Orthopaedics for general medicine Trauma Hospital, Brno Trauma Departement, Medical Faculty, Masaryk Univerzity, Brno MUDr. Jiří Jarošík Definition  Orthopaedic surgery or orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. History  Nicolas Andry coined the word in French as orthopédie, derived from the Greek words ὀρθός orthos ("correct", "straight") and παιδίον paidion ("child"), when he published Orthopedie (translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children[1]) in 1741.  He advocated the use of exercise, manipulation and splinting to treat deformities in children  the discipline was initially developed with attention to children, the correction of spinal and bone deformities in all stages of life eventually became the cornerstone orthopedic practice.  Orthopaedic belonged to surgery the international symbol for orthopaedics Czech school  1. Orthopaedical clinic Ke Karlovu v Praze 1927  1. Orthopaedical clinic in Brno 1933  Prof.Zahradníček /Praha/- modern surgery of DHD  Prof.Frejka /Brno/ - Prejka pillow splint in DHD  Prof.Pavlík /Olomouc/ - Pavlík harnesses  In 1971 /prof. Pavlanský / was orthopaedics excluded from general surgery as a seperate discipline Education system  According to the new guidelines  Specialization in orthopaedics and traumatology of the locomotive apparatus  6 years of residency training  24 month orthopaedic stem  48 month specialized training Specializace pro lékaře - základní obory, vzdělávací programy z roku 2015 podle vyhlášky č. 185/2009 Sb., ve znění pozdějších předpisů. orthopaedic sub-specialties  General orthopaedic  Hand surgery  Shoulder and elbow surgery  Pediatric orthopaedic  Foot and ankle surgery  Spine surgery  Musculoskeletal oncology  Surgical sports medicine  Orthopaedic trauma Problematics  Soft tissue disorders diseases of musels, tendons and connective tissues /tendinopathy, enthesopathy, bursopathy/  Degenerative diseases - arthropathy: crystal, reactive, enteropathic, diabetical, neurological, heamophylic -osteoarthritis a type of joint disease that results from breakdown of joint cartilage and underlying bone - primary - secondary /post trauma, imflammation, systematic diseases,AVN  Congenital and acquired abnormalities of the spine and limbs Skoliosis, DDH, pes equinovarus,  Injuries soft tissue , bones  Tumors soft tissue, cartilage, bones, vessel  Systematic and local immflamation Orthopaedics examination Inspection S- swelling E- erythema A- atrophy D- deformities S- scars Palpation T - tenderness E - effusion S - swelling T - temperature C - crepitus A - atrophy ROM Diagnostic imaging  X-Ray  CT - ia fractures, spine patology, TU,  US - soft tissue disorders  MRI -complex patology of soft tissue and bones , joint, spine, TU  Angiography - vascular abnormalities, trauma, TU,  Scinti - detection of the bone infection, TU, Laboratory diagnostik and special investigations  Blood count  CRP  FW  PCR  biopsy  punction  arthroscopy Arthroscopy  Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Therapy  Conservative Exercise: Regular, aerobic exercise, and stretching and strengthening Physical therapy :heat therapy, elektrotherapy, US, magnet, balneotherapy Medication: pain relievers (in pill form or topical cream) and anti-inflammatory medications injections of the steroids joint nutrition pills, injection i.a.form Splinting, casting, brace Therapy  Surgical Trauma Soft tissue – suture Bone - osteosynthesis external fixation internal fixation Chronic disorders revisions osteotomy arthroplasty- synovektomy, cheilektomy, joint replacement joint fusion amputation Osteoarthritis  Degenerative disease  a type of progressive joint disease that results from breakdown of joint cartilage and underlying bone 4.Stages of OA Etiology  primary osteoarthritis age, genetics  secondary osteoarthritis  Post-traumatic arthritis  Inflammatory arthritis rheumatoid diseases postinfections diseases  AVN - avascular necrobiosis  congenital and developmental abnormalities  alcohol, drugs signs pain stifness swellness deformities loss of movement instability crunching sound when you move your joints X-ray Joint replacement arthroplasty  Replacement Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced by a prosthetic implant. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis (rheumasurgery) or some other type of trauma.  Joint replacements are available for other joints on a limited basis, most notably the knee, hip, shoulder, elbow, wrist, ankle, spine, and finger joints. HIP replacement arthroplasty  The modern total hip replacement was pioneered by Sir John Charnley, expert in tribology at Wrightington Hospital, England in the 1960s.[8] He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a stainless steel one-piece femoral stem and head and a polyethylene, acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement.  For over two decades, the Charnley Low Friction Arthroplasty and its derivative designs were the most-used systems in the world.  This formed the basis for all modern hip implants. Type of implants  Type of implantation - total edoprostesis hemi -cervikokapital  Type of fixation - cemenent - noncemented - hybrid alloplasty surface  keramik  metal  UHMWPE Total hip replacement Anatomy ball-and-socket joint Description Candidates There are no absolute age or weight restrictions for total hip replacements. Most patients who undergo total hip replacement are age 50 to 80 Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis. When Surgery Is Recommended  Hip pain that limits everyday activities  Hip pain that continues while resting, either day or night  Stiffness in a hip that limits the ability to move or lift the leg  Inadequate pain relief from antiinflammatory drugs, physical therapy, or walking supports The Orthopaedic Evaluation  Medical history: general health, surgery  Physical examination: hip mobility, strength and alignment  X-rays, MRI, US Preparing for Surgery  Primary care doctor  Complete medical history – correction of the medication  laboratory tests  EKG  Chest - Xray  Urology  Dental evaluation  Skin preparation  Social and home Planning Surgery  Anesthesia  Medicaments LMWH, ATB, haemostatic drugs, painkillers Type of implantation - total edoprostesis hemi - cervikokapital Type of fixation - cemenent - noncemented - hybrid Materials Ti, Co, Cr,Ni, PE, keramik Surface : Metal-PE, keramik-PE, keramik-keramik, Procedure Follow up  Early RHB and mobilisation  Walking with crutches  sitting, standing and climbing stairs  exercises to restore movement and strengthen your hip Possible Complications of Surgery  Nerve and blood vessel injury, bleeding, fracture  heart attack or stroke  Infection  Blood Clots  Dislocation  Periprosthetic fracture  Loosening and Implant Wear  Leg-length Inequality Complications Aseptic loosening – wear Septic loosening Failure of the implant Protecting Your Hip Replacement  maintain proper strength and mobility of your new hip  avoid falls and injuries  antibiotics prophylaxis  See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays Realistic Expectations With appropriate activity modification, hip replacements can last for many years  recommended physical activity unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.  avoid! high-impact activities such as running, jogging, jumping, or other highimpact sports Preparation Recovery unit RHB unit Common Orthopaedic Disorders Back pain Low back pain Scoliosis Cervicobrachial syndrome Kyphosis Fractures Low back pain pain in the lower back can restrict mobility and interfere with normal functioning causes: repetitive overuse injuries soft tissue, bones degenerative diseases (slipped) disk , spondylarthrosis, spondylosis compression fract. infection tumor Degenerative changes Scoliosis Abnormal shape of the spine in frontal and trasversal plane Causes : idiopatic developmental congenital degenerative Therapy Conservative Surgical lumbar fusion dekompression diskektomy Lumbar fusion Shoulder Injury: contusion, distesion, luxation , fracture Soft tissue disorders -impingement syndrom, rotator cuff sy. - SA bursopathy - frosen shoulder osteoarthritis - omarthrosis reduction of SJ Elbow and hand • Tenis elbow • Golfer elbow • Soft tissue disorders • fractures • Neuropathy • Systemic disaeses Bursopathy Triggerfinger Ganglion fracture X-ray Therapy of the fracture rheumatoid arthritis HIP  Soft tissue disorders Enthesopathy, bursopathy  Coxarthrosis  Sakroilleitis  Fracture  DDH fracture of the femoral neck Coxarthrosis Hip alloplasty OS of the fem. neck fr. Knee • Soft tissue disorders • Degenerative changes gonartrosis • Injuries haemartros Preapatellar bursitis Baker‘s cysts Gonarthrosis total knee endoprosthesis FOOT Soft tissue disorders Degenerative changes Injuries Systemic diseases Sprained ankle Hallux valgus -Bunion Hallux rigidus Pes planus –flat foot Asymetric wear of sole Soft tissue disorders Conservative therapy Ortop. insoles Surgical therapy Orthopaedic team