The abnormal shape, size, and positioning of bone is referred to as bone deformity which occurs due to many reasons like it may be by birth, due to unusual growth of bone in childhood, or healing in the wrong position after fracture surgery. Deformed bone is of four types i.e. angulation (bent bone), translation or displaced bone (deviated from the correct position after surgery), rotation or torsion (twisted bone), and difference in limb length comparing another side.
Amendment to mentioned deformities is possible through osteotomy which is a bone cutting method to regain natural build. Limb bone is either lengthen or cut down for correction, depending on the nature of adjustment required. The procedure is performed in the surgery room with the patient under influence of general anesthesia. The target bone is cut to reshape and secured in place either through internal or external fixation or in combination for stabilization. Internal fixation includes the insertion of rods, plates, or screws to lock treated bone in place for healing in correct alignment. Whole fixation accessories remain under the skin unlike external fixation where pins or bolts radiate out of the skin and structure is built outside the body for adjustment. Holes are drilled into the healthy bone around the operated part, and bolts are screwed into holes and are long enough to extend out of the skin. Outside, the bolts are connected through ball and socket joints with wires that can be adjusted to attain desired stiffness. The surgeon keeps on adjusting the external fixator unless perfect alignment is gained. Insertion points at the skin are sanitized regularly to avoid infection. When the bone heals the fixator is removed and wounds are cleaned.
Referred to as osteomyelitis, bone infections occur due to certain germs and bacteria. Bone underlying sore skin or connected with infected tendons and muscles are more susceptible to osteomyelitis. Infection in one part of the body may circulate through the blood and affect the bone in the other part. Also, osteomyelitis is expected after bone surgery where metal plates and rods have been installed for repair. The artificial implant may cause reactions leading to bone infections. Bones of the hip, spine, and feet are more likely to develop an infection. Diabetes, injury to bone, poor blood supply, hemodialysis, and weak immune system are other instigating factors.
Pain, swelling at the site of infection, discomfort, fever, formation of pus cells in the wound over infected bone and excessive sweating are a few indications that need to be addressed timely by an orthopedist. During the consultation, orthopedists will perform a few examinations and assessments by observing physically or through various laboratory and imaging tests. Bone scans, x-ray, and MRIs disclose structural damage to bone whereas blood cultures, bone biopsy, CBC, C-reactive protein, Erythrocyte sedimentation rate, and needle aspiration of infected bone help diagnose the presence of infection. The Foremost attempt of an orthopedist is to treat through medication like antibiotics that may be through injections or consumed orally. If antibiotics don’t work and the condition worsens, surgery becomes necessary through which damaged or dead tissues and bone is removed to hold the further spread of infection. Bone graft is used to fill space created and any other prosthetic implant like metal plates or artificial joint is removed and replaced with a new one. During the procedure, the patient is kept under influence of anesthesia.
Bone tumours is an abnormal division of cells within a bone, forming a lump of tissues. It is either benign i.e. non-cancerous or malignant which is cancerous and may spread throughout the body, prompting fatal conditions. Serious damage to bone health occurs as both tumors breach the strength of the bone making it more susceptible to fracture. Pain that gets worse at night or after activity, sweating, and fever are prominent symptoms pointing to the presence of a tumor. Evaluation of matter by an orthopedist depends on physical examination initially, followed by certain imaging and laboratory tests. X-ray elaborates the physical condition of the bone, CT-Scan and MRI helps to diagnose damage to associated soft tissues while bone biopsy confirms the presence of a tumor.
Surgical or non-surgical methods can be workable depending on the condition that prevails. Benign is non-cancerous and can be treated through medicines whereas radiation or chemotherapies are solutions to malignant tumors. In cases where a non-surgical method is no advantage surgical pattern is tailed under which a non-cancerous tumor is removed and for cancerous a part of the diseased bone is removed along with a bit of a healthy area and associated healthy tissues, nerves, or blood vessels are kept intact. A prosthetic implant or bone graft is put in to compensate for the bone loss. Amputation may also be a decision for crucial spread as it is necessary to prevent the spreading of tumors further. An artificial limb is fitted after the amputation process to reimburse the loss.
Breaking or cracking can occur with a sudden hit that a bone cannot withstand. Pain at the site of injury, inflammation, bruising, limited range of motion, and deformed shape are symptoms that appear right after bone fractures. Bones get weak with time and diseases like arthritis or osteoporosis deprive them of their natural strength. So the weak bones are subject to fractures that need on-time treatment to avoid further deterioration.
The fractured bone shouldn’t be moved as it may hinder its healing and leads to improper joining. For prevention of such complaints immobilization is the best solution allowing proper healing of the broken bone. Mild fractures can be treated with little care by providing external support like a brace, splint, or plaster cast. In severe fractures, surgery is a priority for orthopedists to improve matter. An orthopedist first diagnoses physically by moving the limb in various directions to check for a range of motion. He looks for bruises, wounds, or any other deformity visible to the naked eye. To examine the inside matter imaging tests are prescribed including an x-ray for fractured bone, CT-Scan, and MRI to look for any damage to ligaments, tendons, nerves, cartilage, blood vessels, or muscles.
After necessary evaluations and assessments, he prepares for surgery. The skin above the affected bone is cut open to remove debris of broken bones and damaged tissues. Bone alignment is made with the help of rods, pins, and metal plates so it heals back in its natural place. In most cases, an external fixation system is provided to immobilize and help the bone grow rightly. The aim is to achieve stability, alignment, and proper healing of bone.
Need for amputation
Amputation is the permanent removal of a limb or any other part of the body which may include the arm, leg, foot, hand, finger, or toe. It’s the last option considered by orthopedic surgeons for the patient’s welfare. Disconnected blood circulation to a certain part of the body cause death of tissues which results in the development of infection. Infection is controlled either by antibiotics or removal of dead tissues through surgery so it couldn’t proceed further but in some cases, a surgeon couldn’t prevent infection from reaching further to damage other parts. To cut back infection progression amputation of a limb or diseased body part is mandatory. Other reasons leading to amputation include frostbite, the spread of a malignant bone tumor, diabetes, nerve tumors, or severe accidents.
For the sake of saving other body parts cutting down diseased portions becomes obligatory. A decision for amputation is made after going through all necessary tests and examinations. The patient’s health is verified to see if he could bear the removal. On surgery day after proper health examination and with the consent of the patient amputation procedure is proceeded. General anesthesia is given to the patient so he remains asleep throughout the surgery. The damaged part is removed with associated dead tissues to leave behind as many healthy parts as a surgeon could. Uneven portions like bones or muscles are even out and shaped so an artificial limb can be installed afterward. Blood vessels and nerve endings are carefully sealed. After closing the incision patient is kept for a few hours in the recovery room and stays in the hospital for 5 to 14 days depending on persisting condition. The orthopedic team rehabilitates the patient physically and mentally to help him recover fast.
Nonunions: failure of fractures to heal
Bones have a natural ability to heal on their own. In case of severe fractures, surgeons provide the necessary treatment for damage and stem cells begin to grow the bone tissues. However in some cases due to certain reasons breakage may not heal on its own even though the best surgical treatment and medication are provided, this is called nonunion. Old age, diabetes, hypothyroidism, intake of anti-inflammatory medicines, severe anemia, deficiency of vitamin D, poor nutrition, crucial bone breakage, and infection could be a reason for the nonunion of bone. A patient will feel persistent pain in the damaged area for months or even years. Through imaging tests, an orthopedist will examine the matter with as x-ray, CT scan, or MRI to evaluate damage in depth. Not only injured bone but tear to soft tissues is also visible in reports.
Nonunion of bone can be corrected through a bone grafting procedure. It’s a surgical method where a bone graft is extracted either from the patient’s own body or from a donor’s body to attach the damaged bone. The graft provides a platform for the development of new bone. Instability is a hindrance to the healing process, to minimize this factor stability is provided through internal or external fixation which immobilizes the treated part thus ensuring proper healing.
Malunions: fractures healing in the wrong position
Malunion happens when the bone heals but in the wrong position which causes the bone to twist, bend, become shorter in length or rotate inappropriately. Mostly it occurs when the joint is displaced due to a fracture. Deformity, pain, swelling, tenderness, and difficulty putting weight on the affected bone are the prominent symptoms. Get yourself examined by an orthopedist when any of such symptoms arise as they need to get right timely.
Imaging tests will be the first preference of an orthopedist to examine the condition developed inside. He passes the patient through x-ray, CT-scan, or MRI tests to get the image of malunion occurring. The patient is put under influence of general anesthesia to revise surgery. Through osteotomy, a procedure of cutting bone as close as possible to the fracture site, the misalignment of bone is adjusted and improved to attain a natural build. The advanced fixation method is used to stabilize and align the bone. Pins, plates, and screws are installed for internal fixation and in a few cases, external fixation is the key to the matter. Pins are screwed into the healthy bone near fracture and extended out of the skin which is then connected externally through metal wires with ball and socket joint for adjustment to achieve required alignment. In some cases, bone lengthening methods are implied for the refurbishment of bone shortening.