history and basics of orthopedics

2.  The term ORTHOPAEDICS was coined by NICHOLAS ANDRE in 1741
 The term orthopedia Is a composite of 2 Greek words
 Orthos- straight
 Paidios – child
 Orthopaedics literally means STRAIGHT CHILD

3.  ANDRE’S book also depicted a crooked young
tree attached to a straight and strong stake,
which has become the universal symbol of
orthopaedic surgery

4.  Orthopaedics was developed during the primitive times
 The Egyptians continued these practises
 The Greeks and Romans subsequently began to study medicine in a systematic
manner
 In the Roman period, amputations were also performed and primitive prostheses
were developed

5.  The union of fractures in fair alignment has been observed that suggests the early use of splints and
rehabilitation practices
 The ancient Egyptians seemed to have carried on the practices of splinting.
splints made of bamboo and reed padded with linen
crutches were also used by this civilization

6.  Procedures such as TREPANATION and crude AMPUTATIONS occurred during the New Stone Age,

7.  The Father Of Medicine,
 Described various reduction manoeuvres
 Principles of traction and counter-traction,
 Correction of clubfoot deformity,
 Treatment of infected open fractures
 The Hippocratic method for shoulder reduction - is still used
for reducing anterior shoulder dislocations

8.  Splints were developed with
fresh rawhide that had been soaked in water.
splints made of clay,
 Furthermore, bone-setting or reductions was
practiced as a profession in many tribes,

9.  He served as a gladiatorial surgeon in Rome, and today, he
is considered to be the FATHER OF SPORTS MEDICINE.
 He described the Musculoskeletal And Nervous Systems.
 He is also credited with coining the terms -
- SCOLIOSIS
- KYPHOSIS
- LORDOSIS

10.  The first medical school in Europe was established in Salerno, Italy, during the
ninth century. This school provided primarily pedantic teaching to its students and
perpetuated the theories of the elements and humors.
 Later on, the University of Bologna became one of the first academic institutions to
offer hands-on surgical training

11.  Until the 16th century, the majority of medical theories were heavily influenced by the
work of Hippocrates.
 The scientific study of anatomy gained prominence during this time, especially due to the
work done by great artists, such as Leonardo Di Vinci.

12.  Scholar and surgeons provided a strong foundation for the field of modern orthopedics.
 •Additional discoveries by
- Joseph Lister,
- Louis Pasteur,
- Robert Koch, and
- Ignaz Semmelweis- relating to antisepsis appeared to revolutionize the surgical
management of orthopedic injuries.

13.  Rapid development of Orthopedic surgery-
- Better control infections
- Introduction novel technology.
- Invention of x-ray in 1895 by Wilhelm Conrad Röntgen
 Spinal surgery also developed rapidly with Russell Hibbs
 In 1942, Austin Moore performed the first metal hip
arthroplasty,
 Subsequently advanced by the work of Sir John Charnley in the
1960s

14.  Considered the Father of Orthopaedics Surgery in Britain
 A pioneer of modern orthopaedics surgery

15.  He advocated enforced REST as the best remedy for fractures and tuberculosis .
 'Thomas Splint‘ -to stabilize a fractured femur and prevent infection
 'Thomas's collar' -to treat tuberculosis of the cervical spine,
 'Thomas's manoeuvre', an orthopaedic investigation for fracture of the hip joint,
 Thomas test, -a method of detecting hip deformity (FFD),
 Thomas's wrench' for reducing fractures, as well as an osteoclast to break and reset bones.

16.  Father of modern orthopaedic surgery

17.  Orthopaedics, is the branch of surgery concerned with conditions involving the
Musculoskeletal Trauma
Sports Injuries,
Spine Diseases
Degenerative Diseases,
Infections,
Tumors And
Congenital Disorders And Deformities.

18.  Body surfaces, planes, and positions are always described in relation to the
“ANATOMICAL PLANES”.
 Anatomical planes of the body
1.Saggital
2.Coronal
3.Transverse

19.  Ankylosis- restriction of joint motion
 Arthrodesis- surgical fusion of the joint
 Arthroplasty- surgery to restore the motion and function of the joint
 Arthroscopy- examination of a joint through an arthroscope
 Effusion – escape of fluid in to the joint cavity
 Arthrocentesis- aspiration of a joint
 Arthrotomy- opening of a joint

20.  Dislocation- complete disruption in the continuity of a joint
 Subluxation- partial disruption in the continuity of a joint
 Fracture dislocation- dislocation that occurs in conjunction with a fracture of the bone
-If incomplete it is called fracture subluxation
 Osteoarthritis- degeneration of a joint
 Osteophytes-new bone growth due to degeneration of the joint

21.  Strain – Muscle tear
 Sprain- Ligament tear
 Bunion—an inflammation and swelling of the bursa (small sac) on the first joint of the big
toe
 Bursa—a small, fluid-filled sac between a tendon and a bone
 Bursitis—inflammation of a bursa, especially of the shoulder, elbow, or knee joint;

22.  Many thousands year ago the Egyptians immobilized fractures by linen
stiffen with gum or plaster, also starch, clay and egg albumin
 Plaster of Paris bandages were first used by Antonius Mathysen, A Dutch
military surgeon in 1852

23.  The name of the plaster of Paris derived from an accident to a house built on a deposit of
Gypsum, Near Paris. The house burnt down. When rain fall on baked mud of the floors it
was noted that footprints in mud set rock hard.

24.  The plaster of Paris consists of roll of muslin stiffened by dextrose or starch and
impregnated with the hemihydrate of calcium sulphate. (CaSO4.1/2H2O)
 When water is added, the calcium sulfate takes up its water of crystallization:
2(Caso4.1/2H2O) +3H2O----2 CaSO4.2H2O+Heat
 This is the process of setting and is an Exothermic reaction
 Plaster Of Paris incorporates 20% of water its soaks up, the remaining 80% lost during
drying

25.  Note: the setting of unmodified plaster starts about 10 minutes after mixing and is
complete in about 45 minutes; however, the cast is not fully dry for 72 hours

26.  The best plaster should be a fairly wide mesh starch free crioline or muslin bandage,6
inches(15.2cm) wide and 4.6 meter long. The completed plaster bandage should be elastic
and springy. An average 4 meter plaster bandage should weigh 8 ounces(224gm)and
contain 85 to 90 percent by weight of plaster.
 Setting time – Time taken to convert from powder form to crystalline form Average time is
3-10 minutes

27.  Reduced by-
High Temperature
Salt solution
Borax Solution
Addition Of Resin
 Increased by
Low temperature
Sugar solution
 Setting time is three times longer at 5 C than at 50 C
 Movement of plaster while it is setting will cause gross weakening

28.  Drying time – Time taken for Plaster of Paris to convert from crystalline from to anhydrous
form
 Influenced by ambient temperature and humidity
 The optimum strength is achieved when it is completely dry.

29.  To Support fractured bones, controlling movement of fragments and resting the damaged
tissues
 To stabilize and rest joints in ligamentous injury
 To support and immobilize joints and limbs post operatively until healing has occurred
 To correct a deformity
 To ensure rest of infected tissues
 To make negative mold of a part of body

30.  Advantages
Slower setting
Infinitely mouldable when wet
cheap
 Disadvantages
Heavy
Messy
Significantly weakened if cast is wet
Partially radio-opaque

31.  Based on Pattern Of Application
Slab: POP encloses partial circumference ex: Short arm back Slab
Cast :POP encloses full circumference ex Short leg full Plaster
Spica: includes trunk and one or more limbs ex : Hip Spica
Brace: Splintage which can allow motion at adjacent joints
 Based on interposition of Material
Unpadded-No material interposed in between Plaster Of Paris and skin
A practice in antiquity
Padded-Interposed material may be stockinette and wool or wool Alone
This is current practice

34.  A. Plaster Of Paris with melamine resin
 B. Fibreglass
– Advantages
Lighter
Three times stronger than POP
Impervious to water
Radiolucent
– Disadvantages
Costly
Less pliable
Requires gloves