Chapter 21 Orthopedic Surgery

abduction

Movement away from the midline

adduction

MOVEMENT TOWARD THE MIDLINE OF THE BODY

circumduction

a circular movement of a limb or eye

rotation

moving a body part around a central axis

dorsiflexion

bending the foot upwards towards the ankle jount

plantar flexion

bending the foot downward at the ankle

eversion

turning the foot outward at the ankle joint so the sole of the foot is pointing outward

inversion

turning the foot outward at the ankle joint so the sole of the foot is pointing inward

flexion

bending a joint

extension

straightening a joint

pronation

pointing a body part downward

supination

pointing a body part upwards

distraction

bone fragments, separated, fills with granulated tissue

avascular necrosis

death to a bone . no blood supply

compound fracture

open fracture

delayed union

Used to describe an increase in the healing time of fractures. The reasons are pathalogical (osteoporosis), mechanical (distraction of the fracture site or inadequate immobilization), or traumatic, referring to the type of injury sustained.

comminuted fracture

fracture in which the bone is splintered or crushed

nonunion

Fractured bones ends do not unite.

malunion

Occurs when the fracture heals in a position that does not resemble the original anatomical form of the bone and alters the mechanical funtion of the bone.

compartmental syndrome

An increase in pressure within a closed space. The fractured ends of the bone cause excess pressure that leads to neurovascular compromise. True emergency

hyoid bone

Just below the mandible and anterior to the trachea

first cervical bone

atlas

axis

second cervical bone

clavicles

articulated medially with the manubrium and laterally with the acromion process of the scapula

scapula

posterior surface is divided into equal portions by a spine or ridge of bone. this spine leads to the acromion process and the coracoid process

scapula

the acromion process articulates with the clavicle and provides attachments for muscles of the arm and chest

pectoral girdle

consists of the glenohumeral, sternoclavicular, and acromioclavicular (AC) joints

rotator cuff

surrounding the shoulder joint are four muscles collectively referred to as the

four muscles of the rotator cuff

infraspinatus, teres minor, subscapularis, supraspinatus

to provide stability and strength to the shoulder joint

the main function of the rotator cuff is

humerus

the upper end is the smooth rounded ball that fits into the glenoid fossa of the scapula

circular pelvis consists of

sacrum, coccyx, pelvic girdle, and provides support for the trunk and attachments for the femur

pubis

anterior portion of the pelvis

hip

ball and socket joint formed by the acetabulum

patella

a sesamoid bone contained within the quadriceps tendon

PCL and ACL

two large ligaments located in the knee joint help stabilize the movement of the joint

PCL

prevents the femur from sliding posteriorly on the tibia, prevents hyperextension of the knee, limits the medial rotation of the femur

ACL

prevents the femur from sliding anteriorly on the tibia

tibia

located on the medial side, shin bone, distally articulates with the talus bone forming part of the ankle joint

fibula

located on the lateral side, non-weight bearing bone, lateral malleolus articulates with the talus bone to form the other portion of the ankle joint

pneumatic tourniquet

extremity will be exsanguinated by elevating the extremity and wrapping, distally to proximally, with an Ace or Esmarch bandage prior to inflating the tourniquet

traction

used to immobilize a joint, reduce a fracture, and or align a body part

manual, skin, skeletal

three types of traction

skeletal traction

sterile procedure

laminar air flow

provides highly filtered air in a uni-direction flow with continuous air exchanges to help reduce microbial count

oscillating saw blade

moves side-to-side

moves back-and-forth

reciprocating saw blade

frequently used alloys in implants

titanium, stainless steel, cobalt-chromium

implants

should never be reused

gelfoam, avitene, thrombin, bonewax

hemostatic agents in ortho surgery

steroids

used for anti-inflammatory action

osteoclasts

large cells that resorb or break down bone matrix

cortical bone

hard, dense, strong bone that forms the outer layer of bone; also called compact bone

cancellous bone

spongy bone found at the ends of bone and lining the medullary marrow cavity

epephysis

wide end of long bone. composed of canellous bone. make the joint area of a bone

epiphyseal plate

the area of active bone growth in growing bone

irregular bones

skull, face and vertibrae

sesamoid

found within tendons. patella and ball of foot

amphiarthrosis

a disk of fibrous cartilage onnects the joint. vertebral cartilage and symphysis pubis

1st part of bone healing

fracture hematoma serves as a foundation for the cellular proliferation stage

false ribs

remaining 5 pair that cartilage do not directly connect to the sternum

arthroscopic equipment needed in every case

video monitor, light source, arthroscopy pump and tubing for fluids, powered shaving system, camera system,video recording system, photograph system

PMMA polymethyl methacrylate

bone cement

suture used to attach tendon to bone

polyester (package orange, suture teal)

iliac crest

optimal source for obtaining autogenous cancellous and cortical bone for use in bone grafting

gouges, osteotomes, curettes, mallet, power saw

instruments used for taking bone graft

arthroscopic repair of meniscal tear

preservation of as much of the cartilage as possible

known as Bucket Handle

most common tear of the menisas

fixation devices for ACL repair

bone screws, staples, spiked washers, buttons

notchplasty procedure

portion of the ACL that remains is debribed using a full radius resector to the arthroscopic shaver

notchplasty procedure

performed using a 4.5mm srthroplasty bur, osteotome, and rasp

notchplasty procedure

widens the anterior portion of the intercondylar notch to prevent impingement on the ACL graft

tibial aiming device

positioned and the guide pin is inserted on the anterior tibial incision into the intercondylar notch, just medial to the site of ACL attachment to the tibia

patellar tendon harvest and preaeration

surgeon uses a marker or cautery to outline a 1 inch long patellar and tibial bone plug

simitendinosis. gracillis

hamstrings

hamstring harvest and preparation

hamstrings are dissected from he tibial attachments

allograft preference

patella, achilles, anterior tibialis

surgeon may use a pituitary rongeur to remove

soft tissue that surrounds the outer portion of the femoral tunnel to facilitate passage of the graft

endoscopic carpal tunnel release

median nerve is entrapped

symptoms of CTS

tingling fingers, numbness in the fingers, loss of sensation, decreased motor control

goal of transposition of the ulnar nerve

to free up the ulnar nerve from the medial epicondyle groove and move it anteriorly

bunionectomy

R) aken, L) chevron, mckeever, keller

drill, depth gauge, tap and scwer

steps for inserting screws

acromioplasty

performed for patients affected by impingement syndrome or limited range of motion

infraspinatus, subscapularis, supraspinatus, teres minor

repair of rotator cuff

internal fixation of femoral shaft fractures

surgery is recommended right away. if delayed, leg should be placed in traction

intertrochanteric procedure

repair of hip fractures. AO dynamic hip screw/dynamic condylar screw (DHS/DCS)

degenerative joint disease DJD

benefit form total hip replacement or arthroplasty

scoliosis

characterized by a lateral curvature of the spinal column and deformity of the rib cage and may also include deformity of the vertebrae