Chapter 21: Case Studies

CS1: Describe the immediate postop care the patient will receive.

-abduction pillow placed btw legs to immobilize joint -transport to PACU -observe for local hemorrhage

CS1: Osteomyelitis is a grave concern; what may be done right after draping, and why?

-change outer gloves of double-gloving after draping

CS3: What are the surgical procedures used to treat a Colles fracture?

-external fixation -internal fixation w/ Kirschner wires -closed reduction w/ cast

CS4: Can the ligaments be repaired? If so, how?

-ligaments repaired by rehab, exercise, other conservative treatment, + arthroscopic repair -repaired with grafts - heavy gauge non-absorbable suture

CS4: What is the long-term prognosis? How long until she can ski again?

-no weight bearing for 5-7 days -full ROM in 3-4 months

After the femoral osteotomy guide is placed over the lateral femur and neck, what should be ST/'s plan to do next?

-prepare oscillating saw for use -prepare blunt Hohmann retractors for placing around the femoral neck

CS1: Describe a routine draping procedure for this case.

1) 4 towels to square off site 2) Place impervious U-drape under the leg with the tails towards the head 3) Stockinette is rolled to mid-thigh and wrapped in Colban 4) Two 3/4 sheets are placed above and below 5) Another impervious U-drape with tails towards feet

CS4: What is the ACL, what purpose does it serve, and how is it positioned related to the other knee ligaments?

1) tendon made of collagen and is 38mm in length + 10mm wide 2) Important for stabilization and is most commonly injured. Prevents femur from sliding posteriorly on tibia. 3) It inserts into the intraspinous area of the tibia + femoral attachment of ligament is the medial aspect of the lateral femoral condyle in the intercondylar notch.

CS2: what is the meaning of the term "distraction"? What complications can be caused?

1-bone fragments separated so bone contact doesn't occur 2-delayed healing -decreased blood supply -interposition of soft tissues

CS4: Knee arthroscopy instrument steps:

1. #11 knife blade 2. Irrigation/inflow cannula 3. sharp trocar 4. blunt trocar

CS3: Patient with Colles fracture and trauma: Describe Colles fracture.

Angulated fracture of the distal radius at the epiphysis approx. 1 in. from wrist joint

CS3: What equipment and supplies will the CST need to make sure are available in the OR?

C-arm, basic ortho instrument set, drill, nitrogen tank, tourniquet cuff, Webril, hand table, Steinmann pins

CS4: 22 yr-old female in ER after skiing accident with ACL tear: What equipment is required for all arthroscopic procedures?

Light source box, video monitor, arthroscopy pump + tubing for fluids, powered shaving system, arthroscopy instrument set, arthroscope

CS4: Steinman pin vs. K-wire:

Steinmann pin - wider, always smooth, more substantial K-wire - delicate, threaded, smooth (think of Steinmann as a thick, broad man)

CS4: Tapping vs. Non-tapping screws:

Tapping - point at the end cuts path in bone for thread to follow so procedural step is ostrasized Non-tapping - threads continue toward point, more blunt, hole must be tapped as another step

CS1: Will the incision be drained?

Yes, 1-2 Hemovac drains will be placed.

CS2: What is the MOST important in bone healing?

blood supply

CS2: Leroy in ER with fracture in leg: why are casts placed on limbs with reduced fractures?

casts will stabilize the fractured bone proper alignment so bone can heal properly

CS2: What does the term "delayed union" mean?

increasing healing time of fractures

CS1: Ellenor admitted to hospital for total hip arthroplasty and has osteoporosis: What type of fracture is she most likely to have suffered?

pathological fracture