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Tuesday, 03 February 2015 15:13

Tibial Spine Fracture Information

The intercondylar eminence, or tibial spine, is a structure of the tibia (shinbone). It lies between the articular areas of the proximal tibia (the top of the bone which articulates with the knee). The spine sits between two prominent tubercles.

The spine or intercondylar eminence separates the medial and lateral condyle of the tibia and it is this intercondylar area where the anterior cruciate ligament (ACL) attaches to the tibia.  

Fracture of the tibial spine is an unusual injury and not commonly seen. Cycling and high impact sports are generally the cause of such a fracture. The anterior spine (front) is fractured more commonly than the posterior (back).

 

Treatment:

Treatment of a tibial spine fracture often requires surgery but the procedure will vary according to the classification type of the fracture.

A tibial spine fracture is classified according to the Meyers and McKeever Classification system:

  • Type I: Nondisplaced
  • Type II: Minimally displaced with intact posterior hinge
  • Type III: Completely displaced

 

Types I and II and can be treated with casting but if they are more severe they will require surgery.

Severe Types I and II and Type III are commonly operated on arthroscopically or with an open reduction.

Published in Tibial Spine Fracture
Tuesday, 03 February 2015 14:28

Compound Injury Post Surgery Information

Following surgery the leg will be immobilised in a splint and elevated. 

Pain medications will be administrated. In addition to these you will usually be hooked up to an intravenous patient-controlled analgesia (PCA) device which delivers pain relief in controlled amounts at the push of a button. 

It is expected you will remain in hospital for two to three days. The duration of your hospital stay is dependant on pain levels, management and the severity of the injury.

A physiotherapist will assist you to mobilise with crutches. Generally it is advised for you to not full weight bear through the injured leg for six to eight weeks. You will be on crutches for this time, however depending on the severity of your injury, you will be either advised to partially weight bear with crutches or to avoid any weight bearing through the injured foot completely.  The physiotherapist will also prescribe you appropriate excises to help strengthen the injured area when the movement and weight bearing restrictions have been lifted.

The wound will be checked prior to discharge and a follow up appointment to see Professor Al Muderis in his room 10 -14 days post surgery will be made.

 

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Compound Injuries
Tuesday, 03 February 2015 14:26

Compound Injury Pre-Surgery Information

The following is what can be expected prior to surgery to treat a compound injury:

Examinations: X-rays will be taken and a CT scan or MRI may also be needed to identify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Betadine Skin test is occasionally used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery:

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with the patient to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Compound Injuries
Tuesday, 03 February 2015 14:03

Ankle Arthroscopy Post Surgery Information

Ankle Arthroscopy is only a day surgery procedure.

Pain medication will be provided and should be taken as directed. 

After surgery, mobilise and weight bear with crutches as tolerated.

You may walk on the operated leg within the limits of pain but it is important not to overdo it. 

You can remove the bandage after 24 hours and place the provided waterproof dressings over the wound.

It is normal for the ankle to swell after the surgery. Elevating the leg when you are seated and placing an ice pack on the ankle will help to reduce swelling. Apply the ice pack on for 20min at a time, three to four times a day until the swelling has reduced.

An appointment with Professor Munjed Al Muderis will be made for 7-10 days after surgery to monitor your progress and remove the stitches.

You can return to driving and work when comfortable unless otherwise instructed.

To stabilise muscles and ensure the success of the surgery, commence strengthening exercises six weeks after surgery. At this stage a return to sport and other physical activities can be commenced.

 

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Ankle Arthroscopy
Tuesday, 03 February 2015 14:02

Ankle Arthroscopy Surgical Procedure

Arthroscopy is usually performed under a general or regional anaesthetic. 

Once the anaesthetic has been administered, the ankle is prepared in a sterile fashion and a tourniquet is placed around the thigh.

The arthroscope is introduced through a small (size of a pen) incision on the back of the ankle. A second incision on the front of the ankle is made to introduce the instruments that allow examination of the joint and treatment of the problem inside the ankle joint. After the surgery is complete the incisions are closed and a sterile dressing applied.

Published in Ankle Arthroscopy
Tuesday, 03 February 2015 14:00

Ankle Arthroscopy Pre-Surgery Information

The following can be expected prior to ankle arthroscopy:

Examinations: X-rays will be taken and a CT scan or MRI may also be needed to identify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Betadine Skin test is occasionally used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery:

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with the patient to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Ankle Arthroscopy
Tuesday, 03 February 2015 13:55

Ankle Arthroscopy Information

Ankle Arthroscopy is an excellent minimally invasive operation that allows thorough visualisation of the ankle joint useful for diagnosing and addressing various pathology inside and outside the ankle joint.

Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. An arthroscope is a small fibre-optic telescope that can be inserted into a joint to evaluate and treat a variety of conditions. A camera is attached to the arthroscope and the picture is displayed on a TV monitor.

Most arthroscopic surgery is performed as day surgery and is usually done under general anaesthesia. Its benefits include:

  • Smaller incisions
  • Faster healing time
  • A more rapid recovery and return to activities
  • Minimal scarring

 

Ankle Conditions Treatable Using Arthroscopy

Several injuries and conditions can be treated with both arthroscopy on its own and as a combination of arthroscopy and conventional surgery.  

The most frequently treated ankle conditions using arthroscopy include:

  • Arthritis and cartilage damage. Ankle arthroscopy can offer a minimally invasive way to perform an ankle fusion.
  • Fractures. To help ensure normal alignment of bone and cartilage, fracture repair may be performed using both arthroscopy along with open techniques. Arthroscopy can also be used to identify cartilage injuries inside the ankle.
  • Synovitis, inflamed lining (synovium) of the ankle which results in pain and swelling.
  • Acute and chronic injury.
  • Loose bodies of bone and cartilage which can cause clicking and catching in the ankle joint.
  • Instability of the ankle. Ligaments surrounding the ankle joint can become stretched and lead to the feeling of the ankle giving way. These ligaments can be tightened using arthroscopy.
  • Anterior ankle impingement. This is often referred to as athlete’s or footballer’s ankle and occurs when the bone or soft tissue at the front of the ankle joint becomes inflamed. Using arthroscopy, inflamed tissue and bone spurs can be shaved away.
  • Posterior ankle impingement. This occurs when the soft tissue at the back of the ankle becomes inflamed and makes pointing the foot down painful. This condition is commonly seen in dancers. The tissue causing the inflammation and pain can be removed using arthroscopy.
  • Unexplained ankle symptoms. Occasionally patients develop symptoms that are unexplained using other diagnostic techniques. Since arthroscopy provides access to look directly into the joint, these unexplained symptoms and problems can be identified.

 

Surgical Procedure 

Ankle arthroscopy is generally only a day surgery. The patient presents at the hospital the day of the surgery and then leaves within a few hours of having surgery.

Arthroscopy is usually performed under a general or regional anaesthetic. The insertion point is through two or more cuts less than 1cm long through which a camera or telescope camera along with associated instruments are inserted to diagnose and treat pathology inside the ankle. 

Published in Ankle Arthroscopy

Following surgery the leg will be immobilised. Pain medications will be administrated. In addition to these you will usually be hooked up to an intravenous patient-controlled analgesia (PCA) device which delivers pain relief in controlled amounts at the push of a button. 

It is expected you will remain in hospital for four to five days depending on pain levels and management.

A physiotherapist will assist you to mobilise with crutches. Generally it is advised for you to not full weight bear through the injured foot for six to eight weeks. 

However, early movement of the leg and knee is advised in order to prevent stiffness and help the healing process. Usually this process begins with passive exercises where a physiotherapist will move the knee for you.

The physiotherapist will also prescribe you appropriate exercises to help strengthen the knee and leg once the weight bearing restrictions have been lifted and it is safe and advisable to do so.

If the fracture was severe and the bone broken in many places or the bone is quite weak, it may take longer to heal and physio exercises may not be prescribed right away.

The wound will be checked prior to discharge and a follow up appointment to see Professor Al Muderis in his room 10 -14 days post surgery will be made.

 

Recovery:

A distal femur fracture needs significant healing time and may take up to three months before all the weight bearing restrictions are lifted and you can return to normal activities. 

Post surgery it is common to feel weak and unsteady on the injured leg. A rehabilitation plan will be prescribed to you by a physiotherapist which contains a series of exercises designed to help restore normal muscle strength, joint range of motion and flexibility. The commitment and diligence to this program will largely determine the success of the surgery and the speed of a full recovery.

 

Concerns: 

Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Surgery is recommended as the best course of action following a compound distal femur fracture in order to both stabilise the bone and joint and to minimise the risk of infection. 

Complex fractures require open reduction and internal fixation.

The internal fixation methods include:

  • Intramedullary nailing: This procedure involves a specially designed metal rod inserted into the marrow canal of the femur. The rod passes across the fracture to keep it in position while it heals.
  • Plates and screws: During this procedure, the bone fragments are first reduced (repositioned) into their normal alignment. They are then held together with specialty screws and metal plates which are attached to the outer surface of the bone.

Both of these methods can be performed using one large incision or several smaller ones depending on the type of fracture and its severity.

If the fracture has broken the bone into many small pieces above the knee joint, it is generally not pieced back together but rather a plate or rod will be fixed at both ends of the fracture without touching the multiple small pieces. This method keeps the overall shape and length of the bone in its natural form while it heals. As it heals the individual pieces will then grow into the new bone, which forms a callous.

In cases where the fracture may be slow to heal, such as when the patient is elderly with poor bone quality, a bone graft may be used to help facilitate the callous forming.  Bone grafts can be obtained from the patient themselves (usually taken from the pelvis) or cadaver bone taken from a tissue or bone bank. Alternatively artificial bone fillers can be used.

In extreme cases where the fracture is too complicated and the bone quality too poor to fix, the fragments are removed ant the bone is replaced with a knee replacement implant.

The following is what can be expected prior to surgery to treat a compound distal femur fracture:

Examinations: X-rays will be taken and a CT scan or MRI may be also be needed to identify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Betadine Skin test is occasionally used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with the patient to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.