In orthopedic clinic, we are receiving many cases, including cases related to accidents or torn ligaments to muscle rupture and cases of tendinitis. There are cases related to the joints, including chronic and acute, and each case is dealt with according to the policy according to the recommendation of the mother school for fractures and dealing with cases in an academic manner, starting with receiving the patient and giving him his full rights and taking the medical history and then the clinical examination, X-rays and the necessary examination for each case according to the protocol followed In all medical complexes of the Kingdom of Saudi Arabia.

We will start talking in our article about the most common cases in the orthopedic clinic at Al-Farabi Medical Complex

Many types of bone fractures, and cases of torn ligaments are received in the orthopedic clinic, and most cases are closed fractures.

A closed fracture (or the so-called simple fracture), and what distinguishes this type of fracture is that the skin around the broken bone is not damaged is -called fracture of the green stick fracture,

orthopedic // Symptoms and signs:-

1.  A feeling of pain and/or discomfort at any pressure – no matter how small and gentle – on and around the affected area.
2. Swelling of the affected area.
3. The inability of the broken limb (if the limb is broken) to bear any weight that is placed on it, and the limb may appear deformed.
4. The soft tissue around the broken bone may be damaged

orthopedic // How to diagnose it:-

The fracture is usually diagnosed by examining the patient and taking x-rays of the area

Such as a CT scan, magnetic resonance imaging (MRI)

orthopedic // Fracture treatment:-

How bone fractures are treated depends on the type and location of the fracture, as well as the patient’s age and medical history.

It is worth noting that most fractures – even minor ones in some cases – are fixed by wrapping them with a plaster (gypsum), a splint or something else according to the need of the injured, but in the event of severe swelling in the area of the fracture, the doctor may wait until the swelling is gone Before applying plaster to the fracture.

As for stress fractures, they are treated only by resting and stopping the activity that led to them, in addition to the use of anti-inflammatory medicines – such as ibuprofen – and the use of ice packs.

orthopedic // General rules for treating fractures:-

The casualty must remain immobile until the broken bone is immobilized

orthopedic // General Tips:-

Exercise regularly, as it helps prevent fractures

Adequate amounts of calcium should be included in the diet of all ages to help prevent fractures.

orthopedic // Orthosis care:-

Fractures may be treated with splints to stabilize them; this is to facilitate proper bone healing and reduce pain caused by movement. So this splint must be taken care of; to reduce complications, and avoid infection, by following the following:-

1 – The area affected by the fracture is often swollen, as the patient feels tight at first. To reduce swelling, the cast should be raised by placing it on pillows, and raised above the level of the heart for a period of 24 to 48 hours

2- Applying ice packs to the swelling places. By placing an ice pack, or a clean cloth with ice in it. It is preferable to put compresses on it for 20 minutes every two hours, avoiding putting ice directly on the skin

3-Take a pain medication for at least 48 hours, such as acetaminophen or ibuprofen; to relieve pain

4- Keep the splint dry while showering, and not allow water to pass inside it, by covering it with two plastic bags, wrapping each bag separately, and fixing them with adhesive tape on the skin outside the cast.

orthopedic // Gout:-

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.

Gout attacks can come on quickly and keep returning over time, slowly harming tissues in the region of the inflammation, and can be extremely painful. Hypertension, cardiovascular, and obesity are risk factors for gout. It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.

orthopedic // Fast facts on gout:-

• Gout is a form of arthritis caused by excess uric acid in the bloodstream.
• The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them.
• Gout most classically affects the joint in the base of the big toe.
• Gout attacks often occur without warning in the middle of the night.
• Most gout cases are treated with specific medications.

Treatment:-

The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi. Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and is usually taken orally. Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney’s ability to remove uric acid from the body (probenecid).

Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment, but there may be significant pain during this period.

Tests and diagnosis:-

Gout can be tricky to diagnose, as its symptoms, when they do appear, are similar to those of other conditions. While hyperuricemia occurs in the majority of people that develop gout, it may not be present during a flare. On top of that, the majority of people with hyperuricemia do not develop gout.

One diagnostic test that doctors can carry out is the joint fluid test, where fluid is extracted from the affected joint with a needle. The fluid is then examined to see if any urate crystals are present. As joint infections can also cause similar symptoms to gout, a doctor can look for bacteria when carrying out a joint fluid test in order to rule a bacterial cause. The fluid may need to be sent to a lab, where it can take several days to analyze. Doctors can also do a blood test to measure the levels of uric acid in the blood, but, mentioned, people with high uric acid levels do not always experience gout. Equally, some people can develop the symptoms of gout without having increased levels of uric acid in the blood.

Finally, doctors can search for urate crystals around joints or within a tophus using ultrasound scan. X-rays cannot detect gout, but may be used to rule out other causes.

Types:-

1. Asymptomatic hyperuricemia
2. Acute gout
3. Interval or intercritical gout
4. Chronic tophaceous gout
5. Pseudogout

Causes:-

Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia. Uric acid is produced in the body during the breakdown of purines – chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood.

Risk factors:-

1. Age and gender: Men produce more uric acid than women
2. Genetics: A family history of gout increases the likelihood of the condition developing.
3. Lifestyle choices: Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body.

orthopedic // Symptoms:-

Intense joint pain that subsides to discomfort, inflammation, and redness.

Affects the large joint of the big toe, but can also affect the forefoot, ankles, knees, elbows, wrists, and fingers

Complications

Kidney stones: If urate crystals collect in the urinary tract and recurrent gout

Prevention tips

• maintain a high fluid intake of around 2 to 4 liters a day
• avoid alcohol
• maintain a healthy body weight

Home remedies

Decreasing foods that are high in purines, to ensure that the levels of uric acid in the blood do not get too high, is reasonable to try. Here is a list of high-purine foods to be wary of:

1. Anchovies
2. Asparagus
3. beef kidneys
4. brains
5. dried beans and peas
6. game meats
7. gravy
8. herring
9. liver
10. mackerel
11. mushrooms
12. sardines
13. scallops
14. sweetbreads

The following foods contain purines. People with gout should significantly limit or avoid them.

red meat and organ meat, such as liver or kidneys, which are high in saturated fat

Seafood, such as lobster, shrimp, sardines, anchovies, tuna, trout, mackerel, and haddock

Sugary drinks and foods those are high in fructose

Processed foods and refined carbohydrates

Alcohol, especially beer and hard liquor

orthopedic // Knee osteoarthritis (OA),

also known as degenerative joint disease of the knee, is typically the result of wear and tear and progressive loss of articular  cartilage.

It is most common in elderly women and men.

Knee osteoarthritis can be divided into two types, primary and secondary.

Primary osteoarthritis is articular degeneration without any apparent underlying reason.

Secondary osteoarthritis is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage, such as rheumatoid arthritis (RA).

Osteoarthritis is typically a progressive disease that may eventually lead to disability.

The intensity of the clinical symptoms may vary from each individual. However, they typically become more severe, more frequent, and more debilitating over time. The rate of progression also varies for each individual.

Common clinical symptoms include knee pain that is gradual in onset and worse with activity, knee stiffness and swelling, pain after prolonged sitting or resting, and pain that worsens over time. Treatment for knee osteoarthritis begins with conservative methods and progresses to surgical treatment options when conservative treatment fails. While medications can help slow the progression of RA and other inflammatory conditions, no proven disease-modifying agents for the treatment of knee osteoarthritis currently exist. This activity highlights the role of the interprofessional team in caring for patients with this condition.

orthopedic // Lower back pain:-

Lower back pain is a common cause for visits to the doctor

In Saudi Arabia, the prevalence of LBP among the general population is reported to be 18.8% [2]. Low back pain (LBP) is an important public health issue, being of widespread and of a considerable negative social, psychological, and economic influence

: Low Back Pain (LBP) is a common disorder involving the muscles and bones of the back. The patients ranged in age from 15 to 52 years. The condition may be further categorized by the underlying etiology as either mechanical, non-mechanical, or referred pain. Little is known about the epidemiology of this condition in the Saudi Arabia.

According to the National Institute of Neurological Disorders and Stroke (NINDS), low back pain is the most common cause of job-related disability. At least 80 percent of Americans will experience low back pain in their lifetime.

• Causes of low back pain
• Strains
• Disc injury
• Sciatica
• Spinal stenosis
• Abnormal spine curvatures

There are a number of other conditions that cause lower back pain. These conditions include:

• Arthritis is an inflammation of the joints.
• Fibromyalgia is long-term pain and tenderness in the joints, muscles, and tendons.
• Spondylitis is inflammation of the joints between the spinal bones.
• Spondylitis is a degenerative disorder

orthopedic // How is low back pain diagnosed?

By requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. A physical exam can also determine if pain is affecting your range of motion.

Imaging tests such as X-rays, CT scans, ultrasounds, and MRIs may be necessary so your doctor can check for:

• bone problems
• disc problems
• Problems with the ligaments and tendons in your back. Electromyography (EMG) or nerve conduction tests can help identify any problems with your nerves.
• Treatment of LOW   BACK  PAIN :-

Medications

Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs

• Muscle relaxants
• Topical pain relievers
• Narcotics.
• Antidepressants
• Physical therapy

A physical therapist can teach you exercises to increase your flexibility,

Plantar fasciitis

Plantar fasciitis is the most common cause of heel pain, according to the Surgeons the condition occurs when the plantar fascia on the bottom of the foot becomes inflamed. This ligament is responsible for supporting the foot’s arch.

Causes:-

Plantar fasciitis is an inflammatory condition that usually does not have a clear cause. Doctors refer to this condition, as idiopathic plantar fasciitis. Risk factors include being obese, having a very high arch, having tight calf muscles, and participating in activities that repetitively stress the heel, such as running.

Symptoms:-

Plantar fasciitis causes a person to experience pain on the bottom of the heel. This pain is usually worse first thing in the morning when getting out of bed. The pain also worsens with activity.

Treatment:-

Most people can manage plantar fasciitis with at-home treatment. Resting the foot and applying ice can reduce inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium, can help with pain management.Stretching the foot thoroughly before and after physical activity, as well as throughout the day, may help to reduce heel pain. Wearing supportive shoes can also help. If an individual’s plantar fasciitis does not get better with these treatments, they can try physical therapy, or see a podiatrist or an orthopedic surgeon for further treatments.

Steroid injections may be recommended to reduce inflammation, or a doctor may prescribe custom-made orthotics to provide extra support to the heel.

orthopedic // Osteoporosis:-

Osteoporosis causes bones to become weak and easily break — making them so fragile that a fall or even minor exertion such as bending or coughing can cause fractures. Osteoporosis-related fractures most commonly occur in the hip, wrist, and spine

Bone is the living tissue that is constantly broken and replaced. Osteoporosis occurs when the creation of new bone does not keep pace with the loss of old bone.

Symptoms:-

• Back pain as a result of fracture or erosion of the vertebrae
• Ease of getting bone fractures than expected

Causes:-

Your bones are in a state of constant renewal—new bone being made and old bone being broken down. When you were young, your body made new bone faster than it broke down old bone, so bone mass increases. After their early twenties this process slows down, and most people reach peak bone mass by the time they reach their thirties. As we age, bone mass erodes faster than it is built.

You get it during your youth. Peak bone mass is controlled to some extent by genetics and also varies according to each ethnic group. The greater the maximum bone mass at the age of 30, the greater your bone balance in the Bone Health Bank

risk factors:-

Immutable risk

• Your gender. Women are more likely to develop osteoporosis than
• Age. The older you get, the higher your risk of osteoporosis.
• Ethnicity. Your risk of osteoporosis increases if you are white or of Asian descent.
• Family history. Having a parent, sibling, or sibling with osteoporosis puts you at greater risk
• The size of the body structure. Men and women with smaller physiques are at greater risk of this risk. Because their bone mass is usually lower and decreases as they age

Nutrition factors:-

• Decreased calcium intake. Lifelong calcium deficiency plays a role in osteoporosis. Calcium intake contributes to reduced bone density, premature bone loss and an increased risk of fractures.
• Disturbance of appetite. Severely restricting food intake and staying below normal weight weaken the bones in both men and women.

medical conditions:-

The risk of osteoporosis is higher in people who have certain medical problems, which include:

• Celiac disease
• Inflammatory bowel disease
• Kidney or liver disease
• cancer
• systemic lupus  erythematous
• Rheumatoid arthritis

Complications:-

Bone fractures, especially in the spine or hip, are the most serious complication of osteoporosis. A hip fracture usually occurs from a fall and can lead to incapacity and even an increased risk of death within the first year after the injury.

In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up the spine (vertebrae) can weaken to a degree

Contracture, which can lead to back pain, decreased height, and an arched forward position in the spine.

Protection:-

Good nutrition and regular exercise are essential to keeping your bones healthy throughout your life.

• Protein
• body weight
• Calcium Vitamin D

Tendinitis and its types:-

• De Quervain’s tenosynovitis
• Trigger finger
• stenosing tenosynovitis

De Quervain’s tenosynovitis is a painful condition that affects the tendons next to your thumb in your wrist. If you have de Quervain’s tenosynovitis, it likely hurts when you turn your wrist, grab an object, or make a fist

• The pain is near the base of the thumb
• Swelling near the base of the thumb
• Difficulty moving the thumb and wrist when you do anything that involves clenching your fist or pinching your fingers
• A ‘tingling’ or ‘cutting’ sensation in the thumb when moving it

treatment :-

The first stage of treatment

The use of anti-inflammatory with a pain reliever with a support for the thumb and when the treatment does not respond to the treatment, the steroid is injected into the tendon, and when the tendon injection does not respond, surgical intervention is required.

Trigger finger:-

• It is a condition in which one of your fingers gets stuck in a flexed position. Your finger may bend or straighten with a clicking sound  like pulling a trigger.
• Trigger finger is also known as “trigger finger”. This condition occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If your trigger finger is chronic, your finger may become stuck in a flexed position

People whose work or hobbies involve repetitive actions that require the use of a fist are at greater risk of developing trigger finger. This condition is also more common in women and people with diabetes. Treatment for trigger finger varies based on the severity of the condition.

Symptoms:-

Finger stiffness, especially in the morning

A popping or popping feeling when moving the finger

Pain or a bump (nodule) in the palm of the hand at the base of the affected finger

Finger stuck in a bent position with snapping when suddenly rebounding to a straight position

The finger is fixed in a bent position without the ability to extend it

Treatment:-

• Steroid injections. Injecting a steroid medication near or into the tendon sheath may reduce inflammation and allow the tendon to glide freely again. This is the most common treatment, and is usually effective for a year or longer in most people treated. But sometimes more than one injection is required.
• transdermal release. After your palm is numbed, your doctor inserts a powerful needle into the tissue around the affected tendon. Moving the needle and your finger helps loosen the blockage that is impeding smooth tendon movement.

orthopedic // Lateral epicondylitis

, also known as tennis elbow, is characterized by pain on the outside (lateral side) of the elbow. The pain is caused by damage to the tendons that bend the wrist backward away from the palm. A tendon is a tough cord of tissue that connects muscles to bones. The tendon most likely involved in tennis elbow is called the extensor carpi radialis bevies, and this condition is usually diagnosed in both men and women between the ages of 30 years to 50 years.

Treatment for tennis elbow includes stopping the activity that produces the symptoms. It is important to avoid the movement that caused the injury in the first place.

 Treatment may include:

• ice pack application (to reduce inflammation)
• strengthening exercises
• anti-inflammatory medications
• bracing
• corticosteroid injections
• surgery