Orthopedic

1. Introduction to the
Orthopaedic
j

2. Goal
Competent student
Attitude
skill
knowledge

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

5. Attitude
Communicator
Personal
behavior
professional
Competency
in Attitude
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

9. NON-TRAUMATIC ORTHOPAEDIC
CONDITIONS
•Spine
•Tumors
•Metabolic
•Joints condition

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

24. Alignment terminology

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

41. Spinal Deformity: Scoliosis

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

44. Osteoarthritis of Knee

45. Metabolic Disorders (Rickets): Bow Legs

46. Osteoporosis: Pathological Fracture

47. Osteoporosis: Colles fracture

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

53. Neuromuscular disorder: Polio

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