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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
1
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