Biomechanic

BASIC OSTEOSYNTESIS 2009

ORTHOPEDIC AND TRAUMATOLOGY
------1.

Please tell about main goal of internal fixation? (1

item)
Main goal of internal fixation is to achieve prompt
and, if possible, full function of the injured limb.
(AO, p.9)

2.

Mechanical effect of a fracture consist of (3

items) (AO, p.10)
a) Pathological deformation
b) Loss of the support function of bone
c) Pain

3.

If you have a patient and ask you what happen if

his fracture was not treated? How do you explain
that?
If the fracture is not treated, it will has an
abnormal bone healing such as malunion (bone
deformity), delayed union (longer time to heal)
even nonunion (fail to heal). It will also has many
complications, like, skin complication (pressure
sore), joint complication (joint stiffness, posttraumatic osteoarthritis), infection (pneumonia,
osteomyelitis), muscular complication (disuse
atrophy), post-traumatic osteoporosis, renal
calculi. (Salter, p. 434-5)

6.

What are general condition that are required as

orthopedic implant? (3 items) (AO, p.33-9)
a) Strength (ability to resist forces
without deformation)
b) Ductility (plastic deformation, ability
to deform)
c) Biocompatibility (inert, no allergic and
toxic reaction)

7.

How to determine the fracture already healed? (2

items) (Salter, p.428)
a) Clinical union (no pain, swelling and
movement of the fragments but
radiological, fracture line is still
present)
b) Radiological union (fracture line is no
longer seen)

8.

In orthopedic, what are indication for ORIF? (5

items) (Apley, p.553)
a) cannot be reduced except by operation
(Galleazis)
b) unstable fracture (transverse facture of
patella or olecranon)
c) unite poorly and slowly (facture of
femoral neck)
d) pathological fracture
e) multiple fracture (to reduce risk of
general complication)
f)
intra-articular is involved
g) present nursing is difficult (paraplegic,
elderly)

9.

What are complication of fracture treatment?

(Salter, p.464)
a) Skin complication (tattoo effect,
pressure sore)
b) Vascular complication (traction &
pressure
lesion,
compartment
syndrome,
gangrene,
venous
thrombosis, pulmonary embolism)
c) Neurological complication (traction &
pressure lesion)
d) Joint complication (infection/septic
arthritis)
e) Bony
complication
(infection/osteomyelitis)

The most important thing, if the fracture wasnt

treated will cause an abnormal function.
4.

5.

What the meaning of conservative treatment? (1

item) How to stabilize was achieved by
conservative treatment? (1 item) (AO, p.18-9)
a) Conservative treatment means nonoperative treatment.
b) In conservative treatment, stabilization
is achieved by

i.

Traction (skin or skeletal

traction) reduce & align
bone by ligamentotaxis

ii.

External splinting (wood,

plastic, plaster) maintain
reduction by three-point
fixation.

Tell phase of bone healing! (4 phases) (AO, p.134)

a) Inflammation (1-7 days post fracture,
hematoma formation and inflammatory
exudation)
b) Soft callus formation (2-3 weeks post
fracture, soft callus is formed,
fragments are no longer moving freely)
c) Hard callus formation (until 3-4
months,
intra-membranous
bone
formation continues, soft callus
converted
into
rigid
calcified
tissue[woven bone])
d) Remodeling (months to several years,
woven bone is replaced by lamellar
bone and it returns to its original
morphology)

Biomechanic

Pelvic ring stability:

a. The posterior SI ligaments form a
posterior tension band for the
pelvis.
b. The transversely placed ligaments,
including the short posterior SI and
the anterior SI along with the
iliolumbar
and
sacrospinous
ligaments,resist rotational forces.
c. The vertically placed ligaments,
including the long posterior SI,
sacrotuberous,
and
lateral
lumbosacral ligaments, may resist
vertical shear or vertical migration

Condition orthopedic implant :

a) Ductility(cold working capacity) so that
they can be contoured to the shape of
the bone during operation.
b) Sufficient strength and elasticity
c) Optimum

Mechanism cause pelvic ring injury:

a. Anteroposterior Force Pattern
b. Lateral Compression Force Pattern
c. External RotationAbduction Force
Patterns
d. Shear Force Pattern
Pelvic unstable:
a) Symphisis diastesis >2,5 cm
b) SI joint displacement > 1 cm
c) Sacral fracture displacement > 1 cm
d) Vertical displacement of hemipelvis
e) Posterior ilium fracture
Patella function:
a) Fulcrum of the quadriceps
b) Protect the knee joint
c) Enhance lubrication
d) Nutrition of knee
Change in biomechanic after patellectomy
Decreased extensor mechanism lever arm
Complication after patellectomy
a) Instability
b) loss of strength in knee
function of spine:
a) to transmit load
b) allow motion
c) protect spinal cord
The FSU consist of
a) two adjacent vertebrae
b) the intervetebral disk.
c) two facets joints posteriorly.
d) The motion segment involves joint
capsules, ligaments, muscles, nerves,
and vessels as well.