Fractures & Corrections
A fracture, or broken bone, often results from an injury or accident and can cause significant disability to a patient. Fractures range from a small non-displaced cracks to severely broken bones with multiple pieces.
Some closed fractures are treated with a cast, where others need surgical repair or fixation also known as an ORIF (Open Reduction and Internal Fixation). There are different methods to fix fractures, including pins, screws, plates, nails (=rods) and external frames. Sometimes fractures don’t heal properly or heal in the wrong position. In those situations, deformities may occur needing further treatment including ‘re-breaking’ of the bone.
Knee Injuries & Reconstruction
There are four main supporting ligaments of the knee. They connect the tibia and femur, and stabilise and guide the knee during motion. These ligaments can be injured during sporting activity or in other accidents, leading to pain, swelling, and potentially a loss of stability. The Anterior Cruciate Ligament (ACL) is one of the most commonly injured ligaments. Absence of a functioning ACL due to injury may present itself as the knee giving way, particularly during twisting movements. Not every torn ligament needs surgery but in some situations it may be advisable to repair or reconstruct the torn ligament. This is usually done by taking a tendon or ligament from elsewhere and replacing the torn one. This is commonly known as a ligament reconstruction.
Arthritis & Joint Replacement
Arthritis is a condition which causes a degradation of the cartilage lining of the joint. Symptoms may include joint pain, tenderness, stiffness, catching, and fluid in the joint. The joint typically is less painful at rest, and painful with prolonged activity. Knee with arthritis may occasionally give way. In more severe cases, night pain may impair sleep and walking may be severely restricted. There are many different causes of arthritis, but the main type requiring operation is osteoarthritis. Osteoarthritis is a process of gradual wear and tear of the joint cartilage over a long period of time. In advanced stages of arthritis the cartilage is gone and bone-on-bone contact affects the joint. In these final stages, joint replacement surgery is often advised. For the knee, this can be either a Total Knee Replacement or a Partial Knee Replacement depending on which part of the knee is affected.
Arthroscopy & Meniscus Surgery
The meniscus is a crescent shaped structure that lies between the cartilage of femur and the tibia on each side (inside and outside) of the knee. The functions of the meniscus is to protect the cartilage by functioning as a shock absorber. Damage to the cartilage leads to arthritis in the knee. The meniscus also contributes to knee joint position sense and joint stability. The outer third of the meniscus, known as the “red zone” is well supplied with blood, and has healing capacity. The inner two-thirds is known as the white zone and has no blood supply and has diminished ability to heal. Meniscus damage can be from injuries (acute) or from general wear and tear (chronic). In most acute meniscus injuries repair or removal is advised through ‘key-hole’ surgery also known as arthroscopy. Arthroscopy uses small 1 cm incisions through which it is possible to repair a meniscus, reconstruct ligaments, remove loose bodies and even fix small fractures.
Pelvis & Hip
The pelvis is a ring of bone at hip level, made up of several separate bones. A pelvic fracture is a break in any one of those bones. Some pelvic fractures involve breaking more than one of the bones, and these are particularly serious as they are more likely to slip out of line.
The hip joint forms part of the pelvis and can also be worn, damaged or fractured. Hip fractures often need fixation or in some cases may need replacement. In case of a worn hip joint, a hip replacement is a very successful operation to treat pain and get people walking.
Limb Corrections
Most fractures heal without problems, but sometimes the fragments are not aligned properly and the bone heals with a deformity (malunion). In those situations it might be necessary to re-break the bone (osteotomy) and realign the fragments. The fragments need to be stabilised with plates or nails until healing has occurred. Occasionally the corrections have to be done gradually over several weeks to months with the use of ring-frames or growing nails.
Robotic Surgery
Robotic Assisted Surgery can be a helpful tool in performing Joint Replacements. Dr Van de Pol uses a robot for Partial Knee Replacements and in selected cases for Total Knee Replacements.
Potential benefits are:
More accurate bone removal and implant placement, which may result in improved outcomes and functioning of the knee.
Less pain in the days and weeks following surgery.
Shorter hospital stay.
Quicker recovery.