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Samenvatting Orthopedie
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Samenvatting van orthopedie voor het vak Problemen van het bewegingsstelsel aan de UGent. Powerpoint + lesnotities.
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ORTHOPEDIELES 1 : ALGEMENE PRINCIPES + POLYTRAUMA/BEKKEN ............................................................................................................................................ 4
1.1 ALGEMENE PRINCIPES..................................................................................................................................................................................... 4
1.2 POLYTRAUMA/BEKKEN.................................................................................................................................................................................. 11
1.2.1 acuut compartiment syndroom............................................................................................................................................................. 11
LES 2 : BOVENSTE LIDMAAT ..................................................................................................................................................................................... 12
2.1 SCHOUDER .................................................................................................................................................................................................... 12
2.1.1 functionele anatomie ............................................................................................................................................................................ 12
2.1.2 Acromioclaviculaire (AC-gewricht) pathologie ...................................................................................................................................... 14
2.1.3 Claviculafractuur ................................................................................................................................................................................... 14
2.1.4 schouderluxatie (glenohumeraal) ......................................................................................................................................................... 15
Anterieure en posterieure schouderluxatie .............................................................................................................................................. 15
chronische posttraumatische instabiliteit ................................................................................................................................................. 17
Atraumatisch ............................................................................................................................................................................................. 17
2.1.6 frozen shoulder ..................................................................................................................................................................................... 18
2.1.7 Bursitis / tendinitis calcarea .................................................................................................................................................................. 18
2.1.8 Impingement = inklemming .................................................................................................................................................................. 19
2.1.9 rotatoren cuff scheur............................................................................................................................................................................. 19
2.1.10 Bicepspees scheur ............................................................................................................................................................................... 20
2.1.11 Omartrose = artrose van de schouder................................................................................................................................................. 20
2.1.12 Humerusfracturen ............................................................................................................................................................................... 21
2.1.13 Schouder pijn gerefereerd ................................................................................................................................................................... 21
2.2 ELLEBOOG ..................................................................................................................................................................................................... 22
2.2.1 functionele anatomie ............................................................................................................................................................................ 22
2.2.2 elleboogluxatie ...................................................................................................................................................................................... 24
2.2.3 distale humerusfractuur !! .................................................................................................................................................................... 25
2.2.4 olecranon fractuur ................................................................................................................................................................................ 25
2.2.5 radiuskop fractuur/ luxatie .................................................................................................................................................................... 26
2.2.6 voorarm / monteggia- fractuur en galeazzi- fractuur ............................................................................................................................ 26
2.2.7 pronation douloureuse = pulled elbow ................................................................................................................................................. 27
2.2.8 epicondylitis .......................................................................................................................................................................................... 27
2.2.9 DISTALE bicepspeesruptuur ................................................................................................................................................................... 27
2.2.10 bursitis olecrani ................................................................................................................................................................................... 28
2.2.11 Distale radiusfractuur .......................................................................................................................................................................... 29
2.3 POLS/HAND ................................................................................................................................................................................................... 31
2.3.1 Pijndiagram ........................................................................................................................................................................................... 31
2.3.2 inklemming............................................................................................................................................................................................ 32
a. carpaal tunnel syndroom ....................................................................................................................................................................... 32
b. de Quervain tenosynovitis ..................................................................................................................................................................... 32
c. flexorpees tenosynovitis ........................................................................................................................................................................ 32
2.3.3 dupuytren = palmaire fibromatose = viking disease ............................................................................................................................. 33
2.3.4 infecties ................................................................................................................................................................................................. 33
2.3.5 peesletsels ............................................................................................................................................................................................. 34
a. boutonnière (=knopschat) ..................................................................................................................................................................... 34
E
1 MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 1
, b. mallet vinger (=hamer vinger) ........................................................................................................................................................ 34
c. flexor pees letsels ............................................................................................................................................................................ 34
2.3.6 osteonecrose ......................................................................................................................................................................................... 35
2.3.7 skiduim .................................................................................................................................................................................................. 35
2.3.8 fracturen en luxaties ............................................................................................................................................................................. 36
A. OS SCAPHOIDEUM FRACTUUR !!! ......................................................................................................................................................... 36
B. PERI-LUNAIRE LUXATIE .......................................................................................................................................................................... 36
C. VINGERS EN METACARPAAL FRACTUUR ................................................................................................................................................ 37
2.3.9 amputaties ............................................................................................................................................................................................ 37
A. VINGERAMPUTATIE ............................................................................................................................................................................... 37
LES 5 : ONDERSTE LIDMAAT ..................................................................................................................................................................................... 38
5.1 HEUP ............................................................................................................................................................................................................. 38
5.1.1 Functionele anatomie HEUP en biomechanica ..................................................................................................................................... 39
5.1.2 heupluxatie ........................................................................................................................................................................................... 40
5.1.3 proximale femur fractuur ...................................................................................................................................................................... 41
A. FEMURHALSFRACTUUR ......................................................................................................................................................................... 41
B. PERTROCHANTERE FRACTUUR .............................................................................................................................................................. 42
5.1.4 osteonecrose = aseptische necrose = avasculaire necrose vd heup ...................................................................................................... 43
5.1.5 coxartrose.............................................................................................................................................................................................. 44
5.1.6 Trochanter bursitis ................................................................................................................................................................................ 46
5.1.7 septische arthritis .................................................................................................................................................................................. 46
5.1.8 stress fractuur femurhals ...................................................................................................................................................................... 46
5.2 KNIE............................................................................................................................................................................................................... 47
5.2.1 functionele anatomie en kinematica ..................................................................................................................................................... 47
5.2.2 meniscusletsels ..................................................................................................................................................................................... 49
5.2.3 ligamentletsels ...................................................................................................................................................................................... 50
5.2.4 kraakbeenlijden ..................................................................................................................................................................................... 52
KRAAKBEENLETSELS .................................................................................................................................................................................. 53
5.2.5 overbelastingsletsels ............................................................................................................................................................................. 54
5.2.6 patella pathologie ................................................................................................................................................................................. 55
B. PATELLALUXATIE .................................................................................................................................................................................... 55
5.2.7 artrose en asafwijking ........................................................................................................................................................................... 56
A. ARTROSE ............................................................................................................................................................................................... 56
B. ASAFWIJKING VALGUS EN VARUS.......................................................................................................................................................... 56
5.3 ENKEL ............................................................................................................................................................................................................ 58
5.3.1 NA TRAUMA .......................................................................................................................................................................................... 60
A) Ligament letsels : enkeldistorsio ................................................................................................................................................................ 60
B) enkelFracturen ........................................................................................................................................................................................... 60
C) Peesrupturen : achillespeesruptuur ........................................................................................................................................................... 61
5.3.2 SPONTAAN OPTREDEN .......................................................................................................................................................................... 61
A) arthritis ...................................................................................................................................................................................................... 61
CHRONISCHE LETSELS .................................................................................................................................................................................... 61
5.3.3 chondrale en osteochondrale letsels : kraakbeenletsels ....................................................................................................................... 61
5.3.4 inklemmingspathologie ......................................................................................................................................................................... 62
5.3.5 arthrose van de enkel ............................................................................................................................................................................ 63
1E MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 2
, 5.4 VOET ............................................................................................................................................................................................................. 64
5.4.1 pes planovalgus = platvoet .................................................................................................................................................................... 65
5.4.2 pes cavus varus = holvoet...................................................................................................................................................................... 65
5.4.3 calcaneonaviculaire synostose .............................................................................................................................................................. 65
5.4.4 hallux valgus .......................................................................................................................................................................................... 65
5.4.5 hallux rigidus ......................................................................................................................................................................................... 66
5.4.6 hamerteen............................................................................................................................................................................................. 66
5.4.7 fasciitis plantaris .................................................................................................................................................................................... 66
5.4.8 teenfractuur .......................................................................................................................................................................................... 66
5.4.9 morton neurinoom................................................................................................................................................................................ 66
LES 7 : KINDEROTHOPEDIE 25/03............................................................................................................................................................................ 67
1. SCOLIOSE......................................................................................................................................................................................................... 67
2. BEENLENGTEVERSCHIL .................................................................................................................................................................................... 68
3. GENU VARUM GENU VALGUM ........................................................................................................................................................................ 69
4. ROTATIEAFWIJKINGEN ONDERSTE LIDMAAT ................................................................................................................................................... 70
5. HEUP PROBLEMEN BIJ KINDEREN: .................................................................................................................................................................. 71
5.1 heupdysplasie DDH .................................................................................................................................................................................. 71
5.3 EPIFYSIOLYSE VAN DE HEUP SCFE ............................................................................................................................................................. 73
5.4 ZIEKTE VAN LEGG CALVE PERTHES............................................................................................................................................................ 74
6. KNIEPROBLEMEN BIJ KINDEREN...................................................................................................................................................................... 75
6.1 ANTERIOR KNEE ....................................................................................................................................................................................... 75
6.2 LATERALE KNIE PIJN.................................................................................................................................................................................. 75
6.3 MEDIALE KNIE PIJN................................................................................................................................................................................... 75
7. VOET EN ENKEL PROBLEMEN BIJ KINDEREN ................................................................................................................................................... 75
7.1 ZIEKTE VAN KOHLER ................................................................................................................................................................................. 75
7.2 ZIIEKTE VAN FREIBERG ............................................................................................................................................................................. 75
7.3 ZIEKTE VAN SEVER = CALCANEALE APOPHYSITIS ...................................................................................................................................... 75
7.4 PLATVOET ................................................................................................................................................................................................. 76
7.5 HOLVOET = PES CAVUS ............................................................................................................................................................................. 77
7.6 CHARCOT MARIE THOOTH CMT ............................................................................................................................................................... 77
7.7 KLOPVOET = TALIPES EQUINOVARUS ADDUCTUS = CLUBFOOT ................................................................................................................ 78
7.8 METATARSUS ADDUCTUS = bananenvoet ................................................................................................................................................ 78
7.9 HAKVOET = CALCANEOVALGUS ................................................................................................................................................................ 78
1E MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 3
,LES 1 : ALGEMENE PRINCIPES + POLYTRAUMA/BEKKEN
1.1 ALGEMENE PRINCIPES
ORTHOPEDIE : kijkt nr structureel probleem vh bewegingsstelsel in impact daarvan op functie
STRUCTUUR FUNCTIE
- Botten - ROM
- Gewrichten - Kracht
- Spieren - Stabiliteit
- Ligamenten - snelheid
- Pezen
Bewegingsstelsel is essentieel bij ALLE menselijke activiteiten ook bij algemene dagelijkse leven.
Incidentie : 1/6 raadplegingen bij de arts heeft te maken met problemen vh bewegingsstelsel
Wie? Zware beroepen (bouw, wegenwerken), muzikanten, (top)sporters, congenitale aandoeningen, tumoren, oudere pt
Pathologie :
- ongevallen : TRAUMATOLOGIE (thuis, vaak dr alcohol)
- veroudering : DEGENERATIEVE AANDOENINGEN : arthrose, peesveroudering
- inflammatie en metabole afwijkingen : REUMATOLOGIE : gewrichtsafwijkingen
- tumoren en infecties : alarmsignaal = nachtelijke pijn !
bot : figuren , uitleg zie volgende p.
WAAROM IS DE ZIJDE VD GEWRICHTEN (blauw) BREDER DAN DE
DOORMETER VAN DE DIAFYSE (groen) ?
De oppervlakte wordt groter aan het uiteinde vh bot.
𝒌𝒓𝒂𝒄𝒉𝒕 (𝑭)
Druk =
𝒐𝒑𝒑𝒆𝒓𝒗𝒍𝒂𝒌𝒕𝒆
Als opp groter wordt, zal druk dalen. Deze daling v druk is belangrijk om het
kraakbeen in de gewrichten te beschermen. Want als de druk >15 mPa gaat
het kraakbeen kapot
WAAROM TRABECULAIR BOT AAN DE UITEINDEN?
Dat zal de demping verbeteren.
WAAROM CORTICAAL BOT IN HET MIDDEN?
Omdat de diafyse vh bot moet weerstaan aan grote krachten.
WET VAN WOLFF ?
Naarmate de kracht toeneemt, zal het lichaam meer bot aanmaken.
Door beweging → elecktrische stimulatie vd osteoblasten → bot aanmaken
- Preventie osteoporose : meer beweging !!
- Astronaut : geen zwaartekracht, dus geen belasting botten , hebben
zware osteoporose
- Tennisser : arm waarmee ze raket vasthouden zal sterker zijn en
meer bot hebben dan andere arm
Op een bep punt, kan het lichaam niet meer bot kan aanmaken =
limietpunt.
Als je dan nog verder belast = stressfractuur.
Dus als je begint met sporten, moet je gradueel opbouwen. Zodat je
lichaam de kans krijgt om bot aan te maken.
Als je te snel te hoge belasting stelt bv. oudere man met overgewicht die
plots begint te trainen voor marathon : dan zal je stressfractuur doen.
1E MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 4
,BOT
- is gespecialiseerd bindweefsel
- biologische functie
o calcium metabolisme
o hematopoïese
- morfologische & structurele kenmerken
o lange beenderen : diafyse, metafyse, epifyse
▪ DIAFYSE
• Been is SMALLER
• Dikke, dens tubulair CORTICAAL bot
• Cortex bot biedt weerstand tegen torsie en plooien
▪ EPIFYSE/METAFYSE
• Been is BREDER
• DUNNE cortex
• TRABECULAIR BOT laat vervorming en demping toe
o cortex = compacta : buitenzijde lange beenderen , heel dens, 10% porositeit
▪ osteoporose: zal cortex dunner maken
o trabeculair = cancelleus : aan uiteinden van beenderen, 50-90% porositeit
▪ osteoporose : zal de porositeit van het trabeculair bot vergroten
▪ hoe hoger de porositeit, hoe minder sterk het bot
o cortex en trabeculair bot hebben
▪ DEZELFDE SAMENSTELLING (hydroxyapatiet) maar
▪ zijn STRUCTUREEL ANDERS geordend
o DE STRUCTUUR WORDT GEDICTEERD DOOR DE MECHANISCHE BELASTING
▪ Richting en grootte orde vd krachten die op het bot inwerken bepalen de structuur
▪ WET VAN WOLFF : hoe kan bot mechanische kracht omzetten in structurele veranderingen?
• Bij zware belasting → zullen de botten sterker worden = hogere botdichtheid
• Bij lage belasting → zullen de botten zwakker zijn = lagere botdichtheid
• Als krachttoename te snel gaat, is er nog geen botaangemaakt => stressfractuur
• Astronaut : gebrek aan mechanische belasting => osteoporose
- mechanische eigenschappen (~hout)
o heel sterk in compressie (drukken) en distractie (trekken)
GEWRICHT
- mechanische functie : transmissie vd kracht vd motor (spieren) naar de grond (bv.voeten) ~ versnellingsbak
- momentarm : M = F X D
- kinematica : scharniergewricht (elleboog) , kogelgewricht (heup), zadelgewricht (carpometacarpaal 1)
GLUTEUS MEDIUS EN MINIMUS = ABDUCTOREN VD HEUP
Ze zitten vast op de trochanter en hechten aan op het ileum.
Vormen samen als krachtkoppel de momentarm vr de heup
1E MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 5
, STABILITEIT VS MOBILITEIT
Gewrichten moeten beweeglijk zijn maar moeten ook zorgen voor stabiliteit
DE STABILIEIT VAN EEN GEWRICHT IS AFHANKELIJK VAN 3 ZAKEN :
- CONGRUENTIE : hoge congruentie, geeft groot oppervlakte en dus daling vd druk
o Hoge congruentie : heup : heel stabiel gewricht
o Middel congruentie : knie
o Lage congruentie : schouder
o PASSIEVE STABILISATIE
- LIGAMENTEN
o Zorgt voor beweging , maar beperken ook de beweeglijkheid
o Verschillend van mens tot mens : leeftijd, genetische, training, geslacht (in functie v cyclus!!)
o Laat beweging toe / beperkt beweging
o PASSIEVE + DYNAMISCHE STABILISATIE (receptoren)
- SPIEREN
o DYNAMISCHE STABILISATIE (actoren)
o Zorgt vr verbinding tss stabiliteit en mobiliteit
De volgorde van deze structuren verschillen van gewricht tot gewricht
PASSIEVE STABILISATIE : congruentie, ligamenten
DYNAMISCHE STABILISATIE : ligamenten (receptoren), spieren (actoren)
Ligamenten zijn sensoren = ze pikken de krachten die op het gewricht worden uitgeoefend op en zullen dit
terugkoppelen centraal of via het ruggenmerg naar de spieren (actoren) zodat deze in werking kunnen treden.
De boog tussen de ligamenten en spieren = PROPRIOCEPTIE = POSITIEZIN
1E MASTER : BEWEGINGSSTELSEL : ORTHOPEDIE 6
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