Selected chapters from orthopaedics

Arthroscopies of knee and shoulder are the most common. Prevailing knee surgeries are for meniscal lesions and crutiates ligaments reconstructions in instabilites. Shoulder arthroscopies are indicated in posttraumatic cases, in degenerative arthritis, rotator cuff lesions and instabilities.

Low back pain could be acute or chronical. The cause of low back pain could be functional, structural or combined. Diagnostic methods consit of anamnesis, clinical examination, including basical neurological evaluation, laboratory and imaging methods. Standing X-rays in two planes are principal. In case of neural deficit, rest and night pain, there is necessary to use MRI. Blood tests, neurological and internal examinations are important in rest and night pain. There is necessity of early diagnosis and treatment of life threatening injuries, inflammations and tumours.

Diagnostic consists of X-ray (in two planes) and CT examination. Limb-saving surgeries prevail in cases of imminent or present pathological diaphyseal fractures of long bones. We indicate nails, or tumour resection, bone cement or graft replacement and plate fixation. In cases of metaphyseal or epiphyseal lesions we indicate arthroplasties – mainly in hip, knee and shoulder lesions.
Spinal cord compression. The indications of surgical treatment are imminent or present neural deficit, collapse of vertebra and spine instability. Progression of neural deficit is clear indication of surgery. X-rays of the whole spine in two planes, MRI of affected region, internal examination, including chest X-ray and abdominal ultrasonography are necessary. The cases of mammar and renal cancer are operated most frequently. We use anterior, posterior or combined approach.

In cases of low back pain we have to find the pain generator. The surgery is indicated in case of clear diagnosis, neural deficit and corresponding imaging findings (standing X-rays, MRI). Early surgery is indicated in neural deficit and instability. Surgical treatment consists of decompression, instrumented or noninstumented fusion, or dynamic stabilisation.
Osteoporosis. Described are etiology, diagnostics and treatment. Primary postmenopausal osteoporosis is the most frequent, senile one is frequent, too. The symptoms include pain, pathological fractures of proximal femor and humerus, distal radius and vertebrae. Surgical treatment of proximal femor includes osteosynthesis of pertrochanteric fractures and total hip arthroplasties in femoral neck fractures. The principal parts of conservative management are calcium, vitamine D, diet and appropriate regime.

Main spine deformities are described. Scoliosis is three-dimensional spinal deformity. Idiopathic, neuromuscular and congenital curves are the most frequent. The curves more than 40 degrees (on the whole spine standing X-rays) in growing children are treated surgically. The technique of distraction and redistraction or guided growth systems are used in young chirldren under 10 years of age. Definitive posterior instrumented fusion is the best method for curves 40 – 60 degrees in adolescents. Kyphosis is the most frequent in thoracic spine. Postural kyphosis is treated by physiotherapy, Scheuermann disease is treated by physiotherapy, braces, the most severe cases by surgery.

Spine trauma classification includes bone injuries – fractures, ligamentous –sprain, subluxation, dislocation, bone-ligamentous – fracture-dislocations. Low-energy trauma causes pathological fractures in osteoporosis or tumours. Diagnostics consists of X-rays of the whole spine in two planes, CT of injured region, or spiral CT, or MRI in indicated cases. Surgical treatment is indicated in cases of instability and neural deficit. We use posterior, anterior or combined approach. Instrumented fusion enables restoration of spine stability and alignment.

Attachment		Date	Size	Availability [?]	Clinically sensitive [?]	Licence
Spinal cord compress		25.4.2016	4.2 MB	anyone	–
Spine trauma		25.4.2016	9.37 MB	anyone	–
Surgery for back pain		25.4.2016	15.95 MB	anyone	–
Artoscopy		25.4.2016	9.33 MB	anyone	–
Bone tumour pain		25.4.2016	3.73 MB	anyone	–
Low back pain		25.4.2016	9.1 MB	anyone	–
Osteoporosis		25.4.2016	8.54 MB	anyone	–
Scoliosis		25.4.2016	31.35 MB	anyone	–