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traumatism, kinds of a traumatism. Definition traumatic disease
c)kinds of a traumatism
Occupational traumatism (10,4%):
Industrial
Agricultural
Nonproductive traumatism
Household - 51,8%
Street - 24,9%
Road and transport - 12,0%
Intentional
Sports
Children's (school, preschool)
a)The trauma
-is effect of external factors (mechanical, chemical, thermal etc.) on
an organism, resulting in morphological and functional damages of
tissue.
b) acute trauma
- is a single-stage damaging effect of an external factor.
chronic trauma
-is a damage arising as a result of regular or periodic and repeated not
Intensive influences of same injuring agent.
Bruise (contusio) is the closed damage of the soft tissue which has
arisen as a result of the short-term direct a trauma, accompanying with
a hemorrhage at preservation of anatomic integrity of hurting organ.
3rd –complete tear of the ligament.there is swelling & pain over the torn
ligament.pain is minimal.DS made on performing a stress test,MRI
ARTHROGRAPHY ARTHOSCOPY
Crush (conquassatio)
- damage of anatomic and structural integrity of the tissue,
caused by direct
influence of injuring force.
TM-application ot tourniquet
5)Definition of a dislocation and a fracture. Theirs clinical symptoms,
differential diagnostics
X-ray examination:-
- 2 views must be obtained (anterior-posterior and lateral views).
-The joint above and the joint below the fracture must be included because
they may also be dislocated or fractured.
6) A bone as organ: parts and types of a bone. Tissues of a bone as
organ. Functions of a bone as organ and as bony tissue.
c)Bone functions:
• mechanical - gives the skeleton the necessary rigidity to function as
attachment and lever for muscles and supports the body against
gravity.
• biochemical - Calcium homeostasis & metabolism
• hemopoietic
7)organic and mineral components of a bone tissue. Cells of a bone
tissue, theirs functions. Development of cells of a bone.
b.matrix 98%-collagen
-non collagen
-bone protein
Osteoblast
-the formation and organization of the extracellular matrix of bone and its
subsequent mineralization.
-synthesis of collagen & other bone proteins.
-Precursors are unknown
-The size up to 30 microns
Osteocyte
-a mature cell of a bone tissue
-provides integrity of matrix due to biosynthesis of organic components
-excretes the enzymes stabilizing mineral structure of matrix
-It is formed from osteoblasts
-The bone without osteocytes is exposed of resorption
Osteoclast
-Carries out resorption of bone tissue
-It is formed of cells of a bone brain macrophage-monocyte's lines
c)Development of cells of a bone
8)Reparation of a bone tissue. The kinds of callus. Stages of fracture
healing of a bone.
a)schema
• Complaints – by the stereotyped pattern
• History of disease:
where, when, how, why there was a trauma (arose disease)?
who, when, where and from what result was rendered assistance
(carried out treatment) up to the moment of examination?
• History of life - by the stereotyped pattern
• The general objective research
• The local status
b) Complaints:
-Complaint is outspoken dissatisfaction of a patient by his own health
-Detection of the complaint is carried out by active interrogation with
detail of subjective sensations
10)Case history – peculiarities of detection. Basic methods of
examination in
b)methods of examination
• Inspection
• Palpation
• Auscultation
• Investigation of function of a movement
• Radiodiagnostics
• Additional special methods of examination
11)Inspection of a patient. Positions of patient or extremity (diagnostic
value, clinic examples).
A)Inspection
• Appearance of a patient
• Position of patient
1. passive position
2. forced position
3. active position
• Determination of the static deformations
• Inspection of region of a lesion
technique,
line Rozer – Nelaton
line Günter
triangle Günter
13)Palpation and auscultation at examination of patients with
traumas and diseases of musculoskeletal system
Palpation
• temperature of a skin in comparison;
• localized pain;
• condition of a skin: humidity, dryness, mobility;
• disorder of a skin sensitivity;
• turgor of soft tissues, and condition of muscles.
auscultation
• function of lungs;
• subcutaneous emphysema;
• crepitus at fractures (bony crepitus), osteoarthrosis, tendovaginitis et
cetera;
• audible clicks at rupture of menisci, stenosing ligamentitis
14)Examination of function of the musculoskeletal system: volume of
movements in joints; muscle strength; condition of the
neuromuscular apparatus.
-measured with help of a goniometer
-Measure of rotational movements
-Placing of branches of a goniometer at the determination of volume of
movements in joints
Kinds
• true (anatomical) – it is caused anatomical change of length of a
segment
• relative (dispositional) – it is caused dislocation of jointed bones
relative each other
• seeming (projective) – it is caused by restriction of locomotions in a
joint
-Open fracture is damage of a bone and soft tissues with skin wound at a
level of fracture regardless of its depth.
Kinds of displacement
-by length
-Impacted fracture
-at angles
-rotation
e.shortening
a. Kinds of displacement
-by length
-Impacted fracture
-at angles
-rotation
A.X-ray
b.Goals
Restoration of a patient to optimal functional state
Prevention of complications
Rehabilitation of a patient as early as possible
The principle of urgent: first aid and treatment of the victim should be
urgent and begin on a place of incident
open
1. stopping bleeding,
2. anaesthesia,
3. aseptic bandage,
4. transport immobilization,
5. transportation to the specialized hospital
Algorithm of realization:
determination of gravity of a patient’s condition,
anamnestic and clinical detection of the concomitant diseases,
the prognosis of development of a complications,
optimum combination of essential methods of treatment and
prophylaxis of complication
The following are some of the clinical findings which suggest delayed
union and non-union:
-persistent pain
-pain on stressing the fracture
-mobility(in non-union)
-increasing deformity at fracture site(in non-union)
Treatment: Most fractures in delayed-union unite on continuing the
conservative treatment. Treatment of non-union depends upon site of non-
union and disability caused by it.
• hypervascular (hypertrophic)
• avascular (atrophic)
Definition:
Malunion is union in a clinically significant abnormal position.
Definition:
Clinical picture:
Traumatic osteomyelitis
X-ray diagnostics:
Fracture of clavicle(collarbone) :
-this is a common fracture at all age groups, results from a fall on the shoulder
or sometimes on an outstretched hand.
Mechanism of trauma:
Treatment:
Complications:
Early complication: fractured fragment may injure subclavian vessels or
brachial plexus.
Late complications: Shoulder stiffness is common, especially in elderly
patients. It can be prevented by shoulder mobilization as soon as the patient
becomes pain-free. Malunion and non-union often cause no functional
disability and need no treatment.
Mechanism of trauma:
A) General symptoms:-
• Pain.
• Swelling
• Increase temperature
• Lesion of function.
B)Authentic symptoms:-
• Shortening of shoulder girdle.
• Deformation of shoulder girdle (prominent acromial end
of clavicle over acromion (symptom ‘key’).
• pathological mobility of acromial end of clavicle.
Diagnosis:-
- X-ray with acromio-clavicular joints of both sides, for comparison, in same
film will show subluxation or dislocation.
-In Grade 3 injury lateral end of clavicle may be unusually prominent
Such injury is treated by rest in a triangular sling and use of analgesics, like
Lidocaine. If the injury’s more severe like grade 3, we have to treat patient
by surgical repair.
Mechanism of trauma
• A fall with an out-stretched hand with the shoulder abducted and
externally rotated is the common mechanism of injury of ant dislocation.
• Occasionally, it results from a direct force pushing the humerus head
out of the glenoid cavity.
• A posterior dislocation may result from a direct blow on the front of the
shoulder,driving the head backwards. Posterior dislocation is the consequence
of an electric shock or an epileptiform convulsion.
• According to classification, dislocation of shoulder divided into:-
Anterior dislocation:head of humerus comes out of glenoid
cavity and lies anteriorly. Can be divided into:-
a) Preglenoid – the head lies in front of the glenoid.
b) Subcoracoid – the head lies below the coracoid process.
c) Subclavicular – the head lies below the clavicle.
Posterior dislocation: the head of the humerus lies posterior to
the glenoid.
Luxatio erecta: head lies in the subglenoid position.
Clinical picture
General symptoms:-
• Pain
• Swelling
• Bruise
• Increase temperature
• Lesion of function
Diagnosis :-
1) Complaints:- a) enters casually with shoulder abducted and elbow
supported with the opposite hand.
b) history of fall on out stretched hand followed by pain and
inability to move the shoulder and may have similar
episodes in the past.
2) Examination:- a) arm is abducted.
b) normal contour of the shoulder joint is lost and it
becomes
flattened.
c) may notice fullness below the clavicle due to the
displaced head.
d) for anterior dislocation it is associated with the
following signs:
• Dugas’s test : inability to touch opposite
shoulder.
• Hamilton ruler test : because of the flattening
of the shoulder, it is possible to place a ruler on the lateral side of the arm.
This touches the acromion and the lateral condyle of the humerus
simultaneously.
• Callaway’s test: in dislocation of the
shoulder, vertical circumference of axialla is increased compared to the
normal side.
Treatment
1) reduction under sedation or general anesthesia.
- technique : a) Kocher’s maneuver – the steps are : 1st reduction,
2nd external
rotation, 3rd adduction.
b) Hippocrates maneuver
2) Immobilization of the shoulder on the chest – arm bandage for 3 weeks.
3) Remove bandage and begin shoulder exercises.
Complications
1) Early – injuries to the axillary nerve resulting in the paralysis of the
deltoid muscle with areas of anesthesia over the lateral aspects of the
shoulder.
2) Late – recurrent dislocation of the shoulder due to : Marfan syndrome,
inadequate treatment of the 1st episode of dislocation leading to improper
healing of soft tissues, an epilectic patient.
35. Fracture of the proximal part of humerus : clinical picture and
diagnosis; the first medical aid; treatment and complications
• Neer-Codman classification
-Fractures are classified by anatomical location and the number of main
fragments.
articular surface
humeral shaft
greater tuberosity
lesser tuberosity
• greater tuberosity
• lesser tuberosity
• humeral head
• shaft
-Two-part fractures involve any of the 4 parts and include 1 fragment that is
displaced.
-Four-part fractures include displaced fractures of the surgical neck and both
tuberosities.
• Mechanism of injury
i. a fall on the outstretched hand from a standing height.
ii. In younger patients, high-energy trauma
iii. violent muscle contractions from seizure activity,
iv. electrical shock
v. athletic events.
vi. direct blow to the proximal humerus
The fracture pattern depends on the applied force. Indirect forces cause most
shoulder fractures.
-Injury forces are tension, axial compression, torsion, bending, and axial
compression with bending.
-The primary fracture patterns from these forces are transverse, oblique, and
spiral.
• Principles of treatment
i. Medical therapy:
a. Immobilization
Treatment
Conservative treatment :
a) - U slab – Is a plaster slab extending from the base of the neck over
the shoulder onto the lateral aspect of the arm. Under the elbow to the
medial side of the arm.
- should be moulded on lat side of the arm in order to prevent lateral
angulation
- The U Slab is supported with a triangular sling. Once the fracture
unites, the slab is removed ( approximately 6-8 weeks) and shoulder
exercises started.
b) hanging cast : it’s used in some cases of lower-third fractures of the
humerus.
c) Chest –arm bandage- The arm is strapped to the chest.
Non operative:
oModerate displacement.
- Immobilize the affected shoulder in a triangular sling.
- As soon as the pain subsides, shoulder mobilization is started.
o Fragments are widely displaced.
- Reduced by manipulation under anesthesia.
- Once reduced, fracture can be stabilized by multiple K-wires
passed percutaneously under image intensifier control.
Operative:
oOperative reduction & internal fixation.
Conservative.
Closed reduction by manipulation under general anesthesia.
Immobilization in an above elbow plaster cast.
Surgery.
Open reduction & internal fixation.
Complications
Infection.
Volkmann’s ischemia. – Is an ischaemic injury to the muscles
and nerves of the flexor compartment of the forearm
Delayed & non union.
Mal union.
Cross union.
38.Luxations of the forearm: mechanism of trauma; classification,
clinical picture and diagnosis; the first medical aid; treatment and
complications.
---Postoperative rehabilitation
immobilization by cravat bandage during 4 weeks
exercise therapy
Complication : 1) non-union is a common complication in cases with a gap at
the fracture-site which prevents the fracture from uniting. Treatment is by
open reduction, internal fixation and bone grafting.
2) Elbow stiffness occurs in some cases. Treatment is physiotherapy. In
selected cases surgical release ( arthrolysis) may required
3) Osteoarthritis occurs late, often after many years in some cases. Because of
the irregularity of the articular surface. Treatment is physiotherapy. In
selected cases elbow replacement may be required
40. Shaft fractures of bones of a forearm: mechanism of trauma; clinical
picture and diagnosis; the first medical aid; treatment and complications.
1) Mechanism of trauma : Mechanism of trauma is direct and indirect.
4)Treatment
conservative
-analgesic
-massage
-u-slab is supported with tranguled sling.After unite,the slab is removed and
start shoulder exercise
-hanging cast-some cases of lower 1/3 of fractures
-chest arm bandage-arm strapped to chest.Usually in children <5yrs
Operative
-in cases where reduction is not possible by closed manipulation or if
fracture is unstable open reduction and internal fixation
-fixed well with plate and screws and intramedullary nailing
If fracture with open or infected using external fixators
4)Complications
-injury to radial and paralysis of fingers,thumb and drop wrist
-delay and non union-if fracture localize in middle 1/3 of shaft
41. Distal radius fractures: mechanism of trauma; clinical picture and
diagnosis; the first medical aid; treatment and complications.
Colles fracture - distal end of radius fracture,Cortico-cancellous
junction[commonest fracture in ppl >40yrs & women cos of post-
menopaused osteoporosis]
1)Mechanism of injury
-results from a fall on an out-stretched hand
3)Treatment
*conservative
a)undisplaced-immobilazation with below elbow plaster cast 6wks
b)displaced-manipulation reduction,immobilazation in Colle’s cast
4)Complications
-stiffness of joints
-mal union
-subluxation inferior radial-ulnar joint
-carpal tunnel syndrome
-Sudecle’s osteodystropy
-rupture of extensor pollicis longus tendon
42. Fractures of navicular bone: mechanism of trauma; clinical picture
and diagnosis; the first medical aid; treatment and complications.
1) Mechanism of trauma : Mechanism of trauma is direct- fall onto
outstretched hand or direct blow on palm and indirect - punch or fall onto
clinched fist.
*diagram*
Postoperative treatment
Immobilization of a hand in medium-physiological position during 6 –
8 weeks
exercise therapy
physiotherapy
-Pelvic ring : the pelvis is a ring-shaped structure joined in the front by the
pubic symphysis and behind the scaro-iliac joints.
- There are projecting iliac wings on either side , a frequent site of fractures.
- The pelvic ring is formed , in continuity from the front , by pubic
symphsis, pubic crest, pectineal line of pubis, arcuate line of the ilium and
ala and promontory of the sacrum.
-Stability of the pelvis- The stability of the pelvic ring depends, posteriorly
on the sacro-iliac joints and anteriorly on the symphysis pubis. The sacro-
iliac joints are bound infront and behind by the strong ,band like , sacro-iliac
ligaments
- Nerve in relation to the pelvis. The obturator nerve and the sacral plexus
pass over the ala of the sacrum and corss the pelvic brim.
1. mechanism of injury(indirect)
• Posterior: force directed along shaft of femur, with flexed hip; usually
in motor accidents (dashboard injury)
• Anterior: when legs are forcibly abducted & externally rotated
2. classification
• Central fracture- dislocation (into acetabulum)
• Obtuating (ant. Inf)
• Pubic (ant.inf)
• Sciatic (post. Inf) –Rozer nelaton line
• Iliac(post. Sup)- Rozer nelaton line
3. diagnosis
• Posterior: history of trauma; pain, swelling, deformity (flexion,
adduction, internal rotation), shortening of leg, may be able to feel
head of femur in gluteal region
x-ray: femoral head is out of acetabulum, lesser trochanter less
prominent, shenton;s line is broken
• Anterior: history of trauma, deformity ( extension, abduction, external
rotation), lengthening of leg
4. treatment
Immediate reduction under general anaesthesia to reduce chance of
avascularization.
Open reduction if:
Closed reduction fails
There is intraarticular loose fragment which doesn’t allow concentric
reduction
Acetabular fragment is large & is from the weight- bearing part of
acetabulum
5. complications
1. injury to sciatic nerve
2. avascular necrosis of femoral neck
3. osteoarthritis
myositis ossifican
Features of vascularity.
1. The blood supply to the proximal end of the femur, divi-ding it into
three major groups: (1) an extracapsular arterial
ring located at the base of the femoral neck;
(2) ascending cervical branches of the arterial ring on
the surface of the femoral neck; (3) arteries of the
ligamentum teres
2. The extracapsular arterial ring is formed posteriorly by a large
branch of the medial femoral circumflex artery and anteriorly by a
branch from the lateral femoral circum-flex artery
a. Mechanism of injury
b. Classification
Garden Classification
Based amt of fracture displacement evident in AP X-ray of
hip
Stage 1
Fracture incomplete, head tilted in a posterolateral dir, impacted
fracture
Stage 2
Fracture are complete, undisplaced
Stage 3
Fractures are complete d partially displaced, as judge by the
directn of the trabecular stream in the yhead fragment, but 2
fragment remain in contact w each other
Stage 4
Fracture fragment are completely displaced and trabecula of
femoral head are out of contact w trabecula of femoral neck
Anatomy classification
Alternative class based on angle of fracture line makes w d
horizontal plane-class femoral neck fracture
Transcervical
Basic cervical (basal)
Midcervical adduction
Midcervical shear
Pauwell Classification
Based on the angle of inclination of fracture, line makes in
relation to the horizontal plane
I degree -30°, II degree -50°, III degree -70°
The more the angle, the more unstable is the fracture, worse
prognosis
c. Diagnosis
Clinical pict:
- Little pain in the groin
- Elderly Pt- inability to move limb or bear
weight on the limb following a ‘trivial” injury
- External rotation of the leg, patella facing
outwards
- Shortening of leg, usually slight
- Tenderness in the groin
- Attempted hip movement painful, severe spasm
- Active straight-leg raising not possible
Radio Features
X-ray of pelvis w both hips
Break in medial cortex of neck
External rotation of femur, lesser trochanter more prominent
Overriding of greater trochanter, lies at the level of the head
of the femur
Break in the trabecular stream
Break in Shenton’s line
d. Treatment
• Difficult to treat coz:
o bld supply to proximal fragment is impaired
o diff to achieve reduction of the fracture d maintain it coz the
prox frag is too small
• Surgery:
a. Impacted fracture
o Conservative,Thomas splint (adults), hip
spica(children), fix w screws
b. Unimpacted or displaced fracture
o Internal fixation
o In elderly patient: head excised and replaced by
a prosthesis as a primary procedure
o Younger patient open reduction of fracture
o In some: an inter-trochanteric osteotomy called
McMurray’s osteotomy is preferred
c. Internal fixation:
o Multiple cancellous screws
o Smith-Peterson nail(S.P.nail)
o Dynamic hip screw
o Multiple Knowle’s pins/
o Moore pins used in children
o Deyerele apparatus
d. Asnis screws: fracture site impacted by impactor and
wound is closed
e. McMurray’s osteotomy: oblique osteotomy at the inner-
trochanteric region
f. Meyer’s procedure: fracture is reduced by exposing it
frm behind, fixed w multiple screws d supplemented w a
vascularized muscle pedicle bone graft taken frm the femoral
attach. Of quadratus femoris muscle
g. Replacement arthroplasty-in patient over 60 years
e. Complications
Non-union: due to inadequate immobilization and poor bld
supply to proximal segment, can overcome this by neck
reconstruction
Vascular necrosis, Loss of fixation
50. Trochanteric and subtrochanteric fractures of a femur.
Mechanism of trauma.
classification
Boyd and Griffin classified fractures in the peritrochanteric area into four
types. Their classification included all fractures from the extracapsular part
of the neck to a point 5 cm distal to the lesser trochanter.
Boyd and Griffin classificcation of the fractures in peritrochanteric area
Type 1: Fractures that extend along the intertrochanteric line from the
greater to the lesser trochanter. Reduction usually is simple and is
maintained with little difficulty. Results generally are satisfactory.
Type 2: Comminuted fractures, the main fracture being along the
intertrochanteric line but with multiple fractures in the cortex.
Reduction of these fractures is more difficult because the comminution
can vary from slight to extreme. A particularly deceptive form is the
fracture in which an anteroposterior linear intertrochanteric fracture
occurs, as in type 1, but with an additional fracture in the coronal plane,
which can be seen on the lateral roentgenogram.
Type 3: Fractures that are basically subtrochanteric with at least one
fracture passing across the proximal end of the shaft just distal to or at
the lesser trochanter. Varying degrees of comminution are associated.
These fractures usually are more difficult to reduce and result in more
complications, both at operation and during convalescence.
Type 4: Fractures of the trochanteric region and the proximal shaft, with
fracture in at least two planes. If open reduction and internal fixation are
used, two-plane fixation is required because of the spiral, oblique, or
butterfly fracture of the shaft. Characteristic history, unable to bear
weight on affected limb
Principles of classification
Evans devised classification system based on the division of fractures
into stable and unstable groups.
In type I fracture, the fracture line extends up-ward and outward from the
lesser trochanter.
In type II, the reversed obliquity fracture, the major fracture line
extends outward and down- ward from the lesser trochanter.
Treatment
Non-operative treatment:-
Operative treatment:-
The goal of operative treatment is strong, stable fixation of the fracture
fragments. The following variables as those that determine the strength of
the fracture fragment implant assembly:
• bone quality
• fragment geometry
• implant placement.
• reduction
• implant design
The surgeon can control only the quality of the reduction and the choice of
implant and its placement.
-Type II fractures extend proximally into the greater trochanter and involve
the piriformis fossa, as detected on the lateral roentgenogram of the hip,
which complicates closed nailing techniques.
Type IIA fractures extend from the lesser trochanter to the isthmus
with extension into the piriformis fossa, as detected on lateral
roentgenograms, but significant com-minution or major fracture of
the lesser trochanter is not present
In type IIB fractures the fracture extends into the piri-formis fossa
with significant comminution of the medial femoral cortex and loss
of continuity of the lesser tro-chanter.
Treatment
IA Piriformis fossa and lesser Standart interlocking IM
trochanter intact nail
IIB Piriformis fossa and lesser Sliding hip screw with bone
trochanter both fractured graft or reconstruction IM
nail
Question 51.
1) Mechanism of injury.
a) Mechanism of injury may be direct or indirect
b) Indirect- twisting or bending force
c) Direct- traffic accidents.
3) Diagnosis.
a) General symptoms:
i) Pain
ii) Swelling
iii) Bruising
iv) Local increase in temperature
v) Lessening of function
vi) Clinics of shock
b) Authentic symptoms:
i) Deformation
ii) Anatomical shortening
iii) Crepitation
iv) Penetrating bone fragment (if open fracture)
v) Pathological mobility
c) X-ray
i) Must be done on anterior-posterior and lateral views
ii) Must include the whole shaft
iii) Additional x-ray of pelvis must be done to rule out associated
injury to pelvis.
4) Treatment
a) Pre hospital aid
i) Anaesthesia
ii) Immobilization- using Diterix’s splint
iii) Infusion therapy- in case of clinics of shock or blood loss
iv) Transport to hospital
b) Hospital management
i) Urgent hospitalization
ii) Novocaine blockade- if bp 70mmHg
iii) Infusion therapy to prevent or treat shock
iv) Skeletal extension as temporary immobilization to prepare for
operation
v) Optimal time for operation is first 3 days. In case of severe shock
or complications, 12-14 days.
vi) Oeteosynthesis by:
(1) Intramedullary nail a.k.a. K-nailing (Kuntscher’s)
(2) Plating with interfragmentary joining screws
(3) Interlocking nailing
5) Complications
a) Early
i) Shock: even in closed fracture 1-1.5L of blood is lost and can
result in hypovolaemic shock.
ii) Fat embolism: symptoms seen after 24-48hours after fracture.
Prevent by avoiding shifting of patient without proper splintage
iii) Injury to femoral artery: most common in fracture at junction
between middle and distal thirds.
iv) Infection: in open fractures. Can lead to osteomyelitis
b) Late
i) Delayed union: if union is insufficient to allow unprotected weight
bearing after 5 months, considered delayed.
ii) Non-union: frank mobility, pain, or tenderness at fracture site. May
lead to fractures of the plat or nail.
iii) Mal-union: generally lateral angulation and external rotation.
iv) Knee stiffness: full movement can be regained with physiotherapy.
Can be caused by:
(1) Intraarticular and periarticular adhesions
(2) Quadriceps adhering to the fracture site
(3) Associated knee injury
Treatment
• Emergency reduction (a delay can lead to a disorder of blood
circulation and as a result to gangrene of an extremity)
• Aspiration of blood from a joint it is carried out after reduction
• Plaster removable joint-immobilizer or bandage during 8 – 10 weeks
• Isometric exercise therapy at second day
• Later, if as a result of a dislocation instability of a joint will develop,
realize surgical treatment - to plastic ligaments’ a joint.
1) Mechanism of injury
- this is a common fracture
- result from a direct or indirect force
- in a direct injury, occur by blow on the anterior aspect of the flexed knee,
usually a comminuted fracture result
- comminution maybe limited to a part or whole of patella a.k.a. stellate
fracture
- sudden violent contraction of quadriceps pulls fragments apart leading to a
separated fracture of the patella with some comminution
3) Diagnosis
- knee is painful and swollen and sometimes gap can be felt i.e. diastasis
- pathological mobility of fragments
- impossibility raising of straigthened leg
- usually there is blood in the joint
- X-Ray diagnosis:
~ AP and lateral x-ray knee are sufficient
~ in undisplaced fracture, skyline view of patella required
~ a fracture with wide separation of fragments is easy to diagnose via
lateral X-Ray
~ 3 types of fracture can be distinguished, but important not to confuse a
crack fracture with congenital bipartite patella in which smooth line extends
obliquely across superolateral angle of bone
4) Treatment
- depends upon the type of fracture and also the ages of patient
- types or treatment are as follows:
a) Undisplaced fracture:
~ aimed primarily at relieving pain
~ plaster cast extending from groin to just above malleoli with the knee in
full extension (cylinder cast) given for 3 weeks followed by physiotherapy
c) Comminuted fracture
~ comminuted fracture with displacement, difficult to restore smooth
articular surface, so excision of patella (patellectomy) is preferred option
5) Complications
- knee stiffness
~ due to intra- and peri-articular adhesion. Treatment by physiotherapy
and arthroscopic release of adhesion maybe required
- extensor weakness
~ results from an inadequate repair of the extensor apparatus or due to
quadriceps weakness
- osteoarthritis
~ patello-femoral osteoarthritis occuring few years after the injury
1. Mechanism.
Most often from indirect, twisting or bending forces on the knee
The various mechanisms :-
a) Medial collateral ligament
i) Damaged if the injuring force has the effect of abducting
the leg on the femur (valgus force)
ii) It ruptures most commonly from its femoral attachment
2. Classification.
1st degree sprain
i) It’s a tear of only a few fibres of the ligament.
ii) Clinical picture – minimal swelling, localized tenderness but
little functional disability.
3. Diagnosis.
a) Clinical examination
• Often history of deforming force at knee (valgus / varus)
followed by the sound of something tearing.
• Pain – over the torn ligament (collateral lig injury)
• Vague pain (cruciate lig injury)
• Swelling (haemarthrosis) is variable but appears early after the
injury.
Stress test – assess medial & lateral collateral ligament injury
• Pain at site or an abnormal opening up of the
joint indicate a tear.
b) Radiological examination
i) Plain XR may be normal or a chip of bone avulsed from the
ligament attachment may be visible.
ii) May be possible to show an abnormal opening up of joint on
stress X-rays
4. Treatment.
a) Conservative treatment
i) The knee is immobilized in a cylinder cast or a Robert-
Jones bandage for 3-6 weeks.
ii) Successful in most cases of grade I & II injuries.
iii) After a few weeks, swelling subsides.
iv) Physiotherapy.
• Mechanism
-The meniscus is a C-shaped fibrous piece of cartilage which is found in
certain joints and forms a buffer between the bones to protect the joint. The
meniscus also serves as a shock-absorption system, assists in lubricating the
joint, and limits the joint flexion and extension.
-A meniscal tear is a tear of the cartilage of the knee. Tears are most
commonly caused by
i. Longitudinal
ii. Radial
iii. Bucket-handle
iv. Post.horn tear
v. Ant.horn tear
Clinical features
Symptoms:
Blockade of the knee
Baikov’s symptom
Shtaman-Bucchard
McMarry
Loading deviation of extended leg
• Examination
i. History
ii. Physical Examination
-Tenderness is elicited by deep palpation (examination using the
hands) along the joint line.
-Twisting the knee while flexing it will occasionally cause or
reproduce the patient's symptoms.
iii. Testing
a. McMurray's test.
-you lie on your back while holding the heel of your injured leg
with your leg bent.
-Pressure is placed on the outside of the knee with the doctor hand,
and the leg is straightened with the foot turned in (internally
rotated). Pain or a click over the inner part the joint means an inner
(medial) meniscal tear.
• Treatment
Conservative: RICE
Rest
Ice
Compression by Robert-Jones bandage
Elevation
NSAIDs
Surgical repair :
-anthroscopic surgery depending on patient’s age/age of tear/size and
location
-Trims of damaged edges of cartilage
Partial menisectomy
Meniscus repair
-Four techniques for meniscal repair are used: Open meniscal repair,
arthroscopic inside-out repair, arthroscopic outside-in repair, and
arthroscopic all-inside repair
Transplantation of meniscus
c) Diagnosis
1 clinical features
- a history of injury to leg followed by classic feature of fracture ( visible
fracture, pain, swelling, deformity, etc )
- there may be wound communicating w the underlying bone
2. radiological features
- diag confirmed by X-ray exam
- evaluation of anatomical configuration of the fracture on X-ray helps in
reduction
d) Treatment
* fr book :
- non-op Tx acc types of fracture
1. closed fracture
- both in adults n children r by closed reduction under anesthesia + above
knee plaster cast
- in child fracture unites in abt 6wks, adults in 16-20wks
- if reduction is not achieved or fracture displaces in the plaster → open
reduction n int fixation is required
- unstable tibial fractures is treated w closed interlock nailing
2. open fracture
- aim is to convert it into closed fracture by care of wound n maintain
good alignment
- following methods used acc grade of open fracture
Grade 1 : wound dressing thru a window in an above knee plaster
cast + Abc
Grade 2 : wound debridement + primary closure ( if < 6hrs ) +
above knee plaster cast. Wound may need dressings thru a window
in the plaster cast
Grade 3 : wound debridement + dressing + ext fixator application.
The wound is left open
- open reduction n int fixation ( op Tx ) is necessary when it is impossible to
achieve a satisfactory alignment of fracture by non-op method
- int fixation device may be a plate or intra-medullary nail depending upon
the configuration of the fracture
- interlocking nailing provides possibility of internally fixing a wide
spectrum of tibial shaft fractures
- op Tx is often indicated in case of
• Delayed-union
• Non-union
• Mal-union
* fr teacher’s note
Closed injury
1. Nonoperative
- best for fracture without significant comminution, shortening or
displacement at the time of fracture. ie low energy fracture
- AKPOP for 6/52, then convert to cast brace or PTB
- union in approx 16 wks for simple fracture, longer for more complex injury
(av 18 wks)
- 90% healed with 1cm or less shortening
- nonunion rate 2.5%
2. Operative
- indicated in :
• pt requires early return to work
• displaced ie higher energy fracture
• Failure of closed treatment
- IM nailing
- infection rate ~ 1-2%
- angulatory deformities rare
- shorter hospital stay, less OPD visits
- earlier return to work
Open Fractures
- Wound management as for any compound fracture
- IM Nailing
- acc grade :
1. Grade 1 : IM nailing - same figures as for closed fracture
2. Grade 2 : infection 3.8%
3. Grade 3
• A: infection 5.6%
• B: infection 12.5%
- External fixation: Use for grade 3B and 3C
- rates of infection same as nailing for grade 3B with added problem of pin
tract infection, delayed union also a feature of ext fixation.
- sometimes need to convert from ext fix to IM nail → risk of infection in
the face of recent pin tract infection is ~ 20%
- However if the ext fix is removed within 3 wks of application + wait
another 2 wks, can nail with infection rate of ~ 5%
e) Complications
1 delayed n non-union
- Tx : bone grafting w or w/o int fixation
- options of Tx r
Nailing w bone grafting
Phermister grafting
Ilizarov’s method
Others eg electromagnetic stimulation
2. mal-union
- Tx : correction of deformity by redoing fracture n fixing it by plating or
nailing n bone grafting
3. infection
- Tx : dressing + Abc, Ilizarov’s method
4. compartment syndrome
- Tx : op decompression of the compartments
5. injury to maj vessels n Nvs
a) Classification of Lauge-Hanson
adduction injuries
- inversion : inversive force w the foot in plantar-flexion results in
sprain of the lateral ligament of the ankle
- may be partial or complete rupture of lateral ligaments
- result in F of lateral malleolus and medial malleolus
abduction injuries
- eversion : medial struc are subjected to distracting force and lateral
structure subjected to compressive force
- results in rupture of deltoid ligament or low-lying transverse F of
medial malleolus on medial side; on lateral side, F of lateral malleolus at
ankle-mortice level with comminution of outer cortex occurs
pronation-external rotation injuries
- occurs when a pronated foot rotates externally
- may result a transverse F of medial malleolus at ankle-mortice level or
rupture of medial-collateral ligament
- with futher rotation of talus, anterior tibio-fibular ligament is torn,
followed by spiral F of lower end of fibula
- F of fibula above ankle-mortice indicate disruption of tibio-fibular
syndesmosis
supination-external rotation injuries
- with foot supinated, talus twist externally within mortice; producing
spiral F at level of ankle-mortice
- futher rotates result transverse F where tibio-fibular syndesmosis
remains intact
vertical compression injuries
- dt vertical compression force
- resulting in either anterior marginal F of tibia or comminuted F of
tibial articular surface w F of fibula – Pilon F
b) Diagnosis
- present history of twisting injury to ankle which followed by pain and
swelling
- crepitus may be noticed if F present
- ankle may lie deformed
- in radiological exam, anterior-posterior and lateral x-ray sufficient in
most cases
- F line can be studied and helps in treatment
- tibio-fibular syndesmosis are carefully exam, so that lateral or posterior
subluxation of talus is not missed
- soft-tissue swelling in absence of F should be exam thru stress x-ray or
clinical exam
c) Treatment
- principle of Tx is to achieve anatomical reconstruction of ankle mortice
to regain good func and min. possibility of osteoarthritis development
later
F without displacement
- usually sufficient to protect ankle in a below-knee plaster for 3 – 6
weeks, followed by physiotherapy
F with displacement
- aim to ensure anatomical reduction of ankle-mortice
- initially, closed reduction is attempted to realign displaced parts; then
plaster is put, followed by physiotherapy
- in general, operative reduction and internal fixation is useful when closed
reduction is not successful or reduction has slipped during course of
conservative treatment
i) Operative method
- nowadays, internal fixation without closed reduction is applied to achieve
perfect alignment and stable fixation of fragments
- eg of internal fixators : tension-band wiring, compressive screw, buttress
plating
- all injured ligaments should be repaired
ii) Conservative method
- can achieve good reduction by manipulation under GA
- to restore alignment without operative method
- once reduced, below knee plaster is applied for 8 – 10 weeks
- frequent x-ray is taken to ensure no displaced F
- plaster removed after 8 -10 weeks and physiotherapy proceed
External Fixation
- used when closed methods cannot be used eg. open F with bad crushing
and skin loss
d) Complications
- simple types of ankle injuries almost free of complications
- but improper treatment of serious F-dislocation may be complicated
i) Stiffness of ankle : can follows immobilization in plaster
- common in elder
- necessary to continue ankle exercise for a long period ( 6 – 8 mths )
ii) Osteoarthritis
- due to short of perfect anatomical reduction which leads to tear and
wear of articular cartilage
- this leads to start of degenerative osteoarthritis
- ptt complains of pain, swelling and joint stiffness
- once established, osteoarthritis cannot be reversed
58. fracture of the talus.
Mechanism of trauma.
Indirect – inversion or eversion injury of foot
Classification
Injuries of the tarsus
Fractures of the talus
Fractures of the calcaneus
Other injuries of the tarsal bones
Fractures of the metatarsal bones and phalanges of the toes
Fractures of the metatarsal bones
Fractures of the phalanges of the toes
Fractures of the corpus of the talus
Fractures of the neck of the talus
Type I: fractures of the neck of the talus without displacement
Type II: fractures of the neck of the talus with displacement and subluxation
in articulatio subtalaris
Type III: fractures of the neck of the talus with dislocation it of the corpus
Subluxation in articulatio subtalaris
Dislocation of the talus
Complication
• Calcaneus – osteoarthritis, stiffness of subtalar & midtarsal joints
b. classification
• Flexion-injury
• Flexion-rotation injury
• Vertical compression injury
• Extension injury
• Flexion-distraction injury
• Direct injury
• Indirect injury due to violent muscle contraction.
c. Clinical features.
• Basic symptoms
o Local pain
o Radicular pain
o Bruise
o Excoriation
o Losing of function
o Pseudo-abdominal syndrome
o Injury of lumbar vertebra
• Important symptoms
o Pain in Axial loading on spine
• Authentic symptoms
o Deformation (only)
d. Treatment.
• Treatment on incident place
o Anaesthesia
o Immobilization, on hard surface.
o Transport to specialized hospital.
• Conservative treatment for stable injury.
o Immobilization : hard surface of bed
o Traction : extension on inclined plane
o Reclination : reclinator (shaft) under place of injury
o Medical exercise
o Physiotherapy
o Massage
• Three period of medical exercise.
o Immediate : 1st day after trauma
• E.g breathing exercise, Movement of upper and lower
extremity
o Approx 2-3 week.
• Movement of segment near from injury.
• E.g femur, cervical, shoulder girdle
o More than 3 week.
• Stretch muscle in place of injury
Diagnostics:-
Detection of a level of a spinal injury. Investigation of sensitivity
Level of Level of the loss of Level of Level of the loss of
injury sensitivity injury sensitivity
CII occiput LI femoral pulse
CIII thyroid cartilage LII - III middle of thigh
CIV jugular incisure LIV knee
CV infraclavicular fossa LV external surface of leg
CVI thumb SI external surface of foot
CVII forefinger SII-IV perianal region
CVIII little finger
TIV line of nipples
TX umbilicus
Refer in paper
Pathogenesis:
Several mechanisms have been suggested for the pathogenesis:
• Matrix loss is caused by the action of matrix metalloproteinases such as
collagenase(MMP-1)gelatinase(MMP-2) & stromelysin(MMP-3).These r
secreted by chrondrocytes in an inactive form.Extracellular activation then
leads to the degradation of collagen & proteoglycans.
• Tissue inhibitors of metalloproteinases (TIMPs) regulate the MMPs.
Disturbance of this regulation may lead to increased cartilage degradation
& contribute to the development of OA.
There is synovial inflammation in OA, producing interleukin-1 (IL1) & tumour
necrosis factor(TNF-alfa). These cytokines stimulate metalloproteinase
production & IL-1 inhibits type II collagen production
1)Radiological classification
Stage 1-not significant changes.narrowing of joints space.Small
osteophytes.Marginal
prominence of articular surfaces.
• Clinical classification:
-compensation: not damage
-subcompensation: no significant changes
-decompensation: significant changes r present
.Clinical features:
• Pain- Earliest symptom, it occurs intermittently in beginning, but becomes
constant over months or years. Initially dull pain, comes on starting an
activity after a period of rest; but later becomes worse & cramp like pain
appears after activity.
• Crepitus- Painless
• Swelling- Late feature & its due to effusion caused by inflammation of
synovial tissues
• Stiffness- Initially due to pain & muscle spasm but later capsular
contracture & incongruity of joint surface.
• Feeling of instability of joint
Locked knee- Absence, periodic, partial locked or full locked
Treatment
Conservative treatment:-
Medicamentous
-NSAIDS:-Nimesil,Naiz,Ambene,Ortropin,Diclopenac
-Chondroprotectons:-Ostenil,Naltrex,Sinvisc,Alflutop
-Reolytics,Angioprotectons:-Trintal,Qurantil
-Symptomatic treatment:-Analgetics,vitamins,sedatives.
Physiotherapeutic treatment
Orthpedics complex
Operative treatment:-
-Diinnervation,decompression
-Arthroplasty
-Arthrodesis
-Corrective osteotomy
-Endoprosthesis
-Osteoperforation
-Palliative grow
-The concept "a recurrent dislocation of the shoulder" is only a special case, a
separate sign of wider concept - instability of the shoulder joint
-Instability of the shoulder joint can be evident not only a recurrent
dislocation, but also recurrent subluxation, voluntary dislocation and
subluxation (arising of patient’s own free will), that is any clinically showing
disorder of active or passive stabilization of a joint
- Instability of a shoulder joint is the morbid condition of a joint which
has the set of the following attributes:
• injury of support function of a joint:
a perversion or inferiority of a load on articulate surfaces
• injury of movement function of a joint:
an outlet of movement function from under the control in any moment of
motion appearance new, not inherent moving for articulate surfaces of a joint
.Cubitus valgus
If the angle of the elbow joint is increased, so that the forearm is abducted
excessively in relation to the upper arm, the deformity is known as cubitus
valgus
Etiology:
1.previous fracture of the lower end of the humerus or capitulum with
Malunion
2.interfere with epiphysial growth on the lateral side from injury or
infection
Diagnostics:
Do know
Treatment:
1.slight uncomplicated deformity is best left alone.
2.if angulation is severe , correction by osteotomy near the lower end
of the humerus .
3. if the fxn of the ulnar nerve is impaired the nerve should be
transported from its post humeral goove to a new bed at the front of
the elbow.
Cubitus varus
a decreased carrying angle, also known as a "Gunstock Deformity", usually
due to an improperly reduced supracondylar fracture or epiphyseal
abnormality during growth.
Etiology:
1. previous fracture with mal- union (especially supracondylar
fracture of the humerus )
2.interfere with epiphyseal growth on the medial side.
Diagnostics:
Do know
Treatment :
1.minor degree of deformity can safely be left uncorrected .
2. if the angulation is severe it may be corrected by osteotomy through
the lower end of the humerus.
68.Osteochondritis dissecans of the elbow: etiology, diagnostics, methods of
treatment.
PHASE 1: ACUTE
Goals
Reduce inflammation and pain
Promote tissue healing
Retard muscular atrophy
Treatment regimen
Cryotherapy
Exercise therapy: stretching in region of the elbow joint to increase
flexibility; extension and flexion of the wrist; extension and flexion,
supination and pronation of the forearm.
High-voltage galvanic stimulation (HVGS)
Phonophoresis
Friction massage
Iontophoresis (with an anti-inflammatory drug)
Avoiding painful movements
PHASE 2: SUBACUTE
Goals
Improve flexibility of a tissue
Increase muscular strength and endurance
Increase of functional activities
Treatment regimen
Physiotherapy
Exercise therapy
Diagnostic test
• Test of a flexion of the hand: the passive maximal flexion of a hand
and fixation of it in this position during 1 minute result in paresthesia
I - II fingers
• Test of an erect hand: the elevation and retention of both hands in
this position during 1 minute result in paresthesia in the diseased hand
• Test of tourniquet: pneumatic tourniquet during 1 minute →
numbness and paresthesia
• Tinnel’s Test: percussion of a carpal tunnel → paresthesia of the
fingers, irradiation to antecubital fossa
• Test of local compression: pressure by a finger on the carpal tunnel
during 1 minute → paresthesia in the zone of innervation of the
medial nerve
Treatment
1.conservative treatment by supporting the wrist for 3 weeks with a simple
splint.
2. if this is unsuccessfull full relief is assured by dividing the flexor
retinaculum to decompress the nerve.
clinical features
=markd athropy of the forearm with flexion deformity of the wrist abd
fingers
=skin over
Prevention:
- requires restoration of blood flow;
- reduction of compartmental pressure
Diagnostic
x-ray (1-2 dregree)
1. roentgenogram by launshtein
2.mri frontal plane
3.mri horizontal plane
Scintigraphy
Hyper fixation of radioactive drug in diseased site
Treatment
1.medical regime
Optimal orthopaedics regime and medical exercise
Walking in mid. Tempo and on stairs.
2.medication theraphy
Rheologic drug : tentral, curantyl
Drugs of calcii : fosamaks
chondoprotectors : Alflutop
other analgesics
3.palliativetreatment
Decompression drilling
Long term interbone blockade
Pt-electromyostimulation,laser
diagnostic
x-ray
normal rbc sedimentation rate and blood count
treatment
Treatment
1.medical regime
Optimal orthopaedics regime and medical exercise
Walking in mid. Tempo and on stairs.
2.medication theraphy
Rheologic drug : tentral, curantyl
Drugs of calcii : fosamaks
chondoprotectors : Alflutop
other analgesics
3.palliativetreatment
Decompression drilling
Long term interbone blockade
Pt-electromyostimulation,laser
Presentation at bre
ech presentation in 10 times more often
Quantity of a pregnancy of the at children from the first pregnancy in 2
mother time more often
Diagnostic
Radiographs show a clear zone of transradiance within the bone. The area
has a homogenous ‘ ground –glass’ apprance
Treatment
If the lesion is seen to be extending , the affected segment of bone should be
excised and replace by bone graft.
75. A foot as organ of movement, support and amortization. Methods of
feet’s investigations. Classification of static deformations.
Plantography
Determination of the axis of the foot, of the angle of turn, of width and
length of feet, of degree of longitudinal platypodia and valgus angulation of
hallux
Radiographic examination
I. Static deformations
1. Functional insufficiency
2. Longitudinal platypodia (planovalgus
deformity)
3. Transversal platypodia (broad foot)
4. Fibro-osseous excrescences in region of heads of I metatarsal bones
5. Hallux valgus
6. Hammer-shaped (or claw-shaped) and others deformity of toes
Causes
Paralytic – Flaccid flat foot.
Traumatic – Fracture calcaneum.
Arthritic – Rheumatoid arthritis.
Spasmodic – Due to peroneal spasm.
Pathogenesis: muscle imbalance –fibular muscle
-ant . and post. Tibial muscle
Clinical picture & Diagnosis
Clinical features:
o Pain, swelling, fatigue, deformation.
o Longer foot.
o Flatting longitudinal arch of foot.
o Wide in middle part of foot.
o Decrease height of foot.
o Valgus deviation of foot.
o Prominence osnavicularis (scaphoid) on the medial side.
Treatment
Conservative:
oMassage.
oMedical exercise.
oSole supinator.
oOrthopedic shoes.
oElectrobiostimulation.
oTibial muscle stimulation & relaxation peroneus muscle.
Surgery:
oTendon achiles longitudinal – young patients.
oArtrodesis – old patients.
Causes:
- due to injury, illness, unusual or prolonged stress to the foot, faulty
biomechanics, or as part of the normal aging process.
Diagnosis:
- arch appears when the person dorsiflexes (stands on tip-toe or pulls the toes
back with the rest of the foot flat on the floor).
Treatment:
Treatment of flat feet may also be appropriate if there is associated foot or
lower leg pain, or if the condition affects the knees or the back. Treatment
may include using arch supports/orthotics, foot gymnastics or other
exercises as recommended by a podiatrist or other physician. Surgery, while
a last resort, can provide lasting relief, and even create an arch where none
existed before, but is usually very costly.
a) Causes
- rheumatoid arthritis, wearing pointed shoes with heels, idiopathic.
b) Clinical and radiological features
• Clinical - Hallux valgus is considered to be a medial deviation of the
first metatarsal and lateral deviation and/or rotation of the hallux with
or without medial soft tissue enlargement of the first metatarsal head.
This condition can lead to painful motion of the joint or difficulty with
footwear.
• Radiological - Width and uniformity of the joint space normally, the
joint space appears uniform. Increase or irregularity is indicative of
degenerative changes. Therefore, if the osteoarthritis is severe enough,
a joint-destructive procedure should be treated.
c) Principles of treatment
• Adapting footwear - Spot-stretching shoes or using of shoes with
wider and deeper toe boxes might be considered. Padding and
strapping have limited success, other than to relieve footwear or
digital pressure in long-term management. Sole suppinator, orthopedic
shoes
• Pharmacologic or physical therapy - Nonsteroidal anti-inflammatory
drugs and physical therapy can also be offered to relieve acute,
episodic inflammatory processes. Corticosteroid injections can also be
offered in the management of acute inflammatory conditions to the
first metatarsophalangeal joint.
• Functional orthotic therapy - Functional orthotic therapy might be
implemented to control the biomechanics. This approach can relieve
symptomatic bunions, though the foot and first metatarsophalangeal
joint must still have some degree of flexibility. Massages. Medical
excercises.
• Operation txn – congruent joint, incongruent/ sublaxed joint, joint
with arthrosis
pathogenesis
epiphysis of disk of vertebrae
Examination of pt
- photometry at scoliosis
classification
Definition
Osteochondrosis is degeneration and dystrophy of the intervertebral disks of
a spinal column, which is accompanied by their progressive deformation, by
decrease of height and by stratification with the following involvement of
bodies of adjacent vertebrae, intervertebral joints, the ligamentous apparatus,
a spinal cord and its roots, and frequently, with a disorder of blood supply of
structures a spine column.
Osteochondrosis affects all parts of spinal column, but usually it is meets in
the most mobile parts: in cervical and lumbar, i.e. in the most functionally
loaded segments.
Cervical part – CV-VI, then CIV-V и СIII-IV.
Lumbar part ― LIV-V
In a thoracal part the osteochondrosis is usually localized at a level TIII-VII
Etiology
• Infectious theory
• Autoimmune (rheumatoid) theory
• Traumatic theory
• Dysontogenetis theory
• Involutory theory
• Muscular theory
• Endocrine and metabolic theory
• Theory of heredity
Pathogenesis
• An effect of endogenous and/or exogenous factor
• A disorder of microcirculation in vertebral segment
• Degenerative changes of cartilage
• Autoimmune inflammation of the changed cartilage and nucleus
pulposus
• Atrophy, thinning, decrease of buffer properties of a cartilage
• Functional change of the overloaded bone, directed to the
consolidation of the bone (a subchondral osteosclerosis) and to
decrease of a load by unit of a support surface - marginal osteophytes
Decongestant:diacarbum,lasixum,furosemide,verospiron