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Orthopaedic Operation
- 1. Orthopaedic Operation Apley & Solomon’s system of orthopaedics and trauma. 10th ed.
- 2. steps PREPARATION INTRAOPERATIVE RADIOGRAPHY THE ‘BLOODLESS FIELD’ MEASURES TO REDUCE RISK OF INFECTION THROMBOPROPHYLAXIS
- 4. INTRAOPERATIVE RADIOGRAPHY ROBOTICALLY ASSISTED SURGERY IMAGING GUIDANCE SYSTEMS RADIATION EXPOSURE MAGNIFICATION
- 5. THE ‘BLOODLESS FIELD’ WIDE AWAKE LOCAL ANAESTHETIC NO TOURNIQUET (WALANT) TOURNIQUET CUFF EXSANGUINATION TOURNIQUET PRESSURE Tourniquet time Deflating and re-inflating the tourniquet Finger tourniquet Complications
- 6. MEASURES TO REDUCE RISK OF INFECTION SKIN PREPARATION AND DRAPING Hair removal Skin cleaning Drapes SURGICAL ATTIRE Gowns Gloves Face mask Glasses and eye protection • VACCINATION • Hepatitis B • Hepatitis C • Human immunodeficiency virus
- 9. THROMBOPROPHYLAXIS prevention General measures Neuraxial anaesthesia Surgical technique Tourniquet Early mobilization Physical methods Graduated compression stockings Intermittent plantar venous compression Intermittent pneumatic compression of the leg Inferior vena cava filters Electrical stimulation Chemical methods Aspirin Unfractionated heparin Low molecular weight heparin (LMWH) Pentasaccharide Direct anti-Xa inhibitors Warfarin
- 10. THROMBOPROPHYLAXIS prevention General measures •Neuraxial anaesthesia •Surgical technique •Tourniquet •Early mobilization Physical methods •Graduated compression stockings •Intermittent plantar venous compression •Intermittent pneumatic compression of the leg •Inferior vena cava filters •Electrical stimulation Chemical methods •Aspirin •Unfractionated heparin •Low molecular weight heparin (LMWH) •Pentasaccharide •Direct anti-Xa inhibitors •Warfarin
- 11. THROMBOPROPHYLAXIS Thromboembolism prophylaxis is essential around surgery, especially for patients with significant fractures. The ideal duration varies, but after knee and hip replacements, prophylaxis is recommended for 14-35 days and 35 days respectively. Oral agents, such as aspirin and inhibitors, offer a practical option for extended prophylaxis without the need for monitoring.
- 13. Operations of Bones OSTEOTOMY BONE FIXATION BONE GRAFTS AND SUBSTITUTES DISTRACTION OSTEOGENESIS AND LIMB RECONSTRUCTION – ILIZAROV METHOD LEG LENGTH EQUALIZATION OPERATIONS TO INCREASE STATURE
- 14. osteotomy LIMB AXES AND REFERENCE ANGLES
- 15. Rules of Osteotomy The position and level of the CORA determine the type and location of the osteotomy to correct the deformity by rotating the bone segments around the bisector. The rules of osteotomy by Paley allow for different types and locations of osteotomies depending on the position of the CORA and the presence of multi-apical deformities.
- 16. Complication of osteotomy and deformity correction General Undercorrection and overcorrection Nerve tension Compartment syndrome Non-union
- 17. BONE FIXATION INTERNAL FIXATION BY SCREWS INTERNAL FIXATION BY PLATES AND SCREWS INTERNAL FIXATION BY INTRAMEDULLARY DEVICES EXTERNAL FIXATION
- 18. INTERNAL FIXATION BY SCREWS Simple screw Lag screw Cannulated variable pitch screws
- 19. INTERNAL FIXATION BY PLATES AND SCREWS Simple straight compression plates allow compression along the axis of the plate. Contoured plates fit specific bones. Low-profile plates reduce the ‘footprint’ on the bone so as to preserve local vascularity. Locked plates enable the screw to engage the plate by a secure mechanism so as to create a rigid three-dimensional on struct which prevents toggling of the screw in the hole. Bridge plates span a comminuted defect without disturbing the fracture haematoma or periosteum and do not apply compression. Neutralization plates do not apply compression but add some extra stability to a fracture that has been primarily compressed and stabilized by a lag screw.
- 20. INTERNAL FIXATION BY INTRAMEDULLARY DEVICES Interlocking nails are rigid devices that provide stability for shaft fractures of the tibia and femur in adults by fitting into the medullary canal and locking with screws. Unlocked nails are flexible rods that act as internal splints for long-bone shaft fractures in children by avoiding damage to the growth plates.
- 21. EXTERNAL FIXATION External fixators are devices that support and adjust the skeleton from outside the body using wires or pins attached to rods or rings. They are used for temporary or reconstructive purposes and have different types and biomechanical properties. Static external joint fixation is a method of reducing joint fractures by applying distraction force through the ligaments. Dynamic external fixation is a method of preventing joint stiffness by using devices that allow bending at the joint axis.
- 22. BONE GRAFTS AND SUBSTITUTES AUTOGRAFTS (AUTOGENOUS GRAFTS) Cancellous autografts Vascularized grafts Bone marrow aspirates Platelet-derived activators ALLOGRAFTS (HOMOGRAFTS) BONE MORPHOGENETIC PROTEINS (BMPs) CALCIUM-BASED SYNTHETIC SUBSTITUTES
- 23. DISTRACTION OSTEOGENESIS AND LIMB RECONSTRUCTION – ILIZAROV METHOD DISTRACTION OSTEOGENESIS CHONDRODIATASIS BONE TRANSPORT CORRECTING BONE DEFORMITIES AND JOINT CONTRACTURES
- 24. LEG LENGTH EQUALIZATION shortening the longer leg slowing growth in the longer leg Physeal arrest Bone shortening lengthening the shorter leg speeding up growth in the shorter leg.
- 25. OPERATIONS ON JOINTS ARTHROTOMY ARTHRODESIS ARTHROPLASTY
- 26. ARTHROTOMY inspect the interior or perform a synovial biopsy; drain a haematoma or an abscess; remove a loose body or damaged structure (e.g. a torn meniscus); to excise inflamed synovium.
- 27. ARTHRODESIS Exposure Preparation Coaptation Fixation
- 28. ARTHROPLASTY excision arthroscopy, partial replacement total joint replacement
- 29. Other MICROSURGERY, LIMB REPLANTATION AND LIMB TRANSPLANTATION AMPUTATIONS IMPLANT MATERIALS
- 30. AMPUTATIONS Indikasi : ‘three Ds’: (1) Dead, (2) Dangerous and (3) Damned nuisance. Varieties A provisional amputation A definitive end-bearing amputation A definitive non-end-bearing amputation
- 31. AMPUTATIONS AT SITES OF ELECTION/ OTHER THAN AT SITES OF ELECTION Amputation technique includes: cutting skin with a certain length, cutting muscle and suturing it to bone and periosteum, cutting nerve with tension, cutting bone and smoothing it, tying blood vessels and closing wound. Aftercare of amputation includes: draining hematoma, wearing compression socks, exercising muscle and joint, and teaching prosthesis use.
- 32. Complication Early Breakdown skinflaps Gas gangrene Late Eczema Ulceration Poor circulation Phantom limb
- 33. IMPLANT MATERIALS Stainless Steel Cobalt–chromium-based Alloys Titanium Alloys Ultra-high Molecular Weight Polyethylene Silicon Compounds Carbon Acrylic Cement Hydroxyapatite
- 34. IMPLANT MATERIALS Implant failure Corrosion Dissimilar metals Friction and wear Infection Malignancy
- 35. Terima Kasih Blom A, Warwick D, Whitehouse M, editors. Apley & Solomon’s system of orthopaedics and trauma. 10th ed. Boca Raton: CRC Press; 2017.