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Diseases and Treatment

ORTHOPEDIC INJURIES


Orthopedic injuries are those that come up as a result of the failure of various body parts that make up the movement system. They comprise a separate section among other injuries since they have negative impacts on the daily production of the person, his/her appearance as well as social standing. Since the prevention and treatment of these injuries fall within the scope of orthopedics; they make up a significant portion of the work carried out by our orthopedist colleagues. Whereas physical treatment-rehabilitation experts and physiotherapists make significant contributions during rehabilitation work.
In this article, short and instructive information without any details will be given in this study regarding the latest treatment options of these injuries.


Congenital Anomalies:
These are congenital injuries that are present since the development stage of the baby in the womb. They have various different types such as stiffness in head, neck, arms and hands as well as the body, legs or feet. The ratio of those that are due to genetic factors is quite low. Families who are faced with such an issue feel guilty and request information from doctors. It is possible for the orthopedist to enlighten the families with general explanations. It may be suggested to the families to receive further information from ”genetic enlightenment” sections.
Now, let’s give some brief information on the injury types that are most frequently seen in orthopedics:


CONGENITAL CLUBFOOT (Equinovarus)
Observed in one out of every 1000 newborns. Hereditary transfer ratio is 5 %. Treatment starts right after birth with casts. A more comfortable treatment program may be followed if families of 50 % of the patients are informed that a surgery might be necessary in the future. Since generally such information is not given, the inclusion of a surgery into the treatment program is perceived as the failure of the doctor. An almost normal foot can be attained if timely treatment is made. Families can continue treatment process with a good morale if they are informed of such a possibility at the beginning of treatment.


 FLAT FEET ( Pes Planus )
Every new born is born with flat feet. Base curve becomes normal until 5-6 years of age in 80-90 % of these babies without any need for treatment (physiological flat foot). Even though there are some criteria as to which type of feet will heal by itself, these are not for certain. It might be that treatment is started late in some children for whom improvement is expected without orthopedic treatment (via monitoring). Hence, there are ongoing discussions in our profession regarding treatment of every child with flat foot using orthopedic shoes or monitoring and giving treatment if necessary. This decision varies among doctors. Orthopedic shoes and exercise are generally sufficient for the treatment of flat foot. Surgery might be required but at a very low probability.


FOOT-LEG DEFORMITIES DUE TO POSTURAL ABNORMALITIES WHILE SITTING OR LYING DOWN
      Such deformities have started to be discussed in orthopedics within the past 30-40 years. Previously, it was not known that postural abnormalities while sitting or lying down could cause deformities. It has been shown that lying face down or sitting on crossed legs (during prayer, while watching television etc.) affects the normal development of feet and legs. (Figure 1,2,3,4 ). Children should be encouraged to sit on chairs, extend or cross their legs while sitting. The fact that such deformities can be prevented just by correcting incorrect postures while sitting or lying down has increased the importance of this issue. The correction of incorrect sitting or lying down is the principal determiner during treatment. In addition, orthopedic shoes or night splints are used effectively in treatment.


DEVELOPMENTAL HIP DISLOCATION
      Congenital hip dislocation was later named as “developmental hip dislocation”. It is observed in 1 out of every 1000 newborns. However, its probability is 35 % higher in those with familial hip dislocation story. The hips of these babies are not dislocated from birth but they are prone to it (hip displacement). The hips of every newborn should be examined via ultrasonography (USG) by an orthopedist after birth in order to diagnose developmental hip dislocation during “hip displacement” period. Hence, treatment can be carried out before “developmental hip dislocation” occurs when hid displacement is diagnosed at an early stage. The treatment of hip displacement prior to its transformation to developmental hip dislocation is carried out in developed countries as “preventive treatment”. It is pleasing to see that the same is applied in our country as well. This provides perfect treatment at the initial stage using simple abduction splints for 3-6 months. Treatment can be successful in late cases with a ratio of about 100 %.


CEREBRAL PALSY ( CP )
      This occurs mostly due to difficulty during birth, premature birth or brain ischemia. Sitting, walking or mental deformities occur as a result of brain dysfunctions. The baby should be monitored prior to birth and if required decision to carry out birth by cesarean section should be given in order to prevent this. If a lesion has formed in the brain, the family should follow a long treatment patiently. Physiotherapy, speech therapy and psychological treatment etc. should be carried out simultaneously. The surgical treatment to remove deformities in patients should be carried out without delay. As a result of these long and arduous efforts, the person can generally adapt to life efficiently.


POLİO
     Occurs when polio virus takes over the central nervous system. Vaccination has prevented polio. Today, it is very rarely seen. Physiotherapy, splinting and surgeries are used effectively in treatment.


PROGRESSIVE MUSCULAR DYSTROPHY
    It is a genetically transferred muscle disease. There is still no efficient treatment. Physiotherapy and splinting are used in treatment. Not having children is accepted as a significant prevention method for this disease.


OBSTETRICAL PARALYSIS
     It is an injury observed during birth. The proper evaluation of the baby in the womb and carrying out the birth via cesarean section if necessary (with a decision given prior to birth) can prevent this. It should be mentioned that microsurgical operations have gained significant successes in some types of obstetrical paralyses. In addition, physiotherapy and splinting also give good results.


TRAFFIC ACCIDENTS – OCCUPATIONAL ACCIDENTS – SPORTS INJURIES

Traffic accidents, occupational accidents and sports accidents are the causes of a significant portion of injuries. Recent developments in orthopedics and traumatology, development of tools and equipment that contribute to this field have increased the success rate in the treatment of these injuries. Current developments in arthroscopy and joint surgery have enabled our colleagues to assist these patients significantly. (Figure 5) We should foresee that sports accidents will increase even further since sports have become a social pleasure because of its positive contributions to human health as well as competitions. As doctors and the society, we should be aware of our responsibilities for the treatment as well as prevention of such injuries.