Orthopedics & Fractures

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Orthopedics Fractures
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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

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Orthopedic Exam

• Meet Sam Simon!!

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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

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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/uni
  t3_4_bone_classification.html

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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

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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.

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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?

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FRACTURES
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Types of Fractures

• Open
• Closed
• Complete
• Incomplete
• Comminuted
• Segmental

• Chip
• Slab
• Pathologic

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Open Fracture
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Closed Fracture
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Complete Fracture
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Incomplete Fracture
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Comminuted Fracture
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Segmental Fracture
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Chip Fracture
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Pathologic Fracture

• Fracture secondary to another disease process

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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

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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

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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

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Normal Fracture Healing
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What Is Necessary to Get Normal Healing?
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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

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Malunion
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Sequestrum
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Non-union
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Osteomyelitis
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Treatment Options

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

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Fracture Reduction Goals

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

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Closed Fracture Reduction
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Open Fracture Reduction
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Intramedullary Fixation
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Pin Insertion
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Cerclage
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External Fixators
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External Fixators
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(view video)
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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

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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!!

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Surgery Tools
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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

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Jeopardy!
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Questions???
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END

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