10^th International Conference on
Arthroplasty

Orthopedic trauma is a branch of orthopedic surgery concentrating in problems related to the bones, joints, and soft tissues (muscles, tendons, ligaments) of the whole body following trauma. The main goal of this specific area in orthopedics is the healing of the fractured bones, as well as restoring the anatomic alignment of the joint surfaces to allow on behalf of recovery and return to extreme function of the injured body portion. 

Our greatly experienced physicians are leaders in extremity and pelvis fracture reconstruction, deformity correction, and bone transplantation. These physicians utilize various leading-edge techniques including minimally invasive surgery and advanced external fixation. The latest in bone graft substitutes and bone-forming proteins are often used to assist in the reconstruction of bones that need not healed. 

Bone healing, or fracture healing, is a proliferative physiological procedure in which the body facilitates the healing of a bone fracture.

Generally bone fracture treatment consists of a doctor falling (pushing) displaced bones back into place via relocation with or without anaesthetic, stabilizing their position to aid union, and then waiting for the bone's natural healing process to happen.

Adequate nutrient intake has been initiate to significantly affect the integrity of the fracture repair. Age, Bone type, drug therapy and pre existing bone pathology are causes which affect healing. The role of bone healing is to create new bone without a scar as seen in other tissues which would be a structural weakness or deformity.

The process of the entire regeneration of the bone can depend on the angle of dislocation or fracture. While the bone formation usually spans the entire duration of the healing process, in some instances, bone marrow within the fracture has healed two or fewer weeks before the final remodelling phase.

While immobilization and surgery may facilitate healing, a fracture ultimately heals through physiological processes. The healing method is mainly determined by the periosteum (the connective tissue membrane covering the bone). The periosteum is one source of precursor cells which develop into chondroblasts and osteoblasts that are important to the healing of bone. The bone marrow (when present), endosteum, small blood vessels, and fibroblasts are other sources of precursor cells 

Repositioning bone without surgery is "closed reduction." Maximum fractures in children are treated with closed reduction. Serious fractures may need open reduction -- repositioning using surgery. In some cases, campaigns such as pins, plates, screws, rods, or glue are used to hold the fracture in place. Open fractures must also be cleaned thoroughly to avoid infection.

Complications of fractures can be acute or chronic.

Acute complications of fractures are mostly due to initial injury and generally  as a result of the initial trauma and include neurovascular and soft tissue damage, blood loss and localised contamination and infection.

Delayed complications of fractures may occur after treatment and may include malunion, embolic complications, infection and loss of function.

Complications of fractures are affected by fracture site and pattern, type of treatment, patient age, nutritional status, smoking status and alcohol use.

The humerus of the upper arm and the paired radius and ulna of the forearm happen to form the elbow joint, a hinge joint in the upper arm. The bony eminence at the slope of the elbow is the olecranon process of the ulna. The antecubital fossa lies over the anterior aspect of the elbow

Injuries to the elbow are common, generally occur secondary to indirect trauma and are often accompanied by injury to shoulder or wrist joints. It is important to assess injuries promptly and exactly, taking into account age and the mechanism of injury, particularly because of the risk of associated vascular involvement. The elbow extension test is a useful screening tool for bony injury - although not reliable.

Most problems in the shoulder include the muscles, ligaments, and tendons, slightly than the bones. Athletes are specially susceptible to shoulder problems. In athletes, shoulder problems can develop gradually through repetitive, intensive training routines.

Some people will need a tendency to ignore the pain and "play through" a shoulder injury, which only intensifies the condition, and may possibly cause further problems. People also may underestimate the extent of their injury because steady pain, weakness in the arm, or restriction of joint motion will become almost second nature to them.

If a germ gets into a bone or joint it can cause an infection. This can happen over the bloodstream, but many infections arise because of injury, a skin ulcer or surgery. The patients treated by the Bone Infection Part include people with infections of:

• Joint replacements
• Broken bones
• Diabetic foot ulcers

These infections can persist, leading to long-term pain, poor mobility and occasionally wound problems. This is much more likely if:

• The bone has been killed by the infection
• there is artificial material present (for example, a joint replacement)
• there is a persistent wound.

Metabolic bone diseases are disorders of bone strength, generally caused by abnormalities of minerals (such as calcium or phosphorus), vitamin D, bone mass or bone structure. The most common metabolic bone disorder is osteoporosis. When untreated, it can lead to fragility fractures, bone deformities and serious disability. Those at high risk for osteoporosis comprise patients with older age, small body size, history of fractures, steroid use, intestinal infections, organ transplants and kidney disorders.

Men and women of all ages may suffer from skeletal disorders. The most common comprise osteoporosis, osteomalacia, Paget’s disease and parathyroid disorders

 Joint replacement surgery is eliminating a damaged joint and putting in a new one. A joint is where two or more bones come together, like the knee, hip, and shoulder. The surgery is commonly done by a doctor called an orthopaedic (or-tho-PEE-dik) surgeon. Sometimes, the surgeon will not remove the entire joint, but will only replace or fix the damaged parts.

The doctor may suggest a joint replacement to improve how you live. Replacing a joint can relieve pain and help you move and feel better. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows.

A child bone fracture is a medical ailment in which a bone of a child (a person younger than the age of 18) is cracked or broken. About 15% of all injuries in children are fracture injuries. Bone fractures in children are dissimilar from adult bone fractures because a child’s bones are still growing. Also, more consideration needs to be taken when a child fractures a bone since it will affect the child in his or her growth.

Peripheral nerve damage is characterised in the Seddon classification based on the extent of damage to both the nerve and the surrounding connective tissue since the nervous system is characterized by the necessity of neurons on their supporting glia. Unlike in the central nervous system, regeneration in the peripheral nervous system is possible.^] The processes that occur in peripheral regeneration can be separated into the following major events: Wallerian degeneration, axon regeneration/growth, and nerve reinnervation. The events that occur in peripheral regeneration arise with respect to the axis of the nerve injury. The proximal stump refers to the end of the injured neuron that is still attached to the neuron cell body; it is the part that regenerates. The distal stump refers to the end of the damaged neuron that is still attached to the end of the axon; it is the part that will degenerate but remains the area that the regenerating axon grows toward.

Forearm fractures account for maximum limb fractures. Wrist fractures are the most common forearm fracture. Fracture risk factors include osteoporosis (more common in women than in men) and malignancy (pathological fractures). Fractures of the radius and ulna might occur in isolation - usually due to a direct blow - but these are usually associated with fracture or displacement of the other bone in that forearm. An epidemiological study in Denmark found that 4 out of 5 forearm fractures were treated conservatively.

The hand is a very complex organ with various joints, different types of ligament, tendons and nerves. With continual use, it is no wonder that hand disease injuries are common in society. Hand injuries can result from extreme use, degenerative disorders or trauma.

Trauma to the finger or the hand is quite common in society. In some particular cases, the whole finger may be subject to amputation. The majority of traumatic damages are work-related. Today, skilled hand surgeons can sometimes reattach the finger or thumb using microsurgery. Sometimes, traumatic injuries may result in loss of skin, and plastic surgeons may place skin and muscle grafts.

Your hips are strong and constant when healthy, but injury and certain conditions, like osteoarthritis and osteoporosis, both common in older adults, may affect the health of the hips.

For athletes, playing sports, running, falling, heavy effect and overuse can lead to hip strains, hip pointers, hip bursitis and something called femoroacetabular iimpingement (FAI).

Your thighbone (femur) is the longest and toughest bone in your body. Because the femur is so strong, it usually takes a lot of force to break it. The long, straight part of the femur is called the femoral shaft. When there is a break everywhere along this length of bone, it is called a femoral shaft fracture.The emergent management of femur injuries in the sports setting is intended to restore alignment. If limb deformity is existing, inline longitudinal traction is applied, realigning the extremity and maintaining limb perfusion. 

The knee is the largest joint in the body, and one of the most easily injured. Your knee is a complex joint with many components, making it vulnerable to a variety of injuries. Many knee injuries can be successfully treated with simple procedures, such as bracing and rehabilitation exercises. Other injuries may require surgery to correct. It is made up of four main things: bones, cartilage, ligaments, and tendons.

• Bones. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella).
• Articular cartilage. The ends of the femur and tibia, and the back of the patella are enclosed with articular cartilage. This slippery substance helps your knee bones glide smoothly across each other as you bend or straighten your leg.
• Ligaments. Bones are connected to other bones by ligaments. The four main ligaments in your knee act like strong ropes to hold the bones together and keep your knee stable.
• Tendons. Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of your thigh to your patella. Stretching from your patella to your shinbone is the patellar tendon.

Foot, leg, and ankle swelling is similarly known as peripheral edema, which refers to an accumulation of fluid in these parts of the body. The buildup of fluid usually isn’t painful, unless it’s due to injury. Swelling is often other apparent in the lower areas of the body because of gravity.

There are many potential causes of foot, leg, and ankle swelling. In most cases, swelling occurs as a result of definite lifestyle factors, such as:

·         Being overweight: Excess body mass can decrease blood circulation, causing fluid to build up in the feet, legs, and ankles.

·         Standing or sitting for long periods: When the muscles are inactive, they can’t pump body fluids back up toward the heart. The retention of water and blood can cause swelling in the legs.

Hand infections can cause severe problems that continue even after the infection has resolved, such as stiffness, loss of strength, and loss of tissues such as skin, nerve and bone.  Thus, early and aggressive treatment of infections is essential.  When seen early, some kinds of infection can be treated with antibiotics and local rest and soaking.  However, many infections begin to cause severe problems, after a day or two, if not treated with antibiotics, surgical drainage, and removal of infected tissues. Rarely, a hand infection can be affected by an “atypical mycobacterium.”  One of the more common types, Mycobacterium marinum infection.

Disorders are ailments, injuries or diseases that cause knee problems, whiplash, dislocated shoulder, torn cartilages, foot pain and fibromyalgia. These are only a few of the known orthopedic disorders. There are as various treatments for orthopedic disorders as there are problems and injuries in the muscles, ligaments and joints.

Pelvic fracture is a disorder of the bony structure of the pelvis, including the hip bone, sacrum and coccyx. The most common cause in the elderly is a fall, but the most significant fractures include high-energy forces such as a motor vehicle crashes, cycling accidents, or a fall from significant height. Diagnosis is made on the basis of history, clinical features and distinctive investigations usually including X-ray and CT. Because the pelvis cradles so many internal organs, pelvic fractures may produce significant internal bleeding which is invisible to the eye. Emergency treatment contains of advanced trauma life support management. After stabilisation, the pelvis may be surgically reconstructed.

Tuberculosis affects predominantly the lungs and gastrointestinal tract, but may also infect the musculoskeletal system. There is caseating granulomatous inflammation with bone necrosis, resulting in the damage of bone.

Extension of the TB osteomyelitis into joint spaces results in tuberculous arthritis. The infection crosses to the bone on the other side of the joint.

An intervertebral disc disorder is a condition that includes deterioration, herniation, or other dysfunction of an intervertebral disc.

As people age, the nucleus pulposus begins to dehydrate, which limits its ability to transfer and distribute loads among the vertebrae. These loads are instead transferred non-uniformly through the anulus fibrosus, which undergoes progressive, structural deterioration. While this may not effect pain in some people, in others one or both of these may cause chronic pain.

Pain due to the inability of the dehydrating nucleus pulposus to absorb shock is called axial pain or disc space pain. One generally refers to the gradual dehydration of the nucleus pulposus as degenerative disc disease.

Lower back pain can be initiated by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:

• The excessive nerve roots in the low back that go to the legs may be irritated
• The smaller nerves that supply the low back may be irritated
• The large paired lower back muscles (erector spinae) may be strained
• The bones, ligaments or joints may be broken
• An intervertebral disc may be degenerating

Arthritis is a term regularly used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types additional organs are also affected. Onset can be gradual or sudden

There are over 100 types of arthritis. The most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis. Osteoarthritis usually arises with age and affects the fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that frequently affects the hands and feet. Other types include gout, lupus, fibromyalgia, and septic arthritis. They are all types of rheumatic disease. 

Primary osteoarthritis is commonly related to aging. With aging, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Repetitive use of the joints over the years causes damage to the cartilage that leads to joint pain and swelling. 

Cervical spondylosis is a general term for degeneration of the structures in the cervical (neck) region of the spine. The seven cervical vertebrae create the top portion of the spine—the long, flexible column of bones that supports the skeleton and protects the spinal cord. Flat, circular pads of cartilage known as intervertebral disks serve as cushions among the vertebrae and allow for smooth movement.

Arthroscopy (also called arthroscopic surgery) is a significantly invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is injected into the joint over a small incision. Arthroscopic procedures can be performed to evaluate or treat many orthopaedic conditions including torn cartilage (known by health professionals as "meniscus"), torn surface (articular) cartilage, ACL reconstruction, and trimming damaged cartilage.