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Baghdad College of Medicine / 5

th

 grade 

Student’s Name :  

 

 

Dr. Mahmood Al-
Mashhadani 
Lec. 2 

Post operative complication in 
orthopedics 

Wed. 28 / 9 / 2016

 

 

 

DONE BY : Mustafa Naser 

مكتب اشور لالستنساخ

 

2016 – 2017  


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Post. Operative complications                                                      Dr. Mahmood

 

28-9-2016

 

 

1

 

 

 

   

      

 

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1. Soft tissue swelling; 

  

 

  Its common after limb surgery its aggravated by tight dressing or POP it may affect 
wound healing & delay joint movement sometimes its so serious causing vascular 
ischemia & compartment syndrome. Prevention is by;

 

a.  Dressing must not be tight.

 

b.  Elevation of the limb.

 

c.  Encourage early joint movement.

 

d.  POP cast must be well padded & not tight.

 

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2. Heamatoma formation; 

 

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By post-operative bleeding or ooze sometimes it’s considerable. It’s reduced by using 
suction drain.

 

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3. Delayed wound healing; 

 

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Usually due to poor circulation.

 

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4. Infection; 

 

 

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It’s seriously disturbing especially in joint replacement surgery.

 

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5. Thromboembolism; 

 

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The incidence of DVT is 20%, only 2% gets pulmonary embolism and only

 

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0.2% will die of it.

 

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Highest incidence in hip surgery especially in old debilitated patient.

 

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The commonest type of DVT is that occurring in calf vein which carry better prognosis 
than that in proximal thigh vein thrombosis.

 

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DVT usually silent, if it’s manifested it may cause calf or thigh pain sometimes swelling & 
local tenderness. 

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 In calf vein thrombosis there will be positive Homan’s sign i.e. increased calf pain on 
passive dorsiflexion of the foot. Sudden slight increase in temperature may occur.

 

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If pulmonary embolism occurs patient may have shortness in breath, mild chest pain & 
sometimes heamoptysis, rarely sudden severe cardiovascular collapse & death.

 

 

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Post. Operative complications                                                      Dr. Mahmood

 

28-9-2016

 

 

2

 

 

 

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Doppler U/S can prove the diagnosis. More accurate is ascending veinogreaphy. 

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In pulmonary embolism ECG changes may happen.

 

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Prevention: 

 

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•Pre-operative;

  by decrease smoking, walking exercises, treatment of systemic diseases 

& calf muscle massage with preoperative Heparin 5000 IU twice daily for high risk patients. 
Recently we can use low molecular weight heparin.

 

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•Per-operative;

 avoid trauma to calf veins & frequent massage or use of special elastic 

stokes.

 

     

• Post-operative;

 calf muscle massage, elastic stokes, early active movement & 

ambulation, leg    elevation together with few days of subcutaneous heparin therapy.

 

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Calf vein DVT treated by heparin 5000 IU s.c. For 10-14 days then change to oral warfarin 
5mg once daily for 2-3 months (all under strict supervision by the doctor with frequent PT & 
PTT check). 

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  Thigh or proximal vein thrombosis is more serious it needs full heparin therapy of 5000 IU 
four times daily intravenously 1-2 weeks followed by 5mg warfarin orally for 3-6 months 
(all under strict supervision by the doctor with frequent PT & PTT check).

 

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It’s used to: 

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1-Reduce pain.

 

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2-Increase range of motion.

 

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3-Strengthen muscles.

 

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4-Restore function. 

 

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All achieved by;

 

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A-Heat; its useful to reduce pain & muscle spasm.

 

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B-Cold; like ice packs it decreases pain & reduces swelling.

 

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C-Transcutaneous nerve stimulation; also relieves pain.

 

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D-Traction; intermittent traction of the spine can relieve neck pain or low back pain.

 

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E-Electrical stimulation & muscle exercises; it builds up muscles & improves weakness.

 


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Post. Operative complications                                                      Dr. Mahmood

 

28-9-2016

 

 

3

 

 

 

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Occupational therapy 

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  Its used to improve function i.e. teaching the patient to use his skeleton & muscles to 
perform useful daily activities as feeding, hygiene, walking. .Etc.

 

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Functional aids

 

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  These are used to decrease stresses on musculoskeletal system during weight bearing 
like: stick, cane, crutches or frame. During weight bearing these patient uses these to 
decrease the mechanical stresses passing through his joints & bones.

 

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A fracture is an interruption in the bone continuity caused usually by strong trauma in 
healthy bones (traumatic fracture). 

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Pathological fracture Stress fr.

 

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 Simple or closed fr 

 

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Compound or open 

 

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       complete fr. 

 

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   Incomplete  or partial fr. 

 

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   comminuted fr. 

 

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    Segmental fr.

 

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  Intra-articular fr 

 

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 

Direct trauma:

 the bone usually breaks at point of impact. 

 

Indirect trauma:

 as angulation or rotation or compression of the limb, this can cause 

fr. Away from the site of injury.

 

 

Multiple or complex

 injury of different forces at the same time that may cause 

serious complex fracture.

 

 

Muscle violence:

 sudden strong muscle pull on the localized bony attachment may 

cause 

(avulsion fr)

 of the bony fragment with or without displacement, eg. 

Quadriceps pull on the patella cause transverse fr, triceps pull on the olecranon causes 
avulsion fr of olecranon. 

 

 


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Post. Operative complications                                                      Dr. Mahmood

 

28-9-2016

 

 

4

 

 

 

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Fr may be undisplaced or usually displaced according to the; type of injury and the direction 
of ft line also depends on localized muscle action and gravity, displacement described 
according to the direction of the distal segment, this can be in form of; 

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Overlap.

 

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Side displacement.

 

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Angulation.

 

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Rotation.

 

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 Tissue death and heamatoma formation:  

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  Local bony necrosis will occur about 1 to 2 mm back from the fracture line and capillary 
bleeding will lead to localized fr heamatoma that bridges the fr and later clots.

 

  Inflammation and cellular proliferation: 

 

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  Within 8 hours there will be acute inflammatory cell reaction, within few days there is 
chronic inflammatory cell accumulation. This later will lead to local granulation tissue 
formation after capillary growth; cellular proliferation will take place as well.

 

 Callus formation: 

 

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  Proliferating cells will show variable chondrogenic and osteogenic activities with 
subsequent cartilage and finally bone tissue formation that will later replaces the whole 
granulation tissue mass leading to a big irregularly laid fusiform bony mass called the 
CALLUS that bridges the fr and locally fix it, the fr now is united but its not healed yet.

 

 Consolidation stage: 

 

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  Here the callus is gradually replaced by physiologically normal solid bone that will cross 
through the fr line and fill the gap, the fusiforrn callus replaced by variable osteoclastic 
(bone resorbing) and osteoblastic (bone forming) cellular activity, the newly laid solid bone 
is of near normal shape and can take normal forces and loading.

 

 Remodeling stage 

 

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    Gradual bone resorbtion and new bone formation will occur where the solid deformed 
bone is replaced by new normal bone that takes the original bone shape with reformation 
of the medullary canal, this may take months or even years to occur.

 

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Done BY : Mustafa Naser

 




رفعت المحاضرة من قبل: Ali Kareem
المشاهدات: لقد قام 28 عضواً و 137 زائراً بقراءة هذه المحاضرة








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