1. Form: appearance, self-confidence
2. Function: eg. ADL (Christopher Reeve - traumatic tetraplegia; Stephen Hawkins - neuro degeneration)

1. Mobility
2. Agility
3. Precision of movts: eg. Microvascular surgery (diameter 0.1mm)
4. Dexterity + elegance

1. Relief of pain + suffering
2. Preservation of QOL
3. Quality of life

1. Trauma: bulk of ortho work (70% in IP setting) - one limb; poly-trauma (multiple parts of body, life-threatening); trauma is 3^rd biggest killer in HK
2. Elective or "cold" orthopaedics: less urgency (more OP work)

1. Trauma
2. Spine
3. Paediatrics: must take into account growth component
4. Hand & microvascular: very intricate function of hand
5. Jt diseases: eg. Degenerative jt disease
6. Sports injuries: esp. affluent countries, more facilities, "iatrogenic" b/c people choose particular sport (and want to go back to that sport after being injured); professional athletes (good quality Tx, rapid return to function - same or next season due to $$ contracts)
7. Tumour: ST sarcoma, bony tumour, primary tumour + secondary metastases (eg. Many tumours spread to bone/ spine -> incontinence)

1. Correction of deformities
2. Preservation of function
3. Restoration of function
4. Enhancement of function
5. Preservation of life

1. Surgery
2. Medicine
3. Physical therapy
4. Occupational therapy
5. Engineering

SLIDE: poliomyelitis

• Arms wasted
• Razor-back deformity

SLIDE: poliomyelitis

• Anterior correction
• Long fusion of spine
• Have straightened form, but cannot maintain original function (spine is now stiff)

SLIDE: after corrective surgery

• Scars: main surgery, bone graft from iliac crest for fusion
• Spine fused - therefore no mobility

SLIDE: TB spine with kyphosis

• Hyperlordosis (resulting from thoracic and lumbar spines) - results in decreased AP diameter of lung (and decreased pulmonary function)
• Internal kyphosis can compress on spinal cord -> spontaneous plegia

SLIDE: bayonet deformity

• Treat with halo-pelvic apparatus
• Need external fixation of trunk
• Measure forces going through spine (electronically)
• Move spine 1mm/ day (can sleep like this, 1-2m)
• Pt awake - therefore any neuro deficit detected immediately

SLIDE: clubfeet

• Varus of heel
• Equinus: heels not touching floor
• Supination

SLIDE: neglected clubfeet

• Walking on talus, foot behind

SLIDE: comminuted # femur

• 1960's: reduce (skeletal traction), immobilise, rehabilitate (took 3m in bed to heal)
• 2000's: intramedullary nail, with interlocking nails (maintain length, stability, control rotation), walk 2d after surgery (partial wt-bearing), 3w (full wt-bearing), 3m to heal completely
• Advantages cf. conservative

1. Decreased hosp stay (3d)
2. Muscle, jt function improved (mobility straight away, cf. Traction)
3. Heal better (well aligned)

SLIDE: giant cell tumour of spine

• Caused collapse on left side of disc - can lead to spinal cord compression
• Tumour: resect with a margin of normal tissue (technically difficult in spine: (1) Spinal cord present (2) Less ST available)
• Total en bloc (?) spondylectomy - remove tumour/ vertebra in 2 parts
• Pedical screws + rod to stabilise spine (connects upper and lower spinal column)
• Using this technique: decreased chance of reoccurrence