WCS36 Reconstruction

Question 1

Reconstruction

Answer 1

Rebuilding of something after it has been destroyed

1. Remove
2. Repair
3. ***Replace
4. ***Regenerate
5. Rehabilitate

(Orthopaedic 5Rs: Repair, Reconstruct, Rehabilitate, Release, Remove)

Objectives:

• prevent potential harm
• relieve pain
• improve function
• improve cosmesis
• restore esteem
• better quality of life

Question 2

Diagnosis in Orthopaedics

Answer 2

1. Congenital + Developmental
2. Infections
3. Rheumatic disorders
4. Metabolic
5. Degenerative
6. Tumours / Lesions that mimic them
7. Sensory disturbance + Muscle weakness
8. Injury + Mechanical derangement

Question 3

Deviation of normal

Answer 3

1. Absence
2. Extra: Lump
3. Malalignment
4. Contracture (↓ ROM of joint)

Question 4

***Operative technique and Non-Operative technique

Answer 4

Operative technique:

• Skin: skin graft, skin expansion, skin flap (transplantation with blood supply), NO donor skin (∵ immune reaction from host)
• Scar
• Blood vessel
• Nerve: graft, neurotisation
• Muscles / tendon: tendon transfer, release tenodesis
• Bone: osteotomy, bone lengthening, graft, ***CAN receive donor graft (∵ metabolically inactive) —> sterilise dead bone (only for mechanical function) + progressive bone turnover (host bone can be formed)
• Joint / Cartilage: transplant of small area, in vitro regeneration, osteotomy, arthrodesis (bone fusion), arthroplasty (articular surface is replaced, remodeled, realigned by osteotomy or some other procedure)
• Ligament: replace with tendon, artificial materials
• Composite
• Biomaterials e.g. metal, organic / inorganic

Non-operative technique:

• Cosmetics
• Prosthesis
• Orthosis (artificial external device serving to support the limbs or spine or to prevent or assist relative movement)
• Physiotherapy
• Splintage (cast / strapping)
• Medication e.g. botox to reduce spasticity

Question 5

Regeneration: Future

Answer 5

• No need for donor site
• Stem cell present in adult —> can be stimulated to differentiate into various cell lines under proper stimulation in proper environment e.g. appropriate growth factors
• Concept of tissue engineering: in vivo / in vitro production of certain tissue for replacement of lost tissue and function
• Wound healing stimulated by platelet rich plasma
• Scaffold for new skin regeneration (use less donor skin graft)