MOVEMENT IS EVERYTHING

Arthritis, broken bones and deep cuts, heavy traumas in a range of situations: in our lives no one is insured that he wouldn't end up at the office of a specialist in orthopaedics and traumatology. Dangers lurk everywhere: from the fact that we are getting older and this affects our musculoskeletal system, to an accident where you find yourself at the wrong time on the wrong place, to the seemingly harmless, but actually deeply consequential work in front of a computer.

Bad luck, old age and sedentary living are not the only culprits for the existence of the bad things that damage in one way or another the bones, the neural system, the joints, the tendons, the blood vessels. Even athletes and people who actively engage in sports activities are not safe.
Humanity has been suffering from such diseases and condition since the beginning of times (the Neanderthals treated broken bones) but it has never been better prepared to deal with these. Minimally invasive surgery and arthroscopy shorten the recovery period and reduce the suffering of the patients. With the help of microsurgery is now possible the precise reconstruction of damaged tissues and the better recovery of limbs that has suffered trauma. The introduction of high technologies in prosthetics lead to the creation of avant-garde prostheses with which, with the use of electronics, patients now can completely control their artificial limbs and even to "feel" them as a natural part of their bodies.

Immersed in our lives, we forget how essential are our hands for its normal rhythm and take them for granted. But our hands are incredibly vulnerable to work and domestic incidents, degenerative conditions, congenital anomalies. The good news is that medicine has advanced, even in cases of loss of extremities or parts of them. "In the past 15-20 years electronics and bioelectronics made a great progress and already there are bioelectronic prostheses with built-in chips that retranslate and turn the nerve and muscle impulse into a mechanical one," says Associate Professor Lyudmil Simeonov, MD, head of the clinic for hand surgery and microsurgery in Pirogov Hospital (admissions at Sofia, 15 Hristo Stanchev St, Fokus 5 Medical Centre, phone: 0876 404 034, www.doc-lyudmil-simeonov.zona.bg). In Bulgaria this technology is not yet used, but Аssoc. Prof. Simeonov and his colleagues successfully restore lost fingers and heavily crumpled hands. "Skills come slowly in this sort of surgery. We work with magnification and we don't have the right of mistake, because the structures are very fine and the surgeries take a long time," says Prof. Simeonov. "If the cut is clear, after the main surgery we can have only one or two follow-up surgeries. In heavier lacerations more time and surgeries are needed for the recovery, structure by structure, of the tendons, the neural system, the skin. When the patient is motivated and collaborates, the result is quite good."

Professor Dr D Shoylev Specialised Hospital for Active Treatment of Traumatology, Orthopedy and Sports Medicine is the only state hospital of this kind in Bulgaria, and is a part of the Ministry of Sport. "We perform diagnosis and treatment of sports trauma of the musculoskeletal system as well as narrowly specialised activities connected to children's and mass sport and high sport achievements. We also take care of veteran athletes," says the hospital's CEO, Dr Georgi Damyanov. You don't need to be a professional athlete, however, to seek help from the specialists at Dr Shoylev Hospital. "It is not a requirement for a patient to be an athlete in order to get qualified and affordable help in our hospital," says Dr Damyanov. "A lot of the traumas are the result of ordinary everyday activities and situations. Each patient, regardless of his age and his level of physical activity can seek help from us at Sofia, 1 N Gabrovski St, phone: 0888 060 408, www.sportstrauma.bg."

"I can say categorically that the quality of arthroscope-assisted procedures in treatment of diseases of the musculoskeletal system in our country is at a top level," says Dr Robert Halvadzhiyan, head of the orthopaedics unit at the Avis Medica Clinic in Pleven (www.ortho.bg) and chairman of the Bulgarian Association of Arthroscopy and Sports Traumatology. "The reason for my words is the level of preparation of the physicians who use this methodology, the yearly courses for training of young and ambitious colleagues, the regular forums for exchange of experience with leading international specialists in the field. Knee and shoulder arthroscopy in the past years has been widely applied in our practice in treatment of specific diseases of these joints – meniscal pathology, plastic restoration of ligamentous apparatus, minimally invasive transplantation of cartilage tissue, stabilisation of shoulder instability, seam of rotator cuff and others. Arthroscopy is increasingly used in ankle and coxofemoral joint for treatment of specific pathologies like impingement, cartilage plastic, seam of labrum, tendon pathology and others. I am proud with the achievements of our arthroscopy association, because I am aware of the times we are living in and of the problems our healthcare system experiences. In spite of this, we are in line with the rhythm of development and we apply the latest novelties in our field."

"A current trend in contemporary orthopaedics is the use of minimally invasive surgery methods where the number of accesses is reduced thus leading to reducing of surgery trauma and to faster and fuller recovery," says Dr Miroslav Rusev, manager of Medical Centre Orthopaedics and Traumatology (Targovishte, 4 Shipka St, www.mcoit.com). "For the same reasons bioresorbable implants are being increasingly used, as they eliminate the need of secondary surgery for their removal. They may be of biopolymers or metals (magnesium, for example), of which are made screws and anchors. Besides cartilage-replacing preparations, we use bone-replacing preparations in cases like avascular necrosis of the femoral head (Chandler's disease), in which with an incision of 5 mm is reached the necrotic part of the bone and after the removal of the damaged tissues the defect is restored. Within 2 hours, the implanted hydroxyapatite is as strong as a normal bone, and in the following 3 months it slowly reintegrates with the neighbouring areas of healthy bone. This allows for a fast recovery without any serious surgical trauma. We are led by our desire to constantly improve our knowledge and skills, to be adequate to the novelties in orthopaedic science and to be optimally helpful to our patients," shares Dr Rusev.

"The aim of femur fracture surgery is patient to be brought back to his condition before the fracture happened" – says Dr Orlin Filipov, manager of Vitosha Orthopaedics Hospital (Sofia, 108B Simeonovsko Shose Blvd, round the clock phone: 02 962 22 92, www.vitosha-hospital.com). Many hospitals refuse to treat fractures of patients who are over 75 years of age, but Vitosha Hospital makes an exception in this. "Senile patients have many underlying diseases and a lot of them have dementia as well, which makes hard to impossible the proper rehabilitation and restoration of movement when stepping on the treated leg is forbidden," Dr Filipov explains. "That is why we implemented surgical methods that allow the patients to use the treated limb on the first day after the surgery. These patients are hard to be taken care of, that is why in Vitosha Hospital we have more staff. A lot of the patients with femur fracture have high risk for surgery, but in the world practice it is accepted for them to be surgically treated because without an operation their mortality is very high: over 70 percent in the first 2 months and according to some authors, it is up to 85 percent. In practice, we aim to treat surgically all of the patients, with the exception of those with clear contraindications that have been clearly defined in standards."

Orthopaedic conditions can cause not only pain and discomfort, but also aesthetic troubles. One of the most common are the so-called bunions that many, mainly women, develop in time due to wearing uncomfortable shoes, age or gene predisposition. A surgery by trained specialist can help. "Hallux valgus affects the big toe joint, and the surgery's aim is to restore the toe's normal position, thus relieving the pain and discomfort, and improving the foot's look," explains Dr Svilen Shiderov, head of the Orthopaedics and Traumatology unit at Eurohospital (Plovdiv, 79 Komatevsko Shose St, www.eurohospital.bg). A specialist with rich experience in the field who has even re-implanted cut hands, Dr Shiderov and his team are also qualified in demanding treatments that ask for knowledge, skill and dedication. "Eurohospital is the only one in Plovdiv where is performed plastic of anterior cruciate ligament, an arthroscopic surgery that spares the patient," he says. The hospital also specialises in joint replacement, revisionist endoprosthesis, reconstructive bone and joint surgery, spine surgery, minimally invasive surgery of the musculoskeletal system.

Physiotherapy, kinesitherapy and massage step on using natural elements for the physical benefit of people during treatment or in everyday life, says Cristian Balan from FIZ – Physiotherapy and Massage Centre (Sofia, 5A Dr Petar Beron St, phone: +359 878 677 955, www.fiz.bg, www.facebook.com/fizbg/). "Movement is the main element that we use. We choоse passive motion (performed to the client/patient by the therapist) or active motion (performed by the client/patient) regarding on the stage that we are in the rehabilitation process and on what we search in the particular session as a part of the rehabilitation plan. As an instrument in Physiotherapy, we use massage for the main effect on the muscle – in order to relax or tone, depending on individual needs. The benefits are significant, and include reducing of stress, muscle tension and pain. We are able to use almost all the procedures and techniques to assist rehabilitation process, prophylaxis (in order to prevent some diseases or complications) or to assist people in reducing stress and tiredness."