Orthopedics and Traumatology

Orthopedics and Traumatology centers treat all kinds of injuries, such as fractures and dislocations, and operatively correct congenital (clubfoot, hip dislocations) or acquired deformities.

Arthroscopic (closed method) surgeries are performed for the treatment of knee and ankle diseases. Prosthetic surgery (Arthroplasty) is performed for disorders of the hip, knee, shoulder and elbow joints secondary to arthritis.

Knee and hip prosthesis

Knees are our joints, where orthopedic problems are most common. The reasons are; the longest two bones of our body make joints, the range of motion is too large and there are shallow bone structures, the strength is only provided by soft tissue, and our knees are exposed to more load than other joints. In sports activities, too much force is loaded. Damage to cartilage tissue, a meniscus tear and ruptured ligaments destroy the health of the knee and results in pain, swelling, laxity and locking. A healthy knee does not ache, lock, or swell.

Prosthesis is a good choice for patients who are not considered to benefit from knee arthroscopy and guidance surgery in limbs that do not respond to medication treatment, intra-articular injection and physical therapy, or who have complaints after they have previously undergone such operations. If there is no response to the above alternatives and knee problems decreases quality of life, it is possible to speculate that a knee prosthesis is required. Given the fact that prosthesis can be left in the body up to 20 to 25 years, the concept of life quality is more important than the age of the patient at the surgery. However, for people younger than 55, other treatment modalities should be tried until the end. Other treatment modalities may be advantageous for people at 55 to 65 years of age. It can be easily applied for people older than 65.

The hip joint and the pelvic bone, where the hip join exists, play the key role in standing, walking and running. Along the birth, with a timely and healthy development of the hip joint and the surrounding bones and soft tissues, the quality of life is improved by the hip joints that are pain free and intact range of motion. Patients with congenital unhealthy development of the hip joint or acquired fractures and dislocations often encounter problems like infections, bone erosion, inguinal pain referring to the medial thigh in the presence of tumors, swelling, irregular walking and limited joint motion. Postural disorders, limping, unequal length of legs, limited joint motion, thigh pain, tenderness and swelling are the conditions that should be examined. Patients with such complaints can be cured with early diagnosis and treatment.

Treatment of Childhood Orthopedic Diseases

Developmental Dislocation of the Hip

Dislocation and insufficiency of hip is a neonatal and childhood problem. If the diagnosis delays, children are brought to doctor with complaint of limping. Dislocation of hip in children can be treated, if the condition is diagnosed early. Appropriate treatment implies: The gentle reduction of the hip joint into the cavity without damaging vessels that feed the hip bone. This problem, which will occur after the treatment, leads to late serious disabilities. We should remember the saying “you can lead a horse to water but you cannot make it drink” in this treatment. Even if these patients are late in the treatment, successful results are obtained in unilateral dislocations up to 10-11 years of age and in bilateral dislocations up to 6-7 years of age. However, previous unsuccessful attempts will have negative consequences.

Developmental Dysplasia of Hip (coverage insufficiency)

This condition is not associated with limping that is encountered in the dislocation of the hip. Therefore, it may not be noticed for a long time. They often present with pain referring to the knee. Therefore, it is an insidious disease. Sometimes, the first manifestation is lumbar hernia. The dysplasic hip plays an important role in early-onset arthritis. Early recognition of these patients and treatment before the age of 30-35 prevents early arthritis. This treatment corrects the coverage insufficiency and delays the need to hip prosthesis.

Perthes Disease

The disease is characterized by limping that starts at 2 to 12 years of age secondary to insufficient blood supply to the hip joint. Perthes disease should be considered in a child who limps longer than 7 days with no pain and fever. Severity of the disease varies largely, similar to an earthquake. In some cases, no surgery is required, while the intended recovery may also fail despite operative treatment. There is no consensus on definite treatment of this disease. However, these patients need at least two years of regular follow-up during the recovery period.

Pes Equinovarus (Clubfoot)

A congenital clubfoot can be unilateral or bilateral. Some cases are not true clubfoot and simple massages can correct the deformity. For true clubfoot, after primary health problems of the mother and the infant are solved, casting is repeated at weekly intervals for 6 to 7 times. A minor procedure, also referred to as tenotomy, is 90% of patients. (Ponseti Method)

The success of treatment depends on the harmony of family, child and doctor.

Cerebral palsy

The disease occurs secondary to no or insufficient oxygen supply to brain. This phenomenon may occur when the mother is pregnant or during and after birth for various reasons. This case is not progressive in the brain. However, involuntary contractions that develop in the muscles sometimes lead to disorders of the bones and joints. This can lead to difficulties in meeting the child’s basic needs. Cooperation of Physical Medicine and Rehabilitation and Orthopedics plays an important role in the treatment.

Spina Bifida (Myelomeningocele)

The disease can be diagnosed during pregnancy. Patients present to doctor with urinary and/or fecal incontinence and varying loss of strength in lower limbs depending on the involved level of the spinal cord. The orthopedic approach is to treat the spinal cord and spinal problems as well as to remedy the deformities in the lower limbs and to adapt to the device. Fractures occur easily. It can be confused with inflammation. Sometimes, wounds that heal hardly develop in soles. These problems can be corrected with appropriate orthopedic treatments.

Pes Planus (Flat-foot)

Physiological Pes Planus:

It is also known as flat foot or collapse of arch. Families start worrying about the child who starts walking. Reinforcements and insoles do not work for these children; self-confidence of children is also compromised. The physician should differentiate pain from pathological foot. The operation requires a limited number of patients.

Pathological Pes Planus:

It is associated with stroke, muscle and nerve diseases or congenital bone abnormalities. These patients often require surgery.

Intoeing and out-toeing in children

It is seen in children who start walking. Their parents worry. Family history is usually remarkable. It originates from hip, legs and feet. Children may have a tendency to W-type sitting position or sit cross-legged. Some of these problems will improve over time. Some of the unresolved problems can be corrected surgically. Sports tendency of these children can be addressed in an examination at 3 to 6 years of age.

Soft tissues such as muscles, tendons, joint capsules and cartilage are injured due to abnormal loading. Besides, bone injuries and visceral organ injuries are also seen during severe trauma. There are 639 muscles in our body and they account for approximately 40% of the body weight. There are around 300 bones at birth and 206 bones in adults (some of them fuse over time).

How Should Emergency Approach Be If There Is Sports Injury, How Should a Final Diagnosis Be Made?

The sport must be terminated immediately and the athlete must move out of the playing area. Cold (ice) compress should be applied on the injured body part; however, cold should not be applied on bare skin. Cold compression should be paused for 1.5 to 2 hours following 20- to 30-minute compression. Compression should be performed with an elastic bandage to prevent swelling and the arm and leg should be elevated to the level of heart. Then, a doctor who is specialized in sports injuries should determine the severity of injury by careful examination. The final diagnosis is made with the help of imaging modalities at the hospital. Direct x-rays and computed tomography (CT) are used for the diagnosis of fractures and dislocations in the bones and joints; ultrasound (USG) and magnetic resonance imaging (MRI) are used for the diagnosis of soft tissue injuries.

How is the treatment done?

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Orthopedic and Open Surgical Treatments of Sports Injuries

Resting, bandage and splinting, non-steroidal pain killers and edema-relieving drugs (NSAIDs), regional cortisone injections and physical therapy are at the forefront in minor injuries. Platelet rich plasma injections, which are also very popular in recent days and used in the treatment of professional athletes, are also effective in tissue healing. If the injury is severe, surgical approach is needed. Open and closed (arthroscopic) techniques are used for surgical procedures. Closed (arthroscopic) methods enable clear visualization of intra-articular structures and intervention. Healthy tissues are damaged less and the healing period is shorter.

Successful outcomes are obtained in management of sports injuries after arthroscopic surgery, since the procedure is maintained with physiotherapy and rehabilitation.