Comprehensive Notes on Rheumatology and Traumatology

Rheumatology: Epidemiology, Risk Factors, Etiology, and Pathophysiology of Osteoporosis

  • Epidemiology

    • Prevalence: Women are 3x more affected than men
    • Incidence: Approximately 1.3 million cases/year globally
    • Prediction by 2050: 4.5 million cases/year
    • WHO Classification: Osteoporosis is among the 10 most significant chronic diseases of our time.
    • One-year prevalence in Switzerland:
    • Women: 6.2% in ages 50-64, >16.4% over 65
    • Men: 1.1% in ages 50-64, 2.3% over 65
    • Bone loss increases with age in both genders.

  • Etiology

    • Osteoporosis is a gradual bone disease.
    • Primary Osteoporosis:
    • Bones undergo continuous remodeling after reaching peak bone mass, with a yearly decrease of ~1% in mineral content (bone density).
    • Genetic predispositions to primary osteoporosis are still unclear.
    • Secondary Osteoporosis:
    • Results from another disease or specific medication treatments, e.g., inflammatory rheumatic diseases, chronic intestinal diseases, malnutrition, malignant bone tumors.

  • Risk Factors

    • Non-modifiable:
    • Age, Female gender, Family history, Ethnicity, Lean body type, Early menopause.
    • Modifiable:
    • Low physical activity, Calcium-poor diet, High protein/phosphate intake, Vitamin D deficiency, Malnutrition, BMI < 20, Alcohol and nicotine use, use of glucocorticoids (e.g., systemic cortisone), proton pump inhibitors.

  • Pathophysiology

    • Stages of Osteoporosis:
    • Early Stage:
    • Bone density decreases without fractures; mild pain may occur. However, microfractures increase internal bone pressure leading to periosteal irritation.
    • Advanced Stage:
    • Notable symptoms include hyperkyphosis, reduced height due to spinal curvature, rib contact with the pelvis, variable pain based on fractures.

  • Physiotherapeutic Management

    • Essential activities:
    • Activities of Daily Living (ADLs): cleaning, shopping, climbing stairs, etc.
    • Strength training to enhance muscle mass, important exercises include running, cycling (swimming is ineffective for bone strengthening).
    • Fall prevention through hip protectors and walking aids.

Rheumatology: Epidemiology, Risk Factors, Etiology & Pathophysiology of Coxarthrosis

  • Epidemiology

    • Coxarthrosis accounts for about 25% of arthritic diseases.
    • Onset usually occurs between ages 50-60, with higher prevalence in older age groups.
    • After age 60, 5-10% of men and 5-15% of women show symptoms.

  • Etiology

    • Primary Arthritis: Cause unclear.
    • Secondary Arthritis: Accounts for approximately 80%.

  • Pathophysiology

    • Common symptoms include:
    • Fatigue and pain after physical activity
    • Morning stiffness or pain after periods of inactivity.
    • Difficulty putting on socks, hip and groin pain, pain that can radiate to the thigh or knee.
    • Symptoms may worsen with weather changes.

  • Clinical Findings

    • Movement Limitations: Particularly in internal rotation, and clinical signs like EOR pain.
    • Development of compensatory movement patterns and muscle atrophy.

  • Therapeutic Interventions

    • Physiotherapeutic measures for neuromuscular training, ADLs, and range of motion improvement.
    • Pharmacological interventions: Various medications available.
    • Surgical options include lavage, arthroscopic debridement, osteotomies, or arthroplasties.

Traumatology/Orthopedics: Relevant Osteosyntheses in Hip Injuries

  • Implant Principles

    • Dynamic Hip Screw (DHS):
    • Used for pertrochanteric femur fractures. Fixation occurs with a screw and a plate allowing for compression during weight-bearing.
    • Gamma Nail:
    • Treatment for proximal femur fractures with similar use cases as DHS, suitable for osteoporotic bone.
    • Proximal Femoral Nail (PFN):
    • Stable angle implant used for pertrochanteric fractures, developed specifically for this type of fracture.
    • Intramedullary Nail:
    • Stabilizes bone from the inside, offering biomechanical advantages and early weight-bearing capabilities.

  • Hip Prosthesis

    • Used post conservative treatment failures in coxarthrosis or after a femoral head fracture.
    • Distinction between total hip prosthesis (TEP) and hemiarthroplasty.

  • Postoperative Physiotherapy

    • Depends on the type of access and surgical preference:
    • AMIS (Anterior Minimal Invasive Surgery) access allows for early load-bearing.
    • Thromboembolism prophylaxis for a minimum of six weeks, with gradual rehabilitation including mobility and strengthening exercises.
    • Careful monitoring for complications post-surgery.

Mechanisms of Injury for Proximal Femur Fractures

  • Injury Mechanisms

    • Proximal fractures typically arise from falls or high-energy trauma.
    • Assessment of treatment approach depends on the stability and complexity of the fracture.

  • Non-displaced stable fractures typically manage conservatively, while displaced or unstable fractures require surgical intervention.

  • Operative vs Conservative Treatments

    • Surgical treatments may involve hip replacements, while conservative treatments may delay surgical intervention in certain cases.