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Monday, 02 February 2015 15:00

Compound Distal Femur Fracture Information

Distal femur fractures occur when the thighbone (femur) breaks just above the knee joint.

These types of fractures occur most commonly in older people whose bones are weak. When they occur in younger patients it is often the result of a high-energy injury such as a car crash. In both of these cases, the breaks may extend into the knee joint and may shatter the bone into several pieces.

The knee is the largest weight bearing joint in the body. The distal femur makes up the top part of the knee joint. The upper end of the tibia (shinbone) supports the bottom part of the knee joint. The ends of the femur are covered in a smooth surface called articular cartilage which protects and cushions the bone and helps it glide as the knee is bent and straightened.

Types of Distal Femur Fractures

Distal femur fractures can be categorised in the way in which the bone breaks and the severity of the break.

Transverse fractures occur when the bone breaks straight across the femur.

Comminuted fractures are the result of the bone breaking into many pieces.

Intra-articular fractures extend to the knee joint and separate the surface of the bone into a multiple pieces. Because these types of fractures damage the cartilage surface of the bone, intra-articular fractures can be more difficult to treat.

A compound fracture or open fracture, is an injury that occurs when there is a break in the skin around the broken bone. This is more serious than a simple fracture with a high risk of infection as the fracture site is exposed to outside dirt and bacteria. While it is often the case, a bone does not necessarily need to break through the skin to be classified as a compound fracture, if the fracture site is exposed at all it is considered a compound fracture. Compound fractures are treated and stablised with surgery to minimise the risk of an infection developing which can prevent the bone from healing.

Causes Of Distal Femur Fractures

Fractures of the distal femur most commonly occur for two different reasons in two patient types; younger patients (under 50) and the elderly.

When these types of fractures occur in younger patients it is usually caused by a high-energy injury such as a fall from a significant height or a car accident. Due to the forceful nature of these fractures often the fracture will be accompanied by other injuries.

When distal femur fractures occur in the elderly, it is generally a result of degenerative bone quality that have become weak and fragile. A lower force injury such as a fall from standing can cause a distal femur fracture in an older person.

Distal Femur Fracture Signs and Symptoms

In most cases the symptoms will be felt around the knee joint but they may also extend to the thigh area. The most common symptoms of compound distal femur fractures include:

Break in the skin where you can see the bone

Pain with weight bearing

Swelling and bruising

Tender to touch

Physical deformity where the knee may look out of place and the leg may appear shorter and crooked

Treatment

A distal femur fracture is confirmed with x-rays to assess the severity of the injury and any associated injuries.

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.

Published in Compound Distal Femur Fracture

Monday, 02 February 2015 10:31

Above the Knee Clinical Amputation

This video demonstrates the clinical above knee right leg amputation. The OGAP-OPL implant is designed to be as close to the human anatomy as possible in order to aid people who have had an amputation such as the one shown in this video.

WARNING: CONTAINS GRAPHIC IMAGES THAT MAY DISTURB SOME VIEWERS

Published in Surgery

Sunday, 01 February 2015 16:39

Paediatric Elbow Trauma Repair Post-Surgery Information

Following surgery the elbow may be splinted or casted for a short period of time. A sling may be worn in if it provides comfort for the child.

Pain medications will be administrated.

It is expected the duration of the hospital stay will be one to two days but this will depend on pain levels and management.

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.

A physiotherapist will prescribe an exercise program to help strengthen the joint and the surrounding muscles and tendons. Motion exercises should begin shortly after surgery, sometimes even the next day depending on pain.

Following surgery the child is restricted from lifting with the injured arm for six weeks. In the early days following surgery it is not uncommon not to be able to straighten the injured elbow and they may need to use the uninjured arm to assist.

Full recovery from an elbow fracture requires diligence and commitment to the rehabilitation exercise program prescribed by the physiotherapist. Success following elbow fracture surgery largely depends on the level of commitment given to the rehabilitation program.

Concerns: Please contact the office if you are worried about your child's level of pain, if there is significant bleeding, or 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 Paediatric Elbow Trauma Repair

Sunday, 01 February 2015 16:37

Paediatric Elbow Trauma Repair Surgical Procedure

An elbow fracture or dislocation is first confirmed with x-rays to assess the severity of the injury and any associated injuries.

Complex fractures require open reduction and internal fixation.

During the procedure an incision is made over the back of the elbow and the bone fragments are first reduced (repositioned) into their normal alignment. The bones are then positioned and held together by a plate attached to the outer bone using pins and screws. In some cases a screw or rod inserted into the bone may be used to keep the bone fragments together while they heal.

If some of the bone is missing or crushed beyond repair (fragments of bone broken off in an accident for example) the fracture may require a bone filler. This can be supplied by the patient (typically taken from the pelvis) or fragment of bone from a bone bank or using an artificial calcium-containing material.

After the incision is closed, a splint may be placed on the arm depending on the severity of the injury.

Published in Paediatric Elbow Trauma Repair

Sunday, 01 February 2015 16:36

Paediatric Elbow Trauma Repair Pre-Surgery Information

The following is what can be expected prior to surgery to treat an elbow fracture or dislocation:

Examinations: X-rays will be taken and a CT scan or MRI may also be needed in order 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 Paediatric Elbow Trauma Repair

Sunday, 01 February 2015 16:30

Paediatric Elbow Trauma Repair Information

The elbow is a hinge joint composed of three bones:

The ulna, one of the forearm bones between the elbow and wrist. When the palm is facing up the ulna is on the pinky side (medial side) of the forearm

The radius, the other forearm bone between the elbow and wrist. When the palm is facing up, the radius is on the thumb side (lateral side) of the forearm

The humerus, the upper arm bone between the shoulder and the elbow

The humerus and the paired radius and ulna meet to form the elbow joint. The olecranon is the bony prominence of the elbow. It is positioned directly under the skin of the elbow without much protection from muscles or other soft tissues.

For this reason, injuries and fractures of the elbow are common and are often accompanied by injury to the shoulder or wrist joints. The joint can easily fracture if you experience a direct blow to the elbow or fall on a bent elbow.

Types of Elbow Fractures

There are several types of elbow fractures including:

Supracondylar: This type of fracture occurs above the elbow in the humerus. This is the most common type of elbow fracture and also one of the most serious as it can result in nerve damage and impaired circulation. These types of fractures generally occur in children younger than eights years old.

Condylar: This type of fracture occurs at the elbow through one of the condyles (the bony knobs at the end of the humerus). Most tend to occur through the lateral (outer condyle). These types of fractures require careful treatment as a fracture here can disrupt the growth plate and the joint surface.

Epicondylar: These types of fractures occur at the inside of the elbow tip at the epicondyle (the bony projection of each condyle). These tend to occur on the medial (inside) epicondyle in children 9 to 14 years of age.

Growth Plate: Both the humerus, the ulna and the radius have areas of cartilage called growth plates located at the end of the bone. The growth plates help bring a bone to maturity and thus a fracture which disrupts the growth plate can interfere with bone formation and lead to deformity if not treated correctly.

Forearm: A severe elbow dislocation can break off the head of the radius and excessive force can also result in a compression fracture to the radius.

Monteggia Fracture: This type of fracture is associated with the dislocation of the top of the radius of the elbow. If the dislocation is not identified early and the fracture treated it can lead to permanent impairment of elbow joint function.

Compound Fracture: When a bone breaks through the skin it is referred to as a compound fracture. A compound fracture carries a greater risk of infection and often involves further damage to the muscles, tendons and ligaments resulting in a longer healing time.

The most common fractures occur upon falling onto an outstretched arm. Radial head fractures are the most common injury in adults, whereas radial neck fractures occur more commonly in children.

Elbow Fracture Signs and Symptoms

Sudden intense pain

Swelling of the elbow and surrounding tissue

Limited range of motion, particularly forearm rotation and elbow extension with pain increasing while doing these movements

Often the arm will be held in pronation (palm facing down) unable to be moved

Inability to straighten elbow

Tender to touch

The injured forearm may appear shortened

Grating, cracking or popping feeling in arm when the condyles are pressed together

Numbness in one or more fingers

Treatment

An elbow intercondylar fracture is confirmed with x-rays to assess the severity of the injury and any associated injuries. In children they can be difficult to diagnose, as radial head ossification does not occur until age four. Further ultrasound or MRI scans may be needed to confirm the diagnosis.

Surgery is recommended as the best course of action following an elbow fracture, especially if there is evidence of nerve or vascular involvement.

Complex fractures require open reduction and internal fixation.

During the procedure an incision is made over the back of the elbow and the bone fragments are first reduced (repositioned) into their normal alignment. The bones are then positioned and held together by a plate attached to the outer bone using pins and screws. In some cases a screw or rod inserted into the bone may be used to keep the bone fragments together while they heal.

If some of the bone is missing or crushed beyond repair (fragments of bone broken off in an accident for example) the fracture may require a bone filler. This can be supplied by the patient (typically taken from the pelvis) or fragment of bone from a bone bank or using an artificial calcium-containing material.

After the incision is closed, a splint may be placed on the arm depending on the severity of the injury.

Most patients will return to full range of motion in the elbow following surgery and can be expected to return to normal activities within four to six months. However, full healing and return to sports may take longer.

Published in Paediatric Elbow Trauma Repair

Thursday, 29 January 2015 16:34

Osseointegration (ILP) One Year Post Surgery

This video demonstrates a patient one year after undergoing Osseointegration surgery as performed by Professor Munjed Al Muderis.

Published in Post Surgery

Thursday, 29 January 2015 16:31

MPFL Reconstruction for Patellar Malalignment Dislocation - 3 weeks post surgery

This video demonstrates a patient 2 weeks post surgery after having MPFL Reconstruction for Patellar Malalignment Dislocation as performed by Professor Munjed Al Muderis.

Published in Post Surgery

Thursday, 29 January 2015 16:29

Meniscal Repair Arthroscopically - Knee

In this video Professor Munjed Al Muderis demonstrates the surgical repair of a torn knee meniscus using an arthroscopically assisted technique.

Published in Surgery

Thursday, 29 January 2015 16:26

Medial Tibial Plateau Fracture Fixation - 7 weeks post surgery

This video demonstrates a patient 7 weeks post surgery following a Medial Tibial Plateau Fracture Fixation as performed by Professor Munjed Al Muderis.

Published in Post Surgery