MUSTHY CF HEALTH OOF URHARYE TRAUMATOLOGY ORTHOPEDICS Few Danae Nar sfuacenisinf higher rrrenicad schol Ai ivvelof cccpn@eccion Vineyisla Hows Kine aotVIIK 617.5(075.8) BBK 54.588173 T65 ml Approved by the Ministry of Health of Ukraine as a textbook for students of higher uilieg educational institutions of V level of accreditation (Protocol Ne 3 of 16.10.2012 of the meetin, of the Committee on Medicine of the Scientific and Methodological Council for Educatign he 5 | Ministry of Education and Science, Youth and Sports of Ukraine) Ne Authors: | Burianov O. A., Golka G. G., Klimovitsky V. G., Loskutov O. Y., Ivchenko yy [Sklyarenko Y. T. Berezka M. I., Bitchuk D. D., Bodnya O. I., Burlaka V. V., Vasyuk y. | Golovakha M. L., Garyachiy E. V., Grek V. P., Zadnichenko M. O., Ivchenko 4. y. Ivchenko D. V., Istomin A. G., Kvasha V. P., Litovchenko V. A., Lykhodiy y, V. Lobanov G. V., Loskutov O. A., Oliinyk A. O., Oliinyk O. E., Omelchenko TJ. M. Samusenko I. V., Sinegubov D. A., Sobolevsky Yu. L., Sulima VY. S., Sukhin Yu, V., Trutyak I. R., Fadeev O. G., Chernysh V. Yu., Chorny V.S., Shvets O. L, Shimon V.M, Reviewers: Gaiko G. V. — Director of the Institute of Traumatology and Orthopedics of the National Acad- emy of Medical Sciences of Ukraine, Academician of the National Academy of Medical Sciences | of Ukraine. Laureate of the State Prize of Ukraine, Honored Worker of Science and Technology of Ukraine, Doctor of Medical Science, Professor; Korzh M. A. — Director of the SE “Sytenko Institute of Spine and Joint Pathology, NAMS Ukraine”. Laureate of the State Prize of Ukraine, Honored Worker of Science and Technology of Ukraine. Doctor of Medical Science, Professor. The publication was prepared in accordance with the Order of the Ministry of Health of Ukraine | of 22.06.2010 Ne 502 as a unified national textbook Traumatology and orthopedics : textbook for students of higher | T65 medical educational institutions : transl. from. ukr. lang. / edited by | Golka G. G., Burianov O. A., Klimovitskiy V. G. — Vinnytsia : Nova | . Knyha, 2018, — 400 p. : il. L ISBN 978-966-382-671-4 The national textbook in accordance with the curriculum approved by the Ministry of Health of Ukraine and the Ministry of Education and Science of Ukraine covers modern views on etiology, development mechanisms, principles of diagnostics and treatment of injuries and diseases of the apparatus of movement support. There is presented a modern view on the pathogenesis of traumatic disease, bone tissue regeneration, common complications, methods for prevention and treatment. Taking into account changes in the structure of injuries, special attention is paid to the issues of combat damages, the organization of stage care for polytrauma, spine, pelvis, limb injuries, and restorative treatment of patients with musculoskeletal injuries. Details include widespread congenital deformities, degenerative-dystrophic, inflammatory and tumor diseases of spine and joints. The publication is intended for students of higher medical educational institunons; eee clinical residents, doctors in sports medicine, traumatologists-orthopedists and 1 surgeons. -List of abbreviations... 6 The history of development of traumatolog and orthopaedics : = The establishement of traumatology and i orthopaedics as part of general SUrgery ........ 8 _Traumatology and orthopaedics as = independent surgical discipline............... 10 1. The introduction to the specialty. The features of clinical examination of traumatic and orthopaedic patients. Ligaments, tendons and muscles injuries. Traumatic dislocations... 17 1.1. Methods of clinical examination in traumatology and orthopaedics ............c..c0.... 17 The procedure of examination of patients with musculoskeletal system traumas.......... 18 Procedure of examination in orthopaedics diseases and musculoskeletal trauma PNUS CNIS) CSW sae ase 2 cy tedarods-nceynrataeovarndianes 24 Features of examination of children with traumas and orthopaedic diseases ......42 Additional methods of investigation in traumatology and orthopaedics .............0. 45 Diagnosis establishMent............--0.ecrere 50 1.2. Injury of ligaments, tendons and muscles .... 51 NES DISIOGALIONS .....-.0--c0<.00-5c0sceeesceseerenconrentncnenins 57 Tasks and tests............:.ceeir re 69 2. Traumatic disease. Multitrauma. Modern principles of medical aid supply during fractures..........--.c 0c i PUT WINATI TIE ALIITIA co ceesesccsesns-onece-tzseecerezcecesoreecaratests i Clinical presentation... serine ese is Estimation of the trauma severity .......------ a ifileleLWAUTEIA I ocegecerenea ones tert Pe e 2.2. Modern principles of aid in fractures.....-.-. x Classification of the fractures... Clinical signs of fractures ek 88 Methods of treatment of fractures..........102 Open fractures: 2.0..)115k nO Gunshot fractures of long bones,............. 10 Compartment syndrome of the extremities .... 126 Traumatic osteomyelitis ......c.ccc0c.cccs0-s0000..-. 129 Tasks\and tests:....,-0:..-1 10) een een ROR ene eda a ale! 3. Amputations of the extremities. Rehabilitation and prosthetics of disabled person with defects of the extremities. Treatment of traumatological and orthopedic patients in outpatient conditions ...................... 137 Indications for QMPULGEION .........c.cseeccee0e. 137 Methods and techniques of amputations... 138 Rehabilitation and prosthetics of the disabled patients with defects of thier EXELEMIEICS ....conssencicsheuna eee eee 139 Prosthetics of upper extremities.................. 143 Lower extremities Prosthetics ........:ccccce 145 Treatment of traumatological and orthopedic patients in outpatient conditions...147 Tasks and tests.......-41:.05. ee 149 4, Injury of bones and joints of the upper extremity..........cccccccceeeseeeeees 152 Fractures Of the SCOPUIG....:...:..scccccsessseseeeees 152 Fracture Of the COVICIC....:ciccccssetscereeessenees 154 Dislocation of Clavicle........:c.ccsee aan 156 Shoulder dislocations ...........:.ccs0600 aa 158 Fractures of the AUMEFUS ..........:c:ceceeeeen 161 Dislocations of the fOrearM..........-:.:cre. 169 Fracture-dislocations of the forearm bones ...173 Fracture of radius in a typical site .............. 174 TOSKS:..... cvcciacscesveyccotansnes coiecnears orto pene sere 180 5. Injuries of the spine and pelvis.............. on 184 5.1, Injuries of the Spine ......-sssseccseesseessrn 184 Causes and mechanisms of spine injuries.....184 Classification of spine INjUTIOS.....ssseevecesseeene 185Injuries of the cervical part of the spine ..-.. 188 Injuries of the thoracic and lumbar parts Of the SPiN... 190 Diagnostics of spine injuries... 190 Treatment of Spine INjUTICS..........02 re 193 5.2. Injuries of the Pelvis........:..cccceesereres 198 Classification and mechanogenesis Of PEIVIC IMJUTICS........ceccereeccercesecneet essere 198 Diagnostics of pelViC INJUTICS.........c 200 Treatment of the pelvic injurieS........00 202 TASKS ONG COSES....ncx...co ccs ese een 207 6. Injuries of bones and joints of the lower ENEMY ee any peer eee a valence anceasie eee edessyeemaesenss 211 Fractures of the proximal part of the PEMMONTIMIOME ere cette ve rsevecacsnares anrceceteentes 211 FEO TIM cs teee cass ves xevccss teens oneene eesti 219 Injuries of knee joint menisci and ligaments... 225 Rupture of the knee joint ligaments............ 228 ES PTIMEL URC eso ee eae eti vocengesvteonees 232 SHMAONMES JRGGHUTCS eek. co cess cesses iecsestaconees 234 IRS STEMIMCH CO SUS es eee eeasencstesten ss ssesee ees 254 7. Degenerative-dystrophic diseases GIMGINESTANGSPING 2c sets receeescny. 257 7.1. Degenerative-dystrophic diseases of joints ...257 SHC WMTMIMIIHIS yt, anlar. caer reteneiel as. 257 PACSUN GI MICGIOSIS:.c2cs.21.r.-c1 ats evens teneveavie. 280 Cystic restructuring of the articular bones....286 7.2. Degenerative-dystrophic diseases MAAN ESTA PPE nec c hein vaeanacesSasetavannsnsdaune 288 EMCO IOMANOSIS) i. o-satacewsnoscentenecnnesedneseecene: 288 Deforming spondylosis and SCO ICONIC See 297 SOMOMIOUSEMCSIS 2. .cisersccceqsresntesesiseveesseessen 299 SMI CISECIIOS Sa encers.ac.se-secnscteciscevssverveoscosas 302 MISH STOMOMLOSES cee eer erctiscstehesescigsatecccsenisusverie 304 8. Congenital deformations of the Spine q bones and joints. Scoliosis Bah eT NW ag Pine of the musculoskeletal system. _ Congenital myogenic torticollis 309 Congenital myogenic Clubfoot... Developmental dysplasia of the hj, Congenital hip dislocation... 8.2. Posture and its impairments, a 8.3. Scoliotic disease (scoliosis) _ terre « “eH 3 JOint asdf 8.4. Kyphotic deformation of the sping a Tasks: and té@sts..2:.4.5.2.54 eee S84 9. Inflammatory, tumorous and tumor-like diseases of the musculoskeletal system. _ uo 9.1. Tumorous and tumor-like diseases a of the musculoskeletal system... ug Benign Done tuMOPs.......:... cscs 3M Malignant Done tuMOTs 02.2... Tumor-like Done dISCGSES ........cc:e.ccsscc0cc....35) 9.2. Inflammatory diseases of the musculoskeletal system ............::c1se. Tasks and tests ..........-2:-- ee K@EY ANSWENS ............. cece eeeceee eer eneteeseensarersnnncaes AttachmenttS...............:..::ccceecesceseeeeeeeneneees ann Re FOO COS orecccccccecccccccceucecvzeosestesss-11 eei The growth of the level of injuries and the prevalence of orthopedic (orthopaedic) , which are inherent in modern socie ty, determine the need to improve the sGlggnosis and treatment of injuries and diseases of the apparatus of support and me vement as a priority direction of health development. Increasing the diagnostic ca- pabilities of modern non-invasive methods for visualizing the condition of bones, joints and sojt tissues, expanding the scope of arthroscopy and high-tech minimally invasive methods of osteosynthesis, developing and improving reconstructive surgeries and en- doprosthetics allow changing the concept of rendering orthopedic and trauma care in the framework of health care reformation. These circumstances change the requirements for the level of training of special- ists at all stages of medical education, which is reflected in the new curriculum for traumatology and orthopedics for higher medical institutions in Ukraine III-IV levels of accreditation, compiled for the specialties "Medical Business", "Medical Psychology’, ‘Pediatrics’, “Medico-prophylactic affair’. According to these changes, it became neces- sary to create a new textbook, which, based on the generalization of many years ex- perience of the Ukrainian orthopedic and traumatological school, would highlight the latest international achievements, systematized standards, guidelines and algorithms for diagnostics and treatment of injuries and diseases of the support and movement apparatus. The textbook presents modern methods of diagnostics of injuries and orthopedic diseases, modern views on the pathogenesis of traumatic disease, bone tissue regen- eration, common complications, ways to prevent and treat them. Due to changes in the structure of injuries, special attention Is paid to the organization of stage care for mul- titrauma, spine, pelvis, limb injuries, restorative treatment of patients with musculoskel- etal system damage. The most common congenital deformations, degenerative-dystro- phic, inflammatory and tumor diseases of the spine and joints are considered in details. Classification of injuries and diseases correspond to the modern international clas- sification of diseases ICD-10, and when covering traumatology issues, the most common universal classification of fractures AO/ASIF is used. The textbook will be useful not only for students of higher medical educational insti- tutions, but also for interns, clinical residents, traumatology-orthopedics physicians and specialists in surgical specialties. The authors will gratefully accept comments and sug- gestions on improving the content of the textbook.“ore AO/ASIF APACHE BMC BMD BP CAD/CAM ciTo COX CRAMS cs CT DCP DHS DIC syndrome Anterior cruciate ligament Abbreviated Index Severity Aseptic necrosis of the femoral head Association for Osteosynthesis/ Association for the Study of Inter- nal Fixation Acute Physiology and Chronic Health Evaluation Bone mineral content Bone mineral density Blood pressure Computeraided design/computer- aided manufacture Central Institute of Traumatology and Orthopedics (Russia, Moscow) Cyclooxygenase Circulation, Respiration, Abdomen, Motor and Speech Chondroitin sulfate Computed tomography Dynamic Compression Plate Dynamic Hip Screw Disseminated intravascular coagu- lation syndrome Dermatan Sulphate Electrocardiography External fixation device Erythrocyte sedimentation rate European League Against Rheu- matism Free radical oxidation (lipid peroxi- dation) Glucosamine Glycosaminoglycans Glucocorticosteroids pase Coma Scale IL-1 ISS KS 1/3 LCL LCP m/3 MCL MEFS MO MRI NAMS NSA NSAIDs OATS OA PCL PG PG-E2 PST SAPS SC SCT SRI SYSADOA TA TGFB TNE TPT TRISS-method u/3 UA UHF-therapy US Interleukin-1 Injury Severity Score Keratansulfate Lower third Lateral collatera| ligament Locking Compression Plate Middle third Medial collateral ligament Military-field surgery Metal osteosynthesis Magnetic resonance j imaging National Academy of Medical s¢ ences (Ukraine) Neck-shaft angle Non-steroidal anti-inflammatory drugs Osteochondral autograft transfer system | Osteoarthritis Posterior cruciate ligament Proteoglycans Prostaglandin-E2 Primary surgical treatment Simplified Acute Physiology Score Spinal canal : Spiral computed tomography Scientific Research Institule : Symptomatic slow acting a1U5>"= osteoarthritisy Traffic accident ae Transforming growth factor Delt Tumor necrosis factor Therapeutic physical tain Trauma and injury severity s¢ Upper third Units of activity Ultrahigh-frequency therap tia Ultrasonic (diag 5 tion etc.) — id world aie orga nization ——_* a, hk —, 5 ae — eee ee : inl | a a Bb fe at 7 7 i ; | eee Ba | iy ee Mae H | = OR ) = aL ‘ : Ute ATOLOGY AN ae I 7 tT bk =n es WK AL =a \ | { }- J UR ENE ta i = Me a % * * —— = ro ee t ie _* : 4 7 ; wi) Se ) , | 1 =~ Ue bd ned the Possibilities of trauma treatme™ ~~ NOstie &, Pe icvins. 's More probable in the ana pe njury with the egy impairment of the posterior semicirc c njuty with the Integay impairment of the anterior wie p, Multiple fracture of pelvic bones. e_ pelviciury with the integrity impairment of the posterior and anterior semicircles TASK Neo patient S» 37 YES" a 2 er pao from the 5 m height during work, Duri bok. I tion of the gluteal areas and pubic bones, in compression of the iliac pa SNe ANOre Ea during the yea, function of the lower limbs is impaired due to the pain. Which is th es with the irradiation to the sacral .- investigation in this case? e most grounded type of the radio- 4. Plan X-fay of the pelvis in the lateral projection. 3. Yay od the anterior part of the pelvic circle. ( PlanY-tay of the pelvis in the anteroposterior projection. D. Plan X-ray of the pelvis in anteroposterior and lateral projections. E \uay ofthe pelvis in the axial projection. TASK N210 at the strike with ferroconcrete construction at the pelvic area. rhages at the area of the postero- ng and sacrum; Patient G., 30 year, during installation work g During examination: hemodynamic indicators are stable, subcutaneous hemor lateral suragce of the righ pelvis side, tenderness during palpation in the area of the right iliac wi Verbeuil, Larrey symtpoms are positive. How will you transport the patient? A. Atthe stretchet. B, Atthe board with the reclination roller under the ( Atthe board with rollers under the knee joints and in the iliac wings ated. D. Atthe board with immobilization with the Dieterich's splint. E Atthe board with immobilization with Kramer splints. lumbar part of the spine. TASK N21 1 e pelvic bones with the ht pelvis side proximal: tishock therapy stable fractures of th dislocation of the rig cident. Closed in ts with the Fateunt Y, 36 years, get the trauma In the car ac ~ ——aterior and : toe integrity impairmen | ee: posterior pelvic cricles integrity ! p st the hospital. An s 4 traumatic shock of fe Il degree Was diagnosed before the aca Mie te eiastenenele o started immediately. Chose the optimal treatment tactics of the p {| &Merpen 7} 4 a ; ‘ned with the internal fixation. jo ahs : ee p, External osteosynthesis combine i * Stemal stabilizaing osteosynthesis with the apparatus - gxtramedil osteosynthesis of pelvic none © Sheetal traction, ae Treatmentin the pelvic sling.pre UCC ction pr tion of traumatized limb. This fact afforded grour calling this method as functional as contrast to u zation. The elaboration of general principles of continuous traction (B. Bardenheuer, 1887) and study on fractured patients functional treatment (J. Lucas - L. Championniere, 1889), the introduction to. clinical practice the definition of medial physiological limbs posi- tion (H. Zuppinger) facilitated the establishment and development of functional methods of fractures treatment. The skeletal method was the best among the methods of continuous traction. However it's us- a ae (1766-1859) — age technique was elaborated only in the first decade of XX century, the founder of Moscow in the 2nd stage of the specialty development. traumatology school Orthopaedics and traumatology has developed as part of the general surgery at the beginning (more than 100 years) in classical evolution way. The quality changes in the development of orthope- dics began to occur at the turn of XVIII and XIX centuries, when spe- cialists of this sphere started to treat musculoskeletal deformations and other diseases not only in children but also in orthopaedics hospitals. In 1888 the orthopaedics hospital was opened in Odessa, in 1896 the hospital for children with different deformations was opened in Kharkiv. In many cities, the enthusiasts traumatologists- orthopaedists worked on the base of hospitals specialized on gen- eral surgery. The distinguishing feature of orthopaedics on its first stage of de- velopment (in the before aseptic era) was mainly usage of conserva- tive methods of patients treatment (redressing, wide usage of casts, tutors and apparatuses for traction or immobilization). In the same Professor N. |. Pirogov years the interest in balneotherapy occurred in orthopedists as well as (1810-1881) to other treatment factors (thermal and mineral waters, sunlight and see positive effects, massage, physical activities etc.). The further progress in its development the orthopaedics and traumatology gained in the second part of XIX century at the background of high speed industrialization and social-economical moderniza- tions of the most of developed European countries. So with help of Louis Paster (France) papers and chemists of many countries the new methods of analgesia and aseptic of operations, surgical instru- ments, surgeon's hand and operation field was adopted to clinical practice. This enabled to achieve better anatomical and functional results, shorten terms of children and adults treatment. Such achieve- ments facilitated fast grow of the specialized clinical centers number in Europe, as well as the forma- tion of proper conditions for distinguishing of orthopaedics and traumatology in separate surgical dis- Cipline. In the last decade of XIX and first years of XX century the process of differentiation started in Europe. One of the first disciplines that have divided separately was orthopaedics and traumatology. The new method of surgical diagnostics X-ray has facilitated this considerably. The usage of X-ray im- Proved the process of determination of features and localization of pathology in bones, it enabled to _ Watch the dynamics of reparative regeneration of bone tissue. aetna ce WON fete ee gs y of development of traumatology and orthopaedicspICS AS INDEPENDENT . ‘ "This stage of traumatology, orthopaedics century was marked by many features: — Ia e It was tree times shorter eee nanan ae pleted e The final formation of new clinical disc! | : i Petition of new progressive methods of fractured patients treatmeny OCCU. servative (skeletal traction) and operative (internal fixation for fract ures), | Cty, e The new prevention systems and complex treatment of patients with polio and bones berculosis was formed; | e Elaboration of pathogenesis based treatment of the gunshot wounds methods, op te gual of scientific assessment of the wound ballistics features, pathomorphology and pathonhes ogy of the gunshot wound, and prosthetics development in the firs halt op The beginning of the second stage of traumatology and orthopaedics is connected to the gpa. of the first in the country hospital and department of orthopaedics in Saint Petersburg in Medical ge. gery academy in 1900 on the base of functioning department of desmurgy and mechanurgy, Professor Turner G. |. - the pioneer of country orthopaedics was its founder and constant hex of it during 46 years. In the time of his activity he improved a plaster technique and some Bandas, suggested plaster splint for shoulder fixation named after him, improved method of fractures tran treatment, march foot fractures, old patella fractures and spine pathology: tuberculous spondylitis” spondylolisthesis, lumbalgias. A In 1906 in Saint Petersburg the first orthopaedics state hospital in the country was opened it was headed by professor Verden R. R. (1867-1934) former educatee of Medical surgery academy al” it was led by him during his life. In 1924 the hospital was renamed traumatology institute, and in 185 named after Verden R. R. He was active and creative surgeon, he modified existing operations 2# suggested many new, elaborated hip and knee-joint arthroplastics methods, simplified the sug approach by a resection of great trochanter, run the resection of ribs exaltations in case of sols suggested arthrodesis of wrist and ankle joints and operations for medium deformations of fo == plasia of hip in flexion joint contractions, described new symptoms in case of meniscus abruption © __ The Medical surgery academy occurred to be third center of country traumatology and offi” i: dics, opened in Kharkiv in 1907 of the means of Russian miners for colliers with industrial a treatment. It can be understood trom the name of the new institution that it was not silat ‘ scentific and clinical interests to the tutoring institutions in Petersburg. It can surely be I " ie ge rt apaecics pate (nowadays Institute of skeleton a jonni Sitenko M. 1. became the director of Ukraines Stent tore of ont ole ouenso © ecame the director of Ukrainian State Clinical Institute of Orthop ratology, which was named by him after his death . asics has est i cciantific orthopaedics and traumatolony sete oe teak Rte se yielcinawn buiece i ae ology Institutions in Ukraine. Site an et heer. a si ee of new scientist generation, oe “al ogy service in Ukraine fer rena nthe highest level in the Bee oe Plastics, treatment of patients with tub ~ © deiMnal “Traumatology and orthopaeci™ » i =_ The period of prosperity for the Kharkiv Institute of ogy and Orthopaedics named after Sitenko M. |. we fessor Alexey Alexandrovich Korzh. . | It should be noted that until 1934 the influence of the institute as central scientific traumatology and orthopaedics organization in the republic was spread not only to treatment and prevention institu- tions of left-bank Ukraine, but all USSR territory for that period. In September 1996 the Institute was headed by the honored worker of science and technology of Ukraine, doctor of medical sci- | OO ence, Professor Korzh N. A. He continued the creative development professor G. |. Turner of scientific and practical activities of the University, dictated by (1858-1941) needs of practical public health issues, the population health condi- tion and the level of musculoskeletal system morbidity. In September 2000 the Institute became to be subjected to the National Academy of Medical Sciences of Ukraine and was renamed Institute of spine and joints pathology named after prof. Sitenko M. I. In the last years the basically new scientifically justified technolo- gies for treatment of spine and joints injuries and diseases was formed in the Institute, as well as instruments for its performance. The number of new methods of operations in case of trauma and spine & joints dis- eases was elaborated and implemented. The history of formation and development of traumatology and orthopaedics base in Kyiv begins from 1919, when the new institution for the treatment of orthopaedics patients was opened, named ‘The House of Lame Child’. Dependently on the tasks and direction of the activities the name of the institution changed. In 1934 after shifting of the capital and People’s Commissariat of Public Health of Ukraini- an SSR from Kharkiv to Kiev, Ukrainian Institute of traumatology and children's orthopaedics in Kyiv was reorganized to Ukrainian Insti- tute of Traumatology and Orthopaedics. From that moment both In- stitutes continued to develop an ambulatory and stationary network of specialized services — each in it’s own sphere of influence. Today it is subjected to Academy of Medical Sciences of Ukraine and is called State Institute “Traumatology and Orthopaedics Institute of Academy of Medical Sciences of Ukraine’. At the beginning of its existing and before the Il World War the main scientific works was directed to the studying of bones and joints tuberculosis, congenial and acquired deformations, defects of muscu- loskeletal system in newborns, elaboration of effective methods of its prevention and treatment. First In the country the method of opera- Me tive treatment of congenital dislocation of the hip was developed and Professor M. P. Novachenko applied (Frumina A. Eh | After the I! World War the scientific works of the Kyiv Institute Concerned the problems of limb amputations and its prosthetics, development of plastic operations, _ Wound shot osteomyelitis treatment and recovery surgery, standard medical examination and treat: Professor R. R. Vreden (1867-1934)ment of the invalids of The Great Patriotic War. The studies _ cee ital and acquired deformations and defects of musculoskeletal system in newborns and children were recovered. The research of bones and joints tuberculosis was continued, the research of haematogenum and trauma osteomyelitis was started. In 1976 on the basics of the Insti- tute the Republic Center on Osteomyelitis was founded. | In 1960s in Kyiv Institute of Traumatology and Orthopaedics the method of complex orthopaedics treatment of nonspecific infectious (rheumatoid) polyarthritis was first developed and implemented, the methods of conservative and operative treatment was explained. The clinical-radiomorphological classification of degenerative-dystrophic disorders of the joints was developed and the methods of conserva- tive and operative treatment were improved. The endoprosthetics of hip joint was implemented. The basic aspects of ethiopathogenesis of scoliosis disease were studied. The methods of operative correction of severe forms of spine deformations, koilosternia and tropeic chest deformations was improved and elaborated. The methods of short- ening vertebrotomy, decompression operations in spine and spinal brain, microsurgical operations were developed and applied. The widening of traumatology service in country continued. In 1921 by the decision of People’s Commissariat of Public Health of USSR the medical faculty of Novorussian University was reorganized into the medical university in Odessa. At the same time by the direction from People's Commissariat of Public Health the department of orthopaedics surgery was opened in Odessa Medical Institute. The first head of the department was Kefer N. |., who has a great achievement in its founda- tion and further development. As Wold War II started the department stopped its activity as scientific institution and was recovered in 1960, Professor A. A. Korzh Professor Gertsen |. G. was chosen as head of the department. (1924-2010) Consequently, orthopaedics in contrast to surgery of skeleton deformations distinguished first and became independent discipline. However complete social and professional (from surgeons) acknowl- edgment of the new surgical specialty happened only in 1920s and the first half of 1930s, when the international societies were founded, in 1929 the SICOT was organized - International Society of Orthopae- dics Surgery and Traumatology (Societe Internationale de Chirurgie Orthopedique et de Traumatologie). ___ In Russia by a suggestion of Polenov A. L. and then in Europe the surgery of injuries was named traumatology, which soon with orthopaedics and prosthetics became the main new surgical special- ty in its nowadays meaning. In 1918 in Petrograd Polenov A. L. or- ganized first in the country department of traumatology as part of ffate Institute of Medical Knowledge (nowadays the department of traumatology, orthopaedics, military field surgery and stomatology M. I. Sitenko (1885-1940) Professor N. named after Mechnikov |. |.). . Before the World War II, the main country t ; | ists, excepeh eee eT THe Me t raumatologists and orthopaedists, EX °F tig: tion of scientifically research S : : , I oe Je 1 and treatment Institutes, achieved an implementation of an 0" ; J fy; ‘TT - a a ite Us — aki | } / j Traumatology ieeenized the health p 1932 in Leniner ae i | is 2 A il a es u the first traumatology posts were organized, the service of first medical aid was formed. = =—— g specie TY. The decision of XXII USSR assembly of ng scientists worked within the walls surgeons (1932), which united orthopae- An ime contribution to its develop- dics and traumatology and acknowledged as made by professor Shumada I. V., who headed it as independent specialty, had a special yr many years. Nowadays the director importance in the list of tasks before war. A problem of organization of orthopaedics and traumatology aid to injured on different stages of medical evacuation was a key Is- sue in 1939 in the I! assembly of orthopae- dics and surgeons and prosthetics workers in Ukraine. Staff of Kharkiv Traumatology and Orthopaesics Institute summarized their experience in four monographs, published before war by Kyiv special district - Novachenko M. P., Eliashberg F. E. ‘Continuous skeletal traction’, Marks V. A. “Examination of patients with injuries and diseases of sup- port and movement organs’, Pogorelskyi M. A. “Plaster technique’, Prychod ko A. K. “Funktional treat- ment of injuries and diseases of movement apparatus’. The great importance of the specialty was acknowledged in the years of the Great Patriotic War. The decision was made by USSR government in 1944 to form 10 new National Research In- stitutes of Orthopaedics and Traumatology on the base of major specialized evacuation hospitals as well as on organization in each district, land, republic the hospitals for treatment of invalids of the Great Patriotic War. Despite the fact that surgery and traumatology had two conservative frac- tured patients treatment methods (plaster and skeletal traction), anatomical and functional results of the wounded patients treatment in hospitals occurred to be much better than general surgical. The first post-war decade ended the second period of traumatology, orthopaedics and prosthet- ics development not only in USSR but also worldwide. The timeliness of the problem of traumatic injuries in human was driven not only by society needs but also by occurrence of entirely new injuring factors appearing for example during road traffic incidents or various industrial accidents. ‘an outstanding scientist, academician, prof. Georgiy asilevich Gayko.The main achievements of the period are the following: : | tients - intra- ment method of trauma pa rn G. A. Kuntscher, J. G. Dubrov M. Venable, S. Sher- e New operativ medullary (M. N. Smith-Petersen, | et al) and Ree osteosynthesis ( lan et al.); | @ Peer anchce of the Great Patriotic War 1941-1945 united organizers, morphologists, physiologists, surgeons, physicians and narrowly focused specialist in a circle of co-thinkers, who achieved not only to show the success and goals but also to maintain the disadvantages, losses and ways of further devel- opment of traumatology and orthopaedics. Until the middle of 1950s 19 scientific research institutes of traumatology and orthopaedics functioned in USSR and 6 institutes of prosthetics, all physicians’ continuing education institutes had the departments of traumatology and orthopaedics, the same de- partments was in 39 medical institutes of the country. Till the end of 1950s the departments of traumatology and or- thopaedics were recovered in Ukraine in higher medical institutes of Kharkiv, Odessa, Dnipropetrovsk and new departments was formed in Donetsk, Simferopol, Zaporizhija, Lugansk, Poltava and other cit- les. In 1957 Donetsk scientific-research institute of traumatology and orthopaedics was established, Professor Revenko T. A. was the head. Consequently, the conditions for application of new forms of aid from institutes of traumatology and orthopaedics for public health organizations occurred. The period of traumatology, orthopaedics and prosthetics pros- perity is concerned to be 1960s. The Central Institute of Traumatol- ogy and Orthopaedics (Moscow) and its director prof. Volkov M. V. initiated the | USSR assembly of traumatologists and orthopaedics in 1963 and played the key role in revealing the traumatology and orthopaedics as one independent clinical discipline, which can de- velop progressively. On the ground of assembly's decisions the new Organizing staff structure of traumatology service was formed with the main trau- matologist-orthopaedics of the country as a chief Traumatology departments were opened In every medical institute of the USSR. The traumatology hospital units were formed in cities and big towns, in small towns — a district traumatology posts for population of 100 thousand people. A legal status, administrative and methodical subordination was maintained for each treatment institutions. In 1977 2 scientific-research Institutes, 91 departments of traumatol- pe and orthopaedics in higher medical institutes and in physicians co uing education Institutes functioned in USSR, there were at dist the number rsumatlogy bea a OBS and orthopae en Be MEE OS UP AU eV Treased Significantly. G. V. Gaiko — Doct, of Medical Sciences, Professo, Academician of NAMS of Ukraine, Honored Worker of Science and Technology of Ukraine, laureate of the sig Prize of Ukraine Professor |.G. Gertse” |od of internal stable-functional osteosynthesis was mented into the practice, which enabled to remove ger, S S. Tkachenko, V. P. Okhotskyi, |. M. Rublennik et al.): e@ Modern traumatology and orthopaedics enriched by a new - traction apparatus, which became popular quite quickly. The creator of the method Ilizarov G. A. discovered the biological growth of tissues with the influence of traction, immobiliza- tion of bone fragments on base of dosed distraction instead of compression, which enabled extension of limb with liquidation of dysarthrosis with simultaneous recovery of segment length, elimination of visible bone deformations etc. e Great success was achieved in spine surgery (transpedicular and anterolateral stabilization), major joints (stable-functional osteosynthesis, endoprosthetics of major joints, minimally inva- sive internal joints operations under arthroscopy control), mi- crosurgery and plastic surgery, bone mattery surgery, oncology orthopaedics, recovery treatment and prosthetics. Among our contemporaries the great contribution in develop- ment of traumatology and orthopaedics was made by Volkov M. V., Chaklin V. D., Gorynevskyi V. V., Dubrov N. P., Zacepin V. T., It izarov G. A., Kaplan A. V., Krasnov A. F., Krupko |. L., Cornilov N. V., Kotelnikov G. P., Klyuchevsky V., Miroshnichenko V. F., Sivash K. M., Tkachenko S. S., Tsivyan Y. L., Shaposhnikov J. G., Shapovalov V. M., Shevtsov V. |., Yumashev G. S. and many others. Traumatology and or- thopaedics in Ukraine was glorified by Sitenco M. I., Novachenko M. P., Korzh A. A., Bogdanew F. G., Yaralov-Yalalyants V. A., El'yashberg F. Y., Marks V. A., Shumada |. V., Kolontai Y. Y., Sklyarenko E. T., Reven- ko T. A., Trubnikov V. P. and many others, who founded school of trau- matology and orthopaedics. Professor Khvisiuk Nikolai Ivanovich is one of the founders of Ukrainian vertebrology and creator of Kharkiv Vertebtology School, which has leading position nowadays worldwide. N. I. Khvisiuk studied and explained a syndrome of unstable spine, proved a possibility of reduction of spinal bones in various types and dis- placements (spondylolisthesis, dislocation fractures), developed range of methods of anterior spondylodesis (auto-, allo-, ceramoplastics). Nikolai vanovich was first to begin studying of osteochondrosis features in chil- ‘immobilization (M. Muller, M. Allgower, H. Willeneg- method of external osteosynthesis with compression-dis- Professor M. V. Volkov (Moscow) Professor A. Y. Loskutov Professor V. G. Klimovitskiy Gren and elderly, elaborate classification of spine osteochondrosis, explained a number of treatment meth- ds with distraction, manual therapy, criodestruction, chemonucleosis. of development of traumatology and orthopaedicsN. 1. Khvisiuk and his co-workers developed a number of surgical ap- proaches to spine bones, as a result the monography was published “Surgical approaches to spinal chest and lumbar bones”, which is still a resource book for specialists vertebrologists. In the present time one of the lead- ing center in endoprosthetics of major joints in Ukraine is specialized clinic in Dnipropetrovsk, headed by profes- sor member of NAMS of Ukraine, hon- ored worker of science and technol- fessor N. IKAvisyuk ogy of Ukraine, laureate of state prize of Ukraine Loskutov A. E. In the conditions of high industrial and domestic traumatism In 1956 in Donbas on the base oe trict traumatology hospital the Institute of Traumatology and Orthopaedics was organized, Mt For a long period the Institute was headed by prof. Revenko T. A. In 1996 the Institute WAS include into the Donetsk National Medical University named after Gorkiy M. and it's director was laureate of state award, doctor of medical sciences professor Klimovskiy. A work in large industrial district erable to solve the issues of studying and development of modern first medical aid, used in aid supa fori jured in emergency field and industrial incidents, their frequency is constantly increasing in different de tricts of Ukraine. | No doubt, as time goes by the history of modern traumatology and orthopaedics will enrich iin names of talented scientists and doctors, who will continue commendably the duty of their outstanding predecessors. i Professor G. 4. lary :SY 42_ THEINTRODUCTION TO THE SPECIALTY. THE y ©~* FEATURES OF CLINICAL EXAMINATION OF TRAUMATIC AND ORTHOPAEDIC PATIENTS. LIGAMENTS, TENDONS AND MUSCLES INJURIES. TRAUMATIC DISLOCATIONS CHAPTER Traumatology (from Greek trauma - “injury” and logos - “science”) - the discipline of clinical med- icine, which studies pathogenesis of mechanic injuries of musculoskeletal system and develops meth- ods of its prevention, diagnostics and treatment. Orthopaedics (from Greek orthos - “straight” and paedia - “child’) - the discipline of clinical medi- cine, which studies prevention, diagnostics and treatment of congenital defects, diseases of musculo- skeletal system and acquired deformations, associated with various pathologic processes and injuries consequences. Traumatology and orthopaedics - an independent clinical discipline, concerned with a develop- ment of measures on traumatism prevention, sufferers and patients with mechanical injuries and mus- culoskeletal diseases treatment, as well as with its consequences in peace and war time. The main sections of traumatology and orthopaedics are: e organization of specialized orthopaedics-traumatology aid for injured persons with fractures of limbs bones, pelvis and spine; e elaboration of prophylaxis measures for population traumatism prevention together with state organs of administrative territory management; e the perspective reconstruction-recovery operations technologies development and its imple- mentation in clinical practice; e treatment of ill and injured with complications and consequences of bone fractures, joints traumas and other injuries of musculoskeletal system and implementation of optimal pro- grams of patients recovery treatment in ambulatory and in-patient hospitals practice; e pophylaxis and treatment of musculoskeletal diseases in children and adults. 1.1. METHODS OF CLINICAL EXAMINATION IN TRAUMATOLOGY AND ORTHOPAEDICS The clinical examination of patients with traumas and diseases of musculoskeletal system is the basis of professional occupation of traumatologist-orthopedist. The methodically correct examination | nables to diagnose the diseases accurately, execute medical records (case Teporis) = st, which confirms the legality of doctors’ acts in case of juridical disputable issues snosis accurately and to assess the probability of diagnostic errors occurrence. c “examination must be performed according to concrete acts algorithm, which 4 _ il ST] 1 = My a a = z _ ih ae ri = : r in: TL sg tees ae . 7 ag oe sea ae a 1 ae iowa 5.2 ae ean ipa 4 = 4 a : '- The introduction to the specialty. The features of clinical exam ination of traumatic and orthe paedic p atients.. ca cha WSs OMe tl | ie raat pai =s and diseases (or injuries CONSEQUENCES) o¢ and therefore has a number of feature. ly to specific manual techniques and symp, alized in different ere Ge Sc heae actor HOt OM satures are Conn ected nol | oe Scat A eee Cama Pil or, comparing to the general ¢ | ination methodology itself, used by a doct pains 6 nical eran = Z THE PROCEDURE OF EXAMINATION OF PATIENTS L WITH MUSCULOSKELETAL SYSTEM TRAV The examination of injured persons with “acute trauma’ is based on the general rnp are approved in medicine - those are the knowledge of propaedeutic medicine with ‘ama clinical features taking into account. The clinical diagnosis (from Greek recognition’) ~ 1 yg factor for correct medical aid supply and treatment of traumatology patient. Vv. 9 Maths te notes: “The high quality hospitals equipment with modern apparatuses paradoxically leads to, tion of some doctors, that full clinical examination of patient may be missed. Such acts Cant concerned as correct, as this is more likely a step back rather forward”. i The clinical examination of patients with “acute trauma” has quite accurately elaborated ss which involves collection and study of subjective complaints and objective symptoms of injuries fs conditions of medical examination of injured patients may differ a lot. In this way, the diagnostics injuries in patients with “acute trauma’ is different, as it is time constraint activity, absence oft plete clinical and instrumental examination possibility. It is not always possible to presume ont cooperation with patient, who can be inadequate, aggressive, obtunded or even UNCONSCIOUSNESS. The scheme of traumatology patient examation: 1. Complaints. 2. Anamnesis: e history of present disease (anamnesis morbi) e history of life (anamnesis vitae) 3. Estimation of patient's state: e General visual and physical examination of the patient (status praesens); e Visual examination and checkup of injured area (status localis). 4. Noninvasive additional examination methods resonance imaging, ultrasonic examination, etc.) . Invasive additional examination methods ( } d magi radiography, computed tomography af puncture, arthroscopy, etc.). After examination of the patient the diagnosis must be established _Due to general principles of medical diag | Nostics, the meeting of doctor with patient ee! be determined. aa > > ony fe le ie oy WO] OT com n ie ce ae | | aes oT | :a) ‘simplifies a diagnosis establishing. The set of complaints of patients with injuries ain, claudication, deformation, extremity or spine malfunction, cosmetics defect), so requires specification. On the basic of typical injury symptoms awareness, it is very diet a doctor to be able to emphasize Major complaints, specify its character and onset mo- connection between the movements and strain. The most common complaint of musculoskel- auma patients is pain, which may have variable character. Pain is a defense reaction of the ism or a signal of problem in some of the morphofunctional branches of human organism. It 6 quired to determine its precise localization, irradiation, intensity, duration and connection to a physical activity, body (extremity) position; it must be remembered at the same time, that localiza- tion of the pain may not correspond to injury location. _ {tis important to keep in mind that pain, after executing of its initial defensive-informational role in human organism, changes its direction and becomes a focus of central nervous system activation, the trig- ger agent of neurodystrophic changes development and disorders, and as a result it becomes a cause of physical and psychoemotional drain of the organism. The pain must be fixed, but completely it should be eliminated after the diagnosis establishing. During further examination it is needed to compare patient complaints and objective data, and determine its correspondence. The history of the disease (anamnesis morbi) : " | i Thoroughly and expertly collected anamnesis and patients’ complaints detailing are the basic of ) further treatment and diagnostic process. It is well known, that one who asks properly, determines 7 diagnosis correctly. “The art of anamnesis taking is concluded of skilled distinguishing of all false and | minor information, and detachment of reliable facts, which enables correct diagnosis establishment” (R. R. Verden, 1938). However doctor is not a detective and cannot insist on receiving data, which pa- tient would like to cover. Anamnesis must be taken only with purpose to assist an effective medical aid. The following aspects should be noted: 1. What happened and where it took place? The circumstances of trauma define the further direction of diagnostic research. At the same time determining trauma circumstances as well as the amount and character of first aid, character of extremity immobilization and features of transporta- tion of patient to the hospital has not only medical but also legal significance. All this data, obtained according to words of injured or accompanying persons are written to the case report. The informa- tion given to the doctor about work trauma, road traffic accident, car number plates, names and ap- pearance of people, who made a trauma, sometimes, has a great importance in determining responsi- bility amount of citizens and material damage of the patient assignment. The collecting of such infor- mation and its fixing in medical documents | responsibility of medical stuff, it is important to perform this highly responsibly. “ss heed be ee ~ ee a ee ee ee ee ee ree ee ren Ga! reales een ae Ge ee os 2. How did the injury occurre iod maintains the technique 0 patient fell, what he felt and w to pay attention to the intensity | ser the trauma; whether a mec auma mechanisms on juries. Virtually every a d? Clarification of the mechanism of trauma and duration of posttrau- clinical examination. A doctor has possibility to ascertain in details | hether he could stand up by himself. During patient inquiry, It ts | of trauma agent, position of the patient during trauma, psychical hanism was direct or not. 7 ‘tl ‘on the basics of which it is possible to suppose some oF = natomical area of the musculoskeletal system has its — trauma. So, the knowledge of the injuries helps to direct the alapnes igs 1d avoid many mistakes. : | i a be — 4 7 "a >, ine ie wa : ki : a Ciba md ras tae \F ohh Ai Gin 25 ( ical eva mination of traumatic and orthopacelc Pe3%. Date and time of trauma. information about the time, WHICH WERK TFOM injury ¢ Cp 7 Dc Ancsen diawanetice anid treatment strategies elaboration. So, informatign abou nificantly facilitate diagnostics am ar hour or gradually increased during a woe ay.” My swelling onset (immediately, after tratr-2n® ot of time (more than 2 bs ald ; help to estimate the severity of traumé’ Pac ai of closed reduction hea a om significantly, for instance, the assessment of possibility | P Meements [POStigg ; nerves and tendons suture performance. Medical aid lied | " 4. Character of primary medical aid or treatment. edical aid supp le tO patient jn fea and hours after trauma effects significantly on the clinical performance. In case of SUPPLY of inate. late clinical aid the symptoms related to fu rther complications may Occur - such aS Peripheral 7 or innervation disorders, because of suppression by incorrectly applied dressing, plaster Splint on vesicles formation (phlyctenas) as a result of increasing swelling, perforation of the skin with bu. ment in case of immobilization incompetence, etc. Inversely, on-time reduction and precise 0s bone fragments may significantly affect patient's complaints character, decrease or neutralize the ite of pain. It is important to prepare full description of previous treatment of the patient, follow the sequere modify it. History of life (anamnesis vitae) Regardless of pathology character, commonly, the data and ascertainments are neces (date of birth, personal development, sustained diseases, allergic anamnesis, bad habits, labora lifestyle conditions and others). During examination of orthopaedics traumatology patients it is important to pay special attention to: health condition and diseases which may cause reparative malfunction or its changes ( id thyrotoxicosis, collagenases, tuberculosis, hormonal therapy, climax, pregnancy, oe hazards); a bad habits (especially systemic alcohol and drugs usage) which may lead to osteoporass = | opment of psychiatry and neurological disorder, etc.; ett | previously sustained traumas, their consequences, functional results after end of {62 labor and lifestyle conditions (sports activity), related to microtraumas, increased cantly decreased physical and functional musculoskeletal system workload; allergic reactions, caused by general and local analgesics, antibiotics (as a!U6° most © used in traumatology), and skin diseases (eczema, contact dermatitis); _ previous operations, blood transfusions: e tuberculosis, virus hepatitis, HIV. e Work anamnesis — if patient is not capable of working, it is needed to provide a\ ml | al certificate; in case the Patient is incapacitated for | one period of time it is Fen” Oleic leave certificate and appropriate chan 4 working condition Hs pnpontant i ascertain a social stat us a the patient, which inv a during the treatment, motivation towards recovery ™