Orthopedic Surgery

Hamate Fractures

Fractures of the carpal bones are rare, with the exception of the scaphoid bone. Of all the carpal bones, the hamate accounts for only 2% of fractures, while the scaphoid fractures would be 70%. Hamate fractures are classified based on the Milch classification which takes into account the part of the bone fractured. Fractures of the hook of Hamate are commonly seen in golfers, baseball players, and racket sports players. It is also very common in patients with falls and crash injuries In comparison, body fractures of the hamate are more associated with the act of a clenched fist striking a wall.

Hamate fractures can be difficult to treat and the diagnosis is often missed. In fact, it can take anywhere up to 5 weeks, but the average is about 10 days. It typically causes hypothenar pain worsened by palpation or gripping. The hook of the hamate pull test is performed to assess for hook fractures, and it is deemed positive if the resisted flexion of the fourth and fifth digits displaces the fracture and causes pain. A fracture of the Hamate can damage the ulnar nerve given its close proximity, causing additional symptoms of paresthesia or weakness.

Treatment of hamate fractures is dependent on the degree of the displacement and fracture location

Plain film radiography is performed for the diagnosis of these injuries. There is an overlap of the hook of the hamate on the body, which makes the radiological diagnosis quite difficult. Computed tomographic (CT) scan can be performed to assist in such cases and for preoperative planning.

The treatment of hamate fractures is dependent on the degree of the displacement and fracture location. For minor, nondisplaced hamate hook fractures, short arm cast immobilization is usually sufficient, along with close clinical follow-up to ensure there is no non-union. Displaced hook fractures or those that are associated with nerve or tendon irritation require a more involved approach. Excision needs to be performed in these settings, and it does not adversely affect grip strength or wrist range of motion. Excision is actually preferred to open reduction internal fixation. Hamate body fractures, on the other hand, are treated with a short arm cast for 4 to 6 weeks, if nondisplaced. Displaced hamate body fractures actually require an open reduction and internal fixation with either compression screws or low-profile plates. In some cases, temporary fixation across the carpometacarpal joints may also be required to aid in stability. Sometimes, rigid fixation is considered for these fracture patterns but may not always lead to desirable patient outcomes.

Overall, hamate fractures are quite rare and can be difficult to diagnosis, given the lack of experience of the radiologist and the intricate nature of the injury, and can lead to significant morbidity if not recognized and treated appropriately. Choosing the right treatment is the next critical step as full recovery depends on it. It has special relevance in sports medicine and lasting sequelae can severely compromise a sports career, making it all the more necessary to properly diagnose and treat it.

Boxer’s Fracture

A boxer’s fracture is a break (fracture) in one of the metacarpal bones of the hand. As these forms form knuckles, it is easy to imagine how they could break while boxing or punching hard surfaces with a closed fist. The fifth metacarpal (pinky finger) is most commonly injured, followed by the fourth metacarpal (ring finger). Most fractures are in the neck, or top, of the metacarpal bone near the knuckle.

It typically presents with a crack or pop sound at the time of injury. There will be pain around the fracture site, along with swelling, bruising, or discoloration. The knuckle may appear disfigured and flat if the break is severe.
Wrapping the hands or using boxing gloves to protect from injury when training is also important in order to prevent this type of injury

The diagnosis is based on clinical history and examination. The injured hand will be examined for deformity, tenderness, swelling, and discoloration. The local neurological exam is also performed to look for evidence for nerve damage. X-rays are obtained to diagnose the fracture.

 

The treatment begins with ice and elevation of the hand to lessen the swelling. Anti-inflammatory medication can also help with pain and swelling. Most such fractures will require immobilization in a cast or splint for 3-6 weeks. However, If there is a break in the skin at the time of the injury, then there is a high risk of infection and antibiotics should be prescribed. A careful surgical assessment is a need for open, complex, or displaced fractures. Physical therapy may be recommended to help regain full use of one’s hand. Surgery is also used for people who use their hands for minute motor skills, such as playing the piano or performing dentistry.

The best way to prevent a boxer’s fracture during boxing is to learn proper punching technique so that the initial contact is not with the fourth and fifth knuckles. Wrapping the hands or using boxing gloves to protect from injury when training is also important in order to prevent this type of injury.

Recovery time varies based on the severity of the fracture and the extent of ensuring treatment. If it was a simple fracture then the recovery may only last two to three weeks. But if surgery or physical therapy is required, then the recovery time may prolong up to four to six weeks or even longer.

It is important to keep to closely follow the doctor’s treatment plan, which includes keeping the splint on for the designated amount of time. It is equally important to follow the physical therapy regimen and perform all at-home exercises daily. Also, protect the injured hand while it heals. Recovery is faster if one eats a healthy diet rich in protein, calcium, and vitamin D. It is critically important to not use the injured hand until the doctor says it’s safe to do so. Stop smoking as it impairs tissue healing.

 

If the boxer’s fracture is diagnosed accurately and treated promptly, with the patient following the medical advice carefully, there are normally no long-term effects and full recovery is achieved in most cases.

Can Platelet Rich Plasma Therapy Heal Sports Injuries?

You may have heard of PRP or Platelet Rich Plasma therapy being used for pro athletes like Tiger Woods. PRP therapy helped him recover from ACL surgery that would have taken a long time to heal otherwise.

PRP therapy is part of regenerative medicine that utilizes the body’s natural ability to heal. PRP can help heal and even regenerate damaged or degenerating tissues, providing a great alternative to surgery.

Platelet Rich Plasma (PRP)

Platelets are blood cells that contain proteins, growth factors, and other components that stimulate healing. Platelets also attract stem cells to the affected site, stimulating healing and new tissue growth.

Platelet rich plasma or PRP is your body’s own blood plasma and concentrated platelets. Platelets in PRP are 5-10 times that found normally in blood.

Conditions treated by PRP

PRP or Platelet Rich Plasma therapy can potentially treat a wide range of sports and other injuries that cause joint, tendon and ligament pain. These include –

  • Joint pain
  • Degenerative Joint Disease
  • Ligament and muscle injuries
  • Tendonitis
  • Partial tendon tears

PRP treatments have proven highly effective and successful. They help to relieve pain and avoid disability, down time and risks associated with major surgery. Recovery from PRP therapy is fast, accompanied only by some soreness in the treated area, that passes away quickly.

To learn more about PRP Therapy for treating sports and other injuries and conditions, call OSPI Arizona in Gilbert, AZ at 480-899-4333. OSPI’s Board Certified orthopedic surgeons have extensive experience and expertise in regenerative and sports medicine, general orthopedics and joint replacement surgery.

PRP Therapy Can Relieve Osteoarthritis Pain

For people suffering from osteoarthritis, even the most common day to day tasks – driving, walking, climbing stairs, can become challenging. While physical therapy and anti-inflammatory medications can provide relief in mild cases, total joint replacement surgery may be required for severe cases. Surgery puts patients at risk and requires a long and painful recovery period.

If you suffer from severe osteoarthritis in hip or knee joints and have been thinking of surgery, here is a highly effective alternative you should consider – Platelet-Rich Plasma (PRP) therapy.

PRP Therapy

Platelets are blood cells that help in clotting. In case of damage to a blood vessel, platelets create a clot at the site of the damage to stop the bleeding and allow healing.

PRP therapy uses a patient’s own platelets to promote healing in the damaged joint. It is a quick and safe procedure.

Blood is drawn from the patient and spun in a centrifuge. This separates the platelets from other blood cells. These platelets are directly injected into the damaged joint. The entire process is done as an outpatient procedure and takes about an hour.

Your orthopedic doctor may prescribe physical therapy regimen for weeks following the injection. You would be asked to come back for an evaluation after six weeks. A second injection is necessary, in some cases. In successful cases, you would be able to comfortably resume activities that arthritis had previously made too painful, within 3 months of the injection.

PRP therapy has also shown to be highly effective in treating osteoarthritis, tendonitis, lateral epicondylitis (tennis elbow), and patellar tendonitis (jumper’s knee).

To learn more about PRP Therapy, call the top Orthopedic surgeon in Gilbert, AZ, call OSPI Arizona at 480-899-4333. OSPI’s Board Certified orthopedic surgeons have extensive experience and expertise in sports medicine, general orthopedics and joint replacement surgery.

 

Conditions That Affect Hand Function

The hands are vital parts of the human body and without them, very little essential and social activities can be performed such as feeding, being productive to be able to make a living and support dependents, and interactions with others. Losing the ability to use one’s hand can be a very emotional and debilitating problem that can lead to increased stress and anxiety that may result in the development of mental health issues such as depression. Therefore, the proper diagnosis and management of conditions affecting hands is extremely important.

The following are conditions that can result in the hands becoming unable to function properly and how they are managed.

Dupuytren’s contracture Hand SurgeryDupuytren’s contracture

  • Progressive thickening of the tissue in the palm of the hand results in shortening of this tissue and causes flexing contractures of the fingers (makes the fingers close).
  • The most commonly affected fingers are the fourth and fifth digits and this can be quite a disabling condition.
  • Management includes physical and occupational therapy and surgical intervention in severe cases.

Trigger finger

  • Referred to in medicine as stenosing tenosynovitis.
  • Trigger finger causes a similar issue to Dupuytren’s contracture. The difference though is that where the latter involves pathology of the tissue covering the palm of the hand, trigger finger is caused by thickening of the tissue that covers the tendons which allow the fingers to close.
  • The condition is characterized by the affected finger seeming like it is stuck in a trigger-pulling position. Since it is difficult for the finger to be straightened, when it becomes unlocked it resembles the pulling of a trigger.
  • Management includes trigger finger surgery and when the thumb is involved is referred to as trigger thumb surgery.
  • These surgeries may be performed through minimally invasive access or open procedures if the cases are severe.

Carpal tunnel syndrome

  • This condition is associated with compression of the median nerve through the carpal bones in the wrist.
  • Compression of the median nerve results in the decreased sensation of the thumb and first two fingers which can complicate and lead to decreased power in the hand with an inability to use the limb.
  • Management of this condition involves initial conservative therapy with pain relieving measure and the use of splints to help take pressure off the median nerve.
  • If these therapies are ineffective, or the case is severe, then carpal release surgery is performed.

Rheumatoid arthritis

  • An autoimmune condition where antibodies are produced by the immune system that attacks and damages the synovial tissue around joints, especially of the wrists and fingers.
  • This process results in damage to the joints leading to deformities of the fingers making them stiff and difficult to use.
  • Management of this condition includes using medications such as steroids and non-steroidal anti-inflammatories such as ibuprofen or naproxen. Early therapy may also include medications such as disease-modifying anti-rheumatic drugs (DMARDs) like azathioprine, sulfasalazine, and methotrexate to help reduce disease progression as well as induce more remissions.
  • Surgical interventions may be warranted in cases where the medications are not working and the patient’s use of their hands has becomes severely debilitating.

What Happens in an Ulnar Collateral Ligament Injury?

Ulnar collateral ligament injuryAn ulnar collateral ligament injury is an injury to the elbow ligament. It happens due to overuse of one of the ligaments on the inner side of the elbow and can result in tearing the ligament.
The injury is very common in contact sports where athletes have to repetitively stretch their arms or where elbow dislocation occurs. The injury is caused by a force that exceeds the strength of the ligament with activities like throwing or overhead sports being very likely triggers.

Possible complications and treatment

Injuries of this type hold the potential to damage other structures of the elbow and cause elbow stiffness.
In most cases, where the injury is not too serious, ice and pain medications can be used to treat the swelling and discomfort. Ice helps target swelling while medications stop the pain temporarily. Where pain persists, the individual may also get a brace or cast to seek relief.

What is Tommy John surgery?

The surgical treatment for correcting an ulnar collateral ligament injury is called the Tommy John surgery. The procedure derives its name from a surgery performed on the MLB pitcher and LA Dodgers Tommy John for a tendon transplant.
The procedure works by replacing the torn ligament with a graft tendon taken from the hamstring, forearm, knee or foot of the individual. However, the surgery is only recommended for those patients who do not find relief from non-surgical methods.
Athletes who need to engage in grueling overhead throwing activities and whose careers depend on performance are ideal candidates for this procedure.
The surgery involves implanting the graft to the injury site by drilling tunnels in both the forearm and upper arm bones once the elbow is opened up.
Flexor muscles in the area are also opened up where the graft is woven and the reconstruction is performed. Any remaining portion of the original ligament is then attached to the reconstructed ligament.
While it might seem like a lot of work, the surgical procedure takes between an hour and an hour and a half to perform. Most patients are required to stay overnight in the hospital and are discharged the next day.

Post-operative care

Post-operative care after this procedure involves keeping the incision dry and clean and not showering for 3 days. The patient also needs to give the elbow a rest for a week with no driving for a minimum of six weeks. Other remedial steps include resting the elbow on a pillow when seated and keep it elevated to minimize swelling.
Most patients will recover from surgery in 6 to 8 weeks with motion achieved in this time without pain.

Rehabilitation

Rehabilitation consists of gentle exercises such as squeezing a softball while avoiding moving the elbow. With improvement, the patient can advance to an active motion from passive motion.
Once comfortable, the patient can move to engaging the elbow more by working with a fuller range of motion. Care needs to be taken not to cause direct stress to the elbow during recovery.
It usually takes 12 months for returning to normal sports.

How Does a Knee Get Replaced?

How do they Replace a Knee?

Knee replacement surgery is performed due to chronic knee pain and loss of mobility. According to the Center for Disease Control and Prevention (CDC), in 2010 alone, almost 700,000 total knee replacements were performed on adults age 45 years and older. Total knee replacement (TKR) has nearly doubled in prevalence over the last couple of decades, especially for women (a 99% increase).

Steps in a Total Knee ReplacementKnee pain 3

Step 1: Administering anesthesia – Knee replacement surgery is usually performed with you under general anesthesia. The doctor will discuss this with you before the surgery. You will be given medications through an intravenous (IV) catheter, and an intubation tube will be placed in your airway.

Step 2: Prepping the knee – After all excessive hair over the knee is clipped or shaved, the skin over the knee is cleaned with an antiseptic solution.

Step 3: Making incision – The orthopedic surgeon will make a 4- to 6-inch incision in the knee area.

Step 4: Removing damaged surfaces – The damaged knee joint and surface will be removed. This involves specialized instruments used to remove cartilage and bone pieces from the joint.

Step 5: Insert prostheses – The artificial components are made of plastic and metal. Most artificial knee components are cemented into the joint. The prosthesis attaches to the bone using a special cement. The components include a tibial component (resurface top of tibia or shin bone), a femoral component (resurfaces end of femur or thighbone), and a patella component (resurfaces the patella or kneecap).

Step 6: Checking motion and implants – After the implants are in place, the surgeon checks range of motion and prostheses stability.

Step 7: Closing incision – The incision is closed using surgical staples or sutures. Depending on the situation, a tiny catheter with drain may be placed in the incision to remove fluid. A sterile, dry bandage dressing is applied over the knee.

How Long does a Total Knee Replacement Last?

A common reply to this question is that a total joint replacement typically lasts 15-20 years. Most current data suggest that both knee and hip replacements have an annual failure rate of around 0.5%. This means that if you have a total knee replacement today, you have a 95% chance of it lasting 10 years, and an 85% chance that it will last 20 years.

canstockphoto10845760

Types of Implants

The orthopedic implant industry has continued to develop innovative technologies to improve the outcomes of total knee replacement. However, many studies show that there is no clear advantage of any of these designs in relation to improving clinical outcomes. Some designs are:

  • Gender specific – This refers to a modified implant design that accounts for the anatomic difference between women’s and men’s knees. Most companies have some modifications in these designs to allows for sizing options so the prosthesis will fit accurately in relation to the patient’s anatomy.
  • Rotating platform – This refers to a plastic component that independently rotates on a metal tray. The plastic bearing will lock into the tray, and was designed to reduce wear on the bearing. In addition, this device can reduce the rate of loosening of metal components and better replicate the normal knee function and movement.
  • Computer technology – There are studies that have evaluated the emerging technologies in knee replacement surgery along with the success of the procedure using computer technology. Computer, robot, and custom cutting guides are used for accuracy in implant placement, as well as a more efficient surgery.

Resources

Center for Disease Control and Prevention (2015). Hospitalization for Total Knee Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010. Retrieved from: http://www.cdc.gov/nchs/data/databries/db210.htm

Basics of Hip Joint Replacement

Hip joint replacement, also called total hip arthroplasty, is a procedure used to replace a damaged or worn hip joint with artificial components (prostheses). This surgery is often performed following a hip fracture or for patients with severe and advanced arthritis.

What types of arthritis affect the hip joint?hip arthritis picture

Three main types of arthritis affect the hip joints. These include:

  • Osteoarthritis – Degenerative joint disease, or OA, affects older individuals. This type of arthritis may cause joint cartilage break down.
  • Rheumatoid arthritis – Severe, deforming type of arthritis that causes synovial lining inflammation and excessive synovial fluid.
  • Traumatic arthritis – This results from an injury or trauma, and it causes cartilage damage.

Will I have a big scar after the surgery?

The traditional approach to hip replacement involves a 6 to10 inch incision over the hip joint. Newer approaches, such as minimally invasive and the anterior approach, involve two smaller incisions. The doctor will tell you which approach is best for you.

How do I prepare for hip replacement surgery?

When you meet with the surgeon, he will discuss the procedure and review the risks and benefits. Because bleeding is a risk, you must hold all blood-thinners for a few days before the surgery. The doctor takes a detailed medical history, inquires about allergies, goes over your medications, and conducts a physical examination. If not available, routine hip x-rays are done. Because this is a major surgery, you will have some preliminary tests (urinalysis, bloodwork, and EKG).

canstockphoto38482995What happens the day of the surgery?

You must arrange to have someone drive you home from the hospital and help you for a few days. Because anesthesia is given, you must fast for 8 hours before the procedure. After you change into a gown, a nurse places an IV catheter in your arm to administer medications. You will be given a mild sedative before going to the surgical room.

What happens during hip replacement surgery?

When you are asleep from anesthesia, the medical workers will clean your hip region using an antiseptic. The surgeon makes incisions and uses special instruments to remove the diseased and damaged hip bones. The prosthesis is inserted into the thigh bone, and the cup is placed into the hip joint socket. After all changes are made, the incisions are closed using sutures. The doctor will place a small drain and bandage over the surgical site.

What happens after my hip surgery?

After your operation, you are taken to the recovery room. A nurse monitors your pulse, breathing, and blood pressure, and once you are alert, you are taken to the hospital room. A nurse helps you to bed and administers pain medication as necessary. The physical therapist will meet with you and discuss your exercise rehabilitation plan. Some patients are moved to a rehabilitation center for recovery, whereas others will go home.

What modifications will I need at home?

After your hip replacement surgery, you will need certain modifications. The physical therapist will do a home visit before you have surgery to ensure you have the right modifications. These include:

  • Safety handrails in the bath/shower
  • Proper handrails along the stairs
  • Raised toilet seat
  • Shower chair
  • Stable chair with firm back and knee rest
  • Sock aid
  • Dressing stick
  • Long-handled sponge
  • Shower hose
  • Reaching stick
  • Firm pillows
  • Removal of all loose carpets and cords

Orthopedic and Sports Performance Institute offers top hip replacement doctors in Gilbert AZ. Most insurance is accepted, call us today!

Recovery after Anterior Approach Total Hip Replacement

Anterior hip replacement is a less invasive approach to hip joint surgery. With the anterior approach to total hip replacement, the orthopedic  surgeon in Gilbert AZ accesses the joint from the anterior (front) of the hip as opposed to the lateral (side) or posterior (back). The anterior approach allows the Arizona hip surgeon to make repairs and replacements without detaching tendons, muscles, or soft tissue.

Small Incision

The anterior approach to hip replacement was first described in the 1940s. This approach is gaining in popularity, and advocates for anterior approach total hip replacement consider its advantages to be earlier restoration of walking, low dislocation rates, and muscle-sparing ability. The ModularEndoprosthesisprocedure begins with the patient lying on his/her back. The surgical incision is slightly lateral to the front superior iliac spine of the pelvis. The 4- to 5-inch incision runs toward the lateral aspect of the ipsilateral knee. After moving soft tissue and muscle, replacement is made.

Because the anterior total hip replacement surgery uses a small incision, and muscles are moved rather than cut, the result is less trauma and damage to the hip soft tissues. Recovery time is usually faster with the anterior approach than traditional surgery, and patients report less post-operative pain. After only 2-3 weeks, patients begin walking without assistance, which is compared to 5-6 weeks with posterior hip replacement surgery.

Length of Hospital Stay

After the minimally invasive hip replacement, you will stay 1-4 days in the hospital. You may stay longer if you have serious health conditions, severe hip arthritis, and complications during the procedure. The length of stay varies from patient-to-patient, but the anterior approach to hip replacement is usually related to a shorter length of hospital stay than the posterior or lateral approaches.

Physical Therapy

Physical therapy begins the day of surgery. To strengthen the hip joint, you must do small exercises, such as contracting buttock and leg muscles and ankle pumps. The therapist works with you to learn exercises that help regain full hip movement. You will work with the therapist two times each day. Once you return home, the physical therapist will see you 3-4 times each week.

 

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Home Recovery

After you leave the hospital, you should have family or friends stay with you for a few days. You will need help with errands and household activities. In addition, you cannot drive for 2-4 weeks, so you will need transportation home from the hospital, to follow-up appointments, and to the pharmacy. It is also important to stock up on easy to prepare foods, such as frozen, canned, and premade meals.

Incision Care

Your anterior incision will be closed with staples or sutures, which are removed around 10-14 days after surgery. The surgical site will be numb, sore, bruised, and/or swollen for a few days. You may experience itching or pulling of the incision site as well. We recommend using an icepack for 10-20 minutes several times a day to relieve discomfort. In addition, avoid using any lotions or creams on the hip area. To keep the incision clean and dry, avoid showering until your wounds are healed. You can bathe, however.

Physical Activity

Being physically active is an important aspect for recovery. Within 2-4 weeks, you will be able to resume your daily routine and normal activities. During the first week, you will start walking with a walker and advance to using a cane. To avoid falls and injuries, you should only walk in areas where there are handrails, no loose rugs, and no cords. You may begin driving after 2-3 weeks, depending on how you progress.

 

OSPI offers the top hip specialists in Arizona, specifically the East Valley. Hip replacements done by the anterior approach need an expert to be done well. Call OSPI today, most insurance is accepted!

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