Fractures, or broken bones, are one the most common problems seen and treated by orthopedic doctors. The most common are hip fractures (mainly among the elderly), ankle fractures, and fractures of the long bones in the lower and upper legs. There are different types of fractures ranging from small, hairline stress fractures to open fractures, where part of the bone sticks out of the skin.

While a large number of fractures may heal with plasters or another type of immobilization, many other fractures will require surgery. Bone fracture surgical repair is performed when a broken bone can’t heal properly with plaster, splinting, or bracing alone.

The most common type of fracture surgery involves internal fixation, where broken pieces of bone are placed back in the right position using surgical screws, pins, rods, or plates. It is most often used in fractures of the ankle, forearm, and leg bones.

Fractures Requiring Surgery

There are many types of fractures that may require surgery in order to heal properly. Some of the most common include:

Femur (Thighbone) or long bone Fracture

A broken femur – or thighbone fracture is quite common. Internal fixation surgery is required to help fix a fractured femur. A surgical rod is most often used to help set and support the bone until it heals. An orthopedic surgeon may also surgically add a plate to reinforce the rod. The full name of this surgery is open reduction and internal fixation (ORIF) of the femur.

Hip Fracture

There are three main procedures used to repair a hip fracture:

• Hip Repair: Hip repair means stabilizing broken bones with surgical screws, rods, plates, or nails. Doctors refer to this surgery as “hip pinning.”

• Partial Hip Replacement Surgery: This procedure replaces the head of the thigh bone (the “ball” of the hip joint) with artificial parts. A partial hip replacement does not replace the “socket” portion of the hip joint.

• Total Hip Replacement Surgery: This surgery replaces the entire joint, including the “socket” portion of the pelvis, with a prosthesis.

Dr. Rajesh Gayakwad, with his extensive exposure to orthopedic trauma at busy municipal hospitals of Mumbai with additional international exposures, has more than sufficient expertise through which he strives to meet the highest standards of orthopedic science. If you or a loved one is suffering pain following an injury, you need a capable, board-certified, and fellowship-trained orthopedic surgeon. Learn about your options from an expert. The staff at Orthopaedic Associates takes advantage of cutting-edge therapies and traditional treatments to manage or cure a variety of painful conditions. Please call us today to schedule an appointment.

Hand surgery is a broad term that covers many different types of procedures. Hand surgery may be done for many reasons, including:

• Hand injuries

• Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, change and damage the structures in the hand

• Degenerative changes to the structures in the hand

• Problems or defects of the hand that are present at birth, or congenital

• Infections of the hand

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

Skin grafts/Flaps

Skin grafts for the hand involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair in the hand is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary delayed primary, and secondary.

• Primary repair of an acute or sudden injury is often done within 24 hours of the injury. This is usually a direct surgery to fix the injury.

• Delayed primary repair is usually done a few days after the injury, but there is still an opening in the skin from the wound.

• Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in the place of the damaged tendon.

Nerve repairs

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. This pressure can interfere with blood flow to the body tissues and destroy function.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

An Ilizarov external fixator (Ilizarov frame) is a ring-like brace. The frame is applied to the outside of the limb and connected through the unbroken part of the bone inside the limb. This is done by using a number of tensioned wires sometimes called pins. These wires/pins are attached to metal rods on the outside frame to provide bone stability.

This system helps provide structural support to the limb and holds the broken bone fragments together so healing can take place over a period of time. It may be necessary to have this frame on your limb for a number of months.

An Ilizarov frame is used to:

• help heal complex fractures (complicated broken bones)

• help heal severe skin or tissue loss

• lengthen long bones if too much bone has been lost at the time of the accident by allowing new bone to grow in between the two broken bone ends

• correct congenital or traumatic deformity of the bones.

Advantages of Ilizarov Surgery

• The cylindrical shape of the apparatus enables correction of the deformities in 3-dimensions.

• Low rates of infection, bleeding, and tissue trauma when compared to the traditional method as it is an incision-free technique.

• Fewer chances of contractures and joint stiffness problems.

• Short-term hospitalization.

Total knee replacement is an operation to relieve the pain and stiffness of the arthritic knees generally reserved for people of the older age group. Newer technology being used in operation coupled with improved designs makes the operation safe and gives predictable good results.

The operation involves carefully removing the damaged surfaces from the ends of thigh and leg bones and capping them with metal and plastic components. The newly implanted device quickly starts to function as a new joint while relieving the pain. The implanted device gives excellent function for 18-20 years in more than 90% of patients.

Before undergoing knee replacement

The preparations​ for a successful knee replacement surgery starts before admission to the hospital. You will be subjected to a number of tests to evaluate your fitness to undergo the surgery. Some people will also need to be examined by a cardiologist much before admission. A pre-anesthesia check is carried out a couple of days before admission to the hospital. All this is done to ensure that you have a safe and hassle-free stay in the hospital.

After Surgery

After surgery, you will receive pain medication and begin physical therapy. It is important to start moving your new knee as soon as possible after surgery to promote blood flow, regain knee motion, and facilitate the recovery process. You may also be out of bed and walking with crutches or a walker within 24 hours of your surgery.

You will be shown how to safely climb and descend stairs, how to get into and out of a seated position and how to care for your knee once you return home. It is a good idea to enlist the help of friends or family to help you once you do return home.

Before you leave the hospital, your therapist will show you a variety of exercises designed to help you regain mobility and strength in your knee. You should be able to perform these exercises at home.

Recovery

Most patients are able to walk without support and drive two to four weeks after surgery. Activities such as golf, doubles tennis and swimming can usually be resumed, but only after a thorough evaluation by your surgeon. Always follow your surgeon's recommendations, as recovery time will vary for each patient.

Partial knee surgery is a well-established procedure carried out to relieve the disabling pain of knee arthritis with minimal risks and suffering. The Surgery involves retaining all the healthy parts of the knee.

Unlike the total knee replacement, you are highly unlikely to need to stay in the intensive care unit or have blood transfusions. Whatever pain is experienced is easily managed by routine pain medicines.

Is it a Temporary Procedure

No for the majority of the patients this procedure is likely to give them prolonged relief (as long as that is achieved by total knee replacement) in rare circumstances where a re-operation may be needed, it is a fairly simple and routine procedure. The complication rates after partial surgery are universally observed to be only a small fraction of what is associated with a total knee replacement.

Advantages of Partial Surgery

• Safety

• Rapid Recovery

• Function comparable to a normal healthy knee.

• Ability to sit on the floor/Squat.

• Excellent Function

• Retain all the healthy parts of the joint.

• Only True Hiflex and "Minimally Invasive" Knee Implant

Total hip replacement is one of the most successful surgical procedure in modern orthopedics. First introduced in 1950’s it has withstood the test of time and proved itself to be safe and reliable procedure providing a lasting relief from disabling hip pain and stiffness. Newer technological advances and biomaterials like ceramics have made it possible for today’s patients to undertake most activities that we take for granted. We have a large series of ceramic total hip replacement with a follow up of 10 years or more.

Introduction of large diameter heads(LDH) has made it possible to sit cross legged in most patients. This operation has proved to be a life changing event for people suffering from arthritis of hip joint.s