Rheumatologist v/s Traumatologist? Who should I go to?

My knee hurts, my hip hurts, my joint hurts, should I go to the traumatologist? Even today many people believe so, although that would be the same as a person suffering from chest pain and cough go to the heart surgeon to operate. Which is the right specialist?

The bone specialist

The idea that the "bone specialist" is the traumatologist is still deeply rooted. This ignorance and confusion are partly explained by the fact that rheumatology is one of the most recent medical specialties in internal medicine in our country, not being recognized as an independent medical specialty until a few decades ago. Until then, the treatment of disorders of the locomotor system had fallen on traumatologists and orthopedic surgeons, although, in most cases, patients would not need surgical treatment.

The appropriate and logical process in all diseases and disorders of the joints should be as follows: general practitioner, to identify the possible disease, rheumatologist, to apply pharmacological and non-pharmacological treatments, and, ultimately, the orthopedic traumatologist to perform surgical interventions. The rheumatologist is the appropriate specialist to diagnose and treat locomotor disorders such as osteoarthritis by non-surgical means. Following the example of osteoarthritis, only as a last option, the rheumatologist will refer his patients to the surgery specialist to treat osteoarthritis by means of hip or knee prostheses.  Go to the physiotherapist it is also an error since the physiotherapist is generally responsible for applying the treatment, not to diagnose the disease or to determine the treatment to follow.

Traumatologists and rheumatologists how are they different?

The rheumatologist is the medical specialist who diagnoses and treats diseases of the locomotor system and is the first specialist to assess, diagnose and treat such diseases , while the orthopedic surgeon is a specialist in the field of surgical or orthopedic treatment of diseases of bones, tendons or joints, whether traumatic (strokes, sprains) or congenital, or to surgically intervene the consequences that medical treatment could not prevent in rheumatic diseases. To put it in a simple way: the rheumatologist is the doctor and the traumatologist is the surgeon.

It is necessary to carry out awareness-raising among the population as this will surely result in better health care for patients. So, when asked if " my knee hurts " or " my hip hurts when walking ", the answer is clear: the rheumatologist.

Orthopedic Implants and Its Types

Get completely familiar with Orthopedic Implants and its types

Orthopedic implants are mainly stainless steel and alloys containing titanium, which makes them ideal for strength parts to be performed, also lined with plastic go to this act as an artificial cartilage. Few orthopedic implants which are cemented in place, most are pressured to adapt so that the bone can grow into the implant to give strength to the implant itself.

There are several reasons why orthopedic implants are necessary, osteoarthritis is the main reason of orthopedic implants. Also, called degenerative joint disease, osteoarthritis causes the worn cartilage product generates much pain contact makes the bone to move. The fact that cartilage down occurs as a result of excess body weight and / or lack of motion of the joint. 

In case, only when all nonsurgical treatments have been tried and have failed, including the most important thing is to weight loss, attending doctor will suggest orthopedic implants as an alternative.

There are advantages and disadvantages of orthopedic implants, the important point to be considered is that different manufacturers differently design orthopedic implants. This means that manufacturers use different theories to develop implants for each type of specific application.

Orthopedic implants not only returns you the quality of life for the patient who receives it , but also helps increase mobility and reduce pain. It is considered that after surgery should follow a very strict plan of recovery and can lead to infection and even having to overcome a possible malfunction of the implant, these are some of the disadvantages of orthopedic implants.

Adding Gold to Titanium Enhances Orthopedic Implants

A great achievement in the orthopedic world : 

From recent studies, it has been proved that an intermetallic compound of titanium and gold with a certain atomic structure imparts increased hardness to artificial joints.

the β-Ti3Au compound shows hardness values about four times higher than in pure Ti and most steel alloys, shows a reduced coefficient of friction and wear, and biocompatibility, which relates to the optimal attributes for orthopedic, dental and prosthetic applications of the joint. Further, it also has advantages of having the ability to adhere to ceramics, which can reduce both the weight and cost of medical components.

According to the researchers, a fourfold increase in the hardness of β-Ti3Au, in comparison with other Ti-Au alloys, can be associated with an increased density of valence electrons, a reduced bond length, and pseudogap formation. The specific mechanism that gives the ultra-hardness of the β-phase of the compound is due to relatively high temperatures, which gives an alloy with an almost pure crystalline form. At lower temperatures, the atoms are organized in another cubic structure - α-Ti3Au, which has the same hardness as ordinary titanium.

Stainless Steel Vs Titanium Medical Devices

As, we all know that an implant is a device helping to replace a biological structure that has been damaged due to trauma or bone or cartilage disorders (e.g hip prosthesis). Medical implants may also be used for cosmetic purposes such as breast implants. This blog is all about metal surgical implants and their application.

The most common metals used for surgical implants include:

Stainless steel

The application of stainless steel has stainless steel implant continued in surgical practice since the early twentieth century. There are many forms of stainless steel starting with the introduction of the type 302 for use in orthopedic surgeries. 316L stainless steel type is commonly used in surgical procedures to replace biological tissue or help stabilize a biological structure, such as bone tissue to help the healing process.

316L stainless steel is very popular for surgical practices because it is the most resistant to corrosion when in contact with biological fluid. It is important that a surgical implant is not susceptible to corrosion when placed within the human body to prevent the chances of infection occur. In the case of an infected implant, the device is removed to prevent any additional trauma to the surrounding biological tissue. This type of stainless steel is particularly effective as surgical implant when in cold worked condition. What makes the Type 316L is ideal as an implant device is the lack of inclusion in this material. Including materials also contain sulfur and this is a key component to promote corrosion of metals.

Stainless steel is a metal alloy. By adding the element chromium (16%) stainless steel, the metal becomes resistant to corrosion. The addition of carbon and nickel (7%) for stainless steel help stabilize the austenite in the steel. The 316L stainless steel selected for the purpose of surgical implants contains about 17 to 19% chromium and 14% nickel. As mentioned, it is essential that the metal implants are not susceptible to corrosion. With surgical implants, molybdenum is added to the stainless steel alloy which forms a protective layer that insulates the metal despite exposure to an acidic environment. The corrosion resistance can also be achieved with the element carbon, but only when the carbon is in solid solution state.

Note : It has to be noted that the ferrite element should not be built in stainless steel as this gives the metal a magnetic property, which is never used for surgical implants because it could interfere with equipment of magnetic resonance imaging (MRI). One of the most obvious problems with the use of magnetic implants is their susceptibility to heating that could change the shape or the structural position of the metal implant.

Titanium Alloy

Compared to stainless steel alloys that have been used in medical practice since the early 1900s, Titanium is relatively new in its application as a medical implant for replacement of a biological tissue. One of the biggest advantages is its strength titanium - titanium retains as strong as steel and is exceptionally light weight (lighter approximately 50%), so this material is ideal for use in surgical implants.

Unfortunately, titanium is easily contaminated when exposed to hydrogen, nitrogen and oxygen, which may influence the corrosion process in this metal and may compromise its use in certain medical procedures. In the 1960s a change was experienced in the selection of metals of best fit for titanium surgical implants becoming a popular choice. The following video compares the strength of pure titanium with titanium alloy.

The structural composition of titanium alloys is divided into three distinct categories: alloys A, aleaciones and alloys. Elements including aluminum, oxygen, tin and zirconium all become vital for stabilizing A. Magnesium alloys, molybdenum, iron and chromium become favorable as stabilizers for  alloys. The most common forms of titanium and vanadium are aluminum or combination of aluminum and niobium that is typically applied to manufacture rods and clamps the spine. High tensile strength and light weight characteristic of titanium makes this ideal metal for reconstructive surgery.

Stainless Steel vs. Titanium       

·        Titanium has a high resistance to repeated loading so it is ideal for use as an implant.

·        Titanium is stronger and lighter in weight compared to stainless steel.

·        A lower modulus of elasticity than stainless steel, titanium is less rigid limiting the amount of tension on bone structures.

·        Titanium is less prone to the generation of an immune reaction based on the fact that this material is more resistant to corrosion compared to stainless steel implants.

·        Titanium has a higher resistance under repeated loading stresses, making this metal able to withstand the tension during the internal fixation.

Hip arthroplasty

Joint replacement or hip replacement

Definition: This surgery is performed to replace all or part of the hip joint with an articulating device (prosthesis).

Alternative Names: Hip arthroplasty (total hip replacement)

Know More about Hip Replacement Implants

Hip Arthroplasty - A surgical process for joint replacement components with implants. The reasons for which you may need to perform such an operation are:

• Rheumatoid arthritis - A chronic inflammatory disorder affecting many joints. 
• Fracture of the femoral neck, as well as their consequences (post-traumatic arthrosis and false joints);
• Hip dysplasia - enlargement of an organ or tissue by the proliferation of cells.
• Coxarthrosis (primary and secondary coxarthrosis);
• Avascular necrosis (aseptic necrosis of the head) - the death of bone tissue due to a lack of blood supply. 

Modern Hip are complex technical products. Cementless fixation prosthesis consists of a head, legs, and the cup and liner. Cemented endoprosthesis consists of the same elements as the cementless, acetabular component is not only divided into the cup and liner, and is solid. Each element has its own size range which one selected by the surgeon during surgery according to your need.

Hip prosthesis differs in the type of fixing to:

• implants fixation;
• cemented prosthesis;
• hybrid fixation of the prosthesis

Depending on the joint are replaced with all the elements or not distinguish pervasive prostheses and pole.

The hip replacement node friction endoprosthesis is that the interaction between than in the artificial hip joint. The quality and type of materials that are used in friction units determine the service life of the implant.

The endoprosthesis of the hip joint by type of friction pairs can be divided into:

• metal-metal;
• metal-polyethylene;
• Ceramic-ceramic;
• ceramic-polyethylene.

Hip replacement surgery

After you receive anesthesia, the surgeon will make a surgical incision to open the hip joint. This incision is often made on the buttocks. Then the surgeon:

• It will cut and remove the femoral head.
• Clean out your hip socket and remove the remaining cartilage and damaged or arthritic bone.
• Put the new hip socket in place, a coating is placed on the new acetabulum.
• You insert the metal stem in the femur.
• It placed the ball right size for the new joint.
• It will ensure all new parts in place, sometimes with a special cement.
• Repair the muscles and tendons around the new joint.
• Close the surgical incision.
• This surgery takes approximately 1 to 3 hours.

After Hip Replacement Surgery

Rehabilitation

The ability to carry out the movement in the bed are allowed after the first day after surgery. It is allowed to sit down in bed, doing breathing exercises, and perform simple exercises for the muscles. Moving on their feet with the help of an instructor is possible from the third day after surgery, walking is carried out with the help of crutches. Sutures are removed in 10-12 days after surgery.

Returning home after a hip replacement

Extract home is usually done after 10-12 days. Returning, it is worth to continue rehabilitation activities nature, observing all the necessary recommendations. If necessary, it is possible to continue the restoration of the center under the guidance of doctor-traumatologist.

At home, you must follow a few rules, reducing the risk of various complications:

• When you sit, your knees should be below the level of the hips, this puts a pillow on a chair;
• Do not cross your legs or sitting or lying down;
• Do not lean forward, always stand up straight with your back flat;
• sit down on a chair, feet slightly apart.
• Follow your doctor recommended mode of transportation on crutches;
• Going up and down the stairs, follow the railing;
• Wear shoes with non-slip soles and low heels;
• When you visit, your doctor be sure to say that you have an artificial joint;
• Do not hesitate to ask your surgeon if you have any pain at the site of surgery or increased overall body temperature.
• Of course, most of these recommendations are not lifelong but act only for 6-8 months after surgery.

Please Remember

• Do not forget that the prosthesis is not eternal. Like any other machinery, tend to wear it. The term of service of the prosthesis can be up to 15 years.
• The rate of wear of the prosthesis is largely determined by the operating conditions of the patient. Do not lift weights and to engage in active sports.
• Not recommended exercises in sports such as tennis, skiing, etc. Swimming and walking are permitted. It is important not to forget to monitor their own weight.

Fractures Of Tibia

On the Tibia

Tibia - It's a long, large, shin bone. It consists of a body and two joint ends. The proximal (upper end) of the tibia part in the formation of the knee joint. The distal (lower end) of the tibia and fibula together with the talus to form the ankle joint.

Fracture of Tibia

Fracture of the tibia is due to the impact of a large force to the shaft of the bone, occurs at its different levels. Most often this happens when road accidents. Of all fractures of the musculoskeletal system, a fracture of the tibia takes 23% of the total number of injuries of the musculoskeletal system.

Classification of tibial fractures

Fractures of the diaphysis of the bone are classified as transverse, oblique, comminuted, fragmented and intraarticular. For intra-articular fractures of the tibial condyles are fractures of the tibia and fracture of the medial ( inner ankle ). The inner (medial) ankle bone is a medial stabilizer of the ankle joint, its fracture occurs during twisting (rotating) the tibia with fixed foot. Also, often fractured inner (medial) ankle occurs when a sharp, non-physiological rotation of the foot.

Diagnosis of tibial fractures

For the diagnosis of tibial fracture is mainly used radiography. In our center of traumatology and orthopedics in addition to the widely used X-ray computed tomography with the function of a three-dimensional image reconstruction. Modern methods of diagnostics of fractures allow to correctly identify the tactics of treatment.

Complications of the tibial fracture

· tibia deformation (change of axis of the limb), as a consequence of displacement of bone fragments,

·        edema,

·        pain on palpation and movement in the limbs,

·        inability to carry the axial load on that foot.

Treatment of tibial fractures

Currently, the treatment of tibial fractures is usually performed by surgical intervention. Due to the anatomical feature structure tibia, the tibia on the main surface located throughout (not covered with muscles on the medial surface), not seldom leads to a secondary fracture bone fragments the perforation of the skin. For immobilization of bone fragments at fractures of the tibia in hospitals apply skeletal traction of the calcaneus. This method is used for preoperative preparation and improvement of the skin on the affected calf.

In our center, doctors Traumatology and Orthopedics apply the most modern methods of conservative and surgical treatment of fractures of the tibia. Using the latest techniques of the plate and intramedullary osteosynthesis allows faster recovery times and rehabilitation of patients with fractures of the shin bone. Typically, the patient may carry the load on the injured leg on the next day after surgery. In most cases, the use of osteosynthesis in intraarticular fractures in the early stages allows most accurately restore the articular surface, which eliminates the risk of early development of osteoarthritis of the damaged joint.

Intramedullary Nailing System - Orthopedic Implants

PFN Nail - (Proximal Femoral Nail)

TFN Nail (Trochanteric Femoral nail)

Tibial Nail, Lower End Distal Hole (14°  Bend)

Tibia Nail 11° Bend (Modified Version) 

 

Femoral Nail, Lower End Distal Hole

Slim Femur Cannulated Nail

 

To know more about intramedullary nails, visit 

http://www.siiora.com/product-category/delta-nailing-system/