Inhoudsopgave
1. Algemeen ................................................................................................................................................................... 1
Wat is orthopedie? ..................................................................................................................................................... 1
Wat is traumatologie? ................................................................................................................................................ 1
Letsels v/h musculoskeletale systeem ....................................................................................................................... 1
Contusie ................................................................................................................................................................. 1
Distorsie/verstuiking .............................................................................................................................................. 1
Dislocatie ................................................................................................................................................................ 2
Spier/peesscheur.................................................................................................................................................... 2
Algemeen: fracturen v/h bot .................................................................................................................................. 2
2. Fracturen .................................................................................................................................................................... 3
Soorten fracturen ....................................................................................................................................................... 3
Fractuurgenezing........................................................................................................................................................ 5
Gunstige factoren ................................................................................................................................................... 5
Ongunstige factoren ............................................................................................................................................... 6
Behandelingsprincipes ........................................................................................................................................... 6
Onderste lidmaat ....................................................................................................................................................... 7
Heupfracturen ........................................................................................................................................................ 7
Fracturen femur ..................................................................................................................................................... 9
Patella fracturen ................................................................................................................................................... 10
Tibiaplateau fracturen .......................................................................................................................................... 11
Tibiadiafyse fracturen .......................................................................................................................................... 12
Fracturen v/d enkel & distale tibia ....................................................................................................................... 12
Tarsus fracturen (beentjes v/d achtervoet) ......................................................................................................... 13
Bovenste lidmaat ..................................................................................................................................................... 14
Claviculafractuur .................................................................................................................................................. 14
Scapulafractuur .................................................................................................................................................... 15
Humeruskopfractuur ............................................................................................................................................ 15
Humerusdiafysefractuur ...................................................................................................................................... 15
Sternoclaviculaire luxaties.................................................................................................................................... 16
Acromioclaviculaire luxaties ................................................................................................................................. 16
Humeruskopluxatie .............................................................................................................................................. 16
Distale humerusfractuur ...................................................................................................................................... 17
Radiuskop fractuur ............................................................................................................................................... 17
Olecranon fractuur ............................................................................................................................................... 18
Elleboogluxatie ..................................................................................................................................................... 18
Monteggia fractuurluxatie ................................................................................................................................... 18
Galeazzi fractuurluxatie........................................................................................................................................ 19
Ongecompliceerde onderarmfracturen ............................................................................................................... 19
Distale radius- en/of ulnafracturen ...................................................................................................................... 19
, Scafoïd fracturen .................................................................................................................................................. 20
Luxaties & ligamentaire pols letsels ..................................................................................................................... 20
Metacarpaal fracturen ......................................................................................................................................... 20
Metacarpophalangeale instabiliteit: skiduim ....................................................................................................... 20
Interphalangeale luxatie ...................................................................................................................................... 21
Phalanx fractuur ................................................................................................................................................... 21
3. Artrose...................................................................................................................................................................... 21
Gradaties kraakbeenslijtage ................................................................................................................................. 21
Klachten bij artrose .............................................................................................................................................. 21
Osteotomie........................................................................................................................................................... 21
De heup .................................................................................................................................................................... 22
Diagnose heupartrose .......................................................................................................................................... 22
Conservatieve behandeling .................................................................................................................................. 22
Heelkundige behandeling ..................................................................................................................................... 22
Heupprothesen .................................................................................................................................................... 23
Vroegtijdige problemen ....................................................................................................................................... 23
Knieartrose ............................................................................................................................................................... 23
Heelkundige behandeling kraakbeenletsel .......................................................................................................... 23
Oorzaken knieartrose ........................................................................................................................................... 24
Viscosupplementatie ............................................................................................................................................ 24
Diagnose ............................................................................................................................................................... 25
Conservatieve behandeling .................................................................................................................................. 25
Als dit niet lukt → chirurgie ................................................................................................................................. 25
Prothese chirurgie ................................................................................................................................................ 26
Revalidatie na prothese ....................................................................................................................................... 26
Tevredenheid na knieprothese ............................................................................................................................ 27
Tibiotalaire artrose ................................................................................................................................................... 27
Hallux rigidus ............................................................................................................................................................ 27
Acromioclaviculaire OA ............................................................................................................................................ 27
Glenohumerale OA ................................................................................................................................................... 27
Elleboog OA .............................................................................................................................................................. 28
Pols OA ..................................................................................................................................................................... 28
Duimartrose (rhizartrose) ........................................................................................................................................ 28
4. Weke delen .............................................................................................................................................................. 28
Femoro-acetabulair impingement ........................................................................................................................... 28
Femurkopnecrose .................................................................................................................................................... 29
oorzaken ............................................................................................................................................................... 29
Diagnose ............................................................................................................................................................... 30
Behandeling.......................................................................................................................................................... 30
Snapping hip ............................................................................................................................................................. 30
, Diagnose ............................................................................................................................................................... 30
Behandeling.......................................................................................................................................................... 30
De patella ................................................................................................................................................................. 31
Stabiliserende factoren ........................................................................................................................................ 31
Femoropatellaire problemen ............................................................................................................................... 31
Acute patellaluxatie ............................................................................................................................................. 31
Ruptuur quadricepspees .......................................................................................................................................... 32
Patellapeesruptuur............................................................................................................................................... 32
Ligamenten in de knie .............................................................................................................................................. 32
Ligamentaire letsels ............................................................................................................................................. 32
Knieluxatie ................................................................................................................................................................ 33
Meniscale letsels ...................................................................................................................................................... 33
Baker cyste ............................................................................................................................................................... 34
Enkel impingement .................................................................................................................................................. 34
Achillespeestendinopathie ....................................................................................................................................... 35
Achillespeesruptuur ................................................................................................................................................. 35
Hielspoor/plantaire fascitis ...................................................................................................................................... 36
Morton neurinoom .................................................................................................................................................. 36
Stand afwijkingen v/d voet ...................................................................................................................................... 36
platvoeten ............................................................................................................................................................ 37
Voorvoetafwijkingen ............................................................................................................................................ 37
Humeruskopnecrose ................................................................................................................................................ 38
Impingement → subacromiale inklemming ............................................................................................................. 38
Biceps tendinopathie/ruptuur ................................................................................................................................. 39
Rotator cuff letsels ................................................................................................................................................... 39
Frozen shoulder........................................................................................................................................................ 40
Tennis elleboog: epicondylitis lateralis .................................................................................................................... 40
Golferselleboog: epicondylitis medialis ................................................................................................................... 41
N. ulnaris compressie ............................................................................................................................................... 41
Carpaal tunnel syndroom ......................................................................................................................................... 41
Peesaandoeningen ................................................................................................................................................... 42
Ziekte v Dupuytren ................................................................................................................................................... 43
Polscyste of ganglioncyste ....................................................................................................................................... 44
, 1. Algemeen
Wat is orthopedie?
• = chirurgie v musculoskeletale systeem
• Orthopedische chirurgen gebruiken chirurgie & niet-chirurgie
• ➔ houdt zich bezig met musculoskeletale aandoeningen & vooral met locoregionale aanpak ervan
Wat is traumatologie?
• Trauma = een letsel = fysiologische wonde veroorzaakt door externe bron
• Koude orthopedie → ziekten bewegingsstelsel
• Traumatologie → musculoskeletale aandoeningen tgv trauma
o Kunnen op zich aanleiding geven tot koude orthopedie
• Ontwikkeling artrose na trauma → bv knie vervangen door prothese
o Dus na trauma → na paar jaar OA dus orthopedie
Letsels v/h musculoskeletale systeem
• Contusie, distorsie, dislocatie, spier/peesscheur, fractuur, kneuzing, verstuiking, ontwrichting, breuk
• Symptomen
o Altijd dezelfde symptomen
o W rood, doet pijn, w warm, verlies v functie
• Basisprincipes
o PRICE
▪ Protect, rust, ijs, compressie, elevatie (over ijs wel discussie over de laatste tijd)
Contusie
• = heel felle blauwe plek
• Inwendige bloeduitstorting
• Rechtstreekse weefselbeschadiging
• ➔ inflammatie
• Lichaam kan dit zelf oplossen + zsm terug bewegen
Distorsie/verstuiking
• 3 graden
o Graad 1
▪ G tss 0 & 5mmm extra open gaat
▪ Functionele behandeling
o Graad 2
▪ 5-10mm open → onstabiel voor een stuk
▪ P moet het wel toelaten want dit doet pijn
▪ Brace + functionele behandeling
1
1. Algemeen ................................................................................................................................................................... 1
Wat is orthopedie? ..................................................................................................................................................... 1
Wat is traumatologie? ................................................................................................................................................ 1
Letsels v/h musculoskeletale systeem ....................................................................................................................... 1
Contusie ................................................................................................................................................................. 1
Distorsie/verstuiking .............................................................................................................................................. 1
Dislocatie ................................................................................................................................................................ 2
Spier/peesscheur.................................................................................................................................................... 2
Algemeen: fracturen v/h bot .................................................................................................................................. 2
2. Fracturen .................................................................................................................................................................... 3
Soorten fracturen ....................................................................................................................................................... 3
Fractuurgenezing........................................................................................................................................................ 5
Gunstige factoren ................................................................................................................................................... 5
Ongunstige factoren ............................................................................................................................................... 6
Behandelingsprincipes ........................................................................................................................................... 6
Onderste lidmaat ....................................................................................................................................................... 7
Heupfracturen ........................................................................................................................................................ 7
Fracturen femur ..................................................................................................................................................... 9
Patella fracturen ................................................................................................................................................... 10
Tibiaplateau fracturen .......................................................................................................................................... 11
Tibiadiafyse fracturen .......................................................................................................................................... 12
Fracturen v/d enkel & distale tibia ....................................................................................................................... 12
Tarsus fracturen (beentjes v/d achtervoet) ......................................................................................................... 13
Bovenste lidmaat ..................................................................................................................................................... 14
Claviculafractuur .................................................................................................................................................. 14
Scapulafractuur .................................................................................................................................................... 15
Humeruskopfractuur ............................................................................................................................................ 15
Humerusdiafysefractuur ...................................................................................................................................... 15
Sternoclaviculaire luxaties.................................................................................................................................... 16
Acromioclaviculaire luxaties ................................................................................................................................. 16
Humeruskopluxatie .............................................................................................................................................. 16
Distale humerusfractuur ...................................................................................................................................... 17
Radiuskop fractuur ............................................................................................................................................... 17
Olecranon fractuur ............................................................................................................................................... 18
Elleboogluxatie ..................................................................................................................................................... 18
Monteggia fractuurluxatie ................................................................................................................................... 18
Galeazzi fractuurluxatie........................................................................................................................................ 19
Ongecompliceerde onderarmfracturen ............................................................................................................... 19
Distale radius- en/of ulnafracturen ...................................................................................................................... 19
, Scafoïd fracturen .................................................................................................................................................. 20
Luxaties & ligamentaire pols letsels ..................................................................................................................... 20
Metacarpaal fracturen ......................................................................................................................................... 20
Metacarpophalangeale instabiliteit: skiduim ....................................................................................................... 20
Interphalangeale luxatie ...................................................................................................................................... 21
Phalanx fractuur ................................................................................................................................................... 21
3. Artrose...................................................................................................................................................................... 21
Gradaties kraakbeenslijtage ................................................................................................................................. 21
Klachten bij artrose .............................................................................................................................................. 21
Osteotomie........................................................................................................................................................... 21
De heup .................................................................................................................................................................... 22
Diagnose heupartrose .......................................................................................................................................... 22
Conservatieve behandeling .................................................................................................................................. 22
Heelkundige behandeling ..................................................................................................................................... 22
Heupprothesen .................................................................................................................................................... 23
Vroegtijdige problemen ....................................................................................................................................... 23
Knieartrose ............................................................................................................................................................... 23
Heelkundige behandeling kraakbeenletsel .......................................................................................................... 23
Oorzaken knieartrose ........................................................................................................................................... 24
Viscosupplementatie ............................................................................................................................................ 24
Diagnose ............................................................................................................................................................... 25
Conservatieve behandeling .................................................................................................................................. 25
Als dit niet lukt → chirurgie ................................................................................................................................. 25
Prothese chirurgie ................................................................................................................................................ 26
Revalidatie na prothese ....................................................................................................................................... 26
Tevredenheid na knieprothese ............................................................................................................................ 27
Tibiotalaire artrose ................................................................................................................................................... 27
Hallux rigidus ............................................................................................................................................................ 27
Acromioclaviculaire OA ............................................................................................................................................ 27
Glenohumerale OA ................................................................................................................................................... 27
Elleboog OA .............................................................................................................................................................. 28
Pols OA ..................................................................................................................................................................... 28
Duimartrose (rhizartrose) ........................................................................................................................................ 28
4. Weke delen .............................................................................................................................................................. 28
Femoro-acetabulair impingement ........................................................................................................................... 28
Femurkopnecrose .................................................................................................................................................... 29
oorzaken ............................................................................................................................................................... 29
Diagnose ............................................................................................................................................................... 30
Behandeling.......................................................................................................................................................... 30
Snapping hip ............................................................................................................................................................. 30
, Diagnose ............................................................................................................................................................... 30
Behandeling.......................................................................................................................................................... 30
De patella ................................................................................................................................................................. 31
Stabiliserende factoren ........................................................................................................................................ 31
Femoropatellaire problemen ............................................................................................................................... 31
Acute patellaluxatie ............................................................................................................................................. 31
Ruptuur quadricepspees .......................................................................................................................................... 32
Patellapeesruptuur............................................................................................................................................... 32
Ligamenten in de knie .............................................................................................................................................. 32
Ligamentaire letsels ............................................................................................................................................. 32
Knieluxatie ................................................................................................................................................................ 33
Meniscale letsels ...................................................................................................................................................... 33
Baker cyste ............................................................................................................................................................... 34
Enkel impingement .................................................................................................................................................. 34
Achillespeestendinopathie ....................................................................................................................................... 35
Achillespeesruptuur ................................................................................................................................................. 35
Hielspoor/plantaire fascitis ...................................................................................................................................... 36
Morton neurinoom .................................................................................................................................................. 36
Stand afwijkingen v/d voet ...................................................................................................................................... 36
platvoeten ............................................................................................................................................................ 37
Voorvoetafwijkingen ............................................................................................................................................ 37
Humeruskopnecrose ................................................................................................................................................ 38
Impingement → subacromiale inklemming ............................................................................................................. 38
Biceps tendinopathie/ruptuur ................................................................................................................................. 39
Rotator cuff letsels ................................................................................................................................................... 39
Frozen shoulder........................................................................................................................................................ 40
Tennis elleboog: epicondylitis lateralis .................................................................................................................... 40
Golferselleboog: epicondylitis medialis ................................................................................................................... 41
N. ulnaris compressie ............................................................................................................................................... 41
Carpaal tunnel syndroom ......................................................................................................................................... 41
Peesaandoeningen ................................................................................................................................................... 42
Ziekte v Dupuytren ................................................................................................................................................... 43
Polscyste of ganglioncyste ....................................................................................................................................... 44
, 1. Algemeen
Wat is orthopedie?
• = chirurgie v musculoskeletale systeem
• Orthopedische chirurgen gebruiken chirurgie & niet-chirurgie
• ➔ houdt zich bezig met musculoskeletale aandoeningen & vooral met locoregionale aanpak ervan
Wat is traumatologie?
• Trauma = een letsel = fysiologische wonde veroorzaakt door externe bron
• Koude orthopedie → ziekten bewegingsstelsel
• Traumatologie → musculoskeletale aandoeningen tgv trauma
o Kunnen op zich aanleiding geven tot koude orthopedie
• Ontwikkeling artrose na trauma → bv knie vervangen door prothese
o Dus na trauma → na paar jaar OA dus orthopedie
Letsels v/h musculoskeletale systeem
• Contusie, distorsie, dislocatie, spier/peesscheur, fractuur, kneuzing, verstuiking, ontwrichting, breuk
• Symptomen
o Altijd dezelfde symptomen
o W rood, doet pijn, w warm, verlies v functie
• Basisprincipes
o PRICE
▪ Protect, rust, ijs, compressie, elevatie (over ijs wel discussie over de laatste tijd)
Contusie
• = heel felle blauwe plek
• Inwendige bloeduitstorting
• Rechtstreekse weefselbeschadiging
• ➔ inflammatie
• Lichaam kan dit zelf oplossen + zsm terug bewegen
Distorsie/verstuiking
• 3 graden
o Graad 1
▪ G tss 0 & 5mmm extra open gaat
▪ Functionele behandeling
o Graad 2
▪ 5-10mm open → onstabiel voor een stuk
▪ P moet het wel toelaten want dit doet pijn
▪ Brace + functionele behandeling
1
