracture) results when bone or other tissue is compacted.
Cruciate
Cross-shaped.
Dislocation
Displacement of a joint from its normal position.
Distraction
A mechanical process in which a structure is elongated. Distraction can be used to suspend a limb (and thereby stretch the soft tissue and bones) during surgery. A distraction injury is caused by the pulling apart or stretching of tissue (the opposite of
Examination under anesthesia (EUA)
Fracture and dislocation may be fully assessed when general anesthesia is used.
External fixation
A method of stabilizing bone fragments in anatomical position from outside the body. A cast is an example of an external fixation device.
Internal fixation
A method of surgically repairing a fracture by implanting a device that holds the bone fragments in place. Metal plates, rods, pins, and screws are examples of internal fixation devices.
Open reduction
Surgical access (through an incision) to bring bone fragments into anatomical alignment.
Orthopedic system
A specific (usually patented) set of instruments and implants used for an orthopedic technique. For example, arthroplasty implants are marketed as systems that include the joint components and instruments that are designed for use with that implant.
Press-fit
To impact or press a joint implant into position. Press-fitted implants do not require bone cement.
Ream
To enlarge a preexisting hole, depression, or channel, such as the medullary canal.
Replantation
Surgical attachment of the hand, thumb, or fingers after traumatic amputation.
Reduction
The process of manipulating a bone structure to restore anatomical position.
Skeletal traction
Traction device in which bone fragments are connected by pins or rods that are surgically inserted into the bone.
Traction
A mechanical method of applying pulling force to fractured bone in order to bring the fragments into alignment.
Label this figure of the anatomy of a long bone using the description and medical terminology as described in the text.
1. Articular cartilage
2. Spongy bone
3. Epiphyseal plate
4. Red marrow cavities
5. Compact bone
6. Medullary cavity
7. Endosteum
8. Ye
1. Electric drill and drill heads
2. Pneumatic low speed drill
3. Jacob chuck
The chuck is attached to the drill head and receives attachments such as reamers, burrs, drill bits, or other rotational cutting tips, which fit into the central hole of the chuck.
4. Jacob chuck keys
A chuck key is used to open and close the chuck's jaws, which are shaped like a cloverleaf.
5. Reamers used for canalization of the long bones
A rod-shaped or chisel-pointed cutter used to ream, or clear, the medullary canal.
6. Diamond burr
A round, conical, or tapered tip used for making narrow holes or for smoothing very small areas.
7. Drill tips
pin with wide cutting threads that is used to make a smooth-sided hole in the bone.
What are the three stages of bone healing, and what occurs during each phase?
a. Inflammatory phase- body's clotting mechanism is triggered and fibrin is released to form the basis of platelet aggregation and hematoma (congealed blood), which eventually is absorbed by the body.
b. Reparative phase - During the reparative phase, gro
How are joints classified?
1. �Synarthrosis (suture joint): A joint with limited movement or fixed articular surfaces, such as between the skull bones.
2. �Amphiarthrosis (cartilaginous joint): A joint in which the bones are connected by cartilage and only slightly moveable. The sy
List the equipment, supplies, and medication used in orthopedic surgery.
During surgery, a moldable preparation called bone putty (Ostene) is pressed into bleeding areas to control oozing. Beeswax combinations (bone wax) traditionally have been used for this purpose, but these have been largely replaced with more effective and
List the different types of instruments used in orthopedic surgery and give and example.
Certain types of bone retractors (e.g., Blount and Bennett retractors) are designed to be used as levers against the bone, to shift its position. Soft tissue retractors are designed for a specific anatomical location, such as the shoulder, and some genera
List the different types of fracture patterns and give an example of each.
�Transverse: The fracture line is perpendicular to the long axis of the bone.
�Oblique: A type of transverse fracture that occurs at an angle. �Spiral: A fracture of the long bone that occurs in a spiral pattern as the result of twisting or torsion on the
List the different types of fracture repairs and define.
Reduction is the process of bringing the bone fragments into anatomical alignment.
�Open reduction takes place through an incision as part of the surgery.
�Closed reduction is performed by manipulation of the bone or with an external traction device that
List the parts of a screw and define.
�Head: The flat or conical part of the screw. The recess of the screw may be hexagonal, a straight slot, or cruciform (cross-shaped). �Shaft: The long section of the screw. The outside of the threads (thread diameter) determines the screw's numerical diam
List and define the different types of screws.
�Cancellous: Used mainly in dense (cancellous) bone; large diameter and greater pitch to increase contact with the bone.
�Cortical: Small diameter and decreased pitch; used in cortical bone. The bicortical screw is inserted into the cortical bone on one s
List the functions of a plating system.
�Protect and neutralize the fracture
�Span the fracture
�Provide compression
�Reduce the fracture (bring the bone fragments together)
�Buttress (support) structures or fragments
List and define the different types of plates.
static, or neutralization, plate spans a two-fragment fracture and is fixed in place with lag screws. This is a simple means of stabilizing (i.e., neutralizing) force acting on the bone fragments with no mechanical action on the fracture line. This type o
Define and give an example of: IM rod, wires and cables, K-wires and Steinmann pins.
An intramedullary (IM) nail is a thick rod inserted into the medullary canal of long bones to provide structural support from inside the bone.This device is used for fractures of long bones, such as the
femur, tibia, and humerus. IM nails are made of tita
Traction is used for:
Traction is a mechanical method of applying pulling force or elongation to fractured bone. Traction is used to:
�Prevent injury to soft tissues, especially blood vessels and nerves near the fracture site
�Align bone after a fracture or dislocation
�Preven
List and define the different types of metal used for joint replacement.
Metal alloys are used in the manufacture of joint implants. The metals and alloys most commonly used are:
�Cobalt-chromium-molybdenum
�Titanium-aluminum-vanadium
�Pure titanium
�Tantalum
Metal-on-metal components were the first type to be used in joint re
For which of the following medical diagnoses would the surgical intervention be arthroplasty? Write "arthroplasty" on the line if it would be used.
a. Avascular necrosis (hip arthroplasty)
b. Rheumatoid arthritis (shoulder arthroplasty)
c. Malignant bone tumor
d. Metastatic bone disease
e. Osteoporosis (arthroplasty)
f. Scoliosis
g. Compartment syndrome.
Define the fracture types listed below:
a. Transverse: The fracture line is perpendicular to the long axis of the bone.
b. Oblique: A type of transverse fracture that occurs at an angle.
c. Spiral: A fracture of the long bone that occurs in a spiral pattern as the result of twisting or torsion
A narrow bridge of bone between two other structures
Neck (of the femur)
A depression in a bone
Fossa (Iliac fossa)
A ridge of bone
Crest (iliac crest)
A sharp narrow projection
Spine
A knuckle shaped portion of bone, generally found in association with a joint.
Condyle
A projection of bone
Process (coracoid process)
A small, rounded projection
Tubercle (deltoid tubercle)
A large, rounded projection
Tuberosity ( ischial tuberosity)
A rounded orifice in bone, a passageway for blood vessels or nerves
Foramen (olfactory foramen)
A cavity within a bone
Sinus (nasal sinus)
A groove in a bone
Sulcus
Case Study 1:
Your patient has just arrived in the emergency department with orthopedic trauma. He will need to be evaluated and then diagnosed using a variety of imaging procedures. These commonly include which techniques?
a. Radiography: Radiographs are the first-level assessment in most cases of orthopedic trauma.
b. Magnetic resonance imaging (MRI): MRI scans generally are not used for routine diagnosis of fractures, but they commonly are performed for spinal cord injuri
Case Study 2:
You have just been called in for orthopedic trauma. Knowing the types of bone fractures helps you choose the type of instrumentation needed for the repair. Working from left to right, label the fractures pictured in the following figure.
a. Open
b. Closed
c. Incomplete
d. Complete
f. Linear
g. Oblique
Define these important terms in your own words for surgical technique in orthopedics: �Internal fixation; �External fixation; �Open reduction; �Closed reduction.
Internal fixation, which requires surgery to insert or implant a device that holds the bone fragments in place. Metal plates, rods, pins, and screws are examples of internal fixation devices.
�External fixation, a means of stabilizing bone fragments in an
Give an example of a specific orthopedic procedure for each of the four techniques listed in question 1.
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What techniques and specific instruments must be used to insert simple bone screws that are not self-tapping?
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Describe the sterilization protocol (rules) for orthopedic implants.
Many implants, including joint components, are supplied by the manufacturer individually in sterile packages. Plates, screws, pins, and rods are not wrapped individually but supplied in sterile sets, from which the appropriate size is selected during surg
What is a lag screw? How does it work?
�Lag: All screws that exert compression on bone fragments, either directly or with a plate.
The screw thread applies compression only on the object farthest from the screw head. For example, in the case of two bone fragments, the fragment farthest from th
What special equipment is used to mix bone cement? Why is this equipment necessary?
may be cemented in place with polymethylmethacrylate (PMMA). Bone cement is an interface or a grout (rather than glue) between the joint implant and tissue. It is formed by mixing two components, PMMA powder and a liquid monomer of methylmethacrylate.
The
Define torque
�Torque or torsion (twisting force): Torque is the type of force applied to a screwdriver to implant a screw. Torsion injury results when tissue is twisted on itself.
During joint replacement surgery, the limb is often prepped and draped "free." What does this mean and why is it done?
ease of manipulation during the procedure.
What is meant by the term cannulated as it applies to orthopedic hardware?
A device having a hollow core; for example, an instrument with a central channel that can be fitted over a guidewire or pin.
What are the most important reasons for immediate stabilization of a fracture?
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