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1
CHAPTER 21
Orthopedic Surgery
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2
Objectives
• After studying this chapter, you will be able
to:
– Recognize the relevant anatomy and
physiology of the musculoskeletal system
– Summarize the pathology of the
musculoskeletal system that prompts surgical
intervention and the related terminology
– Determine any preoperative orthopedic
diagnostic procedures/tests
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Objectives (cont’d.)
– Determine any special preoperative
preparation related to orthopedic procedures
– Indicate the names and uses of orthopedic
instruments, equipment, and supplies
– Determine the intraoperative preparation of
the patient undergoing an orthopedic
procedure
– Summarize the surgical steps of the
orthopedic procedures
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4
Objectives (cont’d.)
– Interpret the purpose and expected outcomes
of the orthopedic procedures
– Recognize the immediate postoperative care
and possible complications of the orthopedic
procedures
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Bone and Bone Tissue
• Characteristics of bones
– Living tissue
– Provide form and structure to the human body
– Actively involved in maintenance of
homeostasis
• Skeletal system
– Comprises bones and other structures that
make up the joints of the skeleton
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Bone and Bone Tissue (cont’d.)
• Skeleton functions
– Provides a framework to support the body
– Serves as points of attachment for muscles
– Protects some internal organs from injury
– Serves as a source of red blood cells
– Serves as a storage site and source of
calcium
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Bone and Bone Tissue (cont’d.)
• Bone tissue
– Compact or cortical bone: hard, dense tissue
of bone that surrounds the marrow cavity
– Cancellous or spongy bone: found at ends of
bone and lining the medullary marrow cavity
– Surrounding bone: thin, fibrous layer of tissue
(i.e., periosteum)
– Bone marrow: semisolid tissue that is found in
the spaces of cancellous bone
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Bone and Bone Tissue (cont’d.)
• Types of bones: refer to Figures 21-1, 21-3
and 21-4
– Long bones: bones of the arm (humerus), legs
(femur), hands, and feet (phalanges)
– Short bones are the bones of the wrists
(carpals) and ankles (tarsals)
– Flat bones: ribs, scapula, sternum, and cranial
bones
– Sesamoid (round) bones: found within tendons
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Bone and Bone Tissue (cont’d.)
• Types of joints
– Immovable
– Slightly Movable
– Freely Movable
– Ball-and-Socket
– Condyloid
– Gliding
– Hinge and pivot
– Saddle
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Bone and Bone Tissue (cont’d.)
• Terms related to joint movements
– Refer to Table 21-1
• Mineral storage
– Bone contains large quantities of calcium
• Factors that affect bone growth
– Hormones, heredity, nutrition, and exercise
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Bone and Bone Tissue (cont’d.)
• Pathology
– Musculoskeletal system is prone to numerous
types of pathological conditions
– Refer to Table 21-2
• Types of fractures
– Complete or incomplete
• Normal bone healing
– Complete bone healing of fracture is expected
in 8–12 weeks
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Bone and Bone Tissue (cont’d.)
• Normal process of bone healing
– Inflammation
– Cellular proliferation
– Callus formation
– Ossification
– Remodeling
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Bone and Bone Tissue (cont’d.)
• Pathological bone healing
– Disruption at any stage can be responsible for
a variety of abnormal conditions
•
•
•
•
•
Distraction
Avascular necrosis
Compound fracture
Delayed union, nonunion, and malunion
Compartmental syndrome
– Casts: refer to Table 21-3
• Method utilized to immobilize a fracture
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Diagnostic Procedures and Tests
• Common orthopedic diagnostic
procedures and tests: refer to Table 21-4
– Radiography
• Standard X-rays
• Fluoroscopy
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15
Instrumentation, Routine
Equipment, and Supplies
• Instrumentation: refer to Table 21-5
– Orthopedic procedures
• Require a general orthopedic set with soft tissue
and basic bone instrumentation
• Also require specific sets with instruments for
exposure, reduction, and internal fixation of a
bone, for replacement of a joint; or for the
placement of an intramedullary rod
– Procedures for the hand or foot
• Typically require a minor orthopedic or hand set
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Routine Equipment
• Orthopedic surgery has special equipment
and instrumentation requirements
– Positioning devices
– Pneumatic tourniquets
– Traction
– Lasers
– Air flow
– Continuous passive range-of-motion
machines
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Routine Equipment (cont’d.)
– Transcutaneous electric nerve stimulation
– Electrical stimulation of bone
– Saws, drills, and reamers
– Arthroscopic equipment
– Other routine equipment
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18
Routine Supplies
• Field of orthopedics requires a large
number of supplies
– Implants
– Suture
– Polymethyl methacrylate
– Other routine supplies
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Orthopedic Surgical Procedures
• Shoulder procedures
– Shoulder arthroscopy
– Bankart procedure, open
– Bankart procedure, arthroscopic with suture
anchors
– Acromioplasty, open
– Acromioplasty, arthroscopic
– Total shoulder arthroplasty
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20
Orthopedic Surgical Procedures
(cont’d.)
• Procedures of the radius
– External fixation of a Colles’ fracture
– ORIF radius
• Hip procedures
– ORIF hip fracture
– Total hip arthroplasty
• Femoral procedures
– Repair of femoral shaft fracture with AO
titanium femoral nail system
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21
Orthopedic Surgical Procedures
(cont’d.)
• Knee procedures
– Arthroscopy of the knee joint with repair of
torn meniscus
– ACL repair
– Above-the-knee amputation (AKA)
– Below-the-knee amputation (BKA)
– Total knee arthroplasty (TKA)
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22
Orthopedic Surgical Procedures
(cont’d.)
• Ankle and foot procedures
– Triple arthrodesis
– Achilles tendon repair
– Bunionectomy
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23
Summary
• This chapter reviewed:
– Anatomy and physiology of the
musculoskeletal system
– The pathology of the musculoskeletal system
that prompts surgical intervention
– Preoperative orthopedic diagnostic
procedures/tests
– Orthopedic instruments and equipment
– Orthopedic procedures
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
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