Introduction into Traumatology and Orthopedics. History of 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

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

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2

3

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

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

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

There are four cindes of the bones callus:

1)Periostal callus;2)Endostal callus;3) Intramedular callus;4) Paraossal callus.

Reparative regeneration of the bone tissue.Reparative regeneration of the bone tissue.The resurses for reparative regeneration: periostal tissue, the marrow, The resurses for reparative regeneration: periostal tissue, the marrow, endostal tissue, the endotelial cells of the vessels walls, the pericytes cells endostal tissue, the endotelial cells of the vessels walls, the pericytes cells and paraossal conective tissue.and paraossal conective tissue.

THE STAGESTHE STAGESI I STAGESTAGE ((11--5 days5 days)) II II STAGESTAGE (10-(10-445 5 daysdays))

1.1. The catabolic changes of the tissue and The catabolic changes of the tissue and cells inflamationcells inflamation

2. 2. The process of The process of differantiation of the cellsdifferantiation of the cells

catabolicalcatabolical anabolicalanabolical

periodesperiodes

Substrate of Substrate of regenerationregeneration

• The granulation tissueThe granulation tissue• The chondroidsThe chondroids• The osteoidsThe osteoids

III III STAGESTAGE ((4545--9090 daysdays))

IV IV STAGESTAGE ((11 yearyear))

3. 3. The formation The formation primary osteonprimary osteon

4. 4. Rebuilding of primary regenerate.Rebuilding of primary regenerate.

Formation Formation small – small – looping net looping net of bones of bones trabeculestrabecules

Resorbtion Resorbtion of needless of needless calluscallus

Regenera-Regenera-tion of tion of vessels vessels net of net of regenera-regenera-tion tissuetion tissue

THE STAGES OF THE BONES THE STAGES OF THE BONES REGENERATIONSREGENERATIONS

Factors influencing bone healing

REPARATIVE

REGENERATION

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