Orthopaedic Surgery

Bones and things!

Orthopaedics is the brancjh of surgery related to conditions affecting bones and joints. Initial thoughts on the subject are typically "treatment of fractures", but there are many other bone, joint and spinal conditions as well as fractures. The radiograph below shows one: Osteochondrosis of teh shoulder.

Joint surgery

The example above is one a conditions that often does not show this clearly on x-rays, particularly in the early stages, and requires examination of the joint surfaces for diagnosis (picture on the left).

Ligament, joint capsule, joint surface and tendon abnormalities all frequently require arthroscopic investigation, and in some the necessary surgery can be performed this way as well. When ithis is not possible, open joint surgery will be required as shown below.

Shoulder osteochondrosis :
The loose flap of cartilage can be seen clearly in this photograph

Elbows, hocks (ankles) and stifles (knees) are all prone to osteochondrosis. Stifles are even more prone to problems with their cruciate ligaments and meniscal cartilages. The stifle is another joint where arthroscopy may be appropriate for diagnosis, but many of teh treatment require open surgery, or correction of abnormally angled joint surfaces by surgery of the tibia.

Spinal surgery

The back bone is made up of many individual vertebrae which are joined together by tough rubbery inervertebral discs. Within these discs there is a jellylike liquid that provides a "shock absorber" mechanism. Degeneration or injury can lead to weakening of the outer disc and its bulging, or to leakage of the inner disk material. To detect thchanges affecting the spinal cord and nerves a radiopaque contrast medium is injected outside the spinal cord to highlight any changes.

Cervical myelography

Compression of the spinal cord or spinal nerves causes pain and/or paralysis. Other causes of spinal problems include "spondylosis", the formation of new (arthritic) bone with entrapment of nerves, spinal deformities and tumours.

The radiograph here shows obstructed flow of contrast medium by a spinal tumour. Spinal surgery can be performed to relieve compression related to "slipped disks" and spondylosis, but it is only worthwhile for a limited range of spinal tumours.

Fracture repair

Old fashioned splints and plaster casts are still effective and appropriate treatments for some broken bones, but healing is relatively slow and there is loss of function during healing.

Surgical realignment and fixation of fractures usually returns the affected area to function more quickly reducing bone atrophy and muscle wastage so that recovery is much quicker.

There are many ways of stabilising fractures: wires, pins, screws, plates etc. Internal fixation is frequently necessary but in areas where there is plenty of intact bone around a fracture "external fixation" may be recommended.