1 Senior Orthopaedic Consultant &Principles of Orthopaedics Mr Suheal A Khan Senior Orthopaedic Consultant & Visiting Professor KTPH Singapore
2 Orthopaedic Elective ProceduresOsteotomy Arthrodesis Arthroplasty: Excision Interposition Amputation
3 Orthopaedic Trauma ProceduresConservative Operative: Nail Plate External Fixator: Monolateral Multiplaner Amputation
4 Functions of the Skeleton1. Protective 2. Locomotion 3. Muscle attachments 4. Metabolic 5. Haematopoetic
5 What is Bone? A protein scaffold (collagen) or Osteoid (35%)Impregnated with Calcium Salts to give it stiffness (65%) ‘Impregnated’ with ‘latent’ Growths factors Minerals Osteoid Normal Osteoporosis Osteomalacia
6 Types of Bone Cortical Bone (compact bone): 80% of Skeletal SystemThick in the bone’s shaft (diaphysis) areas Thinner at the ends of bone (epiphysis) Cancellous Bone (trabecular or spongy bone): 20% of Skeletal System Inner surface of bone Most of the bony structure at the end of bones
7 Bone Healing The skeleton is the ONLY human organ to heal without scarring TISSUE REGENERATION
8 Stages of Fracture HealingInitial Trauma Inflammatory Response Formation of New Soft Tissue: Callus Formation of Bone Matrix & Cartilage Ossification of Cartilage to Bone Remodeling Healing with NO scar!
9 Prerequisites for Bone HealingAdequate blood supply Adequate mechanical stability OKU-6
10 Bone Healing Indirect Direct
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12 ‘a fracture is a severe soft tissue injury with a broken bone in its midst’Astley Cooper
13 Management of FracturesConservative Operative Internal fixation: Intramedullary nail Plates and screws External fixation
14 Tibial Fracture
15 Intramedullary Nail
16 Plate and Screws
17 External Fixation
18 Hardware – In The Lumen Nail VS Rod 1st, 2nd and 3rd Generation NailsAntegrade & Retrograde
19 Hardware – In The Wall Rigid Fixation Angle Blade plate DHS & DCSBridge Plating Locking Plate
20 Hardware – Outside WallTemporary VS Permanent Uni planer VS Multiplaner
21 What determines choice of hardware?The Three P’s (Personalities)
22 The Fracture
24 The Surgeon
25 Goals of Treatment 1. Prevention of infection 2. Fracture union3. Restoration of function
26 QUESTIONS
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29 III Extensive damage to softGustilo and Anderson Wound Size I < 1cm II > 1cm Soft Tissue Crushing None Slight or Moderate Fracture Type Simple Comminuted Segmental Contamination Little Moderate High III Extensive damage to soft tissue, muscle, skin
31 Summary 3 ways to fix a bone: Within the boneOn the surface of the bone Outside the bone The 3 Personalities: Fracture Patient Surgeon
32 Clinical Cases
33 Subtrochanteric FractureLAT
34 28 yr old RTA motorcyclist AdonisCASE 28 yr old RTA motorcyclist Adonis
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36 Fracture:- Closed Pilon 2. Patient:- Alcoholic
37 3. Surgeon:- Locking Plate
38 Open Tibial Fracture 15cm by 5cm wound over posterior aspect of calfAP Open Tibial Fracture 15cm by 5cm wound over posterior aspect of calf LAT
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41 Distal Femoral Fracture and Midshaft Tibial FractureAP Distal Femoral Fracture and Midshaft Tibial Fracture LAT
42 Distal Femoral FractureAP LAT
44 Distal Femoral FractureAP LAT
45 Distal Femoral FractureLAT
46 Ankle Fracture AP LAT
47 Ankle Fracture AP LAT
48 Too Low! Too Medial! AP Valgus Procurvatum LAT
49 CASE 1 47 yr Old Fell off a back of a lorry 1.5 m highGrade 1 Open Distal Tibial Fracture Wounds over posterior aspect of calf, a transvere wound
50 17/11/20122
51 17/11/20122
52 20/11/20122
53 4/3/20132 Plate exposed over medial malleolus and dorsal pedis island flap performed. Foot in 25 degrees of equinus
54 13/5/2013 Flap died and metal work removed with Vac Pump applied.Ankle movement improved!
55 30/5/20132 Ilizaove frame with bone grafting of non union site Cross ankle fixtor to correct equinus deformity
56 Equinus corrected after 21 days of correctionAwaiting union of fracture site 30/5/20132 26/6/20132
57 CASE 2 32 yr old RTA motorcyclistSoft tissue injury anterior aspect of knee (Tscherne grade 3)
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60 79 Degrees MPTA
61 87 Degrees MPTA
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63 Open fracture 10cm longitudinal laceration posterior aspect of calfCASE 4 52 yr old low energy fall Open fracture 10cm longitudinal laceration posterior aspect of calf
64 Open Tibial Fracture
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67 CASE 5 32 yr RTA Open fracture
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72 50 yr old low energy fall Closed fracture Known alcoholicCASE 6 50 yr old low energy fall Closed fracture Known alcoholic
73 What would you do??
74 MIPO plating
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