Ortho Oracle - orthopaedic operative atlas

Preop Considerations for Nail Pathology

– Discussion:     – consider photographs for documentation;     – consent should explain possibility of long term nail disfigurement;     – instruments:          – freer septum elevator, dental spatulas, fine hemostats, beaver blade, small currette, single and double pronged skin hooks;     – an easy way of applying … Read more

PreOp Planning for Removal of Cemented Stems

– Evaluate Proximal Stem:     – decide whether trochanteric osteotomy is required;     – it is essential to avoid a proximal femoral frx while extracting the stem;     – direct extraction of a femoral stem can be blocked by excessive cement or proximal bony overgrowth medial to the greater trochanter;     … Read more

PreOp Planning for Arthrodesis

– Debridement:  – all foreign material must be removed from the knee;       – retained frags of cement can act as nidus for residual infection;  – infected granulation tissue & scar tissue should be excised to provide healthy vascularized soft tissue surrounding the knee.  – number of debridements needed before wound closure depends … Read more

PreOp Evaluation

– Frx – Menu (See: Post Op Orders)  – Axial Skeleton  – C-spine  – Spine  – Pelvis  – Upper Extremity  – Shoulder  – Humerus  – Elbow  – Wrist  – Hand  – Lower Extremity  – Hip  – Femur  – Knee  – Tibia  – Ankle  – Foot  – Systems  – Neuro  – Cranio-Maxillo-Facial  – Spine  – Cardiac  … Read more

Prebending of Plates

– Discussion:     – exactly contoured plates produce asymmetric compression (ie the near cortex is compressed more than the far cortex);           – i.e., the far cortex may not be compressed at all;     – when prebent plate is fixed to the bone, the bend is straightened out;   … Read more

Prednisone

(see Steroids) Adult: 20 mg PO qod, Max dose approx 85 mg PO qd. – Peds: 2 mg/kg/day References Intermittent glucocorticoid steroid dosing enhances muscle repair without eliciting muscle atrophy Weekly steroids strengthen, repair muscles. Steroids thought to waste muscles surprisingly turn out to be beneficial in weekly doses Prednisone in Duchenne dystrophy. A randomized, … Read more

Preclinical (Stage 0) of AVN

– Discussion:     – this stage is both preclinical and preradiographic;     – dx is suspected in one hip when other has definite disease, because it is known that there is high incidence of bilateral involvement;     – this is the stage of the truly silent hip

Pre-Tendinous Cord

– Discussion:     – arises from thickening and contracture of pretendinous bands:     – inserts into skin distal to MP joint & into tendon sheath does not cause N/V displacement, but is responsible for MP            flexion deformities which can be predictably corrected by surgical excision;     – at a point just distal … Read more

Preload

– maintenance of adequate preload is fundamental in the postoperative management of cardiac surgical patients;  – it has been stated that the optimal wedge pressure is in the range of 14-18 mm Hg, although this may not be necessary in many pts and may be insufficient in others;  – in addition the CVP should be … Read more