Department of Traumatology and Orthopedics 2. Orthopedics

There is rheumatology, which can deal with the same points, but in a therapeutic sense.

Orthopedics is traditionally associated with a section of clinical medicine that studies damage to the musculoskeletal system (bones, joints, muscles, ligaments, tendons) - with traumatology. Immanently, orthopedics and traumatology include prosthetics - a complex medical and technical discipline that deals with the manufacture and use of prostheses and orthoses (corsets, bandages, devices, special shoes and insoles) to restore lost forms and functions of the musculoskeletal system [ ] .

Orthopedics is also an important part of sports medicine. Sports medicine is a complex biomedical science that studies changes in the body during sports, both desirable and pathological. Knowledge in the field of sports and physical education are simply necessary for a modern orthopedic doctor. It is impossible to imagine orthopedics without physiotherapy, massage or physiotherapy, - the components of a science called " medical "rehabilitation", or without branches of medicine that study the structure and treatment of various diseases of the hand - "hand surgery" and feet - "podiatry" [ ] .

As part of traumatology and orthopedics, there are many other narrow specializations, for example: biomechanics of the musculoskeletal system, spine surgery, arthroscopic surgery, joint arthroplasty, bone pathology ... In Russia, traumatology and orthopedics constitute an independent clinical discipline, it is designated by the code of the medical specialty 14.01.15.

An integral part of implant orthopedics in maxillofacial surgery and traumatology is orthodontics.

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Subtitles

Sections of orthopedics

Outpatient Orthopedics

About outpatient orthopedics

Community care institutions are called upon to serve as conduits for the preventive direction of our health care, as they are widely associated with various regional and professional populations. The rational organization of polyclinic care is not only the most important medical, but also a serious social problem.

Berglezov M. A.

From 80 to 96% of patients with an orthopedic-traumatological profile begins and ends treatment in a polyclinic, that is, on an outpatient basis, outside the hospital. This indicates the paramount importance of outpatient services as the most massive. Emphasizing the importance of the outpatient treatment cycle for patients with diseases and injuries of the musculoskeletal system, the term "outpatient orthopedics" is used to refer to the organization of the treatment process in a polyclinic or day hospital (for example, this term is supported by such well-known orthopedists, professors A. F. Krasnov, M A. Berglezov) [ ] .

Examples of conservative treatment are: elimination of contractures and congenital clubfoot with staged plaster casts, reduction of congenital dislocation of the hip, etc. Operative methods of treatment developed in orthopedic surgery include: osteotomy - dissection of bones in case of their curvature or vicious position of the limb, paralysis, tenotomy, ligamentotomy and other plastic surgery. Both with conservative and surgical methods of treatment in orthopedics, therapeutic physical education, massage, physiotherapy, as well as various orthopedic devices are widely used, ranging from different kind insoles, orthopedic shoes and ending with corsets and complex splint-sleeve devices and prostheses (""

Orthopedic stomatology

The field of clinical medicine that studies the etiology and pathogenesis of diseases, anomalies, deformities and injuries of teeth, jaws and other organs of the oral cavity and maxillofacial area, developing methods for their diagnosis, treatment and prevention.

Institutes of Orthopedics

Central Research Institute of Traumatology and Orthopedics. N. N. Priorova

Central Research Institute of Prosthetics and Prosthetics

Turner Research Institute of Pediatric Orthopedics and Traumatology

FGU "Research Children's Orthopedic Institute named after G.I. Turner "Rosmedtekhnologii" is the only specialized medical and scientific institution in the country federal significance to provide assistance to children and adolescents with congenital and acquired pathologies of the musculoskeletal system. Founded in 1932 on the basis of a charitable Shelter for children with paralytic cripples, established in 1890 with the assistance of the great orthopedist - Professor G. I. Turner, the Institute has a unique experience in scientific and clinical work, for success in which and in connection with the In 1982 he was awarded the Order of the Red Banner of Labor. Being the leading institution for the problem of "Children's Orthopedics and Traumatology", during the year the institute's clinic accepts for treatment more than 1.5 thousand children and adolescents with diseases of the musculoskeletal system ) and acquired professional skills in the field of orthopedics and traumatology. In addition to the traditional course of diseases and injuries of the musculoskeletal system, the specialist training program usually includes courses in military field surgery (disaster surgery), clinical biomechanics, prosthetics, sports traumatology, rehabilitation, bone pathology, etc. [ ]

Further specialization of the doctor depends on the direction and traditions of that medical institution where he works and continues his education. This may be the trauma department of an emergency hospital or a surgical clinic (clinic for spinal surgery, endoprosthesis or arthroscopic joint surgery). It could be rehabilitation center, department of rehabilitation treatment of a hospital or an orthopedic sanatorium. However, most orthopedic doctors work in trauma centers, polyclinics, medical centers. The main task of these doctors is the prevention and treatment (in close contact with surgical and rehabilitation clinics) of orthopedic diseases and the consequences of injuries on an outpatient basis. source unspecified 2596 days ] .

Candidate of Medical Sciences, doctor of the highest category, associate professor.

The department was formed in 2011 from qualified doctors specializing in various areas of traumatology and orthopedics. This allows you to cover the entire spectrum of diseases and injuries of the musculoskeletal system.

Our specialists regularly improve their professional level, exchanging experience with leading Russian and foreign orthopedic traumatologists. Every year they attend international congresses and scientific conferences. They are trained in leading clinics, including abroad.

The department operates in a planned and emergency mode 24 hours a day. The intensity of the department's work is an average of 10 operations per day. About 2500 operations are performed per year. There is also an outpatient consultation.

Operations are performed within the framework of state programs for the provision of high-tech medical care (HMP) and compulsory medical insurance (CHI). Contacts have been established with the majority of Russian insurance companies operating under the voluntary medical insurance system (VHI). There is also the possibility of providing paid medical services.

What do we treat

Deforming arthrosis of large joints

Coxarthrosis - arthrosis hip joint.

The operation is a replacement of a diseased, "worn out" joint with an artificial one. In this case, all components of the joint are replaced: the head of the femur, the acetabulum.

Depending on the stage of the disease and the severity of the development of coxarthosis, the traumatologist-orthopedist selects the necessary model of the endoprosthesis.

Gonarthrosis - arthrosis knee joint. In this case, all components of the joint are replaced: the femoral component, the tibial component and the gasket between them made of high molecular weight polyethylene - the meniscus.

Omarthrosis - arthrosis of the shoulder joint. Anatomical arthroplasty allows you to replace all damaged and "worn out" parts of the shoulder joint. In the case when omarthrosis is accompanied by an irreparable rupture of the tendons of the rotator cuff, it is possible to perform reverse joint arthroplasty.

Endoprosthetics is also performed for diseases of the elbow, ankle joints and joints of the feet.

Instability of the knee joint

Our department has accumulated vast experience in performing surgical treatment of knee joint instability.

When plasticizing the ligamentous apparatus of the knee joint, both own tissues and synthetic ones are used using absorbable (biodegradable) material.

An individual approach to each patient, taking into account the level and type of his sports activity, modern equipment and early rehabilitation in the hospital make it possible for patients to return to their usual level of sports and household activities.

As a rule, primary dislocation of the patella is treated conservatively, but requires a competent period of rehabilitation.

In cases where dislocation of the patella becomes habitual, it is required surgical treatment. In order to identify the true causes of patella instability (congenital anatomical features joint) a complete examination of the patient is necessary: ​​radiography, CT, MRI examination. This helps the doctor to develop further tactics and type of surgical treatment.

With fresh ruptures of the menisci, it is possible to perform their stitching using a special suture material. This allows you to save biomechanical function menisci and prevent further development of gonarthrosis.

In case of chronic, degenerative rupture of the meniscus, its partial resection is performed using modern technologies such as cold plasma ablation.

Osteosynthesis, performed through a minimally invasive approach, can reduce pain in postoperative period, accelerate the healing of soft and bone tissues, reduce the likelihood of postoperative complications (inflammation and suppuration in the fracture area).

Stable osteosynthesis used in our clinic, using plates with angular stability, lockable pins, provides reliable fixation of fragments, which allows patients to be activated in the early postoperative period, to reduce the length of stay in the hospital and disability.

Treatment of shoulder instability

Primary dislocation humerus after reduction, as a rule, it is treated conservatively: immobilization for up to 4 weeks, followed by a course of exercise therapy.

With repeated dislocations, stabilization of the shoulder joint is indicated.

Soft tissue stabilization of the shoulder joint ( Operation Bankart), in which damaged intra-articular structures, such as the articular lip, together with the capsule and ligaments, are refixed to the place of their anatomical attachment using biodegradable anchor fixators. This operation is performed arthroscopically, in a minimally invasive way.

With repeated dislocations of the humerus, bone defects of the head of the shoulder and the articular process of the scapula are formed. In this case, it is necessary to fill the deficit of the articular surfaces by performing the Latarjet operation with tansposition of the coracoid process. This operation allows you to reduce the risk of subsequent dislocations to zero.

The rotator cuff is a complex of tendons of four muscles that are attached to the head of the humerus and are involved in the main movements in shoulder joint. With their ruptures and separations, a painful limitation of movements in the shoulder joint develops up to pseudo-paralysis. In these cases, their arthroscopic refixation to the humerus is performed using anchor fixators.

Treatment of adhesive capsulitis or "frozen shoulder"

With ineffective conservative treatment of adhesive capsulitis, surgical treatment is indicated, which consists in arthroscopic excision of the rigid, inflamed joint capsule. To prevent the recurrence of capsulitis, early activation of the patient and the beginning of exercise therapy are important. To do this, a microcatheter is installed in the joint cavity at the end of the operation for the introduction of anesthetics in the early postoperative period. This allows you to start exercise therapy a few hours after the operation.

Dislocation of the clavicle, and as the most common pathology - dislocation of the acromial end of the clavicle, an injury accompanied by a rupture of the ligaments between the clavicle and the scapula and the coracoid process. Depending on the age of the injury, the degree of dislocation of the clavicle, a number of techniques are used that we successfully apply in practice.

A disease characterized by excessive growth of bone tissue around the I metatarsophalangeal joint of the foot.

On initial stages diseases of patients are concerned about swelling, pain in the joint area. With the progression of the disease, the deformity of the foot, pain increases, and difficulties with the selection of shoes appear.

With the progression of the disease, increased deformity and increased pain syndrome we use operational method treatment such as corrective osteotomy. It is aimed not only at the removal of bone growths - "bumps", but also at the correction of the axis and the formation of the arch of the altered foot.

Chevron osteotomy, Scarf osteotomy and correction of hammer toe deformity is a complex operation aimed at restoring the supporting function of the foot.

Treatment of articular cartilage pathology

In our department, it is possible to perform surgical treatment aimed at restoring focal articular cartilage defects, such as:

Mosaic chondroplasty. With this method, the bone and cartilage fragment of the affected area of ​​the joint is replaced by a healthy one, taken from the unloaded area of ​​the joint.

Implantation of a collagen membrane into the area of ​​cartilage defect by the method of autochondrogenesis induced on the matrix.

Microfracturing is a treatment for small defects in articular cartilage in which small holes are made in the subchondral bone to form a blood clot in the area of ​​the defect and release growth factors. Later, fibrocartilage is formed from the blood clot.

Arthroscopy of the hip joint is extremely effective in the treatment of pathologies that inevitably lead to the development of coxarthrosis in the future. The main pathologies are damage to the articular lip and femoral-acetabular impingement.

With early detection and elimination of these pathologies by performing an arthroscopic suture of the articular lip or arthroscopic arthroplasty of the hip joint, it is possible to avoid joint replacement in the future.

Arthroscopy of the elbow joint

Arthroscopy is widely used for the treatment of epicondylitis, contracture of the elbow joint, removal of chondromic bodies, synovial ligament syndrome.

The main function of the biceps brachii is to flex the upper limb in elbow joint and supination of the forearm (turning the palm up).

Tendon rupture most often occurs when trying to lift a heavy object at home or when playing sports, such as weightlifting. Special attention should be given to men over the age of 40

To restore the strength of the injured upper limb, to eliminate the deformity, it is necessary to resort to surgical treatment.

There are several surgical techniques, the basic principle of which is to refix the distal biceps tendon to its anatomical attachment on the radius:

• Anatomic fixation
• Fixing via direct access

The fundamental difference between these techniques is the choice of attachment site on the radius.

When using anatomical technique, the tendon is fixed to the tuberosity of the radius through an additional approach. At the same time, both flexion in the elbow joint and supination are restored.

Factors influencing the development of Dupuytren's contracture can be both traumatic, genetic, and associated with a violation of the body's metabolic processes.

As a rule, the hands are affected. A limitation in the movements of the fingers develops, the quality of life of the patient decreases.

In the early stages of the disease, we use conservative treatment, as well as needle aponeurotomy, a technique that allows you to restore the mobility of the fingers without an incision.

In advanced cases, surgical treatment is used - excision of scar tissue.

Carpal tunnel syndrome is a neurological disorder characterized by prolonged pain and numbness of the fingers.

The reason for its development is the compression of the median nerve by the surrounding tendons in the carpal tunnel.

With ineffective conservative treatment, which includes complex anti-inflammatory therapy, neurolysis of the median nerve is performed. In this case, the transverse carpal ligament is dissected, relieving compression on the median nerve.

Department doctors

The department provides comprehensive rehabilitation of patients with various pathologies of the musculoskeletal system.

The rehabilitation is based on the method of artificial movement correction (ICD) by means of electrical muscle stimulation (ESM), which is a unique way for Russia and the world to restore movement disorders. Artificial correction of movements through multichannel electrical stimulation of the muscles of the back and limbs helps to relieve pain, improve the functional properties of muscles, reduce the deficiency of their function and restore the normal locomotor stereotype.

The ICD method by means of muscle ES is carried out along with rational orthotics for patients with various pathologies of the musculoskeletal system. Individual corsets, prostheses, orthopedic devices are made. It is the combination of the ICD method with orthotics that makes it possible to achieve outstanding results. The combined use of the ICD method and orthotics, as studies show, is optimal.

Rational orthotics with various diseases and injuries can significantly compensate for the deficit muscle function. So with paresis lower extremities orthoses contribute to the restoration of the possibility of independent movement of patients, and when the ICD method is added by means of ES of the muscles while walking, it is essential to replenish the lost functions of the limbs.

In the Department of Traumatology and Orthopedics with orthotics, ER prosthetics rehabilitation treatment with the use of ICD and orthotics was effectively carried out in more than 10,000 patients with various pathologies of the musculoskeletal system:

Spinal osteochondrosis complicated by herniated intervertebral discs and radicular symptoms;

Various forms of scoliosis of the spine;

After operations on the spine (after removal of herniated discs, arteriovenous malformations, congenital hernias, etc.);

Complications manual therapy(dysfixation syndromes, hypermobility syndromes, vertebrobasilar insufficiency);

Any consequences of traumatic injuries and operations on the lower extremities (where there is a deficiency of muscle function and restoration of function is required - locomotion);

Post-traumatic contractures of the joints of the lower extremities;

Paresis of the muscles of the trunk and lower extremities in patients with injuries, cerebral palsy, with the consequences of poliomyelitis, the consequences of spinal circulation disorders;

Compression uncomplicated and complicated fractures of the cervical, thoracic and lumbar vertebrae;

Rehabilitation after knee and hip arthroplasty;

Primary and repeated prosthetics for disabled people with limb amputations;

False joints of the lower leg;

Transverse-longitudinal flat feet. Hallus valgus - surgical treatment and orthotics of patients.

Numerous scientific and practical studies conducted in our institution have convincingly proved high efficiency ICD method in combination with orthotics. The results are widely published both in domestic and foreign scientific publications. At present, we are continuing research aimed at improving the methods of rehabilitation of patients and disabled people.