هشام عبد الكريم القطانأستاذ مساعدجراحة العظام
OrthopaedicsIs concerned with: bone,joints,muscles ,tendons and nerves ,the skeletal system and all that makes it move.
describe
Write in details = introduction + pathological process + management All should have equal timeDiagnosis
You have to prove what it is Anatomically (what structure). Pathology (what is wrong). History. Examination. Special test. D.D. is only referred to incidental.Differential diagnosis
What else could be and how would you exclude the other possibilities. by Examination , tests We have to thing of the causes in the following A.anatomical structure. B.the pathological conditions either (congenital,acquired).Give an account
Comprehensive for each Incidence, pathology, etiology, symptoms and sign , treatment. Discuss Select the most important controversial aspect of the subject(compare and contrast).References
Outline of orthopedics 14 edition 2010 adams’s.Apley's system of orthopedics & fracture.Essential orthopaedic and trauma 2009 (david j dandy).Landmarks of surgery in the Nineteenth Century
Fundamental advances depend upon the development of other branches of science & industry. The first ,was introduction of anaesthesia (Crawford 1842) Ether.Louis Pasteur (1822-1895),has fundamental research on bacteria.Joseph Lister (1867) introduce antiseptic surgical technique.Roentgens’ in (1895) discovered X-ray
To start orthopaedic surgery encompassed by general surgeon. Until after the first world war. In great Britain just before twentieth century each of
(Hugh Owen Thomas &Sir Robert Jones) . both they set the sound foundation of orthopaedic surgery that now we enjoys.
History. Examination. Diagnostic imaging Blood test
Synovial fluid analysis. Bone biopsy. Arthroscopy. Electrodiagnosis.Carefully and patiently compiled ,the history can be every bit as informative as examination or laboratory test.
Patient give history e.g. Injury. pain. stiffness. Swelling .
Defomity. instability. Weakness . altered sensibilty and loss function.
Each symptom is need more detailwhen it begin. suddenly or gradually. spontaneously or after some specific events. how it progressed. what make it better or what it make it worse.
Is the most common symptom in orthopaedics .Its precise location is important.Ask the patient to point it.Don’t forget pain might referred.might be boring .dramatic and bizarre .e.g.
Throbbing abcess Aching chronic arthritis Burning neuralgia Stabbing ruptured tendon
G1(mild) : can be easily ignored.G11 (moderate): pain cannt’be ignored,interfer with function and need rx from time to time.
G111 (severe): pain present most of the time ,demanding constant attention. G1V totally incapacitating
Pain arising in or near the skin is usually localized accurately. (it is due to inability of cerebral cortex to distinguish between sensory messages from embyrologically related site). E. g. sciatica.
Is much more vague ,often wide spread and accompanied by vasomotor and trophic abnormalities.
Generalized: and regularrly in early morning as in rheumatoid arthritis. Localized: for a particular joint.
Regular at early morning: as in R. A. OR Transient stiffness : on or two joints after periods of inactivity is typical of osteoarthritis.
Is aspecial variety of stiffness .it is the suddenly inability to complete one particular movement and it suggests a mechanical block
E.g. torn meniscus.
May be in soft tissue , the joint, or the bone .it occurred eitherRapidly as haematoma. Slowly as soft tissue inflammation, joint effusion.
Painful as acute inflammation, infection . Is it constant or continue to enlarge, or comes and goes.
Knock knee
Bow leg
Spinal curvature changes. Kyphosis. Scolosis. Lordosis.Muscle weakness may be associated with any joint dysfunction, It may also suggest a more specific neurological disorder as e.g. poliomylites.
The patient complains that the joint ((( jumps out ))). Due to muscle weakness or ligamentous deficiency. Loose body.
Tingling or numbness signifies interference with nerve function ,as pressure from a neighbouring structure e.g. disc prolapse. Local ischaemia as in C.T.S in nerve entrapment. Or peripheral neuropathy.
e.g. patient say ‘I can't sit for long time rather than I have backache’.
It is very important e.g. history of twisted ankle many years ago may be the clue to the onset of O.A.e.g. in musculoskeletal disorder.
Details about work ,travel ,recreation,home circumstances, and the level of support from family and friends.General. Local examination of the affected parts.
Examination begins from the moment we set eyes on the patient. We should be observing his ,her appearance, posture ,gait . e.g. are they walking freely or do they use stick, any spinal curvature, short limb.Gait consist of four parts.
ExamplesHigh steppage gait (foot drop) Antalgic gait in pain. scissor gait. Shuffling gait Dipping gait. Waddling gait.
Examination of the affected parts
Patient must be suitably undressed. If one limb is affected ,both must be exposed to compare. We examine the good limb then the bad limb. We followed the system of (look, feel, move).Examination
LookFeel
Move
Look
Feel
Move
Look
SkinShape
Position