Adobe Systems Výsledek obrázku pro TLSO orthosis scheuerman ̶weakened / lost function ̶Orthoses: ̶mass produced vs. individual ̶trunk vs. extremities = restoration of lost body functions Ortotics dávka 023 dávka 022 davka 024 Adobe Systems ̶Static: ̶Rigid without movement, relieve pain, stabilize the limb ̶Dynamic: ̶Controlled movement, they replace lost or weakened functions of muscles and joints Ortoses: Adobe Systems Ortotses: Obsah obrázku oblečení, nošení, černá, ochranný oděv Popis byl vytvořen automaticky Adobe Systems Obsah obrázku text, oblečení Popis byl vytvořen automaticky Adobe Systems ̶Walkers: walking practice : Limb motion trainers, eg. after operations Support devices Adobe Systems ̶four-point, French, children's elbow crutch, ̶armpits, walking sticks ̶height-adjustable, folding walking sticks Crutches: support function Support devices HIP JOINT & FEMUR Adobe Systems 9 Adobe Systems •6% of all fractures •2 typical groups – –females, older age (max. about 78 yrs), minimum stress –males, younger, high energy injury – traffic accidents, falls •diagnostics – –anamnesis –clinical exam – external rotation, shortening, pain during motion –X-ray – pelvis + injured hip •2 types – –intracapsular – subcapital, mediocervical, transcervical –extracapsular – basicervical, lateral 10 http://www.achot.cz/detail.php?stat=427 Adobe Systems Výřez obrazovky 11 Adobe Systems 12 Výřez obrazovky Výřez obrazovky http://slideplayer.fr/slide/508571/ https://www.aofoundation.org/Structure/resource/AO-OTA-Fracture-Dislocation-Classification/Pages/AO -OTA-Fracture-Dislocation-Classification-Long-Bones.aspx Adobe Systems Conservative ̶Without dislocation + impact fractures ̶Short life expectancy ̶immobile pts before injury ̶Contraindication of surgery ̶ Bed rest with gradual carefull physiotherapy ̶ 13 Adobe Systems Osteosynthesis ̶Non dislocated a partially dislocated fract. without degenerative arthritis ̶dislocated fract. In young pts without degener. arthritis ̶ Options ̶DHS (dynamic hip screw) ̶Lag screws ̶PFN (proximal femoral nail) ̶130° condylar plate + lag screw 14 Adobe Systems 15 https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/F urtherReading/PFxM2/6_6_1-10a-c.gif https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/F urtherReading/PFxM2/6_6_1-11.gif https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/F urtherReading/PFxM2/6_6_1-12a-b.gif valgisation osteotomy, AO plate – Abandoned Adobe Systems 16 http://www.med.wayne.edu/diagradiology/RSNA2003/DHS-DRH.JPG http://upload.wikimedia.org/wikipedia/commons/2/2b/Cdm_hip_hardware_369.jpg CHS Dynamic hip screw 1962 Massie Richard Manufacturing Co., USA Adobe Systems 17 Figure 5A: Gamma nail migration into the pelvis http://synapse.koreamed.org/ArticleImage/1147HP/hp-24-117-g004-l.jpg http://ars.els-cdn.com/content/image/1-s2.0-S0020138399000911-gr1.jpg Adobe Systems 18 Výřez obrazovky Adobe Systems ̶Alloplasty ̶Older pts with degenerative arthritis ̶dislocated fract ̶Longer time span after inj ̶Head avascular necrosis or pseudoarthrosis ̶ ̶Options ̶CKP ̶THA 19 Výřez obrazovky Výřez obrazovky F, 86 yrs 20 Adobe Systems M, 80 yrs 21 Výřez obrazovky Výřez obrazovky Osteosynthesis of the femur 22 Adobe Systems OS with plate + screws femur_dlaha femur_dlaha2 51f004 23 Adobe Systems OS w. intramedelar nail femur_hreb 51f101 24 Adobe Systems 51f102 51f060 50f032 25 Adobe Systems Hip degeneration Osteoartrosis = non-inflammatory degenerative joint disease characterized by degradation of articular cartilage hips, knees, arms and small joints of the spine Osteoartrosis Signs: •narrowing of the joint space •loos of bone mass & sclerotization •soft tissue changes Coxartrosis Gonartrosis image_artrosis Coxartrosis, Gonartrosis Risc factors: Age Sex Genetic predispozition Trauma Obesity Coxartrosis, Gonartrosis Therapy: Regime measures (activity, adequate body weight) Farmakologic (analgetics, chondroprotectives) Surgical Coxartrosis, Gonartrosis Therapy: Surgical – Total Joint Arthroplasty (THA / TKA). C:\Documents and Settings\rdcuser\My Documents\My Pictures\artrosis\knee_arthroplasty_intro01-cor.jpg Adobe Systems ̶ C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery01.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery02.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery03.jpg THA C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery06.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery05.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\HIP\hip_arthroplasty_surgery04.jpg CoCrMoMetallkopf lesteny-1 trilogy_acetabular_cup2 uk_pic_cement Adobe Systems nar. 1952, objednán na TEP 34 Adobe Systems nar. 1980, posttraumatic osteoarthrosis 35 36 Adobe Systems Uncemented THA - stem c tephiup07f0f19 tephiup07f01b9 tephiup07f01d9 37 Adobe Systems tephiup07f0ff19 tephiup07f01e9 38 Uncemented THA – cup Adobe Systems 39 Adobe Systems hybrid THA cemented THA 40 Adobe Systems nar. 1935, 14 let poop., bez opotřebení jamky (Poldi Kladno) 41 Adobe Systems nar. 1932 po předělání jamky i dříku 42 43 Adobe Systems Revision – Burch-Schneiderova augmentaplate 44 Dislocation of endoprosthesis -the patient is at risk at any time, even years after surgery - -necessity to comply with the regime measures postoperatively !! 45 Adobe Systems 07f114 46 fig13bkhiami Adobe Systems Solution of hip THA complications luxation: qarticulation without / with anesthesia, surgery qorthosis, event. plaster spike qreoperation (replacement of components) qTEP extraction q qinfection qflush drainage, antibiotics qtemporary removal of TEP, rinsing or carrier with antibiotic, possibly. spacer qpermanent removal of the endoprosthesis 47 Infect - septic release of the endoprosthesis 48 Adobe Systems Infection loosening of THA qspacer (cement with gentamicin) introduced after extraction 11 P1090041 78 49 79 Extraction of THA SPACER 78 80 reimplantationce THA uncemented 50 Adobe Systems Extracted THA 602 skenovat0002 51 ̶ Adobe Systems Periprotetic fx. 07f120 52 Adobe Systems 53 Adobe Systems Meralgia paresthetica ̶Compression of the cutaneus femoris lateralis during passage to the thigh in the fibrous canal of the fascia lata medially from SIAS ̶Burning pain and ̶ hypesthesia on the external ̶ thigh area ̶Disposition - obesity, tight clothing ̶Therapy - regime measures, ̶NSAID, cortioid injection, ̶(surgical resection) ̶ Pyriformis syndrom =iritation of n.ischiadicus rare nerve compression by m.piriformis rigid fibers as it passes through the foramen infrapiriforme Buttock pain, tingling with propagation along the back of the thigh and lower leg Adobe Systems ̶ Výsledek obrázku pro piriformis syndrome Výsledek obrázku pro piriformis syndrome Výsledek obrázku pro piriformis syndrome exercise Bursitis and enthesopathy in the hip area Entezopatie- ischiální burza Trochanter maior Tuber ossis ischii Bursa ileopectinea Gracilis syndrom (natažené tříslo) Spina iliaca ant. sup. Spina iliaca ant inf. Kyčel-cévy,burzy1 Obr. 9 Obr. 10 KNEE Soft tissues injury of the KNEE 60 NMR examination 61 ACL – anterior cruciate lig. PCL – posterior cruciate lig. 62 Adobe Systems nmr_knee_1 Akutní ACL poranění - diagnóza: artroskopie NMR vyšetření v celkové anestezii Rupture of ACL 63 Adobe Systems unhappy_triad Unhappy trias: anterior cruciate - rupture medial collateral - rupture mediální meniskus - rupture Injury of the soft tissues of the knee 64 Adobe Systems knee_anat3 Injury of the soft tissues of the knee - meniscal tear 65 Adobe Systems menisk5 menisk_rpt1 66 Adobe Systems menisk1 menisk2 67 Injury of the soft tissues of the knee - meniscal tear Adobe Systems menisk6 Normal meniscus 68 Injury of the soft tissues of the knee - meniscal tear Adobe Systems Artroskopie - meniskus 48c003 69 ACL reconstruction 70 Adobe Systems acl_anat1 knee_anat993 Injury of the soft tissues of the knee ACL rupture 71 Adobe Systems acl_rpt3 acl_rpt4 72 Injury of the soft tissues of the knee ACL rupture Adobe Systems lachman2 Lachman test – ventral drawier test in 30° flection 73 Injury of the soft tissues of the knee ACL reconstruction Adobe Systems Injury of the soft tissues of the knee ACL rupture 74 The most difficult diagnosis is in the acute phase! In 70% of cases of joint bleeding, the anterior cruciate ligament is injured Acute arthroscopy or long-term follow-up Indications for cruciate ligament surgery are limited Adobe Systems 1.autograft (bone-tendon-bone graft from ligamentum patellae, or tendon graft) 2.Alo- graft (cadaver) 3.artificial material (dacron, ribbon) 4.xenograft (animal graft - abandoned) 75 Injury of the soft tissues of the knee ACL rupture Reconstr. with m. semitendinosus autograft 76 Injury of the soft tissues of the knee ACL reconstruction Adobe Systems acl_rpt_plast2 acl_rpt_plast3 acl_rpt_plast4 77 „GOLD standard“ = bone-tendon-bone (BTB) graft from ligamentum patellae Injury of the soft tissues of the knee ACL reconstruction Adobe Systems acl_rpt_plast1 B-T-B graft 78 Injury of the soft tissues of the knee ACL reconstruction Adobe Systems acl_rpt_plast5 acl_rpt_plast6 acl_rpt_plast7 79 Injury of the soft tissues of the knee ACL reconstruction Adobe Systems nar. 1971, 14 let po plastice ACL, artrotické obtíže. 80 Adobe Systems nar. 1944, po plastice 15 let 81 Adobe Systems nar.1969, bilat. plastika ACL před mnoha lety 82 Adobe Systems 010 83 Adobe Systems 011 84 Adobe Systems 012 013 85 Adobe Systems 018 019 86 Adobe Systems 020 87 Adobe Systems Postoperative fixation – LIMITED MOTION CAST 022 88 Adobe Systems Degenerative knee disease 89 Gonartrosis- TKA C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery04.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery05.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery06.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery07.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery08.jpg C:\Documents and Settings\rdcuser\My Documents\My Pictures\knee\knee_arthroplasty_surgery09.jpg TKA Adobe Systems tepknee06f012 06f006 06f014 tepknee06f011 92 Adobe Systems DSC_0013 DSC_0010 TKA instrumentarium 93 ̶ Adobe Systems tep2 94 TKA instrumentarium Adobe Systems tep1 tep3 Total knee arthroplasty implantation 95 Adobe Systems tep6 tep5 96 Total knee arthroplasty implantation Adobe Systems DSC_0034 97 Total knee arthroplasty implantation Adobe Systems DSC_0036 98 Adobe Systems DSC_0041 99 Adobe Systems 100 Adobe Systems 101 Adobe Systems 102 Adobe Systems Complications of TKA qtechnical error during operation qnerve paresis after surgery (n. peroneus) qvascular postoperative complications qknee instability after surgery qdeep infection early or late qrestriction of movement (stiffness) qaseptic release of components qwear of the tibial component 103 Adobe Systems 26.09. 07.11. 104 Adobe Systems 26.09. 07.11. 105 Adobe Systems CT scan of TEP with signs of tibial component loosening 106 Adobe Systems CT scan of TEP with signs of tibial component loosening 107 108 Adobe Systems 109 Adobe Systems Ortosis after TKA - indications qsolution of knee instability qadditional treatment during suture of the ligamentum patellae 0025 110 Adobe Systems TKA - failure P3130251 P3130238 111 Adobe Systems P3130249 P3130247 112 Adobe Systems P1169813 P1169817 P1169818 P1169806 Unicondylar TKA - failure 113 Adobe Systems 114 Bursitis praepatelaris Bursitis pedis anserini Bakerská cysta Entezopathie- bursitis kolena Bursitis in the knee area Therapy: rest puncture + loc. Corticosteroids NSAID extirpation Obr. 11 Obr. 12 Entezo- Baker 2 Baker‘s cyst Burza gastrocnemio- semimembranacea connects to the articular cavity of the knee Arching in the fossa poplitea In adults, it is secondary to the process inside the knee Swelling, tension, pain Restrictions on movement Oppression of venous trunks Therapy: Conservative- puncture, corticoid, NSAID Operational extirpation Entezo- Baker cysta1 Adobe Systems Patelofemoral syndrome Achillodynia Noha- ŠA2 Painful condition in progress and the attachment of Achilles' tendon Causes: Degeneration Haemorrhage, cracks Peritenonitis Risk of transition to partial or complete ruptures Achillodynia Noha- ŠA3 Conservative treatment: Calmness, taping, antiphlogistics Heel increase Physiotherapy Immobilization Prohibition of corticosteroids Surgical treatment: Peritenonectomy Excision of necrotic tissue