Post on 15-Nov-2014
Introduction to the Clinical exposure at Philippine Orthopedic Center (POC)
Skeletal systemConsists of 206 bones
Function:Serves as body’s frameworkAllows movement & locomotion
Protect vital organs
Stores calciumManufactures new blood cells (red bone marrow)
BoneFirm structure of living tissue with vascular connections
Constantly being remodeled (deposition & resorption)
Osteoblasts – cells that are active in bone formation; deposition of bone
Osteoclasts – bone destroying cells; associated with removal of bone during remodeling
Osteocytes – principal cell of mature bone
Division of human skeleton:1.Axial – body’s upright structure; 80 bones
Skull Vertebral column Ribs
2. Appendicular – body’s appendages; 126 bonesArmsHipslegs
Classification of bones:Long bones – femurShort bones – carpals, tarsals, phalanges
Flat – ribs, sternum, scapula
Irregular – vertebraeSesamoid – patellaConnective Tissue – supports and binds other body tissues
Tendon – attaches muscle to bone
Ligaments – bind joints together; connects articular bones & cartilages
Cartilage – non-vascular tissue, protects bone edges from rubbing vigorously
Joint – a space in which 2 or more bones come together
Provide movement & flexibility in the body
Types of joint:Synarthrodial – completely immovable joints (Ex. Joints in the cranium)
Ampiarthrodial – slightly movable joints (Ex. Pelvis)
Diarthrodial (Synovial) – freely movable joint (Ex.Elbow & knee)
Synovial joints are the only joints lined by synovium; a membrane that secretes synovial fluid for lubrication & shock absorption
Epiphyses – 2 knob-like ends; primarily cancellous bone; assists with bone development
Diaphysis – bone shaft; provides strength; resists bending forces
Plays a role in growth & development
AcetabulumHHead
Neck Greater
trochanter
Lessertrochanter
Midshaft
Proximal 3rd
Distal 3rd
Medial condyleLateral condyle
Diaphysis
Epiphysis
Epiphyseal plate – area between the metaphysis & epiphysis
Periosteum – CT covering the bone
Musculoskeletal Injury – accounts for about 66% of all injuries
One of the primary causes of disability in the US
Fracture – break or disruption in the continuity of bone
Caused by direct blow, crushing force, sudden twisting motion or extreme muscle contraction
Classification of fractures:According to the extent of the break:
Complete fracture – break is across the entire width; bone is divided into 2 distinct sections
Incomplete fracture – partial break in the bone; break is confined through only part of the bone
According to the extent of associated soft tissue damage:
Open (Compound) – skin over broken bone is disrupted; soft tissue injury & infection are common
These are graded to define the extent of tissue damage:
Grade 1 – least severe injury; skin damage is minimal
Grade 2 – accompanied by skin & muscle contusions
Grade 3 – damage to the skin, muscle, nerve tissue & blood vessels
Wound is more than 6-8 cms.
Closed (simple) fracture – skin over the fractured area remains intact
Pathologic ( spontaneous) – occurs after minimal trauma to a bone that has been weakened by a disease
Greenstick fracture – one side of bone is broken, the other is bent, most commonly seen in children
Classification According to pattern:
Transverse fracture – bone is broken straight across
Oblique fracture – the break extends in an oblique direction; slanting direction
Spiral fracture – the break partially encircles the bone
Classification as to appearance:
Comminuted – bone is splintered or crushed with 3 or more fragments
Impacted – when fractured end of bones are pushed into each other
Compression fracture – produced by a loading force applied to the long axis of cancellous bone
Depressed – usually occurs in the skull; broken bone driven inward
Longitudinal – break runs parallel with bone
Fracture dislocation – fracture is accompanied by a bone out of joint
Fatigue or stress fracture results from excessive strain or stress on the bone
Fractures
Classification in relation to the joint:
Intracapsular within the jointExtracapsular – outside the capsule
Intra-articular – within the joint
Classification as to Location:
ProximalDistalMid-shaft
Clinical Manifestations:Pain or tenderness over the involved area
SwellingLoss of function
Obvious deformityCrepitus – grating sensation either heard or felt
Erythema, EdemaMuscle spasm/impaired sensation
Bleeding from an open wound with protrusion of fractured bone
Principles of fracture treatment:
Reduction of bone fragments to normal position & immobilization
Maintenance of reduction until healing is sufficient to prevent displacement
Preservation & restoration of musculoskeletal function
Stages of bone healing: 1. Hematoma formation – blood accumulates into the area between & around the fragments. The clot begins 24 hrs after the fracture occurs
2. Cellular proliferation – (within 5 days) hematoma undergoes organization. Fibrin strand form with the clot creating a network for revascularization & invasion of fibroblast & osteoblast.
Beginning of external cartilaginous callus formation.(osteoid tissue)
3. Callus formation – (2-3 weeks) minerals are being deposited in the osteoids forming a large
mass of differentiated tissue bridging the fractured bone.
4. Ossification – mineral deposition continues & produces a firmly reunited bone. Final ossification takes
3-4 months.
5. Consolidation & remodeling – final stage of fracture repair consists of removal of any remaining devitalized tissue & reorganization of new bone
Complications of Healing:Interruption in the sequence of healing are caused by:
Original injuryDebridement
Loss of bone substanceInfectionLoss of circulationImproper immobilization
Inadequate fixationNecrosisMetabolic disturbance
Possible Complications from Fractures:
Pulmonary Embolism Caused by immobility; precipitated by fracture
Clinical Manifestations:Restlessness & Apprehension
Substernal painDyspnea
DiaphoresisABG changesImplementation:Administer O2, notify the doctor, prepare to administer anti coagulant therapy
Fat Embolism An embolism originating from bone marrow (fat globules); occluding the small blood vessels of lungs, brain, kidneys etc.
Occurs 24-72 hrs following an injury
Respiratory failure is the most common cause of death
Occurs frequently in young adults (20-30 years old) Elderly with fracture of long bones
Clinical manifestations:Mental confusionRestlessness due to hypoxiaTachycardia, tachypnea, dyspnea
Cough, chest painThick white sputumPetechial rash over the upper chest & neck
ABG – decrease PaO2Implementations:Early surgical fixationAdminister O2 as orderedAdminister morphine/corticosteroids
Compartment SyndromeIncreased pressure within one or more compartments causing massive compromise of circulation to an area
Enclosing muscle/fascia is too tight or cast/dressing is constrictive
Increased compartment content due to hemorrhage/edema
Forearm/leg muscles frequently affected
4-6 hrs. after the onset of compartment syndrome, neuromuscular damage is irreversible
Clinical Manifestations:ParesthesiaThrobbing painCyanosis of nail beds, pallor, cold finger or toes
Pulselessness
Implementation:Notify physician immediately
Elevate leg above level of heart
Remove restrictive devices
Prepare client for fasciotomy
Passive ROM q 4-6 hrs.Wound closure in 3-5 days
Infection & OsteomyelitisCan be caused by interruption of integrity of the skin, infection invades bone tissue
Clinical Manifestation:Fever> 38° CPainErythema in the area surrounding the fracture
TachycardiaIncrease WBC Count
Implementation:Notify the physicianPrepare to initiate aggressive IV antibiotic therapy
Delayed Complications:Non-union Fibrous tissue exists between bone fragments; no bone salts have been deposited
Reinforce information regarding bone grafts, immobilization & non-weight bearing
Avascular NecrosisInterruption in the blood supply to the bony tissue; resulting to death of bone tissue
Clinical Manifestation:Pain Decrease sensation
Implementation:Notify physicianPrepare the client for removal of necrotic tissue (sequestration)
Mechanical Aids for Walking:Canes:Standard straight-legged caneTripod or crab caneQuad cane – provides the best support
Standard cane – 36 inches in length
The length should permit the elbow to be slightly flexed
Health Teachings:Hold the cane with the hand on the stronger side of the body
Position the standard cane 6 inches to the side & 6 inches in front of the near foot.
When Maximum Support is Required:
Move the cane forward 1 foot while the body weight is borne by both legs
Move the weak leg forward to the cane while weight is borne by the cane & stronger leg
Move the stronger leg forward ahead of the cane & weak leg while the weight is borne by the cane & weak leg.
Walkers – for ambulatory clients needing more support than a cane provides.
Client needs to bear at least partial weight on both legs
Hand bar below the client’s waist & client’s elbow slightly flexed
Crutches Axillary crutch with hand bars
Loftstrand bar – extends only to the forearm; substitute to cane
Canadian or Elbow Extensor Crutch – made of single tube of aluminum with lateral attachments, a hand bar, cuff for the forearm & has a cuff for the upper arm
Nursing Alert:The weight of the body must be borne by the arms rather than the axillae (can injure the radial nerve, eventually can cause crutch palsy)
Crutch Palsy – weakness of the muscles of the forearm, wrist & hand
Measuring Clients for Crutches:
To obtain the correct length for the crutches & the correct placement of the handpieces
2 ways to measure the crutch length:
Client in supine position, the nurse measures from the anterior axillary fold to the heel of the foot & add 1 inch.
The client stands erect. The shoulder rest of the crutch is at least 3 finger widths, that is 1-2 inches below the axilla.
The angle of the elbow flexion must be 30 degrees.
Crutch stance (Tripod Position) –proper standing position with crutches.
Crutches are placed 6 inches in front of the feet & 6 inches laterally.
Crutch gait – gait a person assumes on crutches by alternating body weight on one or both legs & the crutches.
5 Standard Crutch Gaits:Four Point GaitThree Point Gait2 Point GaitSwing toSwing through
Four Point- Alternate Gait – most elementary, safest gait; client needs to bear weight on both legs
The nurse ask the client to:Move the right crutch ahead 4-6 inches.
Move the left front foot forward, to the level of the left crutch
Move the left crutch forward
Move the right foot forward
3 Point GaitClient bears entire body weight on the unaffected leg
Both crutches & affected leg advances
Unaffected leg advances
Two-Point Alternate Gait Partial weight bearing on each foot
Faster than 4 point gait
Move the left crutch & the right foot together
Move the right crutch & the left foot ahead together
Swing – To Gait – paralysis of the legs & hips
Move both crutches ahead together
Lift body weight by the arms & swing to the crutches
Swing –Through Gait Move both crutches forward together
Lift body weight by the arms & swing through beyond the crutches
Going up the StairsNurse stands behind the client
Placing weight on crutches while moving the unaffected leg onto the step
Going down the StairsThe nurse stands 1 step below
Moving the crutches & affected leg to the next step
Interventions for Fracture:ReductionFixationTractionCasts
Reduction – restoring the bone to proper alignment
Closed Reduction – performed by manual manipulation
Maybe performed under local/general anesthesia
Open Reduction – involves surgical intervention
Treated with internal fixation devices
Client may be placed in traction or cast following the procedure
Fixation Internal fixation – follows open reduction
Involves the application of screws, plates, pins, nails to hold the bone fragments in alignment
May involved the removal of damaged bone & replacement with a prosthesis
Provides immediate bone strength
Risk of infection is associated with this procedure
External fixation – an external frame is utilized with multiple pins applied through the bone
Provides more freedom of movement than with traction
Roger Anderson External Fixator (RAEF)
For fracture of the tibia, radius, ulna done under anesthesia
Ilizarov fixator – for severe comminuted fracture, bone lengthening
Traction – is the act of pulling and drawing which is usually associated with counter traction
Provides proper bone alignment & reduces muscle spasm
For support, reduce bone fracture
Nursing responsibility:Maintain proper body alignment
Ensure that the weights are hanging freely
Ensure that pulleys are not obstructed; pulleys move freely
Place knots in the ropes to prevent slipping
Types of traction:Manual traction – done with the use of the hands of the operator
Skeletal traction – pin is driven across the bone to provide an excellent hold while a weight is attached
Use of pins, tongs & wires
Crutchfield tongsFor fracture of cervical spineC1-C5 cervical spine tensionUse for 4 weeks
Vinke’s skull caliperC1-C5 cervical spine tension
Use for 4 weeks
Nursing responsibility:Monitor color, motion & sensation of affected extremity
Monitor the insertion site for redness, swelling or infection
Provide insertion site care as prescribed
Skin traction – applied by the use of elastic bandages or adhesive straps to the skin while a pull is applied by a weight
2 Types:Non-adhesive type – uses laces, buckles, leather & canvas
Ex. Head halter strap
Adhesive type – uses adhesive tape or elastic bandages
Ex. Dunlop skin traction
Cervical skin traction – relieved muscle spasm & compression in the upper extremities & neck
Uses a head halter & chin pad
For cervical spine affectation
For Pott’s disease
Head halter + Pelvic girdle for Scoliosis
Pelvic guilder – for lumbosacral affectation/slip disc
Buck’s skin traction- used to alleviate muscle spasm
Immobilize a lower limb by maintaining a straight pull on the limb
Boot appliance is applied to attached the traction
Not more than 8-10 lbs. of weight must be applied
Elevate the foot of the bed to provide traction
Bryant’s skin tractionUsed to stabilize a fractured femur or correct a congenital hip dislocation in children
Position child with a 90° hip flexion
For congenital hip dislocation
0-6 yrs/0-3 yrs old – minimum of 4 weeks
Note: buttocks must not be touching the mattress
Russell’s skin tractionUsed to stabilized a fractured femur before surgery
Similar to Buck’s traction; provides a double pull with the use of a knee sling
Traction pulls at the knee & foot
Dunlop’s skin tractionFor supracondylar fracture of the humerus
Minimum 4 weeks of application
Boot leg traction – fracture of hip and or femur
Post poliomyelitis with residual paralysis
Halo-pelvic tractionFor scoliosisTemporal to occipital part of pelvic area
Minimum 4 weeks of application in preparation for surgery
Halo-femoral tractionFor severe scoliosisAvoid progression of scoliosis
From temporal to femural area
90-90 degrees tractionFor subtrochanteric fracture of femur or intertrochanteric fracture of femur
Stove in chestFor multiple rib fracture
Parts of an Orthopedic bed:Firm mattressFracture boardBed elevator or shock block
Balkan frame:4 vertical bars2 horizontal bars1 diagonal bar1 straight bar or cross bar
Pulleys (3)Clamps – to hold bars in place
Overhead trapeze
Traction equipments:Thomas splintPearson attachmentRest splintCord sash (3)
Safety pinsClipsFoot restSlings (2 sizes)Weights
Plaster cast – a temporary immobilization device which is made up of gypsum sulfate
Undergoes unhydrous calcinations when mixed with water, swells & forms into a hard cement
Made of rolls of plaster bandage, wet in cool water & applied to the body
Cools after 15 minutesRequires 24-72 hrs to dry completely
Non-plaster cast –(fiberglass cast)
Lighter in weight, stronger, water resistant & durable
Impregnated with cool water-activated hardeners & reach full rigidity in minutes
Diminish skin problems
Functions:To immobilizeTo prevent or correct deformity
To support, maintain & protect realigned bone
To promote healing & early weight bearing
Materials for casting:StockinetteWadding sheetPlaster of Paris
Complications of cast:1.Neurovascular compromise
Watch out for 6 P’s:PainPulselessnessPallor
ParesthesiaParalysisPoikilothermia
2. Incorrect alignment3. Cast syndrome – (Superior
mesenteric artery syndrome) occurs with body casts; any cast that involves the abdomen
Decreases the blood supply to the bowel
Signs/Symptoms:Abdominal pain, nausea & vomiting
4. Compartment syndrome –increased pressure within a limited space, compromises the function & circulation in the area
Long arm circular cast – for fractures of radius/ulna
Fuenster’s cast/Munster cast
Fracture of radius/ulna with callus formation
Long arm posterior moldFracture of radius/ulna with open wound, swelling or infection
Short arm castFracture of the wrist, carpals & metacarpals
Short arm posterior moldFracture of the wrist, carpals & metacarpals with open wound, swelling & infection
Purpose:To change dressingTo adjust the elastic bandage
To assess presence of infection & swelling
Long leg castFracture of tibia fibula
Cylindrical leg castFracture of patella
Quadrilateral/Ischial weight bearing cast
Fracture of femur with callus formation
Cast braceFracture of distal 3rd of femur with callus formation & proximal 3rd of tibia fibula
Long leg posterior moldFracture of tibia fibula with open wound, swelling and infection (OSI)
Basket castFracture of patella with massive bone injury
Short leg cast fracture of ankle, tarsals & metatarsals
Patellar tendon bearing cast
For fracture of tibia fibula with callus formation
Delvit castFracture of distal 3rd of tibia with callus formation
Boot legFor post poliomyelitis with residual paralysis
Internal rotator splint or boardFracture with post op hip surgery
To maintain abduction & prevent internal rotation
With pillow in between legs
Short leg posterior moldFracture of ankle, tarsals & metatarsals with OSI
Rizzer’s jacket scoliosis
Minerva castUpper dorsal lumbar injury
Body castFor lower dorsolumbar injuries
Hanging castFracture of the shaft of humerus
Functional arm castFracture of the shaft of humerus with callus formation
Allows abduction & adduction
Shoulder spica castFracture of upper portion of humerus & shoulder joint
Airplane castFracture of neck of humerus
Fracture with recurrent shoulder dislocation
Body castLower dorsolumbar spineDouble hip spica castFracture of hips & both femur
One & one half hip spica cast
Fracture of ½ hip femur
Unilateral hip spica castFracture of 1 hip & 1 femur
Pantalon castfor pelvic fractureAt level of knees with abduction
Frog castCongenital hip dislocation
Double hip spica posterior mold
Fracture of both hips & both femur with OSI
One & one half hip spica posterior mold
Fracture of 2 hips & 1 femur
Single hip spica posterior mold
Fracture of 1 hip or 1 femur with OSI
Pelvic bone with callus formation
Night splintPost poliomyelitis with residual paralysis
Braces – are mechanical support for weakened muscles, joints & bones
Ex. Milwaukee brace, Yamamoto brace
Milwaukee bracePersonalized/customizedFor scoliosis – thoracic T9 above the thoracic area
Yamamoto braceInvolvement of T9 and below
Forrester braceFor cervico thoracic lumbar spine affection
Pott’s disease
Taylor Knight braceUpper thoracic spine affectation
T1-T3Pott’s disease
Jewett braceLower thoracic spine affection
Chairback braceFor lumbosacral affection
Philadelphia collar braceFor cervical spine affection
Cervical collar/Shuntz collar brace
Cervical spine affection
Cocked-up splintTo prevent wrist dropFor Colle’s fracture – distal radius affected
Banjo splintFor peripheral nerve injuryFor Carpal tunnel syndrome
Lively finger splintFracture of fingers
Dennis Browne SplintFor clubfoot/congenital Talipes Equinovarus
Tendon is short – complete soft tissue release
Congenital Clubfoot
Treatment time – day 1 of life to 7 yrs old
Unilateral leg braceFor post poliomyelitis with residual paralysis
Long leg brace Short leg brace
Bilateral leg brace (long)
Balance Skeletal TractionMaintain the anatomical position of fractured bone
Skeletal traction requires an invasive procedure in which
wires, pins & screws are inserted
Weight ranges from 25-40 lbs. (11-18 kg)
Traction Equipments:1.Thomas Splint & Pearson Attachment
2.Rest splint3.5 Slings (variable sizes)
4. 5 paper clips/safety pins5. Cord sash – short – thigh longer - traction longest – for the
suspension
6. Weights & bags – suspension weight is ½ lighter compared to the weight of the traction
7. Foot support – to prevent foot drop
Materials needed:Thomas Splint – placement of the thigh
Pearson Attachment – placement of the leg
Steinman’s holderSteinman’s pinTraction weight
10 % of the body weightInside of the suspension rope
Suspension weight50 % of the traction weight
Rest Splint3 Cord Sash
Thigh rope – the shortest
Suspension rope – the longest
Traction rope Slings & pinsFoot board
Application of traction:1. Verify Doctor’s order2. Inform the patient about the need & purpose of the procedure
3. Preparation
Identify the different parts of the orthopedic bed
Assemble the needed equipmentsThomas splintPearson Attachment
Know the affected extremityWhere to stand? Look for the last pulley & stand on the side
4. Mount the Thomas & Pearson on the rest splint
5 principles in the application of slings to be emphasized:
Not too tight nor too looseMaintain 1 inch distance between the slings to promote ventilation or aeration
Popliteal & heel portion must be free from sling
Smooth & right side must come in contact with the patient’s skin
(2) longer & wider slings in the thigh area
and (3) for the leg areaSling application:Start from the medial to the lateral side
Secure both ends together
Fan fold nicely on the lateral aspect & secure with a pin or clip.
Observe the principle of not too tight or not too loose & avoid hitting the patient’s extremity with the pin
The thigh rope should be attached on the medial aspect to the lateral aspect
5. Insertion of the apparatus under the affected extremity:
Insert the whole apparatus under the affected extremity
Manual traction to be released after the completion of the traction weight on the 3rd pulley
Lift the affected extremity on the count of three
Instruct the patient:Hold on the trapeze, flex the unaffected leg at the count of 3
6. Application of traction weightRope to be attached to the Steinman pin holder to run along the 3rd pulley & attached the prescribed weight
Check the principles of sling application, make necessary adjustments & check the alignment.
Pulleys must be aligned to the area of injury
1st pulley – aligned to the groin area
2nd pulley – aligned to the knee area
7. Apply suspension traction1 end of the thigh rope to be attached to the lateral aspect of the ischial ring with a slip knot
Attach the suspension rope on the midpart of the thigh rope, to the
1st pulley. Insert suspension weight, hang it on the 1st pulley pass it on the 2nd pulley under the rest splint. Clovehitch knot on the Thomas splint & another clovehitch knot on the Pearson. Secure the knot by closing it.
Be sure to maintain the traction rope inside, & the suspension weight should be outside.
9. Remove the rest splint10. Mount foot board to prevent foot drop with a ribbon knot
11. Check for the principles of traction. Swing the affected leg forward, lateral & backward to check the efficiency of traction.
Principles of traction:1.Patient must be in dorsal recumbent position
2.Line of pull should be in line with the deformity. Consider the position of diagonal bar & positioning of pulley.
1st pulley in line with the thigh, 2nd pulley in line with the knee or screw, 3rd pulley in line with the 2nd & 3rd pulleys
Weight bag must be at the level of the bed frame
3.Traction must be continuous. Emphasized the importance of manual traction.
4. Avoid friction – rope should be running along the groove of the pulley, knots away from the pulley. Weights should be hanging freely. Observe for wear & tear of ropes.
5. Provide counter traction. For every traction there must be a counter traction (Patient’s body weight)
Removal of traction:1. Apply rest splint2. Hang suspension weight on the 1st pulley
3. Complete removal of suspension weight – remove the knot on the Pearson & Thomas
4. Manual traction on the Steinman pin holder
5. Remove the traction weight on the (3rd) pulley, secure the traction rope on the rest splint, another on the Thomas & Pearson attachment.
Summary- Application of Balance Skeletal Traction in Chronological Order:
1.Inform the patient about the purpose of traction
2. Assemble the equipment needed
3. Apply the rest splint to Thomas & Pearson attachments
4. Apply slings on Thomas splint & Pearson attachments
5. Apply traction weight6. Apply suspension weight7. Check alignment of screw of
Pearson’s with knee joint
8. Remove rest splint9. Apply foot board10. Apply initially the
principles of traction
Nursing Care of Patients with Traction:
1. AssessmentAssess patient as to level of understanding/consciousness
2. Provision of general comfort
Skin care – head to toe; focus on the sponging of affected extremity
3. Potential Complications:Upper respiratory – Pneumonia – back tapping & deep breathing
Bed sore – good perineal care; proper skin care, turning, lift buttocks once in a while
Urinary & kidney problem – good perineal care, increase fluid intake
Bowel complication – fear of apparatus, no privacy, lack of fluids/perineal care
Pin site infection – observe for signs & symptoms of infection; loosening pin tract, pus coming out from insertion site, foul smelling odor, fever
Deformity – contracted knees, atrophy of muscles, foot drop, joint contractures
4. Provision of Exercises:ROM exercises with the use of trapeze
Deep breathing exercisesStatic quadriceps exercise – alternate contraction & relaxation of quadriceps muscles
Toe pedal exercises
5. Nutritional status6. Psychological aspectFear of the unknown, fear of death, fear of apparatus, fear of losing a job, financial fear
7. Provision of supportive therapy
Offer books to read, listen to radio or TV, discover interest
8. Spiritual aspect
Know patient’s religion, encourage relatives to give spiritual communication, visiting chaplain
Divertional activities – divert attention for any pain
Surgery Abbreviations & Meaning:ACL – Anterior Cruciate LigamentAEA – Above Elbow AmputationBKA – Below Knee AmputationCHSF – Compression Hip Screw Fixation
CW – Cerclage WiringIMN – Intra Medullary NailingORIF – Open Reduction Internal Fixation
PSF – Posterior Spinal Fusion
ROI – Removal of ImplantRCHSF – Richard Compression Hip Screw Fixation
THRP – Total Replacement & Hip Prosthesis
AKA – Above Knee AmputationBG – Bone GraftingFx - FractureHRI – Harrington Rod InstrumentRAEF – Roger Anderson External Fixation
Anterior Decompression Spinal Fusion (ADSF) - surgical intervention for Pott’s disease
Sequestrum – dead or necrotic bone
Sequestrectomy – removal of dead or necrotic bone
Gibbus formation – classical sign of Pott’s disease; progressive destruction of anterior spine leading to collapse & kyphosis
Axis – 1st cervical vertebraAtlas 2nd cervical vertebraIntertrochanteric fracture – fracture within the greater & lesser trochanter
Supracondylar fracture – fracture above the condyle
Subcondylar fracture - fracture below the condyle
Involucrum – new bone
Screws – used to attach implants such as plates & prosthetic devices to bone; to fix bone to bone, ligaments & tendons to bone
Guideline
in Choosing Absoanchor MIA
for Maxilla : Buccal Area
-06,-07,-08
Diameter: 1.2 - 1.3 mm
-06, -07,-08
Holding power of screw in bone is most dependent on the density & quality of bone
Screw Points:Non-self tapingTrocarStandardPilot point
Plates – stabilize the fracture; provide support to bone as it heals, held in place by screws
Recommended time for removal of plates:
Tibial plates – 1 yearFemoral plates – 2 yearsForearm & humeral plates – 11/2 -2 years
Rods or nails – stabilize diaphysis fractures of middle 2/3 of long bones
Nail-and- plates combination – for rigid immobilization of femoral neck when complete prosthetic replacement is not indicated
Identify the following:
Head halter + Pelvic girdle for Scoliosis