ortho

• The word orthopaedics comes from two Greek words, Ortho - means Straight and Paeds - means children
• Orthopaedics is the art of correcting deformities in children by such means as may easily be put in practice by parents and by themselves and all such others as are employed in children department
• Orthopaedics is broadly classified into

  • Cold Orthopaedics
  • Traumatology –the study of bone, articulars and soft tissue injuries
• Cold Orthopaedics includes


  • Congenital deformities
  • Acquired
• Congenital deformities include


  • Congenital tallipes equino-varus
  • Osteogenesis imperfecta
  • Congenital Dislocation of the Hip
  • Spina- Bifida
  • Cevical Rib
  • Torticolis
• Acquired conditions include


  • Infection of bones
  • Degenerative Conditions
  • Biochemical diseases
  • Neoplasm
• Infection of bones include

  • Osteomyeletis
  • Pyogenic Arthritis
  • Syphlitic Arthritis
• Degenerative Conditions include


  • Oesteo Arthritis
  • Ankylosing Spondilitis
  • Rhematiod Arthritis
• Biochemical diseases include


  • Gout Arthritis
  • Osteo malacia
  • Oestoporosis
• Neoplasm include


  • Primary - Osteo sarcoma
  • Ostochondroma
  • Ewings tumour
  • Mutiple mycloma
  • Malignant - Secondary
  • Benign - Osteod Osteoma
  • Chondroma
  • Osteochondroma
  • Giant cells tumours
• Determinants of diagnosis in orthopaedics

  • Good surgical history
  • Clinical examination
  • Radiology
  • Other specialized methods of investigations e.g. CT scan, MRI
• Surgical history


  Very important in making a diagnosis of an orthopaedic problem, can sometimes diagnose from history alone
• Taking surgical history


  1. Pick the chief complaints

  2. Trace symptoms step by step from beginning to end

  3. Enquire about patient's own knowledge of cause of symptoms

  4. Note aggravating and relieving factors

  5. Enquire about general body health
• Clinical examination


  1. Thorough explanation to patient

  2. Proper positioning and exposure of area

  3. General examination

  4. Local examination

  5. Examination of suspected source

  6. Systemic examination
• Local examination


  1. Exposure - Expose part as much as possible, ensure good lighting

  2. Inspection - Observe bones, soft tissues, skin, scars, sinuses

  3. Palpation - Skin temperature, bones, soft tissues, tenderness

  4. Measurements - Limb lengths, true vs relative shortening

  5. Movements - Active, passive, power, stability, peripheral circulation
• Fracture


  A break in continuity of a bone
• Dislocation


  Persistent loss of contact of two articular surfaces due to a tear or ligaments
• Sprain


  Temporary loss of articular surfaces due to over stretching of the ligaments
• Epiphyseal separation


  A fracture that occurs through epiphyseal surfaces
• Fracture dislocation


  A fracture that involves an articular surface
• Classification of fractures


  • Simple fracture - does not communicate with skin surface
  • Compound fracture - communicates with skin surface
  • Stress fracture - due to repeated trauma
  • Pathological fracture - due to underlying disease
• Garden's classification of compound fractures

  • Grade I - bruise over fracture site
  • Grade II - communication of bone with surface
  • Grade III - communication of bone with surface and gross contamination
• Clinical presentation of fractures

  • History of causative force
  • Severe pain
  • Swelling
  • Inability to use limb
  • Loss of bone contour
  • Bleeding
  • Crepitus
• Principles of management of fractures

  • Degree of illness of patient
  • Nature of fracture (open/closed)
  • Age of patient
  • Type of bone involved
  • Fracture line
• Stages of fracture management

  1. Resuscitation

  2. Reduction (closed/open)

  3. Restriction of movement

  4. Restoration of function

  5. Rehabilitation
• Methods of closed reduction

  • Manual - clinician pulls fragments
  • Skin traction - pulleys and weights
  • Skeletal traction - Steinman pin through bone
• Indications for open reduction and internal fixation

  • Failed conservative management
  • Segmental fracture
  • In elderly
  • Early mobilization required
  • Multiple fractures
  • Early mobilization
• Means of restricting movement

  • Plaster of Paris
  • Skin traction
  • Skeletal traction
  • Internal fixators
  • External fixators
• Means of restoring function

  • Passive exercises
  • Active exercises
  • Massage
  • Heat treatment
• Early local complications of fractures

  • Fracture fever
  • Soft tissue injuries
  • Bleeding
  • Crush syndrome
• Early general complications of fractures

  • Hemorrhage
  • Neurogenic shock
• Intermediate local complications of fractures

  • Infections
  • Fat embolism
  • Pulmonary embolism
  • Compartment syndrome
  • Delayed union
• Intermediate general complications of fractures

  • Hypostatic pneumonia
  • Bed sores
  • Anuria
• Late local complications of fractures

  • Mal union
  • Non-union
• Types of bleeding


  • Revealed
  • Concealed
• Crush syndrome


  1. Prolonged compression of muscles

  2. After release, tendency to release myohaematin acid which is circulated in blood

  3. When it reaches the kidney it may block the renal tubules or cause renal artery spasm

  4. Leads to renal tubular necrosis

  5. Leads to renal failure
• Early general complications


  • Hemorrhage
  • Neurogenic shock
• Hemorrhage


  If severe leads to hypovolaemic shock
• Neurogenic shock


  Due to involvement of the nerves # Ribs
• Intermediate local complications (24-48hrs)

  • Infections
  • Tetanus
  • Gangrene gas
  • Osteomyelitis
  • Fat Embolism
  • Pulmonary Embolism
  • Compartment syndrome
  • Delayed union