Introduction into Traumatology and Orthopedics Introduction into Traumatology and Orthopedics. History of Traumatology and Orthopedics. Regeneration of the bone tissue. Tutor: Kostiv S. Ya.

„ orthopaedics” (the word „ orthopaedics” tu make from Greece „orthos” - derekt and „paes”- child.) is the brunches of medicine which studies and make proffilactice of differend deformations of the limbs, spinal cord (newborns and acquires) as results of varies pathologycal and traumatic injures of locomotor system in addults and childrens. R. R. Vreden.

„Traumatology ” to make from Greece „ trauma ” ─ wound and „logos”-sciense, and attend to studies of injures of the humen body.

Ficsation of the fractures with palm leters

1 2 3 АО - system use: 1) the rots for intramedular osteosintesis; 2) the plates; 3) the screws

There are two types of screws = Machine screws & Wood screws. BONE SCREWS There are two types of screws = Machine screws & Wood screws. Bone screws are machine screws. A wood screw is inserted into a small pilot hole. The screw threads compress the wood, which is less stiff than the screw, resulting in an elastic force. A machine screw is inserted into a pre-drilled & pre-tapped hole. The screw itself deforms plastically when inserted into metal.

INTRAMEDULLARY NAILS

anatomical reduction of the fracture with open techniques PLATES: Benefits:  anatomical reduction of the fracture with open techniques stability for early function of muscle-tendon units and joints Disadvantages:  risk of bone refracture after their removal stress protection and osteoporosis beneath a plate plate irritation, nonunion, infection

G. A. Ilizarov.

Aparates for external fixation

FIXATOR ILIZAROV EXTERNAL wires= 1.5mm in adults & children; 1.8mm in adult femur. wire types= smooth & olives (for stability/translation) Insertion= Push-Drill-Tap Aim for wires at 90deg. to each other & 4-5 wires per segment Bring the ring to the wire- Not the wire to ring -Tether through muscles in joint extension Wire Tension= 1.2mm-90kg; 1.5mm-110kg; 1.8mm-150kg Focus = fracture / non-union site Segments = bone fragments

Factors affecting construct stiffness:

EXTERNAL FIXATION: Advantages: Apply quickly Tecnically easy to perform  Adjust later Soft tissues not disturbed Access to wounds Joints can be mobilised Can dynamize Easy removal Reconstruction surgery

Patient compliance required Soft tissue reconstruction Disadvantages: Pin tract infection Malunion Patient compliance required Useful for: Any fracture Bone transport Limb lengthening Angular correction Soft tissue reconstruction Contractures

Posttraumatic contractures of knee joints

The endoprothesis of the knee and hip joints.

The artroscopic method of treatment

Reparative osteogenesis to make union of the bones and accompany with reparative and inflamatory reactions.

There are four cindes of the bones callus: Periostal callus; Endostal callus; 3) Intramedular callus; 4) Paraossal callus.

Reparative regeneration of the bone tissue. The resurses for reparative regeneration: periostal tissue, the marrow, endostal tissue, the endotelial cells of the vessels walls, the pericytes cells and paraossal conective tissue. THE STAGES I STAGE (1-5 days) II STAGE (10-45 days) The catabolic changes of the tissue and cells inflamation 2. The process of differantiation of the cells The granulation tissue The chondroids The osteoids Substrate of regeneration catabolical anabolical periodes IV STAGE (1 year) 4. Rebuilding of primary regenerate. III STAGE (45-90 days) Formation small – looping net of bones trabecules Regenera-tion of vessels net of regenera-tion tissue 3. The formation primary osteon Resorbtion of needless callus

THE STAGES OF THE BONES REGENERATIONS

Factors influencing bone healing REPARATIVE Systemic Local Age Degree of local trauma Hormones Degree of bone loss Functional activity Vascular injury Nerve function Type of bone fractured Nutrition Degree of immobilisation Drugs (NSAID) Infection   Local pathological condition REGENERATION