PROGRAM OF PEDIATRIC ORTHOPEDIC SURGERY FOR FOREIGN STUDENTS OF

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PROGRAM OF PEDIATRIC ORTHOPEDIC SURGERY FOR FOREIGN STUDENTS OF Powered By Docstoc
					                      PROGRAM OF LECTURES AND LABS
                      PEDIATRIC ORTHOPEDIC SURGERY
                       English Language Program for European Students


Chair and Department of Pediatric Orthopedics and Rehabilitation, DSK, ul. Chodzki
2, Lublin (6th floor)

(15 lectures + 30 exercises - in Ward, in Out-Patient Glinie, in Operative Theater)

  Tutors: Pro f. Tomasz Karski MD PhD (Head of Chair & Department), Prof. Grzegorz
  Kandzierski MD PhD, Jacek Karski MD PhD, Łukasz Matuszewski MD PhD, Jarosław
                                  Kałakucki MD MA

Problems for teaching and discussions:
15 subjects will be presented as "lectures",
all 30 subjects will be presented during "exercises".

   1. General information about Orthopedics in Poland and in other countries [sińce
   founder Nicola Andry 1741]. History (important persons in oprthopaedics) Ambrois
   Parę, Semmelweiss, Koch, Fleming, Wachmann, Salk&Koprowski, Trendelenburg,
   Kitę, Rippstein, Wierzejewski, Dega, Piątkowski, Kamiński, Wośko, Weiss,
   Weisfolg, Szulc Witold, Garlicki, Bartkowiak, Zwierzchowski; other most important
   dates, othefr names and events.
   2. Orthopedics and rehabilitation of movement apparatus. Main fields in pediatrie
   Orthopedics: congenital and acąuired deformities, post-traumatic, post-inflammatory,
   neurological disorders and deformities of movement apparatus at children and
   youths. Illness, deformities in upper, in lower extremities and in trunk. Statistics,
   social problems connected with orthopedic surgery.
   3. Clinical examinations in orthopedic surgery: body symmetry and proportions,
   length of extremities, circumferences of extremities, rangę of joint movements -
   measurement 'according "O" position'. Analysis of gait & of stand position. Standing
   and gait - nfluences on growth and development of spine.
   4. (continuation of point 3) Clinical tests in orthopaedics - Barlow test, Ortolani test,
   Trendelenburg test, Duchenne test, Holt test, Dunkan-Elly test [Thom, Staheli],
   Thomas test, Drehman test, tests for knee stability, Adams test for spine, "Lublin test
   for spine", "kneeing test" for pelvis, QST test, toes flexion test (Karski), neurological
   tests for newborns and babies, functional tests for hands/fingers (for n.medianus,
   n.ulnaris, n. radialis), Moberg test for hands, etc.
   5. Congenital (developmental) hip dysplasia (DDH) -- diagnosis, therapeutic and
   social problem in many countries of the world. Knowledge on this deformation /
   malformation in history (in old books of Orthopedics). Epidemiology, statistics of hip
   dysplasia.
   6. Two type of hip dysplasia (DDH). New classification: A/ dysplasia in laxity of
   joints, B/ dysplasia in "syndrome of contractures" (Dega, Mau, Palmen, Barlow,
   Piątkowski, Wośko). Causes & classification of two groups of hip deformity
   (deformation / malformation - Prof. Dega, Prof. Hensinger, Prof. Howorth, Prof.
   Klisic, Prof. Palmen, Prof. Barlow, Prof. Ortolani).
7. Epidemiology of DDH, clinłcal symptoms, sonographic & radiological symptoms.
Information about ultrasonography. Principles of screening in congenital hip
dysplasia.
8. DDH - conservative treatment. "Over-head extension" - American method in
Europę versus Lange method. Nursing (proper/wrong). Functional treatment. Types
of orthesis for standing and walking. Examples. Complications in conservative
treatment. Two examples of avascular head necrosis.
9. Lublin method for "second R" of Prof. Graf/Austria [RRR = l/ Repositon
(reduction), 2/ Retenzion (retention), 3/ Reifung (proper development)]. Clinical and
radiological examples. Method introduced in January 1982. Successful non operative
method versus operative method - Repositio simplex.
10.Operative treatment of DDH - reduction-reconstruction. Osteotomies according to
    Dega, Salter, Pemberton. Triple pelvic osteotomy according to Steel/Tahdijan. Chiari
    osteotomy (Austria). Isolated (inominate) osteotomy -- Dega/Salter osteotomy of
    inominate bonę. Types of skin incisions.
ll.ChiWs hip joint - other illnesses and deformations: l/ Perthes disease (aseptic
    necrosis of femur head) four stages of disease, etiology, diagnosis, conservative
    treatment, prophylactics, operative surgery, 21 coxitis fugax, 3/ slipped femoral
    capital epiphysis = epiphyseolisis capitis femoris juvenilis, 47 coxa Mara congenita.; 5/
    coxa valga - normal hip or deformed hip - does it reąuire surgery?
12.Crura vara - Blount disease (Lublin etiology: extensive crura vara at babies -
    "syndrome of contractures", rickets, overweight, too early walking); genua valga -
    etiology (inherited, mal-position of sitting [TV-sitting], over-weight, łąck of
    vitamins), diagnosis, new surgery in treatment of genua valga and subluxation of
    patella.
13.Club foot - eąuinus deformity - epidemiology, diagnosis, history of therapy, new
early conservative treatment method: special mobilization maneuvers and plaster
treatment. Operative procedures           Ponseti (USA) method; subtalar total foot
correction (new "W"-like skin incision, rangę of capsulotomy, rangę of tendons
lengthening, transfer of tibialis anterior tendon). Operative method according to
Codivilla(Italy)/Turco (USA) - Lublin modifications.
14.Willineger (Switzerland) drainage in therapy of bonę and joint inflammations.
Rules of surgery and additional therapy. Examples.
15. "Syndrome of contractures" (according to Prof. Hans Mau/Germany) in contests
    of other deformations. Experience of Lublin Orthopedics Pediatrie Department
    (Tarczynska PhD thesis         connection with fetus and with mother conditions.
    Supervisor of thesis - Prof. T. Karski). Conditions for development of "syndrome of
    contractures".
16.Early and łatę deformities of movement apparatus connected with "syndrome of
contractures": plagiocephaly, torticollis (three types of deformity                 in
plagiocephaly, after traumatic delivery, really congenital with tumor neonatorum,
differential diagnosis, early stretching-rotation therapy, operative procedures), feet
deformities (pes valgus, pes equino-valgus, pes calcaneo-valgus), infantile scoliosis.
17.Contractures in hip region: Haltungschwache (Mau) = abduction contracture of the
right hip (Karski) - causative factor in development of the so-called idiopathic
scoliosis.
 18. Old hypothetic causes in development of idiopathic scoliosis. Other types of
     scoliosis -- congenital, neurogenic (paralytic -- spastic), in other syndromes and
     illnesses.
 19.Recent observations in biomechanical etiology of the so-called idiopathic
   scoliosis in Lublin. Stages in discovery of biomechanical etiology (1995-1997-2001-
   2004-2006-2007). Causes - asymmetry between left and right side of hips, of pehds
   and spine. Connection with gait and standing. Asymmetric development of spine -
   scoliosis.
20. New classification of spine deformity -- I-st ("S" scoliosis 3D), II/A-nd ("C"
   scoliosis ID), II/B-nd ("S" scoliosis ID) and IH-rd ("I" scoliosis 2D)
   etiopathological groups so-called idiopathic scoliosis (epg) important for
   prophylactics and therapy (Karski 2001-2004-2006).
21.Harmful posturę habits - clinical groups: shoulders, thoracic spine, pelvis, lumbar
   spine, knees, feet; connection with scoliosis tilt of pelvis symmetrical or
   asymmetrical - important factor in development of scoliosis. Causes - asymmetry
   between front and back side of shoulders, of hips, of pelvis and spine.
22. Information about old (wrong) rehabilitation treatment (exercises) in scoliosis
   and in harmful postures. Examples of wrong exercises and examples of iatrogenic
   deformities.
23.Information about new rehabilitation exercises in so-called idiopathic scoliosis and
   in harmful postures. Examples of new exercises (in therapy decreasing or excluding
   of contractures - shortening of soft tissues).
24.Outcome of new therapy of so-called idiopathic scoliosis -- clinical examples,
   statistic analysis.
25.New screening and new prophylactic programs in the so-called idiopathic
   scoliosis for children in kindergartens and primary classes - aims for every doctor in
   every country. Co-operation with Ministry of Health in Warsaw and Ministry of
   Education in Warsaw. Contribution of orthopaedic surgeons from all the world in new
   prophylaxis - prof. Asher - USA, prof. Hawes - USA, prof. Dangerfield - UK, prof.
   Burwell - UK, prof. Marik - Czech Republic, prof. Kokavec - Slovak Republic, prof.
   Rehak - Slovak Republic, prof. Neff - Germany, prof. Chaneau - France, prof. Luk -
   Hong Kong/China, prof. Leong - Hong Kong/China, prof. Ruan - China, dr Yu - China,
   prof. Alameldeen - Egipt, prof. Bialik - Israel, dr Keny - India.
26.Paresis plexus brachialis -- three types of paresis (neuropraxia, aksonotmesis,
   neurotmesis), conservative early therapy. "Modern" but wrong therapy - examples.
   Operative treatment          experience from Invalid Foundation Hospital in
   Helsinki/Finland. Lublin treatment - publications.
21.Volkmann Syndrome -- posttraumatic blood (arteries) circulation complications,
   clinical symptoms, reconstructive surgery. Bier Syndrome -- varicositas, oedema,
   arthrosis. Sudeck Syndrome - posttraumatic blood (veins) circulation problems /
   retention.
28.Spina bifida occulta, aperta classifications, diagnosis, generał problems,
   orthopedic problems, conservative and operative treatment.
29.Cerebral palsy (CP) -- clinical, social, psychological problems. Classifications
   (types of paresis - Little Syndrome - historical description; monoparesis, diparesis,
   triparesis, tetraparesis, hemiparesis, paraparesis, connection with atethosis,
   connection with chorea, connection with cerebellum malfunction). Diagnosis, clinical
   tests.
30.Conservative methods of treatment. Orthopedic point of view in treatment.
   Rehabilitation point of view in treatment. Yalue of various methods of rehabilitation
   treatment (Yojta, Bobath, Pęto, Kabat-Kaiser, Delacato, Domann and other methods). R-
   A-O (Lublin) method in treatment of children with CP. Complex treatment of all
   levels of deformities. Complex usage of all methods - conservative: stretching,
   orthopedic devices; operative: prof. Thom operative procedures, Project Hope
   Philadelphia and Heidelberg procedures and other. Information about our Sanatorium
   Centers in Rymanów Zdrój and Krasnobród.

Bibliography:

   1. Lovell and Winter's Pediatrie Orthopaedics (2 Yolume Set) by Raymond T.
   Morrissy & Stuart L. Weinstein
   2. Pediatrie Orthopedics in Practice Hefti, Fritz 2007, XI, 781 p. 679 illus. (and
   xl!64 individual illus.), 79 cartoons., ISBN: 978-3-540-69963-7
   3. Netter's Orthopaedics by Walter Greene, MD; Hardbound, 512 pages, publication
   datę: JAN-2006; ISBN-13: 978-1-929007-02-8; ISBN-10: 1-929007-02-7
   4. CampbeH's Operative Orthopaedics, Four Yolume Set by S. Terry Canale
   5. Research into Spinał Deformities 4; Yolume 91 Studies in Health Technology and
   Informatics; Edited by: Theodoros Grivas; June 2002, 502 pp., ISBN: 1-58603-
   289-5
   6. Research into Spinał Deformities 5; Yolume 123 Studies in Health Technology
   and Informatics; Edited by: D. Uyttendaele and P.H. Dangerfield; June 2006, 640
   pp., ISBN: 978-1-58603-630-0
   7. Annales UMCS SECTIO D MEDICINA 2005 vol. 60 nr l, s. 19-31, bibliogr.
   póz. 23, streszcz.
   8. The etiology of the so-called idiopathic scoliosis. The new rehabilitation
   treatment. Prophylaxis. Author - T. Karski, Edited by FOLIUM, Lublin 2003,
   233 pp.
   9. J. Pediatr. Orthop. B 2003 vol. 12 nr 6 , s. 380-386, bibliogr.
   10. J. Pediatr. Orthop. B 2006 vol. 15 nr 2 , s. 120-125, bibliogr. póz. 23.
   11.Pan Arab J. Orthop. Trauma2005 vol. 9 nr l, s. 123-135, bibliogr. póz. 50.
   12.Pan Arab J. Orthop. Trauma 2007 vol. 11 nr 2, s. 128-136, bibliogr. póz. 43. 13.
   www.wheelessonline.com 14.www.ortopedia.karski.lublin.pl



During the last exercises students will pass a test exam based on above written topics.