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This case is a B2B domain case where Willis weigh has to decide between ISR approach and direct sales approach for the sale of Ortho500 which would result in favourable sales results and hence prof...
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Orthopedic Surgery: Schwartz Notes up to Midterm 1
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Defnitive tx in open ractures may !e de"ayed unti" the wound is su#cient"y c"eaned and hea"thy tissue is avai"a!"e $ractures o the scapu"a genera""y resu"t rom signifcant MO%: "oo& or additiona" in'uries to the head( "ungs( ri!s( and spine Shou"der one o M) dis"ocated 'oints: M) anterior* posterior associated with seizures or e"ectric shoc& +umera" shat racture: direct trauma or $OOS+ ,esp- e"der"y.* "oo& or radia" nerve damage Osteoarthritis //0 o S popu"ation( expected to !e /20 !y /343 o 5t "oss o 11 pounds decrease decrease ris& o &nee osteoarthritis osteoarthritis in women !y 230 o 6egu"ar physica" activity "owers incidence as we"" o Sma""er incisions( !etter cosmesis 78 there is decreased visua"ization intra9op ,increased ris& o ma"position( racture( racture( nerve( vascu"ar in'uries.
Orthopedic 8rauma -
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%n'uries inc"ude ractures( 'oint damage( and sot tissue damage oa" o treatments is to restore n" anatomy( immo!i"ize in'ured extremities ,pain re"ie and hea"ing.( and repair;reconstruct in'uries to restore unction . )omminuted ,$. o $ractures resu"t rom high energy trauma and a""s on the extremityMa'ority hea" with immo!i"ization( di?erent methods depend on the ractureractureMethods or %mmo!i"ization o Sp"int or cast M) used Sp"ints are preerred or acute in'ury @ they are not circumerentia" and a""ow or swe""ing o )"osed reduction Disp"aced or angu"ated ractures Necessary to proper"y rea"ign the !one Ana"gesia( "oca" or genera" anesthesia( B;9 musc"e re"axants Perormed with axia" tractions and reversa" o MO%( sp"int( and post9reduction Cray and neurovascu"ar exam %nterna" $ixation o Screws across a racture site create sta!i"ity and compression which promotes hea"ing P"ates p"aced on cortex to create "ong areas o fxation %ntramedu""ary rods common"y used or "ong !one ,emur and ti!ia. Marrow genera""y removed with a reamer prior to insertion Screws through rod proxima" and dista" to racture o >xterna" $ixation
Orthopedic Surgery: Schwartz Notes up to Midterm / ti"ized when patients are severe"y in'ured or when sot tissue damage or swe""ing where it is unsae to ma&e incisions or undergo surgery %nvo"ves p"acement o pins proxima" and dista" to racture through hea"thy tissues Pins are connected !y rods p"aced on the outside o the extremity
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Open $ractures o Occur when the !one !rea&s through the s&in o 8ypica""y resu"t rom high energy in'uries and associated with signifcant damage to the surrounding sot tissues and contamination o the wound 6e=uire immediate irrigation and de!ridement in O6 and anti!iotics to prevent o wound inections and osteomye"itis o D%) >M>6>N)E o Signifcant swe""ing within a compartment o an in'ured extremity that 'eopardizes o !"ood Fow to the "im! o %ncreased pressure compromises perusion to musc"es resu"ting in ischemia or necrosis o SBS Pain( num!ness( passive stretch to musc"es o compartment causes severe pain o Dx 7ased on c"inica" exam )an !e measured !y p"acing need"es in compartment ,necessary or unconscious patients. o 8C >M>6>N8 $AS)%O8OME Over"ying tight ascia is re"eased through "ong incisions ASAP to prevent irreversi!"e necrosis and contractures o nerves and musc"es( which can resu"t in "oss o unction
8reatment o $ractures and Dis"ocations )"avic"e $ractures
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One o the M) ractures Occur o""owing a"" onto shou"der $racture oten evident on inspection Most treated non9op with s"ing( 6OM exercises( and gradua" return to n" activity o Signifcant"y disp"aced( shortened( or penetrating ractures are treated with open reduction interna" fxation ,p"ate and screw fxation. Ma'ority occur in the middle third of the clavicle Dista" c"avic"e racture "ess common May occur with coracoc"avicu"ar "igament ruptures o
Orthopedic Surgery: Schwartz Notes up to Midterm 4 )an !e more trou!"esome o At ris& or non9union % B disp"acement( surgica" tx recommended o A) Goint %n'uries $a"" on the shou"der or $OOS+ o o 6esu"ts in tears o A) and coracoc"avicu"ar "igaments Step9o? separation o A) 'oint may show up on Cray o o Most tx with s"ing and gent"e 6OM Severe disp"acement may re=uire open reduction and surgica" repair o o
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S) Goint %n'uries ON< articu"ation !etween the upper extremity and the axia" s&e"eton o o %n'uries are rare Anterior more common and c"osed reduction can !e attempted o""owed with s"ing o immo!i"ization Posterior can !e dangerous o Pu"monary or neurovascu"ar compromise )"osed reduction under genera" anesthesia with vascu"ar surgeon present ,incase o vascu"ar in'ury.
Scapu"a $ractures 9 9 9
Signifcant MO%( "oo& or associated head( "ung( ri!( and spine in'uries Most tx non9op with exception o g"enoid ractures %ntraarticu"ar ractures ,disp"acement o g"enoid articu"ating surace. indicates need or open reduction and interna" fxation
Shou"der Dis"ocations
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One o the M) dis"ocated 'oints MC anterior dislocation Oten associated with in'uries to "a!rum ,7an&art "esions.( impression ractures o o humera" head ,+i""9Sachs "esions.( and rotator cu? tears Posterior dis"ocations o Seizures or e"ectric shoc& Cray needed or Dx %mportant !ecause missing dis"ocation can resu"t in sig- de!i"itation o shou"der o o Axi""ary view most important Managed with c"osed reduction with short9period o s"ing immo!i"ization
Proxima" +umerus $ractures
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Occurs most re=uent"y in e"der"y patients o""owing a"" onto shou"der A"so occur in high energy trauma Neer )"assifcation ,divides proxima" humerus into H parts. o +umera" head reater tu!erosity o o
Orthopedic Surgery: Schwartz Notes up to Midterm H
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O"der patients with osteoporosis and comminuted ractures +>M%A68+6OP
prosthetic rep"acement or
+umera" Shat $ractures
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Direct trauma or $OOS+ ,esp- e"der"y. 6adia" nerve at ris& or in'ury careu" neurovascu"ar exam o Neuropraxia @ stretching o the nerve( unction usua""y returns around 49H months Accepta!"e degree o angu"ation o Ma'ority hea" on own )oaptation sp"int or unctiona" !racing ,p"astic c"amshe"" with Ie"cro straps. o o )"ose ;u and seria" Crays important to veriy hea"ing 6OM !egin 19/ wee&s post9in'ury o Signifcant angu"ation )ommon"y treated with open reduction and p"ate fxation o Protect the radia" nerve o %ntermedu""ary nai"ing a"so possi!"e !ut caries ris& o shou"der pain o
Dista" +umerus $ractures
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$a"" on e"!ow or $OOS+ MC supracondylar o A!ove e"!ow 'oint Do not invo"ve articu"ar surace o Minima""y disp"aced o Posterior "ong arm sp"int with J3 degree Fexion Articu"ar surace invo"vement o P"ate fxation May need / p"ates ,media" and posterior. o )omminuted o 8ota" e"!ow rep"acement ,esp- e"der"y. Prosthetic dista" humerus( proxima" u"na( radia" head o >"!ow ractures are notorious or deve"oping STIFFNESS >ar"y motion paramount or successu" outcome o o 6OM !egan as soon as patient can tolerate therapy
>"!ow Dis"ocations
- )ommon - 8ypica""y occur posterior"y ater $OOS+ - 6esu"ts in in'ury to 'oint capsu"e and rupture o <)< B;9 M)< invo"vement B;9 ractures o the radia" head( coronoid( or humera" epicondy"es - Simp"es rgent"y reduced under sedation o o 7rie treatment "ong arm sp"int ,913 days. o 8oo "ong o sp"inting w;o ear"y 6OM resu"ts in sti?ness - Associated with ractures Surgica""y i insta!i"ity o o Terrible Triad >"!ow dis"ocation
Orthopedic Surgery: Schwartz Notes up to Midterm 2
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6adia" head raction )oronoid racture 8erri!"e triad unsta!"e and oten re=uire fxation;rep"acement o a"" structures depending on the size o the racture
6adia" +ead $ractures
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Most can !e treated non9op with s"ing 19/ days o""owed !y 6OM Disp"aced or !"oc&s sup;pron o orearm Surgery o 5e"" reduced @ 19/ screws Mu"tip"e pieces @ radia" head rep"acement with meta""ic imp"ant o >"der"y @ excision o radia" head ,may contri!ute to e"!ow insta!i"ity or wrist o symptoms over time.
O"ecranon $ractures
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$o""ow a"" direct"y on a Fexed e"!ow Nondisp"aced o Sp"int H29J3 degrees short period o""owed !y 6OM to prevent sti?ness Disp"aced o 8riceps inserts on o"ecranon and tension may disp"ace racture Surgica" tx o Simp"e transverse o 8ension !and to promote hea"ing )omminuted P"ate and screw o o +ardware may !e irritation May !e re=uested to !e removed ater hea"ing o
$orearm $ractures
- +igh energy trauma or $OOS+ - 8wo !ones P"ate and screw fxation o - %so"ated u"nar shat Lnightstic& racture o o Direct !"ow to side o orearm Simp"e cast o o Angu"ated or disp"aced open reduction and p"ate fxation - "nar shat B radia" head dis"ocation o LMonteggia racture 6adia" head racture may !e missed without Cray o o "nar shat racture raised suspicion a!out additiona" radia" head racture Surgery o "na @ p"ate and screw 6adia" head @ reduction - 6adia" shat B disruption o D6G P"ate and screw fxation o D6G assessed or sta!i"ity and may need wires temporari"y o
Pe"vic $ractures
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+igh energy trauma associated with head( chest( a!domina"( and urogenita" in'uries
Orthopedic Surgery: Schwartz Notes up to Midterm
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>"der"y may su?er ater a a"" o sua""y ractures pu!ic rami Sta!"e in'ury @ managed non9op with protected wt !earing o +>MO66+A> )AN 7> <%$> 8+6>A8>N%NE Oten due to venous p"exus in'ury in posterior pe"vis o Or due to "arge vesse" in'ury ,i-e g"utea" artery. o %MM>D%A8> 6>S)S%8A8%ON ,Fuids and transusions. o $%6S8 <%N> 86>A8M>N8 o Pe"vic !inder or sheet to contro" !"eeding D>$%N%8%I> o Surgica" exp"oration O6 %nterventiona" radio"ogy o >xterna" fxators p"aced in surgery 6etrograde urethrogram or in'uries Pe"vis is a c"osed circuit @ must have two p"aces o disruption ,ractures or "igamentous tears. o AP Lopen !oo& in'ury +inge on intact posterior "igaments 5idening at pu!ic symphysis o
Aceta!u"ar $ractures
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Occurs when emora" head driven into hip soc&et in high energy trauma )8 important to visua"ize pattern enera""y re=uire surgery to restore congruent( sta!"e( aceta!u"um Prevent ear"y degenerative changes and osteoarthritis o o Shou"d uti"ized experienced surgeons
+ip Dis"ocations
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+igh energy trauma MC posteriorly Potentia" in'ury to sciatic nerve or racture o aceta!u"um or emora" head >M>6>N8 6>D)8%ONE o +igh ris& o osteonecrosis o emora" head with de"ated reduction can !e done in >6 with ade=uate sedation and musc"e re"axation ,some pts re=uire o anesthesia. % reduction unsuccessu" or racture ragment gets trapped in 'oint surgery +ip dis"ocation B emora" head racture at ris& or OS8>ON>)6OS%S O$ $>MO6A< +>AD B OS8>OA68+6%8%SE
+ip $ractures
Orthopedic Surgery: Schwartz Notes up to Midterm
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Associated with signifcant MBM >"der"y ater grounds "eve" a""s( $M( osteoporosis ris& +ip racture puts patients at increased ris& or: DI8 o o P> Pneumonia o o Deconditioning Pressure sores o o Death ,morta"ity rate 1 st year /20. - Surgery to prevent comp"ications and he"p patients move ASAP to reduce ris& - 86>A8M>N8 O$ )+O%)> S6>6E o /H9H hours n"ess need to optimize patient !eore o o $unctiona" outcome Q !ased on "eve" o mo!i"ity and independence 7>$O6> surgery Patients may re=uire aid with assistive am!u"atory devices( reha!( or "ong9term o nursing aci"ity
$emora" Nec& $ractures
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Occur with the capsu"e o the hip 'oint 7"ood supp"y Media" and "atera" circumFex arteries o o $ractures at ris& or osteonecrosis Non disp"aced o $O6> in'ury o 8ota" hip rep"acement ,aceta!u"um a"so rep"aced with prosthesis. o 5t !earing immediate"y ater surgery
%ntertrochanteric +ip $racture
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Occur !etween greater and "esser trochanters o proxima" emur A!undant !"ood supp"y Osteonecrosis uncommon o o $ixed with interna" fxation Disp"aced 6ea"ign using traction and rotation o
Su!trochanteric +ip $ractures
- Dista" to "esser trochanter - Area o high !iomechanica" stress - +igh energy trauma and e"der"y patient ater a a"" - 8end to !e signifcant"y disp"aced and may !e di#cu"t to reduce - 8reatment with surgery - %n most cases( protected wt !earing can !egin soon ater
Orthopedic Surgery: Schwartz Notes up to Midterm $emora" Shat $ractures
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+igh energy trauma Associated with other in'uries xterna" fxator unti" sae to undergo surgery o
Dista" $emur $ractures
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$a"" rom height or high energy trauma >"der"y patients with osteoporosis ater a"" on &nee Most re=uire surgery )an invo"ve articu"ar surace o &nee 'oint so anatomic reduction o 'oint surace is o crucia" P"ates and screws o >ar"y 6OM to prevent sti?ness o %ntraarticu"ar No wt !earing unti" signs o hea"ing o
Knee Dis"ocations
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6are !ut devastating( can !e "im!9threatening )"ose proximity o pop"itea" artery !ehind the &nee ,may &in& or tear. o o A)< and P)< torn with in'uries to M)<( <)<( 'oint capsu"e( and menisci %MM>D%A8> 6>D)8%ON B;9 vascu"ar surgeon o o Pay attention to neurovascu"ar exam !eore and ater M6% wi"" identiy torn structures Mu"ti9"igamentous reconstruction Sti?ness common post9op comp"ication
Pate""a;>xtensor Mechanism %n'uries
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%n'uries rom a"" on &nee or rom orci!"e contraction o =uads Non disp"aced pate""a non9op with cast or &nee immo!i"izer ,u"" extension.( wt !earing permitted Disp"aced or comminuted re=uire surgery
8i!ia" P"ateau $ractures
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Axia" "oads sustained in a""s rom height or high energy trauma Associated with in'uries to menisci and carti"age
Orthopedic Surgery: Schwartz Notes up to Midterm J
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)8 to visua"ize intraarticu"ar invo"vement Minima""y disp"aced Non9op without movement unti" hea"s o Disp"aced o Surgery to restore smooth contour o articu"ar surace P"ates and screws B;9 !one grat;su!stitutes o o Strict non9wt !earing or wee&s unti" it !egins to hea"( ear"y 6OM encouraged )ommon to have comp"ications o &nee sti?ness and osteoarthritis
8i!ia" Shat $ractures
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MC long bone fracture +igh energy trauma and direct !"ows ,transverse or comminuted.( severe twisting ,spira". Minima" angu"ation o 6eduction and casting o 8ransition to unctiona" !race o S"ow return to wt !earing May need immo!i"ization or severa" months ,ractures can !e s"ow to hea". o Angu"ation P6>$>66>D @ %ntramedu""ary nai" with inter"oc&ing screws( wt !earing soon ater o surgery P"ate and screw p"acement increase ris& o wound !rea&down Oten occur a"ong with ti!ia" shat ractures
8i!ia" P"aond ,Pi"on. $ractures
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Dista" ti!ia" articu"ar surace o an&"e 'oint +igh energy rom axia" compression or shear orce Associated with Signifcant sot tissue in'ury o o Severe"y comminuted intraarticu"ar ragments 5ound hea"ing pro!"ems o Di#cu"t to treat sua""y managed with externa" fxation unti" swe""ing su!sides ,days to wee&s. o o Surgery Non wt !earing or wee&s unti" hea"ing o )omp"ications An&"e pain and sti?ness o Arthritis o 5ound hea"ing pro!"ems o %nection o o Nonunion May need an&"e usion in uture o
An&"e Dis"ocations
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)omp"ex hinge 'oint Dista" ti!ia" p"aond o Media" ma""eo"us o
Orthopedic Surgery: Schwartz Notes up to Midterm 13
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De"toid Syndesmotic !etween ti!ia and f!u"a o o D)8%ONE $o""owed !y sp"inting
An&"e $ractures
- 8wisting in'uries - Depends on: o Direction o orce Position o oot and an&"e at time o in'ury o - %nitia" treatment )"osed reduction and p"acement o we""9padded sp"int o o Swe""ing oten signifcant thereore e"evate the oot - Surgery De"ayed 19/ wee&s unti" swe""ing decreases to "imit the ris& o wound hea"ing o pro!"ems
Ma""eo"ar $ractures
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Syndesmosis %n'uries
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Severa" "igaments !etween dista" ti!ia and f!u"a Provide sta!i"ity at an&"e 'oint ,resist axia"( rotationa"( and trans"ationa" orces.
Orthopedic Surgery: Schwartz Notes up to Midterm 11
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5idening o space !etween dista" ti!ia and f!u"a post9reduction indicative o in'ury o P"ace screws "atera""y Keep non wt !earing or severa" wee&s o o Screws genera""y removed ater 1/ wee&s( !ut can !e "et in p"ace ,oten asymptomatic.
)a"canea" $ractures
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$a"" rom height oten associated with other in'uries ,"um!ar. Oten intraarticu"ar )an resu"t in co""apse o wt !earing posterior acet )8 !etter visua"ize Most treated non9op in we""9padded sp"int w;o wt !earing 1/ wee&s Disp"aced intraarticu"ar surgica" management once swe""ing su!sites Despite treatment( can !e de!i"itating +ee" pain o Arthritis o
8a"us $ractures
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$orced dorsiFexion o an&"e causes ta"ar nec& to impact anterior dista" ti!ia 7"ood supp"y May !e 'eopardized o 6is& o osteonecrosis ,common o comp"ication.
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Nondisp"aced o )ast 120 ris& osteonecrosis o Disp"aced o Surgica" with screw fxation 4391330 ris& osteonecrosis o o +igh ris& arthritis
$oot $ractures
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%so"ated tarsa" ractures rare Non9op cast or !oot o xcessive antero"atera" aceta!u"ar !ony rim coverage Lpincer "esion 9 6ecognition may !e di#cu"t 9 Presentation o Anterior groin pain exacer!ated !y hip Fexion or pain over greater trochanter o rinding or popping o Pain with Fexion and interna" rotation ater pro"onged sitting o Decreased interna" rotation out o proportion to "oss o other 6OM and "imited Fexion Impingement test - e"icited !y J3 degrees Fexion( aDduction( and interna" o rotation a"most a"ways positive 9 %maging o Cray( )8( M6%( M6A 9 8reatment Surgica" @ open aceta!u"op"asty( hip arthroscopy more popu"ar ,improved unctiona" o outcome with "ow comp"ication rates. 9 )omp"ications o
S+O6 6otator )u? 9 9 9 9 9 9 9