Idiopathic Scoliosis

This group constitutes about 80% of all cases of scoliois, based on the onset,divided into:

• Infantile Idiopathic Scoliosis: age less than 4 years

• Juvenile Idiopathic Scoliosis: age 4-10 years

• Adult Idiopathic Scoliosis: age 10-18 years

Therapy

• Conservative:

When the age is approaching maturity and angulation less than 30o, with bracing and back
exercise

Operative: Angulation more than 30o and rapid progressivity of the deformity

Kyphosis

Kyphosis is the abnormal curvature of the thoracic vertebra. excessive thoracic curvature is
called hyperkyphosis. Kyphos or gibbus, is a sharp posterior angulation of the thoracal
vertebrae, due to localized collapse or wedging of one or more vertebrae, this may be the
result of a congenital defect, a fractures, or spinal tuberculosis.

Spinal degenerative disease

Degeneration of intervertebral discs

Pathology: dehydration of the discus, the volume of the nucleus pulposus is reduced and dry.
Fissure in the annulus fibrosus.Protrusi to the ligaments, formed osteofit, called spondylosis.

Secondary effects: displacement of the facet joints, vertebral corpus shift, root and stenois
canal

Clinical manifestations: initially asymptomatic. Followed by back pain and symptoms of

secondary effects.

Imaging:
- X-Ray: flattening of the disc, marginal osteophytes, vertebral body displacement, facet joint
osteoarthritis.

- MRI: bulging of the annulus fibrosus

- Therapy: asymptomatic therapy. Surgical therapy to overcome secondary effects that occur.

Acute prolapse of intervertebral disc

- Acute disc herniation (prolapse, rupture)

- Protrusi

- Extrusion

- Sequestration

Clinical manifestations: severe acute back pain, unable to straighten the back, sciatica

Imaging: X rays: for exclusion of bone abnormalities. Mielography, CT or MRI

Cauda equine syndrome: alvi and urinary incontinence, perineal numbness, bilateral sciatica,
weakness of the lower limbs, cross straight-leg raising,

Therapy: rest, reduction, removal, and rehabilitation

Spondylosistesis

That is translation to anterior one or more corpus vertebra.

Classification :

• Displastic

• Isthmic or lytic (most common)

• Degenerative

• Post traumatic
• Pathological

• Postoperative

Pathology: damage to the pars interatricularis, the posterior arcus apart from the corpus.
Pressure, facet and corpus subluxation to anterior. There can be emphasis on dura, cauda
equine and root.

Clinical manifestations: back pain, sciatica, step off of the spine.

Imaging: X-ray: anterior translucent corpus vertebra, lateral photo pad

Therapy :

- Conservative

- Operative

Spinal stenosis

It is an abnormal narrowing of the spinal canal, lateral recess, or intervertebral foramen, that
cause neurological symptoms

Cause:

• Congenital vertebral dysplasia

• Chronic disc protrusion

• Hypertrophy, shift, or osteoarthritis facet joint

• Hypertrophy of the flavum ligament

• Paget bone

• Spondylolistesis

Clinical manifestations: pain, weight, tingling, on the buttocks and thighs, after standing or
walking for 5-10 minutes. Improved after sitting, squatting or leaning against the wall with a
spinal flexion position (spinal claudicationo).

Imaging
- X ray: disc degeneration picture, osteoarthritis, or spondilolistesis

- MRI.

Therapy: Conservative. Operative: decompression

Reference:

1. Chapman MW. Chapman's orthopedic surgery. 3rd ed. Boston: Lippincott Williams &
wilkins; 2001.

1. Salter RB. Textbook of disorders and injuries of the muesculoskeletal system. USA:
Williams & Wilkins; 1999.

2. Solomon L, et al (eds). Apley's system of orthopaedics and fractures. 9th ed. London:
Hodder Arnold; 2010.

Topic 13 Trauma
This course consists of 2 sub-subjects, namely:

13.1. Child Invoices and Adults

13.2. Fracture of Upper and Lower extremities

On this topic the lecturer tells the students to be able to:

1. Explain the principles of fracture

2. Explain the clinical picture of the fracture

3. Explain the emergency orthopedics

4. Explain the management of fractures

5. Explain fracture complications

6. Explain fractures in children

7. Explain the healing fracture

1. Fracture Principles

Trauma can be:

• Direct trauma

• Indirect trauma

Pressure on bone can be:

• Rotating pressure

• Bending pressure

• Pressure along the bone axis

• Vertical compression

• Direct trauma is accompanied by resistance at a certain distance

• Fracture due to crumbling

• Trauma due to tug on the ligaments or tendons

Etiology Fraktur:

Two factors affect the occurrence of fractures:

• Extrinsic

• Intrinsic

Fractures come from:

• Injury

• Stress over and over

• Pathologic fracture.

Fracture Type. Fractures for practical reasons are divided into groups.

A. Complete fracture

The bone is divided into two or more fragments.

B. Incomplete invoice

Here the bones are not totally divided and the periosteum remains intact.

Fraktur Classification:

• Etiologic classification

o Traumatic fracture

Pathologic fractures

o Fracture stress

• Clinical classification

o Closed fracture (simple fracture)

o Open fracture (compound fracture)