Adobe Systems MUDr. Robert Vyskočil Orthopaedic Dpt., University Hospital Brno Head od Dpt: Prof. MUDr. Martin Repko PhD. Adobe Systems Orthopaedic surgery: Obsah obrázku strom, rostlina Popis se vygeneroval automaticky. Adobe Systems literature Adobe Systems Orthopaedic Dpt. University Hospital Brno Adobe Systems Adobe Systems Adobe Systems Adobe Systems Adobe Systems Adobe Systems Orthopaedics… ̶Operative / conservative treatment ̶Elective surgery ̶Strict Asepsis ̶Development of „medical industry“ ̶Super-specialisation – teams: TJRs, Arhroscopy, Spine,.. lower extrmity – hip, knee, ankle and foot surgery upper extrmity – shoulder, elbow, wrist and hand ̶ Adobe Systems Orthopaedics – examination methods Adobe Systems Adobe Systems ̶Skin cover - swelling, temperature, redness, joint effusion, haematoma ̶Function examination - Range of Movement S, F, T, rotation ̶Provocation tests - Shoulder - Neer, Hawkins – Kennedy, Appley, Jobe,.. Knee - Mcmurray, Appley / meniscus tear / Lachman, Pivot shift /instability-rpt LCA/ Spine - Thomayer, Lassegue, Schober, Stibor Adobe Systems ̶ROM S 0-0-120, F 40-0-20 3 planes + rotation – Sagital, Frontal, Transverzal + rotation 1.movement out of the body /extension, abduction, ER / - 2. zero position / neutral joint position - 3. movement to the body / flection, adduction, IR/ rameno Adobe Systems ROM of the hip ̶ ̶S 15 - 0 - 140 ̶F 45 - 0 - 30 ̶T 80 - 0 - 30 ̶R90 50 - 0 - 40 ̶ kyčel Adobe Systems Examples of clinical test– videos / Youtube / ̶1. knee instability– Anterior drawer test, lachman test, pivot- shift ̶2. McMurray, Appley – menisci rpt ̶3. Patella Balottment – Joint effusion ̶4. Aprehension test – anterior shoulder luxation ̶5. Drop Arm test – Rotator cuff tear ̶ Adobe Systems X ray Basic examination of bones ̶2 perpendicular projections, AP + lateral view ̶ ̶Oblique /axial/, special projections + navicular quartet /os scaphoideum/ hyperflexion and hyperextension of the spine sun – rise view /PF/ outlet view transthorakal /shoulder/… Adobe Systems ̶CAVE!! stress fraktures/fatigue delayed X ray findings repeat X ray after 4-6 weeks MRI, scintigraphy Don‘t rely always on X rays Adobe Systems ̶Young man, Painful left shin after running ̶X ray negative Výřez obrazovky Adobe Systems ̶1 month later… Adobe Systems MRI, dg. Stress fracture of the Tibia, treated with POP, healed up conservatively Adobe Systems Ultrasound - fast, non-invasive, radiation free -Basic evaluation of newborns hip – DDH ( development dysplasia of the hip ) - FAST US Focussed Assessment Sonograph Trauma - Soft tissues – muscles tendons, insertions – rotator cuff joint effusion / gonitis, children coxitis!! / ̶ femur Adobe Systems CT Computer tomography ̶ ̶Radiation ̶Examination of bone structures ̶ ̶ used in polytrauma – CT – spiral 3D reconstruction ̶ Adobe Systems My own experiance J Výřez obrazovky Adobe Systems CT 3D reconstruction Comminuted dislocated fracture of the proximal humerus ORIF Phillos Plate, healed up nicely with full ROM Výřez obrazovky Výřez obrazovky Adobe Systems MRI - ̶Soft tissues / periarticular, bone marrow ̶ ̶Clinical examination + X ray + MRI + neurology – SPONDYLOSURGERY ̶ ̶KI – cardiostimulator, defibrilator, magnetic implants, 6 weeks post op, claustrophobia, gravidity,.. ̶ ̶ Adobe Systems MRI ̶ ̶Joint examination soft tissues around and inside the joint: - intraarticular /periarticular - menisci, ACL, PCL - collateral ligaments - cartiliage and subchondral bone ̶ Adobe Systems patient DOB 1941, no injury reccurent serosanguinolent exsudate pain over the lateral joint space X ray – arthrosis gr. II Výřez obrazovky Adobe Systems MRI – necrosis of the lateral femoral condyle – gr IV indication of TKR Výřez obrazovky Výřez obrazovky Adobe Systems Scintigraphy, PET, PET–CT, PET–MRI ̶Metabolism of tissues and bones ̶Radionuclides i.a., i.v. ̶High sensitivity!! X low specifity ̶Dg. Tumours, infection, non-union, malunions, fractures Adobe Systems Adobe Systems Adobe Systems ̶Pathlogical examination of the bioptic sample ̶Needle biopsy 1-2mm Trocar biopsy 3-5mm Excision of the tissue sample > 1x1cm, diagnostic / curative ̶Histologic verification of the pathology / tumourous tissue - type - origin Adobe Systems Orthopaedic - Take home message ̶Surgical branch of medicine treating pathology of musculoskeletal system ̶/ spondylosurgery, TJRs, Arthroscopy,../ ̶ ̶Anamnesis and clinical examination are essential + ̶Imaging methods – X ray, US, CT, MRI, scintigraphy, PET diagnosis decision and treatment algorithm determination Adobe Systems Thank you fot the attention D:\ORTOPEDIE\MEDICI+SESTRY\AA obrázky\perop. foto\klinika B+W\DSC_0156.jpg Adobe Systems