[Orthopaedic surgery] Introduction

Orthopaedic surgeons specialise in diseases of the bone, tendons, muscles, and joints.

 

Etymology

Ancient Greek ὀρθός (orthós) = straight, right, proper.
Ancient Greek παιδεία (paideía) = upbringing, training
Ancient Greek παιδίον (paidion) = child
Via French "orthopédie" in the publication "Orthopaedics: The art of straightening the deformities of children."

 

History taking 

 

Physical examination

 

Procedures

 

Connective tissue diseases

Musculoskeletal diseases

 

Diseases:

• Traumatic bone fracture 
• Femoral neck fractures
• Salter-Harris fractures
• Nonunion
• Traumatic muscle / tendon tear (strain)
• Rotator cuff tear 
• Traumatic ligament tear (sprain)
• Osteoarthritis
• Adhesive capsulitis of the shoulder (Frozen shoulder) 
• Medial epicondylitis (Golfer's elbow)
• Lateral epicondylitis (Tennis elbow)
• Impingement syndrome
• Iliotibial band syndrome
• Patellar tendinitis
• Osgood–Schlatter disease
• Legg–Calvé–Perthes disease
• Sever's disease
• Avascular necrosis
• Compartment syndrome 
• Spinal stenosis 
• Osteosarcoma 
• Chondrosarcoma 

Osteitis

Disease class: Bone diseases

 

Acroosteolysis

Disease class: Osteolysis

Subtypes

• Hajdu-Cheney syndrome

Bone resorption

Disease class: Bone diseases

Types

• Ainhum
• Alveolar bone loss
• Osteolysis

Developmental bone diseases

Disease class: Bone diseases

Types

• Acro-osteolysis 
• Basal cell nevus syndrome
• Dwarfism
• Dysostoses
• Funnel chest
• Gigantism
• Leg length inequality
• Marfan syndrome
• Osteochondrodysplasias
• osteolysis, Essential
• Pectus carinatum
• Platybasia
• Proteus syndrome

Marfan syndrome

Disease class:  bone diseases, Developmental

Disease class: Connective tissue diseases

Hypocalcaemia

Disease class: Calcium metabolism disorders 
Disease class: Water-electrolyte imbalance

This refers to calcium levels in the blood below the reference range.

 

Aetiology / Causes

Low PTH (hypoparathyroidism)

• Genetic disorders
• Abnormal parathyroid gland development
• Abnormal PTH synthesis
• Activating mutations of calcium-sensing receptor (autosomal dominant hypocalcaemia or sporadic isolated hypoparathyroidism)
• Postsurgical
• Thyroidectomy
• Parathyroidectomy
• Radical neck dissection
• Autoimmune
• Autoimmune polyglandular syndrome (associated with chronic mucocutaneous candidiasis and primary adrenal insufficiency)
• Isolated hypoparathyroidism due to activating antibodies to calcium-sensing receptor
• Infiltration of the parathyroid gland (granulomatous, iron overload, metastases)
• Radiation-induced destruction parathyroid glands
• Hungry bone syndrome (post-parathyroidectomy)
• HIV infection

High PTH (secondary hyperparathyroidism in response to hypocalcaemia)

• Vitamin D deficiency or resistance
• Multiple causes
• PTH resistance
• Missense mutation in PTH
• Pseudohypoparathyroidism
• Hypomagnesaemia
• Kidney diseases
• Loss of calcium from the circulation
• Hyperphosphataemia
• Tumor lysis
• Acute pancreatitis
• Osteoblastic metastases
• Acute respiratory alkalosis
• Sepsis or acute severe illness

Drugs

• Inhibitors of bone resorption (bisphosphonates, calcitonin, denosumab), especially in vitamin D deficiency
• Cinacalcet
• Calcium chelators (EDTA, citrate, phosphate)
• Foscarnet (due to intravascular complexing with calcium)
• Phenytoin (due to conversion of vitamin D to inactive metabolites)
• Fluoride poisoning

Disorders of magnesium metabolism

• Hypomagnesaemia can reduce PTH secretion or cause PTH resistance and is therefore associated with normal, low, or high PTH levels.

 

Management

• Calcium and vitamin D

 

 See also

• Hypercalcaemia 

Hypercalcaemia

Disease class: Calcium metabolism disorders
Disease class: Water-electrolyte imbalance

Definition

• This refers to calcium levels in the blood above the reference range.

 

Causes

• Hyperparathyroidism
• Neoplasms
• Lymphoma
• Sarcoidosis
• Tuberculosis
• Vitamin D poisoning
• Multiple myeloma 
• Vitamin A poisoning
• Hyperthyroidism

 

Management

Diagram created by uptodate.com

Investigations

1. Serum calcium
2. Total corrected calcium
3. Intact parathyroid hormone (PTH)
4. PTHrP
5. Chest radiograph
6. CT-thorax scan
7. 1,25-dihydroxyvitamin D
8. Lymph node biopsy
9. 25-hydroxyvitamin D
10. SPEP
11. UPEP
12. Serum free light chain assay

 

See also

• Hypocalcaemia

Rickets

 Disease class: bone diseases, Metabolic
Disease class: Calcium metabolism disorders
Disease class: Vitamin D deficiency

Types

• Osteomalacia
• Chronic kidney disease-Mineral and Bone disorder
• rickets, Hypophosphataemic

 

Endocrine bone diseases

Disease class: Bone diseases
Disease class: Endocrine system diseases

Types

• Acromegaly 
• Congenital hypothyroidism 
• dwarfism, Pituitary 
• Gigantism 
• Osteitis fibrosa cystica

Osteogenesis imperfecta

Disease class: Collagen diseases
Disease class: Osteochondrodysplasias

Signs

• Blue sclera

bone diseases, Metabolic

Disease class: Bone diseases

Disease class: Metabolic diseases

Types 

• bone demineralisation, Pathologic
• Osteoporosis
• Pseudohypoparathyroidism
• Rickets

Pituitary dwarfism

Disease class: bone diseases, Endocrine  
Disease class: Dwarfism

Disease class: Hypopituitarism

Female athlete triad syndrome

Disease class: Endocrine system diseases

 

The triad features three pathological processes:

1. Eating disorder or relative energy deficiency
2. Amenorrhoea
3. Osteoporosis 

It is only seen in females, and patients are often athletes.  

Signs

• Beau's lines