Orthopedic Treatments

October 21, 2022by wahaj

Arthroscopic surgeries

Arthroscopy has minimized the protruding incisions made for surgery. It’s a modern face of classic surgeries performed to diagnose and treat the injured or diseased joint. An arthroscope is inserted through a small buttonhole-like incision made over the skin to get a live view of the joint inside over the computer screen placed nearby. The arthroscope is a thin pencil-like tool with a light and camera on top. The cut is made on the skin over the affected joint for insertion of an arthroscope which helps to diagnose the matter while other incisions are made nearby to put in tools for surgery.

Knee, shoulder, elbow, wrist, ankle, and hip joints are common ones viewed through this procedure otherwise arthroscopy of every joint is conceivable. Wounds heal soon with quick recovery as incisions are small, which prolongs other joint replacement surgeries. Complications like excessive bleeding and damage to blood vessels and nerves are far much less in arthroscopy which ensures a return to normal activities soon. Most of the patients have their arthroscopy as outpatients and they discharge after a couple of hours under observation.

Bunionectomy and hammertoe repair

The formation of a painful bony bump over the big toe joint which distorts the natural stature of the foot is a bunion and the surgical procedure applied for its correction is called a bunionectomy. A bunion is a foot bone deformity causing outward projection of the big toe joint. The condition is treatable through various surgical methods depending on the patient’s condition. Surgery aims to reverse the deformed structure to a natural build. Here are a few procedures an orthopedic surgeon will opt for:

  • Osteotomy is a procedure where the cut is made over the big toe joint for aligning to a standard position.
  • Exostectomy is performed to remove bunions without aligning joints.
  • In arthrodesis, under this method, the affected joint is replaced with metal plates and screws to improve deformity.

For a recent report, all the scanning and imaging tests are completed the day before surgery. At the beginning of surgery anesthesia or medicine is injected for numbness in the area to be operated on while the patient is awake. After surgery bandage is applied and the patient is discharged after a few hours under observation.

The hammertoe is another painful deformity that happens to the second, third and fourth toe. As the name implies the toe form a hammer shape by bending upward at the first joint. Muscle weakness is the reason leading to hammertoe condition. When reaching its severity orthopedic surgeons may adopt the following procedures:

  • Through tendon transfer surgeon pulls the tendon near the hammer toe which in return straightens the toe position, improving the look and reducing pain.
  • Joint resection is effective in treating fixed hammertoe. The surgeon will remove ligaments, tendons, and a sometimes small portion of bone also for toe straightening, then insert pins temporarily to fix the toe in place. Pins are removed after a few weeks of surgery.
  • For fusion tendons, ligaments along with the portion of a bone are removed allowing bones to fuse. Pins are inserted temporarily to keep the joint in its place and then removed after joint fusion. Pain is reduced and the toe straightens this way.
  • Amputation is the removal of the affected toe that commence under severe conditions when pain is unbearable and other methods don’t work.

Cartilage repair or resurfacing procedures

Cartilage is a protective layer guarding the end of bones where a joint is formed. It provides a frictionless surface for smooth gliding of joints otherwise bones won’t bear abrasive touch for long. Injury or disease can cause wear and tear of cartilage which doesn’t repair on its own so surgical procedures are designed for the purpose. Most of the procedures are performed using an arthroscope through a minimal incision. Commonly below-mentioned procedures are executed depending on the scope of damage:

  • Microfracture

The process induces the formation of new cartilage through the creation of blood supply towards the damaged portion. It’s an arthroscopic procedure whereby a sharp tool named awl is inserted for piercing numerous holes into bone underlying cartilage layer. This triggers the healing process as a new blood supply brings blood cells to the surface of the joint.

  • Drilling

It’s a similar process to microfracture instead of an awl, the drill is used for penetrating holes. The procedure is not as precise as microfracture, but the goal is alike.

  • Abrasion Arthroplasty

An arthroscopic procedure identical to drilling helps remove damaged cartilage with high-speed burrs to reach the bone underneath.

  • Osteochondral Autograft Transplantation

This technique is effective for patients with small cartilage defects. Through arthroscopy, a bone graft is removed from healthy cartilage in the body joint which is then implanted into the damaged surface. The graft is a cylindrical plug of cartilage and a bit of bone beneath. Its contours and shape match the defect when fitted giving a smooth regular cartilage surface. Single or multiple plugs as a graft could be used depending on the extent of the damage.

  • Autologous Chondrocyte Implantation

It’s a long procedure taking several weeks to complete. The process is commenced in two steps. Firstly healthy cartilage cells are extracted from another non-weight-bearing joint of the body through arthroscopy, which are then cultured in the laboratory to increase in number. It takes 3 to 5 weeks for multiplication. The second step is open surgery to inject cultured cells into the defect. The process is an advantage as the patient’s cells are used for the implant so tissue rejection is no issue.

  • Osteochondral Allograft Transplantation

The respective procedure is an open surgery to operate on bigger defects for which a piece of cartilage from a donor is extracted, sterilized, and tested in a laboratory for the presence of any suspected disease. This is then shaped to match the contours of a defect. Once prepared it is ready to be fitted in place.

Cartilage surgery on the knee

Depending on the magnitude of damage cartilage surgery to the knee could last for 45 minutes or more. General anesthesia is given to the patient and two incisions are made in front of the knee, one to insert an arthroscope and the other for tool insertion to make necessary repairs. Holes are made into the bone beneath cartilage to release stem cells which stimulate healing with blood supply to the surface. This method is of great success in rebuilding torn cartilage. Arthroscopic surgical procedures like drilling, microfracture, and abrasion arthroplasty prove quite helpful in cartilage regeneration.

In critical cases, open surgery may be performed to implant a graft for cartilage regeneration. Through osteochondral autograft transplantation, a portion of cartilage from the healthy joint is extracted for implantation in the damaged part. Autologous Chondrocyte Implantation proceeded in two steps, whereby healthy cartilage cells are removed and cultured in the laboratory to multiply which takes several weeks then the specimen is injected into the place of injury. Osteochondral Allograft Transplantation is for larger defects where a donor is required for a graft. A portion of cartilage along with a bit of bone is removed from the donors’ joint, tested, and shaped accordingly to fit into the damage.

As knees are weight-bearing joints proper rest is recommended after surgery to avoid putting any stress over the treated part. With continuous physical therapy and light exercises muscles are strengthened to regain lost motion. Most of the patients return to routine activities after six weeks however complete recovery takes 5 to 6 months.

Fracture care

Orthopedic fractures are common health issues handled by an orthopedist. An injury, disease, or weakness can be an aspect leading to a fracture. After physical diagnosis, examination, and assessment through questioning patient-doctor prescribe diagnostic tests to reveal the inside matter. They orders X-rays, MRIs, or even CT scans if needed to see the severity of damage because of not only bone but muscles, and ligaments may also damage along. Fracture care includes operative and non-operative methods depending on the severity of the injury. Inoperative method surgery is required for aligning the badly displaced bone or to remove debris of broken bone which will otherwise cause infection. Rods, metal plates, and screws may also be inserted for alignment. The non-operative method is to cure matter externally whereby brace, splint, or casts are applied for immobilization so the bone could heal naturally.

The fractures and their extent of damage are numerous, each defect is treated accordingly. Various types of fractures treated are:

  • A comminuted fracture is the shattering of bone into many pieces.
  • Avulsion fracture, where muscles or ligaments pull the bone causing fracture.
  • Intra-articular fracture is the damage that occurs to the joint surface
  • Compression or crushes fractures occur in spongy bones due to diseases like osteoporosis.
  • Pathological fractures arise because of diseases that weaken bones.
  • Fracture dislocation is when the joint dislocates and one of the joint bone fractures.
  • Greenstick fracture is incomplete breakage of bone from one side.
  • A hairline fracture is a very thin fracture to the bone.
  • An impacted fracture happens when a piece of fractured bone impacts another bone nearby.
  • Longitudinal fractures are fractures along the bone length.
  • Oblique fractures are those across the bone length.
  • A spiral fracture is the twisting of bone after breaking
  • A stress fracture occurs due to repetitive activities that put stress on the bone.

Joint fusion

Joint fusion is the permanent fixation of a joint in a place. The procedure immobilizes joints forever but is much more effective in relieving pain. The space where two bones form joints is fused to make a solid body. Highly recommended for patients complaining of incurable pain due to joint motion. Arthritis, an irredeemable disease is a major reason behind this procedure. It’s a worthy alternative to joint replacement surgery as in some cases patients may encounter issues after joint replacement, so this method proves commendable to compensate for damage.

After health assessment patient is given local anesthesia and surgery is instigated through a small incision made on the skin over the joint to fuse. Damaged cartilage at the end of bones is removed along with a bit of bone beneath. This initiates the healing of bones and fuses them. For effective union, bones are held together with the aid of plates, pins, screws, and rods. They keep bones intact to ensure merging in the correct position. In a few cases, fusion is accelerated by putting a bone graft extracted from a healthy joint in the space created. Surgery is concluded by stitching the incision. The recovery period varies among patients after joint fusion surgery. For those who recover late brace, cast, or external support is provided to immobilize the joint for proper healing.

Arthroplasty or joint replacements

Mostly, people recognize arthroplasty as joint replacement surgery, however, both are the same as the procedure involves the replacement of damaged joints either partially or totally with prosthetic ones. These parts are made of metal, ceramic, or plastic. Unbearable joint paint due to injury or disease like arthritis could give way to arthroplasty. Joints in any part of the body can be replaced through this method. On the day of surgery, the patient went through a health assessment and imaging tests like CT-scan, MRI, or X-rays to see the recent condition of the joint. The whole procedure is commenced by putting a patient under influence of anesthesia. Surgeons adopt variable techniques depending on the condition of the joint.

An incision is made over the skin to expose the affected joint beneath. In total joint replacement surgeon carefully remove the joint and place artificial or prosthetic components in its place. Rod, pins, screws, staples, and bone cement are used to fix components in their place. Then the cut is closed by stitching, a bandage is applied and the joint is given external support with a brace or cast to immobilize unless the wound heals and components are fixed in their place. The prosthetic joint imitates the movement of the natural joint. For partial replacement, only the damaged part is removed and replaced with a prosthetic one. The patient is either discharged on the same day after keeping under observation for a few hours or may have to spend a couple of days in the hospital depending on the condition.

Ligament reconstructions

Ligaments are bands of tissues connecting bones, they play a vital role in joint motion. A little tear or damage to it can induce severe pain and limit the range of motion. A sudden stop or drastic change in direction can damage a ligament. Sportspeople are more susceptible to this injury. Reconstruction of a torn ligament is conceivable through surgery.

Before surgery, the doctor will ask you for necessary physical therapy to reduce joint swelling and gain a full range of motion so these factors don’t interrupt the recovery afterward. If you are taking any medication do discuss it with the surgeon he may ask you to stop taking some of it a few days before surgery. The incision is made over the affected joint, the damaged ligament is removed and a graft tendon from a healthy joint is fixed in its place. Tendons are a thread of tissues, connecting muscles to bones. The graft tendon initiates reconstruction and serves as a platform for ligaments to grow. The surgeon drills tunnels or sockets into the respective bone for attaching the tendon in the right position then secure the position using pins, screws, or staples. An incision is closed and bandaged, and external support is provided to immobilize the joint for a few days until healing is done. Ligament reconstruction is an outpatient process depending on the condition patients are discharged the same day after putting a few hours under observation to see any complications that may arise.

Repair of torn ligaments and tendons

Tendons connect muscles to bones while ligaments attach two bones. Both are soft tissues and are of much significance in joint motion. Pain, swelling, and disability to put weight on joints signify damage to these tissues. A pop sound may be heard or felt at the instance of injury. Mild tears heal on their own with the right medication and immobilizing joint through external support like a brace, elastic band, or cast whereas crucial defects need surgical procedures to fix.

On visiting, the doctor will do a physical examination to assess the damage. He looks for bruises, and cuts that may cause the injury. The patient may be asked to move the joint in various directions to evaluate a range of motion. After physical assessment patient is gone through imaging tests most preferably a CT scan or MRI to get the internal image of the damage.

During operation, the table patient is given anesthesia for terminating pain sensation. A cut is made over the affected joint to expose internal parts. The surgeon will sew the torn tendon or ligament so it heals back but if the tendon is too short to be stitched back a tendon graft from a healthy joint is used to fix it in its place and the damaged tendon is removed. When surgery is done the incision is sewed back and a bandage is applied. The patient is advised proper rest keeping the operated joint elevated to beat swelling. The Joint is immobilized with external support and removed on the doctor’s say.

Minimally invasive surgery

Minimally invasive surgery is a modern method to commence operation through small incisions. Arthroscopy is one of its faces that uses a sleek pen-like tool with a camera and light at the top to see the inside matter. The surgeon will insert the arthroscope through a small incision and the camera over it will display video inside on a computer screen placed nearby. This way surgeon can see the defect closely and operate it by inserting tools through 2 or 3 other small incisions made nearby.  Arthroscopy helps to diagnose as well as operate the bone defect. Small incisions heal quickly, probability of bleeding and nearby tissue damage lowers considerably.

Orthopedic injuries are variable so are the methods to address them. The most common minimally invasive surgeries are that of the knee, hip, shoulder, and wrist. The patient is operated on under local anesthesia so the pain doesn’t feel. After the surgery, the cuts are closed and bandaged. The risk of getting an infection is reduced which may arise complications if persist. Patients don’t need to spend many days in the hospital as patients with open surgery have to. With regular physical therapy as advised by a health care person and rest recovery time accelerates. The patient can regain lost motion and conduct regular activities soon after surgery.

Advanced external fixation

Bone fractures are a serious concern that needs immediate treatment. Non-operative fractures can be treated by providing external support like a brace, cast, and splint. This help immobilizes joints for successful healing. If such methods prove inappropriate to fix bone advanced external fixation is applied for adequate healing of the fracture. The surgery is conducted in the operating room with the patient under influence of general anesthesia. Holes are drilled across the skin into the healthy bone around the fracture where wires and bolts designed for the purpose are screwed. Bolts extended out of the skin are connected with rod or metal in curved shape through ball and socket joints. This develops rigid support aligning the bone in position. Further anatomy can be configured by adjusting ball and socket joints. Regular cleaning of points needed where bolts were inserted to keep infection at bay. Depending on the bone to be treated and the extent of fracture it gets external fixators may remain intact for weeks or months. After healing fixator is removed using wrenches and this time without anesthesia as detaching doesn’t cause pain.

External fixator could be uniplanar, bilateral, circular, unilateral, or can be fixed in multiple planes forming multiplanar fixation. The construct can be handled in many ways by building hybrid frames with a little manipulation and making a combination of mentioned types. Surgeon effort to get in the best way of achieving a high level of stability to encourage the healing of bone in the correct position.

Use of bone graft substitutes and bone-fusing protein

Bone injury or damages range from mild to severe and are addressed accordingly. In many cases after doing certain repairs assistance of bone graft or bone fusing protein is incorporated to ensure quick healing. The skin is cut open to expose the fractured bone which is then cleaned by removing damaged tissues and bone fragments to prepare the surface for graft. The graft is installed and secured using surgical hardware like screws, wires, plates, or pins. Concluding surgery cut is stitched carefully and the bone is left to recover. All this procedure is carried out by keeping the patient under influence of anesthesia which temporarily numbs all sensations and keeps the patient asleep during the process. A few bone grafting techniques directed to aid fracture healing are:

  • Allograft, where the donor is required for bone graft extraction, is then sterilized and tested in the laboratory for the presence of any possible infection or disease. Afterward, the graft is fixed to the patient’s fracture to allow bone fusion.
  • Autograft is a technique in which a graft is taken from another bone (i.e. mostly hip bone) of the patient’s body and secured to the fracture site. Such graft provides successful fusion without any probability of tissue rejection.
  • Bone marrow aspirate is another workable method to initiate healing as it is a house of bone-building cells. With the help of a Needle, bone marrow is extracted from the patient’s hip bone which is then used along with other grafting methods to support healing.
  • Synthetic bone graft has changed the grafting scenario as it could be used to treat larger defects without hesitation. It is composed of porous substances and proteins to assist the development of bone. With this method, quantity is no issue. 
  • Bone fusing protein is incorporated into the bone graft and fixed on the fracture site. It’s a natural healing substance that exists in bones and helps in bone formation. It has the power to initiate bone fusion without using a bone graft.