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Clinical Orthopedic Scenarios

Joint Diseases

Degradation in the joints due to aging and injury as well as inflammatory diseases of the joints (particulary rheumatism) can lead to severe pain and decreased quality of life. The development of artificial joint replacement has brought considerable improvements for patients in the last 50 years. The insertion of artificial hip and knee joints is now a routine procedure. Other forms of joint replacement are also available at some HELIOS hospitals.

Spinal Diseases

The spinal column consists of a complex system of intervertebral discs, bones, muscles, ligaments and joints. In this finely tuned system, degenerative changes (due to wear and tear) to the intervertebral discs lead to loosened joints, primarily with hardening of the back muscles and irritation of nerves. This chain reaction can lead to chronic back pain.

The most common spinal diseases are wear and tear, intervertebral disc damage and spinal deformities.

Treatment, which is often long and complex, depends on close interdisciplinary collaboration between Internal Medicine/Rheumatology, Neurology, Neurosurgery, Orthopedics/Traumatology as well as Rehabilitation, Physiotherapy and Pain Therapy.

Femoral Neck Fractures

Femoral neck fractures are a typical and frequent injury in elderly people. In old age, a slight impact, e.g. a lateral fall, can be enough to cause a femoral neck fracture. A fall onto the hip at home is the most common cause of a bone fracture between the head of the femur and the femur – known as the femoral neck. In contrast, young people are affected extremely rarely. Here, an injury virtually only occurs as a result of a strong impact, e.g. in a road accident or when falling from a great height. A femoral neck fracture can also occur if a bone is destroyed due to tumors. Such fractures are called pathological fractures.

A femoral neck fracture causes pain in the hip joint as well as walking disability, and is usually associated with leg contracture. Therapy is essentially geared towards the findings, age and any existing illnesses. A non-operative ("conservative") treatment is only considered in a few cases if the fracture meets special criteria or an operation is not possible (at the present time). There are several operating procedures, which can be subdivided into hip-preserving and hip-replacing methods.

Congenital and Acquired Foot Diseases

Hallux valgus is the most common and significant toe malalignment in humans. This involves an outward malalignment of the big toe and a clearly visible osseous elongation of the metatarsal. These conditions are frequently accompanied by painful arthrosis in the metatarsalphalangeal joint.

Hammertoe and claw toe are classic toe malalignments that often occur in conjunction with hallux valgus (big toe malalignment). Hammer toe involves a fixed flexion of the toe end joint, whereas claw toe is characterized by overstretching of the metacarpophalangeal joint with a bent middle and toe end joint.

In addition to wearing excessively tight footwear for many years, causes of the formation of hallux valgus and hammer or claw toe include foot malalignments such as splayfoot, flatfoot and pes valgus as well as rheumatic, neurological and accident-related foot diseases. Toe deformities and painful pressure points on the foot with the formation of corns characterize the clinical picture. Even in the early stage, conservative measures such as toe exercises, padding and the wearing of loose wide shoes cannot always stop the deterioration of the disease, with the result that an operation is frequently necessary at a later stage.

Shoulder Diseases

Shoulder pain is usually caused by soft tissue diseases which involve the tendons, the joint capsules and the bursa. As the shoulder girdle contains a total of eight functional joints, impairments of different structures can be a factor in shoulder pain. Functional, degenerative, traumatic and inflammatory changes, tumors, neurological and vascular diseases or joint problems are all possible causes of shoulder pain.

Other Diseases

There are various types of joint injury (e.g. cruciate ligament ruptures) as well as the numerous types of fracture through to multiple trauma.

Diagnosis and Therapy
Diagnosis

We have the following diagnostic equipment at our hospital:

• Anamnesis and physical examination
• Laboratory examinations
• Instrument-based diagnosis
• X-ray
• Computer tomography CT
• Magnetic resonance tomography MRT
• Bone scintigraphy
• Sonography (ultrasound)
• Bone density measurement

Therapy

Therapy of numerous orthopedic illnesses and injuries are carried out through interdisciplinary consultations at the individual HELIOS hospitals. A surgery is often required to treat these clinical situations. In addition to emergency treatment of fractures (operative fracture consolidation (osteosynthesis)), there is a distinction in the joint area between generally joint-preserving procedures (arthroscopic operations, osteotomy) and joint-replacing procedures (hip, knee and other joint replacement). After the operation has been performed, intensive physiotherapy exercises as well as pain therapy, ergotherapy and, if applicable, psychotherapy are usually carried out. The measures to be applied immediately after the operation to restore mobility and functionality are called early rehabilitation. In elderly people, follow-up treatment after an operative joint replacement is often carried out in the Geriatrics department, as it specializes in the needs of elderly people. After completion of in-patient treatment, the follow-up treatment can be continued in a rehabilitation establishment with the approval of the health insurance fund. However, the active cooperation of the patient is always an essential condition for full restoration of mobility and functionality of the limbs operated on.

Conservative therapies for arthrosis, spinal diseases and other disorders of the musculo-skeletal system often advice weight reduction to alleviate undue stress on the joints.

Physiotherapy is individually designed to each patients requirements to strengthen atrophied muscles, promote circulation and alleviate pain in tight muscles by stretching and lengthening shortened muscles. Physiotherapy is essential for a rapid recovery after surgery and teaches the patient specific exercises for their complete recuperation and return to a normal lifestyle.