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1. The assessment of any patient with a musculoskeletal complaint or injury must include a careful history and a physical examination that includes the neurologic, vascular, and muscular bony assessment.

2. Fractures frequently involve significant soft tissue as well as bony injury.

3. Open fractures (fractures where the fracture hematoma extends to a wound in the skin) require urgent operative irrigation and débridement.

4. The majority of fractures can be managed nonoperatively, with a cast or a brace.

5. Orthopedic injuries in pediatric patients are managed differently than in adults. Injury to the physis (growth plate) are common and require special management. Bone injury in young patients heal so quickly that prompt treatment and close follow-up is critical.

Orthopedic surgery is a broad and actively growing surgical specialty. It concerns the nonoperative and operative treatment of disorders of the musculoskeletal system including bones, joints, muscles, tendons, ligaments, and nerves. The orthopedic surgeon must be familiar with the normal growth and development of the musculoskeletal system, as well as disorders that can arise from genetic or developmental abnormalities, trauma, infection, inflammatory processes, the degenerative process, and neoplasm. In every patient, the orthopedic surgeon will work hard to find nonsurgical solutions for the patient’s condition. However, surgical treatments are often necessary to preserve or restore musculoskeletal function, assist in healing, or palliate pain.

Anatomy of Long Bones

Much of an orthopedic surgeon’s practice concerns treatment of the “long bones.” Long bones generally consist of an epiphysis (the portion of the bone on either end which usually contains an articular surface). The epiphysis is formed from an epiphyseal ossification center at either end of most long bones separated from the metaphysis of the long bone by the growth plate (Fig. 43-1). After skeletal maturity, the ends of bones continue to be referred to as the epiphyseal region. The metaphysis of a long bone is the region immediately below the growth plate or its remnant. The metaphysis tapers to become the shaft or diaphysis of the long bone.

Fig. 43-1.

Long bones have three sections. The end is the epiphysis or secondary ossification center, the adjacent area is the metaphysis, and the middle of the bone is the diaphysis. The metaphysis is broader than the diaphysis, has a thin cortex, and is composed of primarily cancellous bone.

Long bones are composed of one or more articular surfaces, covered with hyaline cartilage, thick durable cortex of dense bone, and an interior region of trabecular bone and marrow. It is important to know that all bone is subject to turnover with resorption and new bone formation, occurring in both the trabecular bone and the cortex. Cortical bone does turn over considerably slower than trabecular bone, however, by a factor of ...

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