1. Introduction to Orthopaedics.ppt
- 3. Knowledge Competency in the knowledge Domain Diagnose & initially manage of the urgent Orthopaedic conditions Clinical presentation, investigation, management & complications of the common and community related orthopedic conditions
- 4. Skill History taking Physical exam Procedural skills • Reduction • Splinting & casting • Knee aspiration Competency in skill domain
- 6. Goals By end of his course, students will have demonstrated the ability to: • Demonstrate essential knowledge required to diagnose, initially manage and to know when to immediately refer a patient with a condition that requires urgent specialist management. • Demonstrate knowledge to specify the symptoms, signs and immediate complications; to outline the assessment and appropriate investigation and; to outline the immediate and long term management of patients with common and community related orthopedic conditions and musculoskeletal trauma. • To take a relevant and a focused MSK history in the knowledge of the characteristics of the major conditions of: bone; joints; connective tissue; nerve tissue and; muscle tissue. • To perform a focused physical examination of major joints (shoulder, hip, knee, foot and ankle, PN and spine) • To order and to demonstrate an appropriate use and interpretation of appropriate investigations including: radiography, CT/MRI/bone scan, MSK U/S, serology, synovial fluid analysis, and EMG/NCS. • The ability to perform a common non-surgical orthopaedic procedures like joint aspirations and ability to apply and remove a cast.
- 7. Orthopaedic Core Competencies •EMERGENCIES / RED FLAGS •FRACTURES / TRAUMA •PEDIATRIC ORTHOPAEDIC CONDITIONS •NON-TRAUMATIC ORTHOPAEDIC CONDITIONS •CLINICAL ASSESSMENT & DIAGNOSIS SKILLS
- 8. EMERGENCIES / RED FLAGS •Open Fractures •Fractures with nerve or vascular compromise •Compartment Syndrome •Bone, Joint and Soft Tissue Infection •Multiple Trauma (Pelvic Fracture) •Acute Joint Dislocations
- 10. Bone tumors •Metastatic bone disease •Primary bone lesions •Benign bone tumors •Malignant bone tumors
- 11. Metabolic bone disorders •Osteoporosis •Osteomalacia and Rickets
- 12. Joint conditions •Degenerative OA •Shoulder Chronic Condition
- 13. Clinical Assessment & diagnosis skills •History taking •Physical Examination •Investigation interpretation •Communication and attitude skills •Procedural Skill •joint aspirations. •Apply and remove a cast •Joint/fracture reduction techniques
- 14. Teaching and learning methods and places • Lecture (Large group): • Case-based learning –CBL- (Small groups): – Topics will be assigned in a head of time to the students with clear objectives • “Hands-on” small groups sessions: – Physical examination skills – Splinting and casting technique skills – Principles of fractures & joints dislocation reduction – Joint aspirations. • Plaster room – Each student will have chance to observe, apply and remove the cast/splint during the course for at least two times
- 15. Learning Resources •Books •Tutorials / Lectures •CBL •Handouts
- 17. Skills sessions •Cast application and removal •Principles of reduction and immobilization. •Knee aspiration
- 19. Orthopedic Surgery = Not only Bone Surgery •Orthopedic specialty is the branch of medicine which manage trauma and disease of Musculoskeletal system •It includes : bones, muscles, tendons, ligaments, joints, peripheral nerves, vertebral column and spinal cord and its nerves
- 20. Orthopedic Specialty •Sub-Specialties in orthopedic include : •General •Pediatric Orthopedic •Sport and Reconstructive Orthopedic •Orthopedic Trauma •Arthroplasty •Spinal Surgery •Foot and Ankle surgery •Oncology •Hand Surgery •Upper Limb (New)
- 21. Red Flags •Red Flags = Warning Symptom or Sign •Red flags should always be looked for and remembered •Presence of a red flag means the necessity for urgent or different action/intervention
- 22. Examples of Red Flags Open Fractures : more serious and very high possibility of infection and complications Complicated Fractures : fracture with injury to major blood vessel, nerve or nearby structure Compartment Syndrome : increase in intra-compartment pressure which endangers the blood circulation of the limb and may affect nerve supply Cauda Equina Syndrome : compression of the nerve roots of the Cauda Equina at the spinal canal which affect motor and nerve supply to lower limbs and bladder (also saddle or peri- anal area)
- 23. Examples of Red Flags Infection of Bone, Joint and Soft Tissue Osteomyelitis : Infection of the bone Septic Arthritis :Infection of the joint Cellulitis :spreading Infection of the soft tissue May cause septicemia or irreversible damage . Multiple Trauma or Pelvic Injury: more than one fracture or injury sustained at the same time consider massive blood loss and associated injuries . Acute joint Dislocations : requires urgent reduction or may cause serious complications
- 25. Alignment Terminology: Cubitus Varus
- 26. Alignment terminology: Cubitus Valgus
- 27. Congenital or Acquired •Acquired conditions include : •Trauma •Developmental •Inflammation •Infection •Neuromuscular •Degenerative •Metabolic •Tumor
- 28. Congenital Anomaly : Talipes Equino Varus TEV
- 29. Traumatic Injuries •Fractures •Dislocations •Soft tissues injuries: ligaments, tendons •Nerve injuries •Epiphyseal injuries
- 30. Fractures: Break in the continuity of bone
- 31. Dislocations Complete separation of the articular surface Distal to proximal fragment Anterior, Posterior, Inferior, Superior
- 32. Dislocation with fracture of the bone Always X-Ray Joint Above and Below Fracture Dislocation
- 33. Force due to Resisted Muscle Action:- “Avulsion” Transverse pattern Avulsion Fracture
- 34. Intra-articular Fractures • If displaced ; should always be treated by ORIF= Open Reduction and Internal Fixation failure to reduce and fix such fracture results in loss of function, deformity and early degenerative changes
- 35. Soft tissue injuries of the knee
- 36. Anterior Cruciate Ligament injury: MRI
- 37. (Developmental Dislocation of Hip) DDH
- 38. Developmental Foot deformity: Hallux Valgus
- 39. Developmental: SCFE (Slipped Capital Femoral Epiphysis)
- 40. Spinal Deformities: Kyphosis or Hyperlordosis
- 42. Degenerative Disorders • Occur at any joint • Can be primary or secondary • Can lead to pain and/or deformity and/or loss of function
- 43. OA Hip
- 45. Metabolic Disorders (Rickets): Bow Legs
- 48. Bone Tumor
- 49. Bone tumors
- 50. Neurological Evaluation : Sensory & Motor
- 51. Nerve Injury: Muscle wasting
- 52. Spinal Cord Injury •Often results from fracture dislocation of spine •When injury is at cervical spine it may result in Tetraplegia or quad •Injury at dorsal spine may result in Paraplegia
- 54. Chronic Osteomyelitis : discharging sinus
- 55. Chronic Osteomyelitis : Sequestrum
- 56. Physiotherapy for Orthopedic Patients •Physiotherapy is an important part of orthopedic and trauma management •It is used for : pain relief, prevention of stiffness, muscle strengthening, mobilisation of stiff joint or spine, training non- weight bearing or partial weight bearing •Physiotherapy modalities include: heat, cold, exercise, ultrasound, traction, electrical stimulation
- 57. Clinical Skill: Cast application
- 58. Clinical Skills: Knee Aspiration