Doctors
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Conditions
The UOHC Musculoskeletal Trauma surgical team provides the following services:
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Management of sudden, severe musculoskeletal trauma, including computer aided surgical planning for complex fractures and deformities.
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Reconstruction and joint replacement for periarticular fractures (fractures involving joints)
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Reconstrcution and revision implant surgery for periprosthetic fractures (fractures associated with Total Joint Replacement implants).
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Managment and fixation of complex pelvic and acetabular fractures.
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Management and fication of fragility fractures in the elderly patient.
Our surgeons also have extensive expertise in the long-term treatment of debilitating post-traumatic sequelae including:
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Chronic osteomyelitis (infection of the bone)
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Non-unions (failure of the broken bone to heal)
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Mal-unions (failure of the bone to heal with appropriate alignment)
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Joint stiffness following trauma
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Limb length discrepancy (one limb shorter than the other)
Fractures of the Upper Extremity
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Shoulder - The joint of the body formed by bones and joints including the soft tissues by which the arm is connected with the trunk.
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Clavicle - A bone of the (collarbone) pectoral girdle that articulates with the scapula and sternum bones.
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Scapula - A large triangular (shoulder blade) that is at the back of the shoulder.
Figure 2. Upper Arm (humerus shaft)
Figure 3. Proximal Humerus
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Elbow - The joint of arm which connects the upper arm bone (humerus) with the forearm bones (radius and unla).
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Forearm - The portion of the upper extemity including the raduus and ulna (lower arm bones) extending from the elbow joint to the wrist joint.
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Radius - The bone located on the thumb side of the forearm.
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Ulna - The bone located on the 'little-finger' side of the forearm.
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Factures of the Lower Extremity
- Hip - The ball-and-socket joint formed by the head od the femur and the cup-shaped cavity of the acetabulum. Sometimes this term is used to refer specifically to the proximal femur.
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Femur (upper leg) - The upper bone of the lower extremity that extends from the hip joint to the knee joint.
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Proximal Femur - The upper portion of the femur.
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Distal Femur - The lower portion of the femur which forms the upper portion of the knee joint.
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Knee - A joint in the middle of the leg that articulates between the femur, tibia/ fibula, and patella.
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Patella - A thick triangular bone that is located in the front portion of the knee joint and provides knee stability and joint protection.
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Tibial Plateau - The upper portion of the tibia which forms the bottom portion of the knee joint.
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Tibia (lower leg) - The bone located in the inside portion of the lower leg which is the larger of the two bones between the knee and ankle joints.
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Proximal Tibia - The upper portion of the tibia.
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Distal Tibia - The lower portion of the tibia.
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Pilon - The lower portion of the tibia which (with the distal fibula) forms the upper portion of the ankle joint.
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Fibula - The bone located in the outside portion of the lower leg which is the smaller of the two bones between the knee and ankle joints.
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Distal Fibula - The lower portion of the fibula which, together with the tibia, forms the ankle joint.
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Ankle - The joint between the foot and the lower leg.
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Calcaneus - The heel bone of the foot.
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Talus - The bone that bears the weight of the body and forms the lower portion of the ankle joint.
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Foot - The terminal part of the lower extremity upcon which an individual stands.
Other Fractures and Conditions
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Pelvis - A basin-shaped structure, comprising the pubis in front and the sacrum and coccyx behind, that support the weight of the upper body and transmits weight-bearing to the lower extremities.
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Acetabulum - The cup-shaped cavity at the base of the plevis into which the ball-shaped head of the femur fits (upper portion of the hip joint).
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Fragility Fractures - Fractures that occur in osteoporotic bone, generally affecting elderly patients.
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Polytrauma - A short verbal equivalent used for patients usually with two or more severe injuries in at least two areas of the body.
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Non-union - Failure of a fracture to unite.
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Mal-union - A bone which heals in a non-anatomic position (out of alignment).
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Limb Length Discrepancy - Where one limb is shorter than the other.
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Spine - The series of vertebrae forming the axis of the skeleton that protects the spinal cord.
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Plevis and Acetabular Fractures
Fractures of the pelvis and acetabulum are amoung the most serious injuries treated by orthopaedic surgeons. These injuries usually result from high velocity accidents, such as motor vehicle accident or fall from height. People of all ages are vulnerable to these injuries. In addition, some elderly patients with fragile bones, due to osteoporosis, develop pelvic fractues and fractures of the acetabulum with a lower impact fall.
Fracture right acetabulum
As with all fractures, our priority in treating fractures of the acetabulum and plevis is to maximize the patient's ability to return comfortably to daily activities, both work and play. Acetabular fractures are fractures through the socket part of the hip joint. It is an injury of both the bone and cartilage of the joint. These fractures are often displaced (the bones are not in proper position) and require treatment to put the fracture fragments back into place (reduce the fracture). If a joint heals with the bone displaced, the surface of the joint will have irregularities, which may cause excessive wear and result in severe arthritis of the joint, loss of motion, decreased function and pain. To prevent this proper alignment of the bones during healing is essential.
Stable pelvic fracture (without displacement or dislocation) may usually be treated without surgery. Displaced fractures usually realignment of the bones. This may be done by either open (where the orthopaedic surgeon makes an incision to directly manipulated the bone) or closed means. Once the bones are realigned, the surgeon uses internal or external fixation to hold the bone in proper position during healong. Metallic devices including wires, pins, screws, and plates are used.
Patients with pelvic fractures may require one or more surgical procedures. Following reduction of the fracture, the surgeon may use an External Fixation (Ex-Fix) frame to hole the bones in place. Applciation of an external fixator is done by inserting threated pins into the bone on either side of the fracture. These pins are then connected to rods outside the skin to form a frame.
While the Ex-Fix technique is sometimes the only procedure needed to repair a fractured pelvis, some patients require additional surgery or surgeries in which plates and screws are used internally to hold the bones in place. Depending on the site and complexity of the fracture, the surgeon may have to fix the front of the pelvis, the back of the pelvis, or both. Separate operations may be needed for each area that needs treatment.
Patients with acetabular fractures often require Open Reduction with Internal Fixation (ORIF), especially those patients who also have displacement of the joint. The surgeon realigns the bones are precisely as possible to reduce the risk of developing post-injuring related problemes, especially arthritis. The bones are then fixed with plates and screws to prevent future displacement and allow for early rehabilitation.
Fractures of the acetabulum are usually not treated for 5-10 days following the injury. This is to reduce the rick of intraoperative bleeding. During this period the patient may be in traction to prevent additional injury.
Complications
Throughout treatment and recovery, doctors and nurses are watchful for the following potential complications:
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Deep Vein Thrombosis and Pulmonary Embolism: Blood clots that may form in the veins of the pelvis, thight and/ or lower legs and may travel to the lungs.
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Pneumonia: An infection of the lungs that may affect any patient whi is confined to bed and cannot expand his or lungs as fully as they normally do.
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Skin Problems resulting from being in one position for a long period of time.
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Muscle Complications due to inactivity.
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Heterotopic Ossification, a condition in which the body mistakenly forms bone in an area where there is normally muscle; prompt treatment is required to prevent this new bone from interfering with joint movement.
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Damage of the Head of the Femur: if the articular cartilage lining of the joint is affected in an injury to the pelvis, and particularly in fractures of the acetabulum, it's important to keep the surfaces of the joint from rubbing together-and to avoid the risk of future development of arthritis. Preoperatively, traction or a system of ropes, pulleys and weights are used to relieve pressure in the joint. Obviously, surgery with open reduction and internal fixation is performed to realign the joint with enough stability to allow immediate mobilization and hence preserve the smooth lining of cartilage and avoid subsequent arthritis.
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Avascular Necrosis of the Head of the Femur: Patients with dislocated hip and / or fracture of the acetabulum may have disrupted blood flow to the head of the femur (the ball in the hip joint). This can result in death and collapse of bone tissue and hip joint arthritis.
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Nutritional Problems: The body requires more protein and calories during healing.
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Constipation resulting from inactivity.
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Infection at the site of the injury.
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Fragility Fractures
Osteoporosis-related fractures are becoming a growing problem. This is particularly problematic in our region where there has been an exponential increase in the numbers of patient requiring treatment for this fracture type. We aim to achieve secondary fracture prevention in our osteopototic patients through paper investigations, education, drug treatment and regular monitoring.
Osteoporotic knee fracture in an elderly patient
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Minimally Invasive Procedures
Our musculoskeletal trauma surgeons approach each patient as conservatively as possible, but when surgical treatment is required, we encourage the most minimally invasive solution for the speediest recovery.
Some of the techniques we employ when treating various fractures include the following:
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Intramedullary Nailing: Nails / Rods are inserted into the bone marrow canal in the center of long bones of the exremities (commonly the femur or tibia) to align and stabalize the limb. One significant advantage of these rods is that they share the wight with the bone, rather than support it entirely alone, so patients are able to use the extremity more quickly.
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Plate and Screws: Fixation with plates and screws is used commonly. The purpose is to return the bone fragements to their proper position and stabilize the bone until it heals. Previously, plate and screw fixation of fractures required extensive incisions. However, our surgeons are trained to perform minimally invasive plate fixation through small incisions.
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External Fixation: The purpose of this different menthod of treatment, often chosen when the bone is infected or a significant amount of bone has been lost from an open fracture (compound), is to immobilize the bone in order to allow it to heal properly. This is accomplished with rigid support, through the placement of pins or screws into the bone on both sides of the fracture that are secured with an external apparatus bridging across the broken area. It may also be used to correct the shortening or angulation of an extremity.
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Correction of Deformity and Limb Length Discrepancy
Individuals with abnormal alignment of the extremity from a prior injury or a shortened extremity can opt for surgery to correct the problem.
Limb lengthening and reconstruction techniques are used to replace missiong bone and to lengthen and/ or straighten deformed bone segments of legs and arms. This may entail the use of intramedullary nails, somethimes plates, and possibly external fixation. Deformities secondary to osteoarthritis can also be corrected to not only to relieve pain, but also delay future progression of the arthritis.
A circular external fixator applied for correction of deformity
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