Orthopedic Surgery
finger
(interphalangeal) synovial hinge joint
knuckle
(metacarpophalangeal) synovial condyloid joint
T/F
Be aware of heat and vapors from methyl methacrylate (bone cement)
most orthopedic surgical procedures are classified a ____________: ____________, because the incision is made under ideal surgical conditions
Class I: Clean
traumatic wounds can be classified two different ways. if the would is open and less than four hours old, it is considered _____________: _______. if the wound has been open for more than hour hours it will be considered a __________: _________
Class III: Contaminated Class IV: Dirty/infected
T/F
Examine the patient for any evidence of body infection. Even an ingrown toenail can cause a post op infection
T/F
Good patient psychological and physiological care IS important for patients having surgeries involving implants, grafts, limb reattachment or amputation
T/F
If bone does not heal back together it is called NON-UNION
T/F
MANDATORY exchange of personnel to avoid excessive fatigue
T/F
Many traumatic bone wounds involve contamination to soft tissue that is easily infected
T/F
SOME facilities use UV lights, but over-exposure is not good
T/F
a full 10 minutes mechanical and chemical scrub is required
hand table
a table attached to the bed for hand or wrist or arm surgery
tibial osteotomy
a wedge cut into the tibial plateau to correct varus or valgus deformity
scoliosis, kyphosis, and lordosis
abnormal curvature of the vertebral column that can lead to compression of internal organs and results in difficult breathing and pain
dysplasia
abnormal tissue growth and development
exostosis
abnormal, benign growth causing build up on bone surfaces. This is commonly a result of arthritis of the first metatarsal joint and causes the formation of a bunion (hullux valgus), a lateral deviation of the great toe
long arm/leg cast
above elbow/knee to wrist/ankle
osteomalacia
adult version of rickets
T/F
always insure that the extremity is ABOVE THE LEVEL of the heart to avoid swelling
single toe amputation
amputation of one toe (if spread of infection is minimal)
disarticulation
amputation of the extremity at the joint
disarticulation
amputation through a joint (stop major infection process)
describe tendon repairs and give example
an emergency procedure to re-establish a lacerated or severed tendon ex: Achilles tendon
thrombin
applied as spray or liquid solution for topical application
avitene
applied dry directly to bone surface
pneumatic tourniquet
applied for control of extremity bleeding. this is a dangerous piece of equipment
write description of elbow draping
apply impervious "down sheet" over armboard. follow with stockinette and extremity sheet
describe arthrocentesis
aspiration of synovial fluids to check for anamolies
describe bone marrow biopsy
aspiration of the marrow to check for abnormal blood count
Volkmann's contrature
atrophy of a muscle due to prolonged interference of circulation
leg holder
attached to the table to secure leg for knee surgery
ligament
band of exceptionally strong, flexible connective tissue that joins two separate bone surfaces
short arm/leg cast
below elbow/knee to wrist/ankle
osteochondroma
benign tumor in the spur of a long bone
osteoma
benign tumor of the bone
label pictures (obj. 14)
bone currettes bone cutters Hibb's chisels bone file battery powered drill gouges mallets liston amputation knife meniscus knife osteotomes rasps rongeurs bone holding clamps bone hook sweet retractor saws tendon strippers
closed (simple) fracture
bone fragments do not protrude through the skin
autogenous graft
bone from your own body
Corrective surgeries include the following:
bone graft- natural replacements for bones that can grow back implants- artificial replacements for bones that cannot be reconstructed internal and external fixation- screws, rods, pins, nails, plates, braces & casts
multiple fracture
bone is broken in several places
Corrective surgeries for orthopedic
bone reconstruction joint reconstruction tendon or ligament repair
fractured metatarsals or phalanges
broken toes
Consolidation, ____________, and bone remodeling- bone resumes its original strengths. This process continues for up to a year
calcification
describe AE (above elbow amputation)
can be short (right at shoulder=no shoulder rotation) or long (right above elbow)
myeloma
cancer of the bone marrow plasma cells
T/F
cast rooms should be separate from the OR, but if not the cast should be cut in the patients room, not in the OR
hammer toe correction
caused by narrow toed shoes
label figure 2
clavicle scapula humerus ulna radius carpals metacarpals phalanges
label picture (objective 16)
clavicle forearm wrist hip knee tibia ankle
hematoma or hemorrhage stage- blood seeps from blood vessels that have ruptured and forms a _______ at the point of injury of breakage. This is accompanied by swelling and occurs at the time of damage
clot
colles fracture
common fracture of the wrist in elderly
____________- bone splinters or breaks into more than two pieces, resulting in multiple intersecting breaks and bone fragments
communicated fracture
__________- the bones is crushed
compression fracture
intertrocanteric fracture
compression hip screw and plate
arthroscopic procedures
continuous irrigation of joint is required using 3000cc bags of NS
fluoroscope
continuous x-ray to observe implant placement
anti-inflammatory agents
cortisone steriods
body cast
covers trunk from axillae to hips for vertebrae fracture
Minerva jacket cast
covers trunk from lower head to hips
list (5) types of bone composition
cranial facial long bone flat bone short bone
_____________-done by plastic surgeons for maxiofacial or Lafort fractures
craniofacial
fragmentation fracture
crushing or shattering of bone that disperses bone throughout the injured area
osteoarthrists (OA)
degeneration due to wear and tear of the aging process
Perthes' Disease
degeneration of juvenile joints
_____________-bone is forced inward, generally to the skull
depressed fracture
special arthroscopy drape
designed with pockets containing drainage holes to reduce the risk of contamination from heavy irrigation
arthroscopy
direct visualization into a joint via an endoscope
_______________-surgeon removes the nuceus pulposus or the ruptured portion of the annulus fribrosis
discectomy
cartilage
elastic substance attached to bone surfaces where they meet
osteogenesis- bone growth can be stimulated with the use of minute ___________ impulses
electrical
electric bone stimulator
electrical current devices that stimulate bone growth
beanbags, sandbags, and pillows
elevation of an extremity or joint
frames and external fixation devices
external application of internal traction with metal pins, screws, bars, and straps
T/F
extremely delicate and lengthy procedure; often requires 12-24 hours
label figure 5
femur patella tibia fibula tarsals metatarsals phalanges
label figure 13
fibrous capsule articular disc articular hyaline cartilage fat pad fibrous capsule synovial membrane synovial fluid
joint
fibrous sheath or capsule enclosing bone surfaces where they meet
joint capsule
fibrous sheath that encloses articular bone surfaces
tendon
fibrous tissue structure that connects muscle tissue to bones and other tissue
carpal fracture
fixed with k wires
fractured olecranon
fixed with k wires and wire, or plate and screws
fractured humerus
fixed with plates and screws or a rod
describe bone densitometers
for measuring bone density
T/F
for younger arthroplasty patients no bone cement is required. metal implants have a ROUGHENED surface to allow bone to grow to implant
Buck's traction
form of skin traction with weights pulling on the extremity
complete fracture
fracture all the way through bone
incomplete fracture
fracture through part of the bone
open (compound) fracture
fragments do pierce skin
hairpin or sugartong splints
from back of hand around elbow and back to wrist
cylinder cast
from groin to ankle to immobilize knee/patella
_____________=soft granulation tissue develops and acts as an internal splint. Bone fragments are resorbed. This generally occurs within the first week after the injury
granulation
_____________-bone partially bent or broken; commonly found in children whose bones have not completely calcified
greenstick fracture
irrigation
high pressure pulsing irrigation (pulse lavage)
describe BE (below elbow amputation)
if blood supply is sufficient to the muscle and tissues below the elbow
T/F
if no complications occur, many times the prognosis of orthopedic patients is good
arthrotomy
incision into a join to biopsy the synovium
hip spica cast
includes trunk with both hips and down one/both legs
shoulder spica cast
includes trunk with shoulder and upper extremity
describe (SAP) serum alkaline phosphatase
increased levels of SAP indicate bone disease
osteomyelitis
infection that causes destruction of bone tissue
osteomyelitis
inflammation of bone tissue caused by pathogenic organisms; can lie dormant for 20-40 years
bursitis
inflammation of the synovial fluid between tendons and bones
describe arthrography
injection of dye to check cartilage and ligaments
fixative bone cement (polymehtyl methacrylate/ PNMA)
inserted into the bone to stabilize implants (EXTREME HEAT)
for more critical surgical procedures, such as a trauma patient, the patient may be transported directly to the _______________ _____ _____ because of a high risk of complications
intensive care unit (ICU)
Stages of treatment for orthopedic surgery:
investigation preservation restoration
congenital hip dislocation reduction
involves closed reduction with application of a hip spica cast
skeletal traction
involves insertion of a metal pin through the bone with weights attached
T/F
involves many specialists including orthopedic, vascular, plastic, and neurosurgeons
T/F
involves reattachment of a severed extremity; every case is DIFFERENT
femoral head fracture
involves replacement of bipolar hip implants
osteoporosis
lack of calcium in bone, resulting in fragile bones that are easily broken
_______________-removal of the lamina in the individual vertebra to gain access to the spinal cord
laminectomy
hip dislocation
lateral and upward dislocation of the femoral head in infants less than 2 years old
braces or cast
made of cloth or foam
Andrew's frame
maintain patient in modified knee-chest position
___-_____ = bone heals but is not in proper alignment
mal-union
chondrosarcoma
malignant tumor of hyaline cartilage
osteosarcoma
malignant tumor of the bone
repair of joint dislocation
manipulating the associated bones back into proper alignment
describe the method of (CREF) Closed reduction via external fixation
manipulation of fracture of bone using external devices such as casts or traction
describe the method of (OREF) open reduction with external fixation
manipulation of the fracture via an incision. Fixation, once the procedure is completed, used external devices such as cast or traction
cortical graft
matchsticks or small narrow slices of bone
describe (ESR) erythrocyte sedimentation rate
measures rate red blood cells fall
synovial
membrane that lines the joint capsule
gelfoam
moistened with saline, thrombin or epinephrine in pad form, then applied over areas of capillary bleeding
polydactylism
more than the usual number of fingers or toes
tuberculosis of bone or joint
most common in spine
braces
most often metal devices that provide rigid support to minor fractures or weak joints or postoperatively
fracture table
narrow flat table that supports only the trunk and provides traction to reduce fractures
splints
non-encasing devices that can be wrapped in plaster or bandages to immobilize a fracture
_________= fracture shows no evidence of healing
non-union
____________ fracture line lies at an angle to the long axis of the bone
oblique
an ________ fracture viewed as a medical emergency because of the risk of infection
open
bone
osseous tissue that comprises individual parts of the skeleton
dupuytren's contracture release
partial or total excision of the palmar fascia
T/F
pass sharps on a magnetic mat where available
bristow procedure
performed for recurrent dislocation of the shoulder
articular cartilage shaving
performed on aging and wearing of cartilage
transverse fracture line lies ____________________ to the long axis of the bone
perpendicular
write description of knee draping
place impervious down sheet under affected leg covering opposite leg. apply stockinette over foot and leg to tourniquet then place extremity sheet or split sheet
articulation
point of contact or connection between bones
write description of shoulder skin prep
prep entire arm and shoulder. requires a second person to hold arm or an arm holder
Acromioplasty
procedure to relieve impingement of the soft tissue in the joint
glenohumeral dislocation repair
procedure to tighten the ligaments connecting the glenoid fossa to the humeral head
ossification
process of bone development and fusion, ending at about 25 years of age
isolation drape
provides separation of sterile supplies, staff and equipment from non-sterile area of anesthesia, ESU, suction, and radiographic equipment
label figure 12
radioulnar joint hip joint symphysis pubis joint knee synovial joint metatarsophalangeal joint shoulder joint elbow joint wrist joint finger joint sacroiliac joint ankle joint
describe ligament repairs and give example
reconstruction of ligaments may require non-absorbable sutures, wires, staples, and grafts ex: trigger finger release
Types of fracture treatment include all of the following:
reduction rehabilitation immobilization
most orthopedic surgical procedures are performed under general or ____________ anesthesia which require the patient to be transported to the PACU until the patient is awake
regional
syndactyly release
release of webbing between digits
ganglion cyst excision
removal of a fluid filled sac in the wrist
Baker's cyst excision
removal of a soft tissue cyst from the posterior popliteal fossa
synocectomy
removal of excessive synovium
bunionectomy
removal of exotosis of the MPJ
wrist arthroplasty
removal of injured or arthritic carpals
medical or lateral meniscectomy
removal of meniscus
The primary purposes of orthopedic surgery includes?
repair revision reconstruction reattachment removal of: -bones, joints and affected tissues -tendons, ligaments or cartilage
fractured ankle joint
repair of medial and lateral malleolus with plate and or screw
rotator cuff repair
repair of torn rotator cuff muscles
strain
repetitive stretching of joint, tendon or ligament
arthroplasty of the humeral head
replace humeral head with implants
total hip arthroplasty
replacement of the acetabular cup and femoral head with implants
total ankle arthroplasty
replacement of the ankle joint
arthroplasty of the total elbow
replacement of the distal portion of the humerus and the proximal portion of the ulna with implants
fractured femoral shaft
requires closed reduction and the use of a femoral rod
T/F
requires extensive, detailed positioning of patient and affected areas
internal fixation devices
rods, plates, screws, nails and wires
herniation
rupture in the fibrous cartilage, most often discs and vertebrae
_____________- Luc or Harrington rods are attached to the vertebral processes
scoliosis
press-fit implants
secured without the use of cyanoacrylate or bone cement
Boney callus formation- this process begins 3-4 weeks after injury and continues for several months. ________ ___ ___ _______
shows up on x-ray
____________-where bones remain in proper relation to each other and the skin remains intact. little tissue damage
simple (closed)
T/F
some facilities use a cooling apparatus which provides a continuous flow of cooling fluid around the joint (NOT AIR)
T/F
some patient's bodies may reject the implant if they are on medication for their immune system
T/F
sometimes SPECIAL AIR CLEANING SYSTEMS are used
__________ _________-stabilizes the vertebrae using bone graft
spinal fusion
_________ fracture line forms a spiral pattern around the bone
spiral
cancellous graft
spongy bone scooped out with gouge
arthrodesis
stabilization of the joint. usually degenerative
fractured tibia
stabilize the tibia with a rod or plates and screws
bone wax
sterile beeswax applied directly to cut bone surfaces. assists hemostasis in bone
T/F
strict adherence to aseptic technique must be followed and prophylactic antibiotic given because a simple superficial infection can continue deeper into the bone, which can result in any implants having to be removed
write description of hand position
supine with armboard
write description of hip positioning
supine with sandbag placed under thigh or lateral with bean bag and pillows for extremity support
write description of ankle or foot skin prep
support affected leg using a leg holder or by supporting the leg at the knee. Betadine scrub and paint cicumferentially from knee to and including the feet and toes
T/F
surgeons CANNOT estimate with certainty what the outcome will be for each individual orthopedic patient
arthroplasty
surgical repair of a joint by reshaping or replacing joint
intercarpal
synovial plane joint
carpometacarpal
synovial saddle joint (to thumb) or synovial plane joint (to other digits)
Rheumatoid arthritis (RA)
systemic deterioration of connective tissue, especially the joints
arthroplasty of the tarsals
tarsals replaced with implants
ulner nerve transposition
the anterior ulnar nerve is brought to the posterior position after elbow trauma
T/F
the basic sequence for a reattachment procedure is: BONE VASCULATURE AND NERVES RESTRUCTURING
cancellous bone
the spongy bone found at the ends of long bones and within flat bone; contains red marrow
arthrodesis
the surgical fixation of a joint
T/F
there are some additional scrub attire for orthopedic surgery, but it MAY NOT BE USED FOR ALL ORTHO CASES
Another primary purpose of orthopedic surgery includes:
to investigate, preserve and restore form & function to the musculoskeletal structures, associated tissues of the extremities and also the spine
AC separation repair
to repair or reattach the ligaments at the joint between the acromion and the clavicle
dislocated joint
torn joint support structures such as ligaments or tendons
knee arthroplasty implants
total knee or hinged knee
MPJ arthroplasty
total replacement of the MPJ joint with prosthesis
total knee arthroplasty
total replacement of the knee joint
sutures
tough and resilient
fractures of the radius and ulna
treated with k wires or plate and screws, or rush rod
excision of radial head
treatment for osteoarthritis of the elbow
fibroma
tumor of connective tissue
repair of ACL, PCL
use of autogenous or homogenous grafts
vicryl sutures
used for work with periosteum
ethibond, prolene, and nurolon sutures
used in attaching tendon to bone
surgical steel sutures
used most often in bone-to-bone closures, but is occasionally used to secure tendons
adjustable extremity appliances
used to hold an extremity in position
traction devices
used to provide a steady, constant pull with alignment of the distal portion of the fracture site
arm holder
used to raise arm during shoulder procedures
wooden or metal splints
used to support digits or other joints
abduction splint
usually applied right after hip surgery to maintain constant abduction
fractured fibula
usually reduced without the need for implants
wilson frame
utilized for prone position
perineal post
utilized to provide resistance to the traction
arthroscopic support equipment
video system, monitor, cameras
describe arthroscopy
visual inspection of joint
rickets
vitamin D and calcium deficiency that leads to abnormal bone growth in children
syndactylism
webbing between adjacent digits