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OrthoKlinik AVSTRIA

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TREATMENT


The orthopedic surgeon is involved with various abnormalities of the musculoskeletal system. Physical and radiographic examination will usually take place to determine the cause of your complaint(s). Orthopedic surgeons use both surgical and nonsurgical means to treat problems.

KNEE

Anterior Cruciate Injury
The Anterior Cruciate Ligament (ACL) is a tendon-like structure in the middle of the knee, that runs from the shinbone to the thigh-bone. The ALC provides stability in the knee, along with the posterior cruciate ligament and the inner and outer knee strings. Cruciate Ligament Injury may occur during strong twisting of the knee during sports or during an accident. The same contortion knee can also cause injury to the meniscus, knee strings, or combinations. During winter sports, especially skiers are at risk of injury to these structures.

What are signs of an ACL injury? 
As a result of a torn anterior cruciate ligament there may be instability of the knee, causing the knee to ‘give way’ when standing or just feel uncomfortable and instable. The tearing of the ligament can be painful, and sometimes a "crack" is felt or heard. In addition, the knee may swell after a tear of the cruciate ligament.

How is ACL injury diagnosed?
Your doctor will ask about the origin of the injury. This provides important information about the forces that have acted on the knee (trauma mechanism). In addition, the knee is examined. An X-ray of the knee is made to be exclude fractures (see also: tibiaplateaufractures). Usually, the physical examination gives a good indication whether the ligament is torn or intact. If not, an MRI scan of the knee needed to provide more certainty about the presence of ligament injuries. In that case, we ensure that these can be made quickly in Radstadt.

How is an anterior cruciate ligament treated?
A tear of the anterior cruciate ligament is usually treated surgically. According to current conceptions, a torn ACL cannot be re-attached. Therefore, a donor tendon, preferebly from the own body (the hamstring tendons or the middle part of the patellar tendon or (rarely) the quadriceps tendon), is used. Through keyhole surgery, the new tendon is attached to the tibia and femur at the site of the old ligament attached.

However, at OrthoHaus, we are working with a team of orthopedic surgeons to develop a surgical technique whereby the remains of the torn ligament itself can be used without the need of a donor tendon. This operation must be done within 48 hours of the injury to be succesful. It has potentially large benefits in terms of faster recovery and the fact that no tendon needs to be harvested from the body. We expect to start using this surgical technique in the course of 2013.

Where is the ligament plastic implemented?
We perform arthroscopic surgeries in Radstadt.

How can you prepare for a cruciate ligament repair? 
Good preparation for the cruciate ligament repair is to improve the strength of the upper leg muscles, in collaboration with your physiotherapist. It is important that you have crutches.

What can you expect after a cruciate ligament repair? 
The surgery itself takes about 45 minutes. The day after the operation you will start to practice with a physiotherapist. It is important that you also practice individually. Recovery after cruciate ligament surgery takes several months. The aim is that you return to your old functional level including the exercise of sports.

Non-operative treatment
Sometimes a non-surgical treatment of anterior cruciate ligament injuries is opted. This requires the knee to be stable, which can return if a torn portion of the anterior cruciate ligament attaches to the posterior cruciate ligament. This occurs in approximately 10% of the cases.

 
Meniscal lesion
The meniscus cartilage is a semi-circular disk that is part of the knee joint. The meniscus is located between the tibia and the femur in and is formed of two parts: the inner (medial) and an outer (lateral) meniscus. The meniscus has a shock-absorbing function, and in addition, it also contributes to the stability of the knee.
Meniscus injury is usually the result of a rotation of the knee. The meniscus gets clamped between the femur and tibia, partially or fully tearing the meniscus. Rotation of the knee may also lead to injury of the anterior cruciate ligament, collateral ligaments or combinations thereof. During wintersports, skiers are especially at risk of injury to these structures, snowboaders are at risk only one foot is bound to the board. In older people, a tear of a meniscus may also be due to the meniscus becoming stiffer. This is called a degenerative tear.

What you notice a meniscus injury? 
A meniscal tear may cause pain in the knee. Mostly it is a tear on the inside meniscus and causes pain at the inner side of the knee. In addition, the knee often swells. In some cases, the meniscus clamps in. This leads 'locking complaints', which means that it is not possible to fully extend the leg.

How meniscal injury diagnosed?
Your doctor will ask about the origin of the injury. This provides important information about the forces that have acted on the knee (trauma mechanism). In addition, the knee and hip are examined. An X-ray of the knee is made ​​to exclude fractures. Sometimes an MRI scan of the knee is required in order to obtain more certainty about the presence of meniscal injuries. In that case, we ensure that these can be made ​​quickly in Radstadt.

What is the treatment of meniscus injury?
Usually knee surgery is necessary. This is done with an arthroscopy of the knee, in which we look inside the knee with a small camera (scope). Via two small incisions (1 cm), water is injected, creating enough space in the joint to perform the surgery. Through the first incision the inside of the knee can be looked at with the scope, while the second incision can be used as a working channel. Sometimes the torn meniscus can be re-attached, in other cases, the torn part of the meniscus is excised partially or the meniscus must be completely removed. Damaged cartilage can be cleaned.

Where will the arthroscopy of the knee instead?
We perform arthroscopic surgery in Radstadt.

What to expect after an arthroscopy of the knee? 
The first days to weeks after surgery, the knee is still swollen and sensitive. The dressing can be removed after two days. If the wounds are completely dry for 24 hours you may take a shower. Because of the swelling and the pain it is often necessary to use crutches during the first two weeks after surgery. Paracetamol is advised against the pain during the first days after surgery. If pain permits, the crutches may be dispensed. Two weeks after surgery you will come to the hospital with the nurse practitioner, physician assistant or physician, for a medical check-up. Full recovery will take months, but often leads to good results.

 
Tibial plateau fracture
The tibial plateau is the part of the shinbone (tibia) that forms the lower surface of the knee joint, it is the roof of the tibia. A knee fracture often refers to a fracture in the kneecap or a fracture of the shin-/thigh-bone that reaches into the surface of the knee joint. If the fracture does not continue into the joint, we call this either a shinbone or thighbone fracture (tibial or femoral fracture). Because the tibial plateu is part of the knee joint, it is important that the bone parts are put back as closely as possible to their original position.

What you notice a tibial plateau fracture? 
After a substantial injury to the knee, a fracture in the tibial plateau may occur. The knee is thick, painful and you usually can’t place weight on the affected leg. Pressure applied at the site of the fracture is also very painful.

How is a tibial plateau fracture determined?
Your doctor will ask about the origin of the injury. This provides important information about the forces that have acted on the knee (trauma mechanism). Furthermore, the knee is examined and an X-ray study is conducted. Sometimes a CT-scan of the knee is required in order to obtain more certainty about the presence of a tibial plateau fractures or other injuries. In such cases cases, we provide for quick access to a CT-scan in Radstadt.

What is the treatment of a tibial plateau fracture? 
In the case of a tibial plateau fracture it is important that the fractioned parts and the cartilage grow together exactly the way they were before the injury. Small displacement of these parts may have major consequences for the function of the joint. Therefore, surgical repair of the fracture is often required, wherein the parts of the bone are set with fixation material. This material may consist of metal plates, screws and wire. In less severe cases, traction is applied and operation is not required. Traction is applied to the leg with weights in order to ensure that the bone fragments stay in position without any loading, until the bone has firmly grown. In even milder cases a plaster treatment suffices, with plaster casting from the groin to the ankle, so you cannot move the knee.

Where will the operation take place?
We perform operations where the bone is set and fixed with fixation material (Open Reduction and Internal Fixation, ORIF) in Radstadt.

What are the risks of treatment?
Immobilization in plaster (after operation), has is a risk of thrombosis, because that the calf muscle can’t be used. To prevent deep vein thrombosis heparin or warfarin is usually temporarily prescribed. An operation always has small risk of infection or bleeding.

 
LOWER LEG AND ANKLE

Fracture of the lower leg
In each lower leg, we have a shinbone (tibia) and the calf bone (fibula). A lower leg fracture is when if one or both of these bones are broken, except if the fracture runs through the end of these bones. If the fracture extends into the knee joint, this called a tibial plateau fracture, while fractures and the low end of the lower leg fractures are grouped into the ankle fractures (malleolus fracture).

What you notice a lower leg fracture?
Lower leg fractures are painful when the leg is loaded. If the tibia is fractured, it is usually no longer possible to place weight on the leg. If only the fibula is broken, standing and walking with the affected leg is sometimes still possible. A fracture will hurt pressure is applied at the fracture site.

How is a leg fracture diagnosed?
Your doctor will ask about the origin of the injury. This provides important information about the forces that have acted on leg (trauma mechanism). Furthermore, the leg and the ankle are examined and X-rays will be made. On the X-ray pictures, we can see if the bone is broken and what type of fracture occurred.

What is the treatment of a leg fracture?
For the treatment of bone fractures, it is important that the fractions are fixed in a correct position and have the opportunity to heal. When bone fragments have been displaced too much, the bone must first be set. Once the bone fragments are in good position, a plaster cast is applied to prevent displacement, allowing the bone to heal. To ensure that the position remains adequate, a check-up X-ray is taken after one week. If the bone can’t be set or the fragments keep dislocating (instable fracture), you often need surgery.

What happens during surgery for a leg fracture?
If it is not possible to allow the bone to heal, it must be surgically fixated. The bones are set during the surgery and fixated with screws, a metal plate, pins or wires.

Where will the operation take place?
We perform operations where the bone is set and fixed with fixation material (Open Reduction and Internal Fixation, ORIF) in Radstadt.

What are the risks of treatment?
With plaster-immobilization comes a risk of thrombosis, because the calf muscle can’t be used. To prevent deep vein thrombosis heparin or warfarin is usually temporarily prescribed. An operation always has small risk of infection or bleeding.

 
Ankle Fracture
The ankle joint is made ​​up of different bones, all of which can break. The shinbone (tibia) and calf bone (fibula) can fracture during substantial spraining or direct forces. The heel bone usually breaks after a jump or fall from a great height. Ankle fractures and torn ankle ligaments used to be widespread among skiers. Modern skiing material protects against fractures of the ankle. Softboots that snowboarders wear, much less protect against ankle fractures, especially when only one foot is bound to the board. The snowboarders fracture is a fracture of the outside of the ankle bone (Talus, positioned between shinbone and heelbone) that is unique to snowboarders. It can be the result of a trauma in which the foot is turned inwards with the toes pulled up towards the face.

What are characteristics of an ankle fracture? 
After breaking an ankle you mostly notice your ankle to be swollen. Also, there is often some bruising around your ankle and you can’t place weight on the affected leg because of the pain. Sometimes there is a deformity of the leg or foot.

How is an ankle fracture diagnosed?
Your doctor will ask about the origin of the injury. This provides important information about the forces that have acted on leg (trauma mechanism). Your doctor will examine your ankle. When an ankle fracture is suspected, he’ll decide to make X-rays. With this X-ray fractures in the bones can be seen and the severity of the injury can be determined.

What is the treatment of an ankle fracture?
An ankle fracture can often be treated with plaster. Sometimes, there is too much displacement of the bone fragments, there is a complex fracture or an unstable fracture. In those cases, an operation needs to take place. The bone pieces are then put together with plate and screws. It is important that the joint fully recovers and the articular surface is completely smooth.

Where will the operation take place?
We perform operations where the bone is set and fixed with fixation material (Open Reduction and Internal Fixation, ORIF) in Radstadt.

What are the risks of treatment?
With plaster-immobilization comes a risk of thrombosis, because the calf muscle can’t be used. To prevent deep vein thrombosis heparin or warfarin is usually temporarily prescribed. An operation always has small risk of infection or bleeding.

 
Ankle Injury
The ankles collateral ligaments are rigid structures that provide stability to the ankle joint. The upper ankle joint allows the foot to move upwards or downwards. Ankle injury occurs when the foot sprains inwards or outwards, movements the upper ankle joint isn’t built for. It is a common injury, especially among adolescents and young adults between 15 and 35 years old. In about 80% of acute ankle complaints are the result of a sprain. This means that the ankle ligaments are stretched, but not torn, and that these will fully heal without intervention. 10% of the complaints prove to be based on a fracture of the ankle (see ankle fracture). The remaining 10% has a torn ligament, wherein a distinction is made ​​between a partially and fully torn ankle ligament.

What you experience symptoms of ankle sprain?
Almost immediately after the accident, an egg-shaped swelling forms on the outside of the ankle. In about half the cases, this is accompanied by a red, red-brown and green or blue discoloration of the skin. The outside of the ankle is sensitive. This pain increases when the foot is pulled inwards. In most cases, standing on the affected leg is still possible, however painful.

How is it diagnosed?
Your doctor will ask about the origin of the injury. This provides important information about the forces acting on the ankle have interacted (trauma mechanism). Furthermore, the leg and the ankle examined. When there is a pain when the site of the ligaments is pressed, combined with a blue-green discolouration on the outside of the ankle, and the foot can be shifted forwards, there is 95% chance of a ruptured collateral ankle ligament. If instability of the ankle is found, a total rupture of the ligament is safely assumed. In many cases the physician decides to make an X-ray to exclude fractures. In some cases it may be clear that an x-ray is not necessary.

What is the treatment of ankle sprain?
After an ankle injury it is wise to put ice on it as soon as possible to counteract the swelling. In case of a sprain, activities can be resumed in reference to the symptoms. If one or more ankle ligaments are completely torn, the ankle should be kept stable. The collateral ankle ligaments naturally grow back together. Stabilization can be acquired through the use of pressure bandage, tape, stockings, braces or plaster. The choice is influenced by the severity of the injury, but a pressure bandage will usually suffice. Braces offer the advantage that they can be easily removed, for example, to take a shower.

What can you do after the treatment?
After an ankle sprain, one can resume working and doing sports within a week. After an ankle ligament tear occurs work is mostly resumed after one week of therapy, with a pressure bandage or tape immobilization. However, prolonged standing and long walks are not yet possible. Not only stability, but also the coordination of the leg and foot is often affected after ankle injury. Please keep in mind that this creates a greater risk of secondary injury. Physiotherapy can help to regain the strength, stability and coordination of the ankle. After six weeks, you should be able to resume all activities.
Less than 1% of the ankle ligament tears do not properly heal. If this is the case, the ligaments can be stretched or surgically reconstructed using a donor tendon (peroneus brevis muscle, an extensor tendon of the little toes, plantaris tendon).

Where will the operation take place?
We can perform these oprations in Radtstadt.

What are the risks of treatment?
The treatment with the aid of a compression bandage and tape-immobilization normally goes without any problems. For cast-immobilisation after surgery, there is a risk of thrombosis, because the calf muscle can’t be used. To prevent deep vein thrombosis heparin or warfarin is usually temporarily prescribed. An operation always has small risk of infection or bleeding.



OrthoHaus is located at a short distance and easily accessible from the main road between the ski lifts of Hauser Kaibling in Haus im Ennstal, Plainai-Hochwurzen in Schladming and Reiteralm in Pichl.

ORTHOHAUS
MARKTSTRAßE 209
A-8967 HAUS IM ENNSTAL
Tel: 0043 (0)3686 28557
info@orthohaus.com

OrthoHaus is only open by appointment. 


ORTHOHAUS, MARKTSTRAE 209, A-8967 HAUS IM ENNSTAL

TEL: 0043 (0)3686 28557 | EMAIL: info@orthohaus.com