Orthopedics & Fractures
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
Orthopedic Exam
• Meet Sam & Simon!!
BONES
Major Functions:
1. Support for body’s 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
Anatomy of a Typical Bone
• Types of Bone
- Compact Bone – bone’s outer layer, what we can
see. It is dense, strong, and heavy
- Spongy Bone – bone’s inner layer; self- organizes
in response to the direction of weight put on it
•
http://training.seer.cancer.gov/module_anatomy/unit3_4_bone_classificat
ion.html
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
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.
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?
FRACTURES
Types of Fractures
•
•
•
•
•
•
Open
Closed
Complete
Incomplete
Comminuted
Segmental
• Chip
• Slab
• Pathologic
Open Fracture
Closed Fracture
Complete Fracture
Incomplete Fracture
Comminuted Fracture
Segmental Fracture
Chip Fracture
Pathologic Fracture
• Fracture
secondary to
another disease
process
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
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
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
Normal Fracture Healing
What Is Necessary to Get
Normal Healing?
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
Malunion
Sequestrum
Non-union
Osteomyelitis
Treatment Options
• Fracture Reduction
- Closed
* temporary (until surgery)
* permanent (cast or splint)
- Open (orthopedic surgery)
• Intramedullary Fixation
• Cerclage
• External Fixation Devices
Fracture Reduction Goals
• Get bones close enough to heal
• Proper alignment
- avoid mal-union + loss of function
• Avoid additional trauma
- further fracture
- infection
Closed Fracture Reduction
Open Fracture Reduction
Intramedullary Fixation
Pin Insertion
Cerclage
External Fixators
External Fixators
(view video)
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
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!!
Surgery Tools
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
Jeopardy!
Questions???
END
• All images used from government
websites as indicated OR with
permission from Dr. Sharon Kerwin &
Dr. Ben Young, Texas A&M University
College of Veterinary Medicine