Professional Documents
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Curs 1 - Engl
Curs 1 - Engl
Orthopaedics and
Traumatology
The human skeleton contains
206 bones, 360 joints, 640
muscles
Long bones, flat bones
Long bones have two
epiphysis, one diaphysis and
two metaphysis with two
growth plates during childhood
Orthopaedics and
Traumatology
The term Orthopaedics is derived from the Greek words
orthos ("correct", "straight") and paidion ("child")
Orthopaedics deals with chronic diseases of the ostheo-
articulary system : deformities, arthrosis, infections,
tumors, etc.
Traumatology deals with acute diseases of the osteo-
articulary system: fractures, sprains, dislocations and
contusions.
Functions of the skeleton :
Esthetic
Mecanical and locomotion: protect soft structures
(heart, lungs, brain), mobility and the sense of hearing
Hematopoetic: bone marrow
Metabolic
Systemic depository for Ca and PO4, growth
factors
Regulates systemic pH by absorbing or eliberating
alkaline salts
Detoxifying by absorbing heavy metals
General notions about fractures:
Paraclinical investigations:
• RX = anterior-posterior and lateral views = golden
standard!!!
• CT
• MRI
• Ecography
• Artrography
General notions about fractures:
• General :
• Venous ThromboEmbolism (VTE requires
prophylaxy!)
• Pulmonary Thromboembolism (fatal)
• Fatty embolism
• Shock
• Decompensation of any chronic dieseases
Complications:
• Local :
Immediate:
- Open of fracture site
- Blood vessel injury
- Nervous injury (neuropraxis, axonotmesis,
neurotmesis)
• Associated lesions (dislocation, articular fractures)
Complications:
1. Inflamatory phase
2. Bone repair = fibrous callus, primitive
bony callus
3. Bone remodelation
1. Inflamatory phase (24-72h)
Metaphyseal
vessels
Bone
vascularisation
– They enter the bone through the thin cortical present in the
metaphyseal region and form an anasthomosis with the
intramedular vascular network
Mechanisms of bone healing
Contact healing
Direct contact of the fractured bone segments forms
lamelar bone tissue.
Healing by diastasis
A diastasis smaller than 200-500 microns is filled by
non lamelar bone tissue that is subsequently molded
into lamelar bone tissue
A bigger diastasis in indirectly healed - > it is partially
filled with fibrous tissue that is subsequently ossified
Direct bone healing
B. Indirect bone healing
Healing mechanish for
fractures that are not rigidly
fixed
Soft periostheal callus that
acts as a bridge and hard
medular callus reestablish
bone continuity
The callus thus formed in
followed by an endostheal
ossification
Relatively fast process – takes
weeks
Umoral factors that regulate the bone
healing process
1. Growth factors
2. Cytokines
3. Prostaglandines/Leucotrienes
4. Hormones
Anatomical factors that influence bone
healing
Malnutrition
Diminishes osteocondral cells activity and proliferation
Inhibits callus formation
Smoking
Inhibits the osteoblasts
Nicotine determines vasoconstriction that restricts local
bloodflow to the fracture site
Sistemic factors that affect bone
healing
Diabetes
– Associated with collagen defects, organic matrix
decrease, inefficient fibrilar connections and collagen
subtypes proportions alterations
Fracture treatment
1. Closed reduction
2. Plaster or continuous extenstion for immobilisation
3. Rehabilitation
Fracture treatment