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Thursday, 29 January 2015 15:14

ACL Reconstruction Using All Inside Single Hamstring Technique - Part 1: ACL Exam

This video is Part 1 of a four part series where Professor Munjed Al Muderis takes you through an ACL reconstruction using the new All-Inside technique.

In this video Professor Munjed Al Muderis performs an ACL Physical Examination to prepare for ACL reconstruction surgery.

Click here to view Part 2 - Tendon Harvesting

Click here to view Part 3 - Preparing the Graft

Click here to view Part 4 - Preparation of the Tunnels

Published in Surgery

Wednesday, 28 January 2015 14:00

Elbow Intercondylar Fracture Post Surgery Information

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

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 one to two days. Discharge from hospital will be dependant 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 levels.

Following surgery you are 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 the uninjured arm may be needed to help 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 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 Elbow Fracture

Wednesday, 28 January 2015 13:54

Elbow Intercondylar Fracture Surgical Procedure

An elbow intercondylar fracture is 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 Elbow Fracture

Wednesday, 28 January 2015 13:52

Elbow Intercondylar Fracture Pre-Surgery Information

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

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 occasionally is 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 Elbow Fracture

Wednesday, 28 January 2015 13:34

Elbow Intercondylar Fracture Information

The elbow is a hinge joint composed of three bones:

The Ulna: One of the forearm bones between the elbow and wrist. When 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.

Intercondylar fractures are T or Y shaped fractures with varying displacement between the condyles and the humerus.

They are the result of a direct (falling directly onto the elbow) or indirect blow (landing on the wrist with the arm locked out straight) to the elbow where the olecranon (the bony point of the elbow) is forced as a wedge between the two condyles of the humerus.

Elbow Intercondylar Fracture Signs and Symptoms

Sudden intense pain

Swelling of the elbow and surrounding tissue

Limited range of motion, particularly forearm rotation and elbow extension and 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.

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.

Elbow Fractures in Children

Elbow fractures can be difficult to diagnose in children as the radial head (the head of the forearm bone) ossification does not occur until age four. These fractures may be associated with an ulna shaft fracture as well and often an ultrasound or MRI may be needed to confirm the diagnosis.

For more information on elbow fractures in children see Paediatric Elbow Trauma Repair.

Published in Elbow Fracture

Wednesday, 28 January 2015 10:33

Ankle Fracture Post Surgery Information

Following surgery the ankle 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 one to two days. Discharge from hospital will be dependant 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. 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 ankle 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 Munjed Al Muderis in his rooms 10 -14 days post surgery will be made.

Upon returning home, for the first four to five days it is advised to limit the amount of time spent on your feet and to elevate your ankle. This helps the blood to drain away from your ankle and control swelling.

Once the bone has healed and your strength is equal in both ankles you may gradually return to sports and other physical activities. This can take four to six months following surgery.

To prevent a recurring injury it is recommended you continue with the strengthening exercises prescribed by the physiotherapist in order to strengthen the muscles and tendons of the lower leg.

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 Post Surgery

Thursday, 22 January 2015 00:00

Ankle Fracture Pre-Surgery Information

The following is what can be expected prior to surgery to treat an ankle 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 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 Pre Surgery

Tuesday, 20 January 2015 00:00

Tumour Removal Post Surgery Information

The following is what can be expected post tumour removal surgery:

On the day following surgery your drains will usually be removed and you will be allowed to sit out of bed or walk.

You can expect to be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your level of pain and amount of help at home.

Your rehabilitation plan will vary depending on the surgical procedure and approach decided upon but you can expect to use crutches or a walker for a period of time.

Physiotherapy is recommended and a physiotherapist will run through what is involved in the post-surgical program.

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 Post Surgery

Tuesday, 20 January 2015 00:00

Tumour Removal Pre-Surgery Information

The following can be expected prior to tumour removal surgery:

Examinations: Routine blood tests will be conducted to check infection and inflammatory markers, CT scan will be performed in order to look closer at the anatomy and bone scans and x-rays will also be carried out.

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline 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 Pre Surgery

Tuesday, 20 January 2015 00:00

Tumour Information

Tumour growth or behavior will vary according to the type of tumour and depending on whether they are non-cancerous (benign) or cancerous (malignant).

Most bone tumours are benign. They tend to grow slowly and don't usually tend to reoccur once they have been removed by surgery. Benign tumours tend to stay non-cancerous expect in rare cases.

The most common benign types of tumour include:

Non-ossifying fibromaunicameral (simple) bone cyst

Osteochondroma

Giant cell tumour

Enchondroma

Fibrous dysplasia

Malignant tumours are cancerous and vary in size and shape. They grow in uncontrolled and abnormal ways, interfere with bodily functions and can be life-threatening if not treated.

A malignant tumour which begins in the bone (primary bone cancer) is different from a tumour that begins somewhere else in the body and spreads to bone (secondary bone cancer).

The four most common types of primary bone cancer occurring in the knee are:

Multiple Myeloma: Multiple myeloma is the most common primary bone cancer. It is a malignant tumor of bone marrow

Osteosarcoma: Osteosarcoma is the second most common bone cancer and is commonly found in teenagers

Chondrosarcoma: Chondrosarcoma occurs most commonly in middle aged to elderly patients

Symptoms:

Most patients with a bone tumor will experience pain in the area where the tumour occurs. The pain is generally described as dull and achy and may get worse with activity, however this is not always the case. The pain often keeps the patient awake at night.

Tumours are not caused by trauma but in some cases an injury can cause the tumour to start hurting. Injury can also cause a bone that is already weakened by tumour to break or fracture.

In some cases patients will not experience any symptoms of pain but instead note a mass or lump.

Depending on the type of tumour, tumours can be treated either surgically or non-surgically.

Published in Information