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Introduction to the Orthopaedic 452 course

Introduction to the Orthopaedic 452 course. Dr. Waleed Awwad, MBBS. FRCSC Assistant professor of Orthopaedic surgery Spine and scoliosis surgeon. Goal. Knowledge. Skill. Attitude. Goals. By end of his course , students will have demonstrated the ability to : 

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Introduction to the Orthopaedic 452 course

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  1. Introduction to the Orthopaedic 452 course Dr. Waleed Awwad, MBBS. FRCSC Assistant professor of Orthopaedic surgery Spine and scoliosis surgeon

  2. Goal

  3. Knowledge

  4. Skill

  5. Attitude

  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 • Cauda Equina Compression • Bone, Joint and Soft Tissue Infection • Multiple Trauma (Pelvic Fracture) • Acute Joint Dislocations

  9. Fractures & trauma • Common Adult & pediatric Fractures • Upper Limbs • Lower Limbs • Pelvic • Peripheral Nerve Injuries • Acute Spine Injuries • Soft tissue injuries • Joint dislocation

  10. Pediatric orthopaedic • Common Hip Conditions • Common Lower Extremities Condition • Alignment / Rotational conditions • Gait Problems • Lower extremities deformities

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

  12. Spine • Degenerative/Mechanical neck/back pain • Spinal cord or root entrapment (for example, herniated lumbar disc) • Vertebral fracture of osteoporotic origin • Spinal deformity (scoliosis) • Destructive (infectious and tumor related) back pain (for example, tuberculosis, metastasis, certain cancers)

  13. Bone tumors • Metastatic bone disease • Primary bone lesions • Benign bone tumors • Malignant bone tumors

  14. Metabolic bone disorders • Osteoporosis • Osteomalacia and Rickets

  15. Joint conditions • Degenerative OA • Shoulder Chronic Condition

  16. Clinical Assessment & diagnosis skills • History taking • Physical Examination • Investigation interpretation • Communication and attitude skills • Procedural Skill • Knee joint aspirations. • Apply and remove a cast • Joint/fracture reduction techniques

  17. 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. • Ambulatory care teaching • History taking skills • Each student will have a chance of take, present, and discuss patient history with the attending staff tow times during the course • Plaster room • Each student will have chance to observe, apply and remove the cast/splint during the course for at least two times

  18. Learning Resources • Books • Tutorials / Lectures • CBL • Handouts

  19. Assessment • Continues assessment (20%) • History taking at OPD • CBL • Hands-on skills sessions • attendance • OSCE (40%) • History taking • Physical examination • Communication skills • Written (40%)

  20. Ambulatory care learning/Assessment Students will learn and will be assessed for how : • To take and present 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 show an appropriate communication skills & Attitude toward and patient.

  21. Ambulatory care learning/Assessment • Each student will have chance at least 2 times during the 4 weeks course to do full clinical assessment of real patient in the Orthopaedic outpatient clinic. • Student will be assessed for skills in obtaing and presenting a full history and clinical examination. • 5% of total mark

  22. Skills sessions • Cast application and removal • Principles of reduction and immobilization. • Knee aspiration • 5% of total mark

  23. Case-based learning • Six different cases covered the most common MSK problems which can be presented to the ER or orthopaedic/primary clinic • Cases will be assigned ahead of time to the students with clear objectives • 5% of total mark

  24. Attendance • 5% of total mark

  25. 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

  26. 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)

  27. 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

  28. 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 • CaudaEquina Syndrome : compression of the nerve roots of the CaudaEquina at the spinal canal which affect motor and nerve supply to lower limbs and bladder (also saddle or peri-anal area)

  29. 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

  30. Alignment terminology

  31. Alignment Terminology: Cubitus Varus

  32. Alignment terminology: Cubitus Valgus

  33. Congenital or Acquired • Acquired conditions include : • Trauma • Developmental • Inflammation • Infection • Neuromuscular • Degenerative • Metabolic • Tumor

  34. Congenital Anomaly : Talipes Equino Varus TEV

  35. Traumatic Injuries Fractures Dislocations Soft tissues injuries: ligaments, tendons Nerve injuries Epiphyseal injuries

  36. Fractures: Break in the continuity of bone

  37. Dislocations Complete separation of the articular surface Distal to proximal fragment Anterior, Posterior, Inferior, Superior

  38. Fracture Dislocation Dislocation with fracture of the bone Always X-Ray Joint Above and Below

  39. Avulsion Fracture Force due to Resisted Muscle Action:- “Avulsion” Transverse pattern

  40. 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

  41. Soft tissue injuries of the knee

  42. Anterior Cruciate Ligament injury: MRI

  43. (Developmental Dislocation of Hip) DDH

  44. Developmental Foot deformity: Hallux Valgus

  45. Developmental: SCFE (Slipped Capital Femoral Epiphysis)

  46. Spinal Deformities: Kyphosis or Hyperlordosis

  47. Spinal Deformity: Scoliosis

  48. Degenerative Disorders Occur at any joint Can be primary or secondary Can lead to pain and/or deformity and/or loss of function

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