WHAT IS ORTHOPEDICS AND TRAUMATOLOGY?
The word orthopedics was first used in 1741 by the French physician Nicholas Andre, and it means "uniform child" in Greek. Andre named the book he wrote Orthopedia and defined orthopedics as "the art of preventing and correcting deformities in children". Orthopedics and Traumatology deals with the movement system; that is, the bone structure, muscles and joints of the arms, legs, pelvis and spine. In the modern sense, we can define Orthopedics and Traumatology as follows: It is a medical specialty that includes the preservation of the shape and functions of the movement system and, if impaired, its physical and functional correction with medical and surgical methods.
Orthopedic examination begins with the patient entering the room. The examination is carried out in a certain order.
A good history substantially leads the physician to the diagnosis.
Pain is the most common complaint. Decreased joint movements, deformity and weakness are other common complaints.
Development, progression of complaints, factors that reduce or increase it, injuries, work habits and sports activities are thoroughly investigated in the history.
Systemic diseases are questioned. Family history is important in terms of hereditary diseases.
2. CLINICAL EXAMINATION
The general rule is naked and symmetrical examination. In addition to the general appearance, stance and gait of the patient, the region of complaint and related regions are examined.
A- Examination of the affected area:
- Visual examination (inspection): Abnormal posture and appearance disorder (deformity) is evaluated. Discoloration, scars and wounds on the skin are investigated.
- Examination by touching (palpation): Local sensitivity, temperature changes, masses in soft tissues can be understood by touching.
- Joint movements examination: Active and passive movements of the joints are measured. The stability of joints and whether there is abnormal movement is checked.
- Measurements: The circumference of the affected side and the healthy side is measured so that muscle loss or swelling is assessed. Shortness or length is evaluated by measuring the heights of the affected side and the healthy side.
- Neurological examination: Muscle strength, sensory and reflex examinations are performed.
- Circulation: Color of the extremity, capillary circulation and pulses are examined.
- Lymphatic system: Examination of lymph tracts and lymph nodes is important, especially in cases of tumor and inflammation.
B- Examination of the regions where complaints may arise:
Sometimes patients present with complaints in regions far from the main complaint area. For example, a patient with hip disease may present with knee pain, and a patient with neck disease may present with elbow and wrist pain. Therefore, it is very important to inspect the relevant remote regions as well.
When the examination of the patient is completed, the necessary evaluation is made, and laboratory examinations are made for definitive and differential diagnosis. Many diagnostic examinations are performed in orthopedics. The most commonly used of these are direct radiographic examinations.
·Direct Radiography: It is requested as 2-way. In some special cases and pediatric pathologies, radiographs of the healthy side may be requested for comparison.
- Computed Tomography (CT): It is a frequently used diagnostic tool in the evaluation of pelvis, spine pathologies and bone tumors.
- Ultrasonography (USG): It is useful in the evaluation of soft tissue pathologies.
- Magnetic Resonance Imaging (MRI): It is the imaging tool that best determines bone and soft tissue pathologies according to their anatomical location.
- Bone Scintigraphy: It should be evaluated together with other diagnostic tools. It is sensitive in localizing lesions.
1. Cases that do not require treatment:
Some developmental disorders and some congenital disorders do not require treatment.
2. Conservative treatment:
- Rest: Rest of the whole body or the diseased area.
- Supports and devices: Corsets, devices and casts used to support the joints, prevent and treat deformities.
- Physical therapy applications.
3. Surgical treatment:
A) Bone surgeries:
- Drainage, opening of the bone cover, intraosseous scratching.
- Osteotomy: Cutting the bone: For angular correction, correction of joint disorders, shortening, elongation.
- Bone fixation: Bone fragments are kept fixed by means of wire, screw, plate-screw, nail, external fixator, etc.
B) Joint surgeries:
- Arthrotomy: Opening the joint.
- Arthroscopy: Visual optical evaluation and treatment of the joint
- Arthrodesis: Immobilization of the joint.
- Arthroplasty: Operations that give back the joint the function lost: Resection arthroplasty, interposition arthroplasty, replacement arthroplasty (total or partial prosthesis).
C) Soft tissue surgeries:
- Myotomy (cutting muscle),
- Tenotomy (cutting the tendon),
- Tenoplasty (tendon elongation),
- Capsulotomy (opening the capsule),
- Tendon transfers.
- Deformity corrections,
- Tissue transplantation,
- Prosthesis applications.