describe total knee arthroplasty
replace worn surfaces of knee joint
indications for total knee arthroplasty
rheumatic/traumatic arthritis
varus/valgus deformity (destroy medial/lateral)
pain, instability
position for total knee replacement
supine w/ footrest for flexed leg
2 principle methods of implant fixation for joint arthroplasty
cemented
noncemented
ideal candidate for cemented or uncemented/press fit
noncemented: younger active people. Biofixation
Cemented: old people
what is bone cement
poly methyl methacrylate monomer
IM of cemented arthroplasty prosthesis
adheres to metal/polyethylene but not bone
how is PMMA used to ensure fixation
fills cavity and interstices of bone for mechanical bond
adverse reactions to PMMA
transitory hypotension
cardiac arrest
CVA, PE
hypersensitivity
osteoarthritis
noninflammatory progressive degenerative joint disease-hypertrophic hyaline/subchondral bone
wear and tear after 50
cause of most joint replacements
rheumatoid arthritis
autoimmune disease-system attacks synovium and articular surfaces-inflammation
ages 25-50
osteomalacia
softening of bones due to lack of vitamin D
inadequate mineralization
osteoporosis
excessive loss of calcified matrix-decreased bone mass
metabolic disorder producing porous, brittle, easily fractured bones
continuous passive motion
early postop passive ROM
stimulates healing in articular tissue (tendon, cartilage, ligament)
doesn’t interfere with incisional healing over joint
benefits of CPM
inhibit adhesions
decrease joint stiffness, swelling, pain
early functional ROM
decreased effects of immobilization
osteomyelitis
bone/marrow infection from Staph A.
hard to treat expensive
diarthrotic joint
freely moveable/synovial
skull
amphiarthrotic joint
slightly moveable-connected by cartilage
symphysis pubis, intervetrebral joints
avulsion fracture
ligaments are intact on separated bone fragments
luxation
complete dislocation of one surface to another
subluxation
partial dislocation (ligament instability)
monteggia fracture
proximal ulnar fracture w/ dislocation of radial head
blow to ulna or fall w/ arm hyperextended
not treated with OR in kids
Colles’ fracture
distal radius fracture w/ posterior displacement of distal radial fragment
reduce, close, immobilize
fall on outstretched hand
compound fracture
bone through skin-extensive tissue damage
significant anatomical displacement
ORIF
comminuted fracture
more than 2 pieces
spiral/oblique fracture
bone twisted apart
oblique-shorter than spiral
pathologic fracture
due to weakened state-osteoporosis
greenstick fracture
bending partially ossiated bone
convex side breaks, concave bends and heals
incomplete fracture
stress fracture
incomplete fracture from overuse/high impact sports
small crack
5 stages of bone healing
hematoma
fibroblasts network formation
osteoblasts invade
calcium callus
remodeling
malunion
fracture heals out of anatomical position
impaired function/significant angulation of extemity
nonunion
healing ends without connecting bone (hematoma)
delayed union
healing hasn’t occurred in normal time
terrible triad
torn anterior cruciate ligament, medial meniscus, medial collateral ligament
osteoarthritis if untreated
where is a Baker’s cyst
popliteal fossa
cast for complete knee immobilization
cylinder
cast for complete hip immobilization
spica with abduction pillow
anatomy of knee joint
2 articulations
condyle of femur and tibial plateau
femur and patella
supraspinatus syndrome
impingement syndrome (shoulder)
why use a tourniquet for appendicular surgery
bloodless field
why use Esmarch
exsanguinate appendage distal to proximal elevation
3 contraindications for tourniquets
compartment syndrome
McArdle disease
hypertension
3 safety rules for tourniquet
don’t compress bony/neurovascular structures
place as high as possible, not on skin folds
wrap w/ stockinette w/o wrinkles
cuff overlap min 3in. max 6in.
recommended max time for tourniquet inflation
less than 1hr. upper extremity
less than 2hrs. thigh
what is done when tourniquet limit expired
take down 5 min for every half hour (rewrap)
minimize effects on muscles/nerves
3 examples of antibiotic therapy
IV-cephalosporin, irrigation, ointment
2 antibiotics used
polymixin, bacitracen
bones in skeletal system
206
what is appendicular skeleton
upper and lower appendages
pelvic/pectoral girdles
bones in appendicular skeleton
126
axial skeleton
skull
vertebrae
rib cage
bones in axial skeleton
80
cortical bone
hard outer shell
main support
cancellous bone
soft, spongy, red bone marrow
iliac crest, pelvis, ends of long bones
cortical vs. cancellous screws
cortical-tight threads, sheet metal screws, transfix
cancellous-wide threads, wood screws
allograft vs. autograft bone
autograft-from self
allograft-substitute, cadaver
where is autogenous bone harvested
iliac crest-cortical cancellous
femoral head, patella
fibula-cortical
anatomy of hip joint and proximal femur
proximal femur –> trochanter
acetabulum and femur
3 fused bones of os coaxes (hip bone, innominate)
ileum
ischium
pubis
acetabulum
socket of hip joint
total hip arthroplasty
removal of ball and socket and replace
surfaces replaced in total hip arthroplasty
femoral head and neck
acetabulum
indications for total hip arthroplasty
rheumatoid arthritis
degenerative joint disease
avascular necrosis
what is a bunion
hallux valgus-soft tissue or bony mass at medial side of first metatarsal head
patients frequently experiencing bunions
women-shoes
goal of bunionectomy
cosmesis: correct deformity
reconstruction: resect abnormal bony components
function: ROM
Keller procedure
proximal 3rd of proximal phalanx of big toe resected
implant in IM canal to stabilize joint
Mayo procedure
CHECK
McBride procedure
abductor tendon fixed to lateral metatarsal neck
excise sesamoid bone
triple arthrodesis
fuse talocalcaneal, talonavicular, calcaneocuboid joints
why perform triple arthrodesis
inversion or eversion deformity of foot
intraarticular fracture
clubfoot, poliomeylitis, rheumatoid arthritis
goal of triple arthrodesis
limit motion of foot and ankle to plantar flexion and dorsiflexion-pain relief
4 bones and 3 fusions of arthrodesis
bones: talus, calcaneous, navicular, cuboid
fusions: talocalcaneal, talonavicular, calcaneocuboid
eight carpal bones
scaphoid lunate triquetrum pisiform
trapezium trapezius capitate hamate
most fractured carpal bone
scaphoid
internally fixate scaphoid
k-wire fixation
carpal tunnel syndrome
compression of median nerve at wrist
thick synovium, trauma,
carpal tunnel release
curvilinear longitudinal volar incision
release transverse carpal ligament
7 tarsals
talus calcaneous navicular cuboid
lateral, medial, intermediate cuneiform
shoulder dislocation surgery
CHECK
goals of shoulder dislocation surgery
prevent reoccurrence/complications
stop arthritic changes
maintain ROM/fix pain
Putti-Platt
joint capsule attached to glenoid rim and lateral advancement of subscapularis
Bankart
reattach attenuated anterior capsule to rim of glenoid fossa with heavy suture
Bristow
coracoid process and muscle inserted to neck of glenoid cavity
attachment with screw in subscapularis muscle
position for shoulder dislocation surgery
supine or semi-sitting with sandbag or sheet under shoulder
rotator cuff muscles
supraspinatus
infraspinatus
teres minor
subscapularis
function of rotator cuff
abduction of shoulder
stabilty
3 bony articulations of shoulder girdle
glenohumeral
sternoclavicular
acromioclavicular
anatomy of shoulder joint
pectoral girdle-scapula, clavicle
glenohumeral, sternoclavicular, acromioclavicular joints
arthroscopy
visualization of joint
diagnose, conservative treatment of cartilage, ligament, synovial, bony surface defects
frequent joints for arthroscopy
knee, shoulder, wrist, ankle, elbow, TMJ
3 procedures performed via arthroscopy
ACL repair
repair of meniscal tear
patellar tendon graft
irrigation for joint distention in arthroscopy
lactated ringers
NaCl
epi for irrigation in arthroscopy
minimize bleeding in joint capsule
pros and cons of arthroscpoy
pros: short stay, rehab, recovery, pain, inflammation
cons: hard to maneuver, injure articular surfaces
ORIF
expose fracture to use plate, screws, pins, rods to correct
no skeletal traction
anatomic alignment obtained
closed reduction external fixation
manual traction to reduce
pins, rods, k-wire to stablilize
OR external fixation
open surgically to reduce
pins and rods to stabilize
indications for external fixation
severe open fracture
highly comminuted closed fractures
arthrodesis
infected joint/nonunion
intramedullary fixation
nails and rods driven into IM canal brings ends together for union
splint, ease pain, align for comminuted
benefits of closed reduction IM fixation
less infection, soft tissue, vascular injury
prevent rotating or gliding of fragments
prevent short limbs from bone loss
dynamic vs. static IM fixation
dynamic: screws in proximal OR distal fragments-bring gap close together
static: screws in proximal & distal fragments
why use flexible IM rods for healing
better fixation, return to function, early ambulation, support
what is a fracture table
ortho OR bed w/ attachments for positioning, traction, diagnostics (x-ray, casts)
lateral body brace, sacral rest, perineal post
benefits of fracture table
attachments for position and traction
easy diagnosis
traction
pulling force to maintain proper alignment
reduce fracture and pain, vascular ability
benefits of traction
prevent/reduce muscle spasm
reduce fracture/dislocation
immobilize joint/body part
treat joint disorder
skeletal vs. skin traction
skeletal: sterile supplies, force directly to bone with pins
skin: tape, straps, moleskin, elastic bandage
3 common forms of traction
skin: Bucks for Hip’s, Russel’s for Cong. Hip dislocation, skeletal for preop long bone fx
skeletal-pin through bone to tong and rope and pulley with weight
manual-operative reduction closed or open
lumbar laminectomy
remove ruptured disk (nucleus pulposis) to relieve compressed nerve
why do lumbar lami
compressed nerve
position for lami
prone
spinal fusion
fixate pedicles of vertebrae with screws, plates, rods
indications for spinal fusion
infection
neoplasm
post trauma/surgery rheumatoid arthritis
INSTABILITY
