Orthopedics and Traumatology

Orthopedics and Traumatology

The musculoskeletal system that enables us to move includes hundreds of bones, joints, ligaments, tendons, and muscles.

Daviva Health Group’s Orthopedics and Traumatology Department provides care for diagnosing and treating problems in this system, which is connected through a highly complex structure, with experienced academic staff.

What Is Orthopedics and Traumatology?

Orthopedics involves the diagnosis and treatment of chronic, degenerative, and congenital musculoskeletal disorders, while traumatology covers traumatic injuries such as fractures, dislocations, sprains, and crush injuries.

Orthopedics and traumatology generally includes the treatment of traumatic, developmental, and degenerative disorders of the musculoskeletal system, as well as certain tumors affecting bones and soft tissues.

In the orthopedics and traumatology department, many musculoskeletal disorders are treated, from childhood to advanced age.

In addition to diagnosis and treatment, doctors in the orthopedics and traumatology department also provide preventive medicine services, especially to help prevent sports injuries.

Which Diseases Does Orthopedics and Traumatology Treat?

Fractures and Dislocations

A fracture is the loss of integrity of bone tissue as a result of trauma, a fall, or impact. It may occur as a crack in the bone or as a complete separation. Dislocation is the displacement of the bones in a joint from their normal position. It usually occurs as a result of severe trauma, a fall, or sudden strain.

Treatment for fractures and dislocations may vary depending on severity and location. In general;

• Splint
• Cast
• Surgery
• Closed reduction, that is, treatment by manually manipulating broken bones or a dislocated joint back into proper alignment without the need for surgery.

Shoulder Pain

The shoulder has the widest range of motion among all joints in the body. It is the most commonly dislocated joint in the body and is prone to injuries that cause pain. Pain or stiffness felt in the shoulder joint may stem from different causes. The most common causes of shoulder pain are trauma and overuse of the shoulder. However, conditions such as inflammation in the shoulder joint, rotator cuff tears, arthritis, and frozen shoulder can also cause shoulder pain. Shoulder pain can lead to limited movement during activity and may also occur at rest. Some pain not originating from the shoulder joint may also be felt in the shoulder. A herniated cervical disc or heart problems may present as shoulder pain. Treatment for shoulder pain varies depending on the cause. Different treatment options, from lifestyle changes to surgical methods, may be used.

Shoulder Impingement Syndrome

Shoulder impingement syndrome is one of the most common causes of shoulder pain. It occurs when a tendon in the shoulder structure rubs against tissue or bone, causing pain. In shoulder impingement syndrome, pain usually develops in the upper and outer part of the shoulder. The pain may increase when the arms are raised above the head. In the treatment of shoulder impingement syndrome;

• Medication
• Injection therapy
• Physical therapy
• Surgery to widen the space around the tendon to prevent it from rubbing against tissue or bone may be performed.

Frozen Shoulder Syndrome

It occurs as a result of thickening and inflammation of the capsule around the shoulder joint. Frozen shoulder syndrome usually causes a dull type of shoulder pain. The pain may be felt more at night while lying down. In later stages, limited shoulder movement may develop. The person may even have difficulty dressing or combing their hair.

In the treatment of frozen shoulder syndrome;

• Exercises to improve range of motion
• Medications to reduce pain
• Injection therapies
• Surgical methods may rarely be used.

Rotator Cuff Syndrome (Rotator Cuff Tear)

The rotator cuff muscles are the main muscles that provide stability to the shoulder joint. They control the movement and rotation of the joint and ensure it functions properly. A rotator cuff tear may occur in younger patients due to traumatic injuries and in older patients due to degenerative diseases, and it is one of the common causes of shoulder pain and limited movement. Pain that increases with lifting the arms and a feeling of weakness accompanied by pain even when lifting light objects are the most prominent symptoms. Shoulder pain even at rest or with the arms in a normal position may indicate that the tear is severe. Rest, medication, and physical therapy are the first steps in the treatment of Rotator Cuff Syndrome (Rotator Cuff Tear). However, surgical options should be considered if the condition does not improve despite these measures.

Tennis Elbow

It is a condition caused by overuse and misuse of the arm and elbow, leading to pain on the outer side of the elbow. Tennis elbow occurs as a result of damage to the tendon that attaches the forearm muscles to the upper arm bone. Although this condition is seen more often in people who play sports such as tennis or rowing, people who work in jobs that involve using screwdrivers or hammers, people who write for long periods at a desk, painters, and artists are also at risk.

Treatment for tennis elbow generally includes:

• Rest
• Medication
• Stretching exercises
• Steroid injection
• In cases where treatments do not work and pain and limited movement increase, surgery is rarely considered.

Golfer's Elbow

It is a painful condition caused by overuse and inflammation of the tendons on the inner side of the elbow that attach the forearm muscles to the bone. It is a common disorder in professions involving repetitive gripping or wrist flexion movements. It can affect a wide range of people such as carpenters, plumbers, computer users, and knitters. In most people with golfer's elbow, pain occurs only when they use their forearms.

The following methods generally stand out in the treatment of golfer's elbow:

• Rest and medication
• Devices that support the elbow area
• Stretching exercises
• Injection therapies
• Surgical methods are preferred rarely.

Knee Pain

Knee pain is a common symptom that affects people of all ages. It may be accompanied by discomfort, swelling, stiffness, or instability in the knee joint. Causes such as trauma, meniscus injuries, and overuse of the knee can lead to knee pain. The area where knee pain is felt intensely may provide clues about the cause of the pain. Pain in the front of the knee may be caused by arthritis, while pain in the back of the knee may be related to tendon or ligament injuries. Treatment for knee pain varies depending on the cause. Different methods, from simple pain relievers to surgical options, may be used.

Knee Osteoarthritis

It is a common condition that causes the protective cartilage cushioning the knee joint to break down and the bones to rub against each other. It is more common in people over the age of 50. The most common symptom of knee osteoarthritis is knee pain. Stiffness in the knee may be especially noticeable when getting out of bed in the morning. A creaking sound when moving the knee may also be a sign of knee osteoarthritis. Treatment may include pain relievers, injections into the knee, and physical therapy. Losing weight is also important for reducing the problems caused by knee osteoarthritis. Knee replacement surgeries are performed for advanced cases of knee osteoarthritis.

Meniscus Tear

The cartilage tissue inside the knee, located between the thigh bone and the shin bone and reducing pressure on the knee, is called the meniscus. Meniscus tears are known as an injury that occurs mostly in athletes. However, apart from sports injuries, they can also occur in people who experience wear in the meniscus cartilage with age and in traumatic injuries such as sprains in the knee. Knee pain along the joint line is one of the most common symptoms. Other symptoms of a meniscus tear can be listed as follows:

• Stiffness and swelling around the knee
• Difficulty moving the knee
• A sound coming from the knee joint when moving
• If the meniscus tear occurred due to sports or sudden movement, a loud sound may be heard from the knee at the moment the tear occurs.

In the treatment of small tears in the meniscus; rest, ice application, and physical therapy may be used.

However, arthroscopic surgery methods are used in the treatment of advanced meniscus tears.

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome is commonly known as runner's knee and is the most common cause of pain in the front of the knee. It usually results from overuse and misuse of the knee, such as running, climbing stairs, or squatting. Knee pain when climbing stairs or a dull pain that increases after sitting for a long time are among the symptoms of Patellofemoral Pain Syndrome. Rest, ice application, physical therapy, and foot orthoses are among the methods used in the treatment of Patellofemoral Pain Syndrome.

Anterior Cruciate Ligament Injuries

It is a tear or damage to the ligaments that run crosswise through the middle of the knee to stabilize the knee joint. It is common in people who do sports involving twisting, sudden changes in direction, or jumping. The symptoms of anterior cruciate ligament injury are as follows:

• A loud sound may come from your knee during an anterior cruciate ligament injury.
• Severe pain and swelling may occur within the first 24 hours after the injury.
• Loss of mobility may occur.

Treatment for anterior cruciate ligament tears varies according to the patient's individual needs. For people who are actively involved in sports, treatment is usually surgical. Long-term physical therapy is also necessary for these individuals to regain strength and balance.

For those who live a more stable life and do not want surgery, methods such as physical therapy and the use of a knee brace may be applied for anterior cruciate ligament tears.

Hip Pain

Hip pain can affect people of all ages. There are many different causes of hip pain. Osteoarthritis, commonly known as joint degeneration, may present as hip pain with age. In addition;

• Hip fracture
• Hip pain after intense or repetitive exercise
• Rheumatoid arthritis
• Joint infection
• Conditions such as bursitis are among the causes of hip pain.

Initial treatment for hip pain usually includes rest, ice application, compression, and over-the-counter pain relievers.

If hip pain is caused by a severe fall, there is deformity in the joint, you have difficulty bearing weight, or hip pain is accompanied by fever, you should consult a specialist doctor without delay.

Hip Osteoarthritis (Osteoarthritis)

Osteoarthritis, commonly known as hip degeneration, is a condition that causes the cartilage in the hip joint to wear down and the bones to rub against each other. When osteoarthritis develops in the hip joint, part of the cartilage thins and its surface becomes rough. In this case, pain and limited movement occur in the hip joint.

Hip osteoarthritis (Osteoarthritis) is usually seen with advancing age

• Trauma to the hip
• Activities or physical work that strain the hip
• It may also be seen due to causes such as obesity.

The first-line treatment for hip osteoarthritis includes exercise, lifestyle changes, pain relievers, and physical therapy.

In patients who do not benefit from first-line treatments, total hip arthroplasty, that is, hip replacement surgery, is a common and effective solution.

Bursitis

Small fluid-filled sacs called bursae are found at friction points such as joints or bony prominences. Bursae help protect bones from friction as tendons and muscles move over them during movement. Bursitis can occur when these fluid-filled sacs become irritated and inflamed due to excessive friction or pressure.

The fluid-filled sacs called bursae are present in every area where joints are located. However, the largest bursae are especially found in the hip, knee, and elbow. Bursitis, which occurs as a result of inflammation of the bursae, can cause symptoms such as pain and swelling.

Bursitis is usually relieved with rest, ice application, and anti-inflammatory medications. However, bursitis is a condition that can recur.

Hip Impingement Syndrome

The hip consists of two bones connected by cartilage, ligaments, tendons, and muscles.

The femoral head, located at the upper end of the thigh bone, is one of these and is ball-shaped.

The socket-shaped structure on the side of the hip bone, the acetabulum, is the joint socket.

The protective cartilage layer covering the ball and socket parts of the hip joint allows the leg to glide smoothly backward, forward, and sideways. A special cartilage ring called the labrum in the acetabulum also protects and stabilizes the joint further. In a normal hip, there is smooth gliding movement within the socket between the femoral head and the acetabulum. In hip impingement syndrome, this gliding movement is disrupted and normal hip motion is restricted.

The early stages of hip impingement syndrome may go unnoticed for years because they are usually not painful. Symptoms usually appear between adolescence and middle age, especially in active people. People with hip impingement feel pain in the groin after sitting or walking for a long time. The pain may spread from the side of the hip and upper thigh to the buttocks and even to the lower back.

Physical therapy to strengthen the muscles, activity modification, anti-inflammatory medications, and cortisone injections are the first step in the treatment of hip impingement syndrome. However, arthroscopic surgery in advanced cases or in patients who do not respond to these treatments can reshape the bones and repair damage to the labrum or cartilage.

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve in the arm is compressed at the wrist. Carpal tunnel syndrome is common during pregnancy and in older women. In addition;

• Repeated overuse of the wrist and hand
• Cysts or tumors in this area
• Diabetes
• Excess weight can lead to carpal tunnel syndrome.

Symptoms of carpal tunnel syndrome include tingling or numbness in the hand, nerve pain, and weakness.

Treatment for carpal tunnel syndrome includes a wrist splint, anti-inflammatory medications, lifestyle changes, and, in severe cases, carpal tunnel release surgery to relieve nerve pressure.

Trigger Finger

It is a condition that appears as catching, locking, or clicking when one of the fingers, usually the thumb, is bent. It usually causes pain in the palm. Trigger finger occurs when the tendon controlling the finger cannot glide smoothly within the sheath surrounding it.

Treatment for trigger finger;

• Splint use
• Anti-inflammatory medications
• Steroid injections
• Surgical options.

Ganglion Cysts

A ganglion cyst is a fluid-filled sac that develops outside a joint or along a tendon. These cysts are usually benign, but they can sometimes become painful. Ganglion cysts usually occur in the wrist and fingers, although they can rarely also form in the foot. They are most commonly seen in women aged 20-40 and in those who participate in sports activities involving sudden stops and movements.

Treatment for a ganglion cyst varies depending on the size and location of the cyst. In some cases, if the cyst is small and does not cause pain, treatment may not be necessary.

The following methods may be used in the treatment of ganglion cysts;

• Drainage of the cyst by injection
• Medications to reduce inflammation
• Splint use
• Surgical removal in more serious cases

Hallux Valgus

It is considered one of the most common foot deformities. It is the condition in which the big toe starts turning inward toward the second toe. Hallux valgus is more common in women. Tight shoes or high-heeled shoes can worsen the symptoms.

Treatment for hallux valgus may include;

• Avoiding prolonged standing
• Wearing comfortable shoes that fit the foot
• Taking anti-inflammatory pain relievers
• Using orthopedic devices such as toe pads to reduce pressure on the big toe bunion.
• More serious cases may require surgery.

Heel Spur

It is a bony protrusion that forms on the underside of the heel bone. It usually develops as a result of chronic inflammation and stretching of the plantar fascia ligament that connects the heel to the toes. It can cause a sharp, stabbing pain, especially with the first steps in the morning. However, most heel spurs are painless.

Treatment options for heel pain and heel spurs may include:

• Resting and avoiding activities that worsen the pain
• Ice application to reduce inflammation
• Taping the foot
• Stretching and strengthening exercises
• Wearing appropriate shoes
• Extracorporeal shock wave therapy is used to promote healing.

Plantar Fasciitis

It is inflammation of the thick band of tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the toes. It usually presents with heel pain that feels like a stabbing pain in the first steps of the morning or after long periods of rest.

The following approaches are generally followed in the treatment of plantar fasciitis;

• Rest and ice therapy
• Stretching exercises
• Night splints
• Supportive shoes
• Physical therapy
• Medications and injections

Although non-surgical treatments almost always improve plantar fasciitis pain, surgery may be necessary in some cases where recovery is not seen.

Common Orthopedic Problems in Children (Pediatric Orthopedics)

Developmental Hip Dysplasia (Congenital Hip Dislocation)

The hip is a ball-and-socket joint. In a normal hip, the ball at the upper end of the thigh bone fits snugly into the socket, which is part of the large pelvic bone. In babies and children with developmental hip dysplasia, the hip joint has not formed normally. The ball is loose in the socket and can easily slip out of place.

The symptoms of developmental hip dysplasia can be listed as follows;

• Differences in leg length
• Uneven skin folds on the thigh
• Limping, walking on tiptoes, or walking with a duck-like waddle

If left untreated, it can lead to severe pain and early arthritis. Treatment methods for Developmental Hip Dysplasia depend on the child's age and the severity of the condition.

In newborn babies, a method called the Pavlik harness is usually used to tighten the ligaments around the hip joint and support the formation of a normal hip socket. In some children, looseness worsens as the child grows and becomes more active. Surgical methods may be used to realign the hip.

Scoliosis

Scoliosis is the sideways curvature and rotation of the spine, causing it to take on an 'S' or 'C' shape. It usually begins in children and adolescents while they are still growing. Scoliosis symptoms may become more noticeable depending on the degree of the curvature.

• The shoulders not appearing level
• The shoulder blades becoming more prominent
• A gap appearing on one side between the arm and the torso
• One hip appearing higher than the other are among the symptoms of scoliosis.

Treatment for scoliosis in children may vary depending on how curved the spine is and the age. In general, scoliosis treatment includes;

• Cast application
• Brace
• Surgical methods are preferred.

Kyphosis

Kyphosis, also known as hunchback posture, is an excessive forward rounding of the spine, usually in the upper back area. Kyphosis is more common in boys than in girls. The upper back gradually takes on a more rounded appearance. It may be accompanied by back pain that worsens during the day and eases with rest. If present, the pain is usually felt at the most curved point of the spine. It may worsen with activity, prolonged sitting, or standing.

The following methods are used in the treatment of kyphosis;

• Exercises to strengthen the back and abdominal muscles
• Orthopedic support devices
• In cases of advanced kyphosis or cases causing breathing problems, surgery is the preferred option.

Flat Feet

• It is a condition in which the arch on the inside of the foot is low, underdeveloped, or absent. When the child stands, the sole of the foot touches the ground. Although it is a common condition in childhood, flat feet can also occur in adults.
• Flat feet are usually caused by genetic factors. However, they can also appear after a work- or sports-related injury. Although it may not seem like a major problem, if not diagnosed and treated in time, it can negatively affect children's leg development. It can lead to serious problems in the knees and ankles.
• In the treatment of flat feet, foot arch supports suitable for the child's foot, supportive shoes, physical therapy, and weight management are more prominent.
• Surgical methods are generally considered for structural, severe, persistent pain that does not respond to conservative treatment.

In-Toeing and Out-Toeing

Some children's feet turn inward or outward while walking. Parents worry that their child's foot turns inward or that their child walks like a duck when out-toeing occurs.

Both conditions are very common in early childhood. They are part of the normal development of the musculoskeletal system. They may change over time and as the child grows.

Children whose toes point inward or outward may fall more often than other children.

Most children do not need treatment for in-toeing or out-toeing. These conditions usually correct themselves over time.

Observation and follow-up, and if necessary special exercises, are the methods used in the treatment of in-toeing and out-toeing.

Treatment Methods Used in the Orthopedics and Traumatology Department

Treatment methods used in the orthopedics and traumatology department can be considered as non-surgical methods, regenerative applications, and surgical methods.

Among the non-surgical methods;

• Medication and Injection Therapies
• Physical Therapy and Rehabilitation
• Casts, Splints, and Bracing
• Custom Insole Applications.

Regenerative applications, whose use has increased significantly in recent years and have yielded successful results, are as follows;

PRP Application

Platelet-rich plasma (PRP) injections can be used in the treatment of many conditions in the field of orthopedics and traumatology. In this treatment, the patient's own blood cells are used to accelerate healing in a specific area.

PRP treatment may help support wound healing in trauma and joint injuries. In addition, PRP treatment can be used in the treatment of many conditions such as knee osteoarthritis, tennis elbow, and golfer's elbow.

Stem Cell Therapy

It is a regenerative method that, like PRP application, uses the body's own repair mechanisms. Stem cells obtained from the patient's bone marrow or adipose tissue are injected into the affected area. It can be used in knee osteoarthritis to reduce pain and inflammation.

Intra-Articular Fluid (Hyaluronic Acid) Injections

It is used to treat osteoarthritis, especially knee pain, by injecting a gel-like fluid into the joint to increase joint lubrication, reduce friction, and relieve pain. Usually considered for patients who do not respond to conservative treatments such as exercise or pain relievers, this method has the potential to delay surgery by providing long-term relief.

Arthroscopic Surgery

Arthroscopy is a type of minimally invasive surgery performed to examine or repair joints. A small incision is made near the affected joint, and a narrow tube connected to a fiber-optic video camera is inserted through this incision. The image inside the joint is transmitted to a high-resolution video monitor. With this procedure, joint problems can be diagnosed and surgical procedures can also be performed. Although arthroscopic surgery is used more often in the knees, it can also be applied to other joints such as the shoulder and elbow.

Arthroscopic surgery is used more often for;

• Meniscus Tears
• Anterior Cruciate Ligament Injuries
• Rotator Cuff Tears
• Shoulder Impingement Syndrome and Recurrent Dislocations
• Intra-Articular Cartilage Damage and similar conditions.

Hand Surgery and Microsurgery

Hand surgery is a specialized surgical field that covers all tissues in the hand and wrist region, including bones, joints, muscles, tendons, nerves, and skin. This specialty carefully addresses not only fractures and acute injuries, but also long-term conditions and congenital deformities or birth defects.

Microsurgery, on the other hand, is a more advanced technique aimed at repairing delicate structures such as blood vessels and nerves, especially those smaller than 1 mm in diameter, and tiny tissue pieces that cannot be seen with the naked eye or are very difficult to see.

• Carpal Tunnel Syndrome
• Trigger Finger
• Ganglion Cysts
• Tendon, Nerve, and Vessel Lacerations
• Replantation, that is, reattachment of severed limbs by microsurgery, is performed with hand surgery and microsurgery methods.

Joint Prostheses (Arthroplasty)

It comes to the forefront in people with chronic joint pain, limited movement, or functional impairment who have difficulty performing daily activities and do not benefit from physical therapy, medication, or injection treatments.

It is generally suitable for people with advanced arthritis or injuries.

It is the replacement of severely worn joints with artificial joints

• Total Knee Replacement
• Total Hip Replacement
• Shoulder and Elbow Prostheses are the most commonly performed joint replacement surgeries.

Robotic prosthesis surgery: With robotic orthopedic surgery, knee and hip replacement surgeries are performed with high precision using robot-assisted systems. This allows patients to experience less pain, less bleeding, earlier discharge, and a quicker return to work and daily life.

ROBOTIC ORTHOPEDIC SURGERY LINK WILL COME HERE