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
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
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.
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
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 ...