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Orthopedic surgery requires a wide variety of implants to reconstruct
the musculoskeletal system. Each area has unique mechanical requirements, but
many surgical principles remain constant throughout the appendicular skeleton
(extremities), and many of these principles are carried over into the
axial skeleton (spine). The universal goal of surgical intervention
in the spine or the extremities is to provide painless musculoskeletal
function.
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Implants are used for joint and ligament reconstructions, soft
tissue repairs, fusion, and fracture fixation. Postoperative complications
related to orthopedic devices that are commonly seen in an ED include
implant failure, loss of fixation, nonunion, malunion, and infection.
Unlike other body tissues, musculoskeletal infections most often
present with severe pain and pressure (abscess/pyarthrosis)
or with a draining sinus tract, and present less frequently with
fever or sepsis. This is also true of infectious complications related
to orthopedic devices.
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Whether the goal is fracture healing or joint fusion (arthrodesis),
there are several implant options that one uses to achieve these
goals. Table 275.1-1 reviews the categories
of bone-to-bone fixation. The type of implant dictates the relative
stability of the bony interface, thereby dictating the type of healing,
the time of immobilization, and the return to function.
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Plates with screws are used to provide stability while bone unites
in the setting of fracture, osteotomy, or joint arthrodesis. When
managing fractures with plates, the bones are often placed in direct contact,
and healing usually occurs without the large amount of callus formation
seen with casting or intramedullary nailing (Figure 275.1-1). Therefore, it is often difficult to determine when
fracture union is complete, and it is not uncommon for the
fracture line to be visible >1 year after surgery (Figure 275.1-2). ...