MIO Tibial Plating

A 24 year old male had a RTA and sustained a Femur fracture with a Comminuted Tibia Fracture and Compound Foot injury.

Tibia Fracture was Comminuted in the Mid shaft for about 2/3 rd of the tibial length. There was segmental fracture of the fibula

Pre Op Xray :

Considering the Comminution MIO/MIPPO plating was planned.

The length of the Plate could have been a problem and hence X rays were taken with the longest plate available.

PLATE XRAY

OPERATIVE PEARLS :

·         MIO Plating was performed spanning the Comminuted Shaft fragment.

·         Segmental Fibula fracture was fixed with One proximal and one distal Rush nail.

 10 WEEKS                                                                            10 WEEKS 

 Fianl 10 WEEKS                                                                   Final 10 WEEKS 

   

After 24 Weeks                                                                       After 24 Weeks                                                                 

Fracture united at 5 months and patient has excellent Functional Range of movements.

Post OP Xray

Post OP Xray

Hip Replacement in Acetabular Fracture

A 78 year old Patient had an RTA and sustained a Hip injury. He was diagnosed as having a Central fracture dislocation (Bicolumnar Fracture). He was not operated by the treating Orthopedic Surgeon considering the Risks involved at the Age. He presented to us after 7 months with ProtrusioAcetabuli with AVN of Femoral head.

His major Complaints were:

•             Severe restriction of daily activities
•       Night pain and Rest Pain
•        Difficulty in Sitting and Getting up

Pre Op Xray

Discussing the risks involved, the Patient was asked to undergo a hip replacement to alleviate his symptoms.

CT Pelvis was done to get a better understanding of the defects.

CT 1

CT 2

CT 3

CT findings :

·         Defect in anterosuperior wall

·         Posterior wall was intact

·         Defect in anterosuperior part of head

Challenges of Surgery :

·         Defect Reconstitution

·         To get the Perfect Rim fit

·         Early mobilization considering the advanced age

·         Restoring near normal Hip Centre

Operative Pearls:

·     It was decided to use a Trabecular Metal cup and Uncemented Stem on the Femoral side Head and neck

·       The graft was Fixed with the Screws through the cup

·       Rim fit Gription Cup was placed and sufficient lateralization was achieved

Post Op Xray

Colle’s Fracture / Broken Wrist

Colle’s fracture is a wrist fracture which occurs within an inch of the wrist joint involving the forearm bone’s distal end of the radius.

The fracture runs transversely just above the wrist joint and displays this distal end of the bone more dorsally giving the wrist the classical “dinner fork” deformity look.

Colle’s fracture is named after Abraham Colles, an Irish surgeon, who first described the condition. Another name for this fracture is the “Pouteau” fracture. It mostly results from a “slip and fall” on an outstretched hand.

Usually the incidence goes up after the rains or after the first snow fall in winter when the roads are icy and slippery or. Typically, when people fall they try and prevent injury to their head or other parts of the body by putting their hands out to hit the ground first. A bad fall results in fracture of the wrist with bruise of the skin over it. As the bone is a living hard tissue it is supplied by blood vessels and nerves. This causes the fracture to be very painful.

Although this fracture occurs in all age groups it tends to be more common in two age groups – the elderly people and in children. In Children the bones are soft and supple and hence tend to bend easily. Here the fracture is usually incomplete while in adults it is a complete fracture. These fractures are also seen in menopausal women with osteoporosis, in whom it is second only to vertebral fractures.

Wrist arthritis can occur as a Colles fracture complication, either from cartilage injury, or from wear and tear in the joints after the fracture is healed. Carpel tunnel syndrome, characterized by numbness and tingling, may also set in after the fracture.

Knee Cap Fracture

A Patella Fracture is a fracture of the knee cap and is one of the most common knee injuries.

The knee cap (patella) acts like a shield for the knee joint and so it can easily be injured. About 15% percent of sport injuries involve the knee. The knee is the weakest if a person is involved in high-velocity, cutting, twisting, and jumping activities. Patella fractures are more common in males than in females.

Falling directly onto the knee is a common cause of Patellar fractures.

Pain and swelling of the knee are the common symptoms of Patellar fracture.

Diagnostic techniques like x-ray and MRI can be used to determine the type and extent of fracture.

Patellar fracture is a serious injury and often requires surgery to heal. In the long run, it may cause arthritis in the knee, weakness of the quadriceps muscles and chronic pain.

What are the Causes of Fracture of Knee Cap?

The knee cap can be fractured due to -

- A direct blow, such as a collision with dashboard in a motor vehicle accident.

- A fall on a flexed knee or forceful quadriceps contraction, such as with stumbling or falling.

- Chronic stress to the knee.

- Pathologic conditions or chronic infections can lead to fractures.

- Swelling and pain in the knee are the main symptoms of knee cap fracture.\

Other symptoms include

- Bruises over the knee in case of direct violence.

- Inability to straighten the knee.

- Inability to walk.

MRI Can Spot Early Signs of Knee Arthritis: Study

WEDNESDAY Dec. 2, 2015, 2015 -- MRIs can spot the warning signs of knee osteoarthritis in people who have normal X-rays, researchers report.

They looked at 849 people, average age of 60, who showed no evidence of arthritis in either knee in X-rays. They were deemed at high risk due to factors such as being overweight or having a history of knee injuries.

The Northwestern University team also assessed cartilage damage, bone marrow lesions and meniscus tears on MRI images taken three years apart. If the MRIs showed worsening damage during that time, the patients were at increased risk of developing knee arthritis or symptoms such as pain, stiffness and/or swelling.

Depending on the type of lesion revealed by MRI, the risk of developing knee arthritis within three years was three to 20 times greater, the researchers said.

"These worsening lesions are an early warning sign and an opportunity to intervene before a person develops the debilitating disease," lead investigator Dr. Leena Sharma, a rheumatologist and professor of medicine, said in a university news release.

"If we employ aggressive prevention strategies in persons with these lesions before they develop knee osteoarthritis, we may be able to delay disease development or alter its course," she added.

Those preventive measures include weight control and avoiding potentially harmful physical activity.

Anesthesia for Orthopedic Surgery

When people think of surgical anesthesia, they typically think of general anesthesia. However, local anesthesia can block sensation to a smaller area for the purposes of surgery or other medical procedures. Both general and local anesthesia can be used for orthopedic surgeries and are described below.

People who smoke, abuse alcohol, or have other medical conditions are at a greater risk of complications regarding anesthesia. Patients concerned about their individual risks should talk to their doctor.

General Anesthesia

Typically, general anesthesia is administered through a needle in the vein of the patient’s arm. The patient is rendered unconscious—often referred to as being “put to sleep”—and does not feel pain. Patients under general anesthesia are closely monitored for changes in blood pressure, heart rate, and breathing.

Sometimes a patient can choose whether to have general or local anesthesia during surgery, but often the medical needs of their procedure dictate this choice.

Local (or Regional) Anesthesia

This type of anesthesia can be used instead of or in combination with general anesthesia. There are two types of regional anesthesia:

• Spinal and epidural anesthesia techniques anesthetize the entire lower half of the body. The anesthesia is administered between vertebrae and affects the spinal cord. Spinal anesthesia is administered with a needle and goes into the fluid that surrounds the spinal cord. Epidural anesthesia is administered continuously through a catheter into the outermost area of the spinal canal, known as the epidural space. People are most familiar with the epidural technique because of its frequent use in childbirth.

• Peripheral nerve blocks target the specific limb on which the surgeon is operating. This approach can stop sensation at the nerve roots, where nerves branch off from the spinal cord. For example, a nerve block may be administered to the lumbar plexus—a group of nerves that emerge through the lumbar spine and provide sensation to a leg—for a hip replacement.
Peripheral nerve blocks have become more common in recent years as medical technology has made them more precise and reliable.
 A peripheral nerve block can be administered before surgery and used in combination with general      anesthesia. Local anesthesia may be used for a brief time following surgery. This allows a patient to emerge from general anesthesia and regain consciousness without pain.

  

Patient-controlled Intravenous Analgesia

Pain must be controlled following surgery. Post-surgical pain differs from patient to patient. To account for these pain variations, hospital patients are sometimes given control of their own pain medication. The patient presses a button on a patient-controlled analgesia (PCA) pump, which then administers analgesia through an IV. The pump is programmed to deliver doses specific to the patient, so there is no risk of overdose.

Stress Fracture

Stress fractures are small breaks in a bone that occur due to overuse or repeated application of force to a particular bone. It is commonly seen in the bones of the lower limbs in sports persons or military recruits.

Normally, a fracture occurs following an obvious trauma to the bone. However, in the case of stress fracture, an obvious trauma is absent. Normal human bones continuously undergo a process of remodeling. In this process, any small damage that occurs to the bone is replaced by new bone, thus maintaining the normal structure as far as possible. In some people like athletes who undergo rigorous workouts, the bones especially of the lower limbs do not get enough time to rest and repair. This results in the formation of small cracks in bones that are subject to extreme stress, resulting in a stress fracture. The occurrence of a stress fracture may be favored by the presence of predisposing factors like osteoporosis or hormonal issues that may further weaken the bone.

Like other fractures, symptoms of stress fractures include pain, tenderness and swelling in the affected area. The pain increases when additional stress is applied to the part and may be relieved with rest.

Stress fractures are diagnosed using imaging tests like MRI and bone scans. The patient is treated with resting the affected part and painkillers. Surgery may be required in some cases.

What are the Causes of Stress Fractures?

Intense physical activity or improper exercise techniques are the common reasons for the appearance of a stress fracture.

Causes of stress fractures include:

• Rigorous physical activity without adequate intervening rest periods
• Prolonged periods of stress on a particular bone
• Use of improper equipment or lack of good training while exercising or participating in sports
• Excessive weight-bearing activities