Orthopaedic Resource Folder March 2017

Mercy Health Learning 

Orthopaedic Resource Folder

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Author: Med/Surg 

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2017 

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Orthopaedic Resource Folder 

Picture courtesy of http://doctorexclusive.com/wp-content/uploads/2011/04/Types-of-Bone- 

Fractures.gif


Orthopaedic Terminology 

Abduction: 

Adduction: 

Arthro: 

Arthodesis: 

To draw away from the midline of the body or from an adjacent part 

or limb 

To draw inward toward the median axis of the body or toward an 

adjacent part or limb 

Indicating a joint 

The surgical fixation of a joint, ultimately resulting in bone fusion 

Arthroplasty: Surgical reconstruction or replacement of a malformed or 

degenerated joint 

Avulsion #: 

Axial compression #: 

Barton's #: 

Bennett’s #: 

Capillary #: 

Chondro: 

Circumduction: 

Closed #: 

Colles' #: 

Comminuted #: 

Complete #: 

Compound #: 

Separation of a small fragment of bone cortex at the site of 

attachment of a ligament or tendon. 

Fracture of a vertebra by excessive vertical 

force so that pieces of it move out in horizontal directions 

Fracture of the distal end of the radius into the wrist joint 

Fracture that occurs at the base of the thumb 

One that appears on a radiogram as a fine, hairlike line, the 

segments of bone not being separated; sometimes seen in fractures 

of the skull. 

Prefix meaning cartilage 

Circular movement of a limb 

One that does not produce an open wound in the skin. Also called a 

simple fracture 

Fracture of the lower end of the radius, the lower fragment being 

displaced backward; if the lower fragment is displaced forward, it is a 

reverse Colles' fracture. 

One in which the bone is splintered or crushed. 

One involving the entire cross section of the bone. 

A fracture in which the bone is sticking through the skin. Also called 

an open fracture


Coxa: 

Cubitus: 

Dislocation: 

Distal: 

Dorsiflexion: 

Exostosis: 

External rotation: 

External fixation: 

Eversion: 

Fracture #: 

Greenstick # 

Haemoarthrosis: 

Hallux: 

Hemi: 

Impacted #: 

Incomplete #: 

Internal rotation: 

The hip joint; the head of the femur and the acetabulum of the 

innominate bone 

The upper limb distal to the humerus: the elbow, forearm, and hand 

Displacement of a body part, especially the temporary displacement 

of a bone from its normal position; luxation 

Away from centre 

The turning of the foot or the toes upward 

A benign bony growth projecting outward from a bone surface 

Turning outwardly or away from the midline of the body, such as 

when a leg is externally rotated with the toes turned outward or 

away from the body's midline 

External fixation is a method of immobilizing bones to allow a 

fracture to heal. External fixation is accomplished by placing pins or 

screws into the bone on both sides of the fracture. The pins are then 

secured together outside the skin with clamps and rods. The clamps 

and rods are known as the "external frame." 

A turning outward or inside out, such as a turning of the foot 

outward at the ankle 

A complete or incomplete break in a bone resulting from the 

application of excessive force 

A partial bone fracture, usually occurring in children, in which the 

bone is bent but only broken on one side. 

Accumulation of blood in a joint or joint cavity 

The big toe 

Half 

One in which one fragment is firmly driven into the other. 

One which does not entirely destroy the continuity of the bone. 

The turning of a limb about its axis of rotation toward the midline of 

the body


Internal fixation: 

Inversion: 

Kyphosis: 

Lordosis: 

Medial: 

Metatarsal Osteotomy: 

Open #: 

ORIF: 

Osteotomy: 

Plantar flexion: 

Pott's #: 

Pronation: 

Proximal: 

Rolando's #: 

Scoliosis: 

Simple #: 

Subluxation: 

Internal fixation refers to fixation of screws and/or plates to enable 

or facilitate healing 

A turning inward, inside out, or other reversal of the normal relation 

of a part 

Extreme curvature of the upper back also known as a hunchback 

An abnormal forward curvature of the spine in the lumbar region 

Relating to, situated in, or extending toward the middle; median 

Distal shortening osteotomy of the lesser metatarsals for the 

treatment of metatarsalgia. 

A fracture in which the bone is sticking through the skin. Also called a 

compound fracture 

Open Reduction Internal Fixation: Open reduction refers to open 

surgery to set bones, as is necessary for some fractures. Internal 

fixation refers to fixation of screws and/or plates to enable or 

facilitate healing 

Incision or transection of a bone 

Bending of the toes or foot downwards toward the sole 

Fracture of the lower part of the fibula, with serious injury of the 

lower tibial articulation, usually a chipping off of a portion of the 

medial malleolus, or rupture of the medial ligament. 

(of the arm) the rotation of the forearm so that the palm of the hand 

faces downward or backward 

(of the foot) the lowering of the medial edge of the foot by turning it 

outward and through abduction in the tarsal and metatarsal joints 

Nearer to a point of reference such as an origin, a point of 

attachment, or the midline of the body 

3-part fracture at the base of the thumb metacarpal. 

Lateral (side-to-side) curvature of the spine 

One that does not produce an open wound in the skin. Also called a 

closed fracture 

Incomplete or partial dislocation, as of a bone in a joint


Supination: 

Valgas: 

Varus: 

Applied to the hand, the act of turning the palm upward. 

Characterized by an abnormal outward turning of a bone, especially 

of the hip, knee, or foot (knocked knee) 

Denoting a deformity in which the distal part of a limb is turned 

inwards towards the midline of the body (bowed legs)


The Musculoskeletal System 

Most of the body mass is made up from the musculoskeletal systems and comprises bones, joints, 

ligaments, muscles and cartilage. In addition to supporting the weight of the body, the 

musculoskeletal system maintains body position and produces controlled, precise movements. 

Bones 

Bones are a form of connective tissue, reinforced with calcium and bone cells. There are 206 

bones in the adult body. The bones of the body perform five main functions. 

 

 

 

 

 

Provide support for the body — the skeletal system provides structural support for the 

entire body. Individual bones or groups of bones provide a framework for the 

attachment of soft tissues and organs 

Store minerals and lipids — bone assists with homeostasis by storing and releasing 

minerals and calcium into the blood and tissues. Normal bone growth depends on 

calcium and phosphorus. 

Produce blood cells — red blood cells, white blood cells, and platelets are produced in 

the bone marrow. 

Protect body organs — many soft tissues and organs are surrounded by skeletal 

elements. For example, the rib cage protects the heart and lungs, the skull protects the 

brain, the vertebrae protect the spinal cord, and the pelvis protects the delicate 

reproductive organs. 

Provide leverage and movement — many bones function as levers that can change the 

magnitude and direction of the forces generated by muscles. 

Bone Classifications 

Bone 

classification 

Features Function(s) Examples 

Long Greater in length than width Leverage 

Femur, tibia, fibula, 

humerus, ulna, radius, 

Short 

Approximately equal in Provide stability, support, 

length, width, and thickness limited movement 

Carpals, tarsals 

Flat Thin and curved 

Protect internal organs and Sternum, ribs, scapulae, 

facilitate movement cranial bones 

Sesamoid Small and round 

Protect tendons from 

compressive forces 

Patella 

Irregular Complex shape Protect internal organs Vertebrae, facial bones 

(Adapted from Pudner, 2010) 

Bone structure 

Each bone in the skeleton contains two forms of tissue: 

Compact bone; relatively solid; found on the external surface of the bone; main functions 

are to support and protect 

Cancellous bone; lighter than compact bone; located inside the bone; main function is 

support 

The proportion of compact and cancellous bone varies with the shape of the bone.


Other elements of the musculoskeletal system 

Joints —where two bones interconnect. Each joint reflects a compromise between stability 

and range of motion. 

Cartilage —a type of connective tissue. It is a firm gel-like substance. The body contains 

three major types of cartilage: hyaline cartilage, elastic cartilage, and fibrocartilage. 

Hyaline cartilage is the most common type of cartilage. This type of cartilage 

provides stiff but somewhat flexible support. Examples in adults include the tips of 

ribs (where they meet the sternum) and part of the nasal septum. Another example 

is articular cartilage, which is cartilage that covers the ends of bones within a joint. 

The surfaces of articular cartilage are slick and smooth, which reduces friction 

during joint movement. 

Elastic cartilage provides support but can tolerate distortion without damage and 

return to its original shape. The external flap of the ear is one place where elastic 

cartilage can be found. 

Fibrocartilage resists compression, prevents bone-to-bone contact, and limits 

relative movement. Fibrocartilage can be found within the knee joint, between the 

pubic bones of the pelvis, and between the spinal vertebrae. 

http://legacy.owensboro.kctcs.edu/gcaplan/anat/notes/Image585.gif 

Cartilage heals poorly, and damaged fibrocartilage in joints such as the knee can interfere with 

normal movements. The knee contains both hyaline cartilage and fibrocartilage. The hyaline 

cartilage covers bony surfaces and fibrocartilage pads in the joint prevent contact between bones 

during movement. Injuries to the joints can produce tears in the fibrocartilage pads, and the tears 

do not heal. Eventually, joint mobility is severely reduced.


 

 

 

Tendons — these attach muscle to bone. 

Ligaments — these attach bone to bone. 

Skeletal muscles — these muscles contract to pull on tendons and move the bones of the 

skeleton. In addition to producing skeletal movement, muscles also maintain posture and 

body position, support soft tissues, guard entrances and exits to the digestive and urinary 

tracts, and maintain body temperature. 

http://www.atlantaequine.com/images/tendon_ligament_diagram.png


 

Nerves — Nerves control the contraction of skeletal muscles, interpret sensory 

information, and coordinate the activities of the body's organ systems. 

http://classconnection.s3.amazonaws.com/680/flashcards/1572680/jpg/nerves_of_the_back_leg 

1359920642982.jpg


Common orthopaedic disorders 

Osteoarthritis 

Osteoarthritis occurs when the cartilage that cushions the ends of bones in joints gradually 

deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In 

osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears 

down completely, the patient may be left with bone rubbing on bone. Almost any joint can be 

affected by osteoarthritis, but the condition most often causes problems in the knees, hips, and 

small joints of the hands. 

Treatment for osteoarthritis can be conservative or surgical and can include: 

Medication: analgesia 

Therapy: Aids and appliances; Physio; OT; hydrotherapy 

Surgery and other procedures: Injections; arthroplasty 

Rheumatoid arthritis 

Rheumatoid arthritis is a chronic inflammatory disorder that causes pain, swelling and stiffness in 

the joints. The hands, feet and wrists are commonly affected, but it can also cause problems in 

other parts of the body. In some people, the condition also can damage a wide variety of body 

systems, including the skin, eyes, lungs, heart and blood vessels. 

Rheumatoid arthritis is an autoimmune disorder. Unlike the wear-and-tear damage of 

osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that 

can eventually result in bone erosion and joint deformity. 

Treatment for rheumatoid arthritis can be conservative or surgical and can include: 

• Medication: analgesia; disease-modifying anti-rheumatic drugs (DMARDs); steroids. 

• Therapy: Aids and appliances; Physio; OT; hydrotherapy 

• Surgery: synovectomy; arthroplasty 

http://images.medicinenet.com/images/illustrations/arthritic_joints.jpg


Fractures 

A broken bone or bone fracture occurs when a force exerted against a bone is stronger than it can 

structurally withstand. 

There are different types of bone fractures that vary in severity. Factors that influence severity 

include the degree and direction of the force, the particular bone involved, and the person’s age 

and general health. 

Common sites for bone fractures include the wrist, ankle and hip. Hip fractures occur most often 

in elderly people. Broken bones take around four to eight weeks to heal, depending on the age 

and health of the individual, and the type of break. 

Symptoms 

The symptoms of a bone fracture depend on the particular bone and the severity of the injury, but 

may include: 

 

 

 

 

 

Pain 

Swelling 

Bruising 

Deformity 

Inability to use the limb. 

Different types of fracture 

The different types of bone fracture include: 

 

 

 

 

 

 

 

Greenstick fracture – the bone sustains a small, slender crack. This type of fracture is more 

common in children, due to the comparative flexibility of their bones. 

Comminuted fracture – the bone is shattered into small pieces. This type of complicated 

fracture tends to heal at a slower rate. 

Simple fracture – or ‘closed’ fracture. The broken bone hasn’t pierced the skin. 

Compound fracture – or ‘open’ fracture. The broken bone juts through the skin, or a 

wound leads to the fracture site. The risk of infection is higher with this type of fracture. 

Pathological fracture – bones weakened by various diseases (such as osteoporosis or 

cancer) tend to break with very little force. 

Avulsion fracture – muscles are anchored to bone with tendons, a type of connective 

tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of 

bone. This type of fracture is more common in the knee and shoulder joints. 

Compression fracture – occurs when two bones are forced against each other. The bones 

of the spine, called vertebrae, are prone to this type of fracture. Elderly people, particularly 

those with osteoporosis, are at increased risk.


Complications of bone fractures 

Complications can include: 

Blood loss – bones have a rich blood supply and a bad break can result in substantial blood 

loss. 

Injuries to organs – such as the brain (in the case of skull fractures) or chest organs (if a rib 

breaks). 

Growth problems – the fractured long bone of a young child may not grow to its intended 

adult length if the injury is close to a joint, since bone fuses when it heals. 

First aid 

Suggestions for immediate treatment of a suspected bone fracture include: 

Do not move the person unless there is an immediate danger, especially in the case of a 

suspected fracture of the skull, spine, ribs, pelvis or upper leg. 

Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a 

clean dressing. If a bone is protruding, apply pressure around the edges of the wound. 

If bleeding is controlled, keep the wound covered with a clean dressing. 

Do not attempt to straighten broken bones. 

For limb fractures, provide support and comfort such as a pillow under the lower leg or 

forearm. However do not cause further pain or unnecessary movement of the broken 

bone. 

Apply a splint to support the limb. 

Immobilise the area by applying a sling for arms. Limbs should be immobilised above and 

below a fracture site to be effective. 

If possible, elevate the fractured area and apply a cold pack to reduce swelling and pain. 

In an emergency dial triple zero (000) for an ambulance. 

Do not eat or drink anything until seen by a doctor, in case surgery is required. 

Diagnosis and treatment 

Bone fractures are diagnosed with x-rays. CT and MRI scans may also be used. 

Broken bones heal by themselves – the aim of medical treatment is to make sure the two pieces 

are lined up correctly. Subsequent x-rays are taken to monitor the bone’s healing progress. 

Depending on the site of the fracture and the severity of the injury, treatment options may 

include: 

Splints – to discourage movement of the broken limb 

Braces – to support the bone 

Plaster cast – to provide support and immobilise the bone 

Traction – this option is less common 

Surgically inserted metal rods or plates – to hold the bone pieces together 

Pain relief.


The healing process 

The blood clots that form on the broken ends of bone are the beginning of the healing process. 

Over five or so weeks, the body fuses the two bone portions together with a combination of 

fibrous cells and cartilage. This bridge is temporary and not as strong as real bone. It can break 

easily with comparatively little force. 

A cast or splint may be removed after a few weeks, but the bone still needs to be handled with 

care for at least one more month. The temporary bone (callus) is slowly replaced with real bone 

over the next couple of months. 

Unlike skin, broken bones heal without forming scar tissue. However immobilised muscles tend to 

weaken and wither. Rehabilitation, including strengthening exercises, may be needed for a short 

time. 

Adapted from: 

Ref: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Bone_fractures


Types of Fractures 

Picture courtesy of http://www.webmd.com 

Greenstick Fracture 

Transverse Fracture


Spiral Fracture 

Oblique Fracture 

Compression Fracture 

Pictures courtesy of http://healthlibrary.brighamandwomens.org


Colles Fracture 

Pictures courtesy of http://www.e-radiography.net/radpath/c/colles_fracture.htm 

Comminuted Fracture 

Pictures courtesy of http://arthritis-symptom.com/fracture/comminuted-fracture.htm


Orthopaedic Procedures 

 

 

 

 

 

 

 

Total Hip Replacement 

Hemiarthroplasty 

Dynamic Hip Screw 

Gamma Nail 

Total Knee Replacement 

Shoulder Arthroplasty 

Ankle


Total Hip Replacement (THR) 

Picture courtesy of http://www.medicinenet.com/total_hip_replacement/article.htm 

Total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is 

surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a 

"cup-shaped" bone of the pelvis called the acetabulum. The ball is the head of the thigh bone (femur). 

Total hip joint replacement involves surgical removal of the diseased ball and socket and replacing them 

with a metal ball and stem inserted into the femur bone and an artificial plastic cup socket. 

Total hip replacements are performed most commonly because of progressively worsening severe 

arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is 

degenerative arthritis (osteoarthritis) of the hip joint. 

Ref: http://www.medicinenet.com/total_hip_replacement/article.htm


Hemiarthroplasty 

A hip hemiarthroplasty is the word used to describe a half of a hip replacement. In this procedure, 

the ball of the ball-and-socket joint is removed, and a metal prosthesis is implanted into the joint. 

Hip hemiarthroplasty is favoured in patients with displaced fractures because of the complications 

described above with trying to repair these fractures. 

A hip hemiarthroplasty is performed under general anaesthesia. An incision is made over the 

outside of the hip. The fractured femoral head is removed, and replaced with a metal implant. In a 

normal hip replacement surgery, the socket of the pelvis would also be replaced. This can be done 

in patients with pre-existing arthritis of the hip, but in most cases of femoral neck fractures the 

socket is left alone. The prosthetic stem can be cemented into the bone in patients with thinner, 

more osteoporotic bone, or press-fit into patients with better bone quality. 

Ref: http://orthopedics.about.com/cs/hipsurgery/a/brokenhip_2.htm


Dynamic Hip Screw 

Pictures courtesy of http://www.med.wayne.edu/diagradiology/rsna2003/dynamic_hip_screw.htm 

Intertrochanteric fractures are usually repaired with a metal plate and screws. The patient is given a 

general or spinal anaesthesia in the operating room. They are then positioned in a manner to realign the 

fractured bone. Once the fracture is well positioned and confirmed to be in a good position using x-ray, an 

incision is made on the outside of the thigh. The femur (thigh bone) is exposed, and a metal plate is placed 

along the outside of the thigh bone using several small screws. A large screw is inserted across the fracture 

and into the femoral head. This large screw is held to the plate. Together, this plate and screw implant 

holds the broken bones in place. 

Ref: http://orthopedics.about.com/cs/hipsurgery/a/brokenhip_3.htm


Gamma Nail 

Picture courtesy of 

http://www.med.wayne.edu/diagradiology/rsna2003/femoral_nail_2.htm 

Intertrochanteric fracture fixated with a proximal femoral intramedullary nail.


Post-operative Nursing Care for Hip Procedures 

It is important to follow the post-operative orders from the surgeon and the clinical pathway for the 

specific surgery. 

Do’s and Don’ts Post Hip Procedures 

After hip replacement surgery the surrounding muscles and tissues will take time to heal and 

strengthen. During this time the hip is at risk of dislocating. In order to minimise this risk the 

patient needs to be aware of precautions: 

Do 

Do the exercises at least twice a day 

Do continue to lie on your back for 30 

minutes once a day 

Do use your stick(s), particularly outside. 

Use at least one stick for 6 weeks 

Do be critical of your own posture in sitting, 

standing and walking 

Do sleep on the side on your new hip and 

place a pillow in between your legs for 

comfort 

Do use the equipment to help you put on 

your footwear and socks 

Do ask for advice if in any doubt 

Don’t 

Don’t cross your legs 

Don’t sit on a low chair or toilet 

Don’t sleep on your unaffected side for 2 

months 

Don’t squat or bend down to pick things up 

from the floor 

Don’t bend your leg up to your chest 

Don’t attempt to get in or out of a bath for 6 

weeks after your operation 

Don’t drive until 6 weeks after you 

operation


Total Knee Replacement (TKR) 

A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with 

artificial material. The knee is a hinge joint which provides motion at the point where the thigh 

meets the lower leg. The thigh bone (or femur) abuts the large bone of the lower leg (tibia) at the 

knee joint. During a total knee replacement, the end of the femur bone is removed and replaced 

with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a 

channelled plastic piece with a metal stem. Depending on the condition of the kneecap portion of 

the knee joint, a plastic "button" may also be added under the kneecap surface. 

Total knee replacement surgery is considered for patients whose knee joints have been damaged 

by progressive arthritis, trauma, or other rare destructive diseases of the joint. 

Picture and Ref: http://www.medicinenet.com/total_knee_replacement/article.htm


Shoulder Joint Replacement 

Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder 

joint replacement surgery. 

Osteoarthritis (Degenerative Joint Disease) 

This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age 

and older, but may occur in younger people, too. The cartilage that cushions the bones of the 

shoulder softens and wears away. The bones then rub against one another. Over time, the 

shoulder joint slowly becomes stiff and painful. 

Unfortunately, there is no way to prevent the development of osteoarthritis. It is a common 

reason people have shoulder replacement surgery. 

Osteoarthritis of the shoulder. 

Rheumatoid Arthritis 

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and 

thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, 

pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed 

"inflammatory arthritis." 

Post-traumatic Arthritis 

This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or 

tears of the shoulder tendons or ligaments may damage the articular cartilage over time. This 

causes shoulder pain and limits shoulder function. 

Rotator Cuff Tear Arthroplasty 

A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthroplasty. In 

this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis 

and destruction of the joint cartilage.


Avascular Necrosis (Osteonecrosis) 

Avascular necrosis is a painful condition that occurs when the blood supply to the bone is 

disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause 

destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe 

fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk factors for avascular 

necrosis. 

Severe Fractures 

A severe fracture of the shoulder is another common reason people have shoulder replacements. 

When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the 

pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. 

In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis 

are most at risk for severe shoulder fractures. 

Failed Previous Shoulder Replacement Surgery 

Although uncommon, some shoulder replacements fail, most often because of implant loosening, 

wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a 

revision surgery — may be necessary. 

Shoulder Replacement Options 

Shoulder replacement surgery is highly technical. It should be performed by a surgical team with 

experience in this procedure. 

There are different types of shoulder replacements. Your surgeon will evaluate your situation 

carefully before making any decisions. He or she will discuss with you which type of replacement 

would best meet your health needs. Do not hesitate to ask what type of implant will be used in 

your situation, and why that choice is right for you. 

Total Shoulder Replacement 

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly 

polished metal ball attached to a stem, and a plastic socket.


A total shoulder joint replacement. 

These components come in various sizes. They may be either cemented or "press fit" into the 

bone. If the bone is of good quality, your surgeon may choose to use a non-cemented (press-fit) 

humeral component. If the bone is soft, the humeral component may be implanted with bone 

cement. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement. 

Implantation of a glenoid component is not advised if: 

 

 

 

The glenoid has good cartilage 

The glenoid bone is severely deficient 

The rotator cuff tendons are irreparably torn 

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good 

candidates for conventional total shoulder replacement. 

These x-rays were taken before and after total shoulder replacement surgery for osteoarthritis. 

Stemmed Hemiarthroplasty 

Depending on the condition of your shoulder, your surgeon may replace only the ball. This 

procedure is called a hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus 

is replaced with a metal ball and stem, similar to the component used in a total shoulder 

replacement. This is called a stemmed hemiarthroplasty. 

Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but 

the socket is normal. Other indications for a hemiarthroplasty include:


 

 

 

Arthritis that only involves the head of the humerus with a glenoid that has a healthy 

and intact cartilage surface 

Shoulders with severely weakened bone in the glenoid 

Some shoulders with severely torn rotator cuff tendons and arthritis 

Sometimes, surgeons make the decision between a total shoulder replacement and a 

hemiarthroplasty in the operating room at the time of the surgery. 

Studies show that patients with osteoarthritis get better pain relief from total shoulder 

arthroplasty than from hemiarthroplasty. 

Resurfacing Hemiarthroplasty 

Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a 

cap-like prosthesis without a stem. With its bone preserving advantage, it offers those with 

arthritis of the shoulder an alternative to the standard stemmed shoulder replacement. 

Resurfacing hemiarthroplasty may be an option for you if: 

 

 

 

The glenoid still has an intact cartilage surface 

There has been no fresh fracture of the humeral neck or head 

There is a desire to preserve humeral bone 

For patients who are young or very active, resurfacing hemiarthroplasty avoids the risks of 

component wear and loosening that may occur with conventional total shoulder replacements in 

this patient population. Due to its more conservative nature, resurfacing hemiarthroplasty may be 

easier to convert to total shoulder replacement, if necessary at a later time. 

This x-ray shows the cap-like prosthesis used in resurfacing hemiarthroplasty. 

Reverse Total Shoulder Replacement


Another type of shoulder replacement is called reverse total shoulder replacement. Reverse total 

shoulder replacement is used for people who have: 

An x-ray of a reverse total shoulder replacement. 

 

 

 

Completely torn rotator cuffs with severe arm weakness 

The effects of severe arthritis and rotator cuff tearing (cuff tear arthroplasty) 

Had a previous shoulder replacement that failed 

For these individuals, a conventional total shoulder replacement can still leave them with pain. 

They may also be unable to lift their arm up past a 90-degree angle. Not being able to lift one's 

arm away from the side can be severely debilitating. 

In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal 

ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This 

allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. 

(Left) Rotator cuff arthroplasty. (Right) The reverse total shoulder replacement allows other 

muscles — such as the deltoid — to do the work of the damaged rotator cuff tendons.


Shoulder Post-Operative Precautions: 

 

 

 

 

 

 

 

 

 

 

 

Sling should be worn for 3 weeks for comfort 

Sling should be used for sleeping and removed gradually over the course of the four weeks, 

for periods throughout the day. 

While lying supine a small pillow or towel roll should be placed behind the elbow to avoid 

Shoulder hyperextension / anterior capsule / subscapularis stretch. 

Avoid Shoulder active range of motion. 

No lifting of objects 

No excessive shoulder motion behind back 

No excessive stretching or sudden movements (particularly external rotation) 

No supporting of body weight by hand on involved side 

Keep incision clean and dry 

No driving for 3-4 weeks- dependent on medical sign off 

Ankle Replacements 

This procedure replaces the ankle joint with an implant and an alternative to Tibial-talar 

arthrodesis. Surgery is performed to restore ankle function as a result of degenerative diseases of 

the ankle, such as rheumatoid arthritis. 

The procedure is performed under general or spinal anaesthesia. Patients are generally 

hospitalized for 1 to 4 days. A period of physical therapy is often required after ankle replacement. 

Within two weeks of surgery patients can wear a cast boot and start to put weight on the new 

joint. Around two months post-op they can slowly begin to not use the boot and around 4-6 

months you can resume normal activity.


What is ankle arthrodesis 

This procedure, commonly known as ankle fusion, is only completed when your ankle joint has 

been completely worn down. This could be due to a variety of things including a severe ankle 

fracture or degenerative arthritis in the joint itself. After you’ve injured the ankle, several years 

down the road, it can wear out the joint and it can become quite difficult to move it as you have. 

This procedure basically removes the joint and allows your tibia to grow together with your 

footbone. That will remove the joint completely and allow your pain to subside. 

An open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe bone fracture, or 

break. “Open reduction” means surgery is needed to realign the bone fracture into the normal position. 

ORIF 

“Internal fixation” refers to the steel rods, screws, or plates used to keep the bone fracture stable 

in order to heal the right way and to help prevent infection. 

Open reduction internal fixation can also refer to the surgical repair of a joint, such as a hip 

or knee replacement. 

ORIF Surgery Complications 

Complications of ORIF can include infection, swelling, and movement of the installed hardware. 

The recovery process can take months, because bones grow slowly. Other factors that can affect 

recovery are the location and severity of the break, the age of the person, and the type of bone 

broken. 

Potential Post-Operative Complications for Joints 

 

 

 

 

 

 

 

 

Anaphylaxis 

Aspiration pneumonitis 

Peripheral nerve damage 

Damage to teeth 

Embolism 

Nerve Damage 

Prosthesis Problems 

Infection 

Deep Vein Thrombosis 

To prevent this complication patients receive a variety of prophylactic measures including: 

o Low molecular weight heparin injections 

o Oral anticoagulants 

o Anti-embolic stockings


o Intermittent pressure devices – sequential stockings 

o Deep breathing exercises 

o Dorsi and plantar flex of the ankles 

Infection 

Patients are at risk of bacterial infection to both wound and bone. To minimise the risk: 

o Prophylactic antibiotics 

o Strict wound aseptic non-touch technique 

Joint contracture 

It is important for the patient to continue to flex and extend the knee in order for a range of 

movement is achieved and maintained. 

o Do not place pillows under the knee – will leave the knee in a flexed position. 

o Education post knee surgery


References: 

Clancy, J & McVicar, A. (2002). Physiology & Anatomy – a homeostatic approach (2 nd Ed.) London; 

Arnold. 

Dougherty, L & Lister, S. (2015). The Royal Marsden Manual of Clinical Nursing Procedures (9 th Ed.) 

Chichester; Wiley 

Pudner, R. (2010). Nursing the Surgical Patient (3 rd Ed.) Edinburgh; Ballière Tindall. 

Resources: 

http://patient.info/doctor/important-complications-of-anaesthesia 

http://www.nhs.uk/Conditions/Anaesthetic-general/Pages/Definition.aspx 

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bone-fractures 

http://www.nhs.uk/Conditions/Osteoporosis/Pages/Introduction.aspx 

http://www.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-20198248 

http://www.nhs.uk/conditions/osteoarthritis/Pages/Introduction.aspx 

http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Introduction.aspx 

http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/home/ovc-20197388 

http://orthoinfo.aaos.org/topic.cfm?topic=A00094

Orthopaedic Resource Folder March 2017

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