Orthopedic Surgeon

Also referred to as orthopaedics, orthopaedic surgeons are doctors who focus on bone, joint and muscle surgery. Orthopaedic surgeons are specialists in treating disorders in the musculoskeletal system that comprises of bones, ligaments, joints, muscles, tendons and nerves. Corrective surgeries such as joint replacement and removal of torn cartilages are also performed by these surgeons. Orthopaedic surgeons can also specialize in certain areas of surgery such as shoulder surgery, hand surgery etc.

After completion of medical school, they have to complete another five years residency of which one year is concentrated in general surgery and the rest in the field of orthopaedic surgery. They can train for another one year in any kind of sub-specialization if they are interested. Orthopedic surgeons specialize in:

• Joint replacement surgeries.
  
• Treating injuries in athletes and in athletic surgeries.
  
• Hip replacement, hip surgery in adults.
  
• Sports medicine.
  
• Treating dislocations and lacerations.
  
• Set right broken bones.
  
• Perform reconstructive hip and knee surgery in adults.
  
• Spinal surgeries
  
• Arthroscopic surgery.
  
• Treat hand injuries and conduct hand surgeries.
  
• Treat conditions related to arthritis.

Latest techniques employed in orthopaedics

• Arthroscopic tools are used for re-constructing torn ligaments in a non-invasive method where in the patient recovers in a few days after the surgery rather than months as required to recover in open surgeries.
  
• Uni-compartment knee replacement facilitates replacement of one of the knees and is very popular.
  
• Joint replacement surgeries have become easier with the use of newer materials as replacement substitutes.
  

Blount Disease

Blount's disease or 'tibia vara,' is a growth disorder in the shin bone that affects the bones of the lower leg causing the lower leg to angle inward. This resembles a bow leg.

Named after the American orthopedic surgeon, Putnam Blount (1900 - 1992), Blount's disease is characterized by progressive lower limb deformity. Though Blount can affect people at any time during the growing process, it is more common in kids younger than four and in teens. A lot of pressure is put on the growth plate on the top of the tibia. This portion is called the physis - made out of cartilage, weaker than bone. The function of the physis is to allow the bone to lengthen and grow.

Due to excess pressure, the bone does not grow normally and instead the lateral outer side of the tibia keeps growing whereas the medial or inner side of the bone does not. Because of uneven bone growth, the tibia tends to bend outward instead of growing straight. Blount is not the same as naturally bowed legs that babies and toddlers have which usually straighten out when they start walking.

Blount is described as two distinct forms, early or infantile and late or adolescent Blount disease.

Infantile Blount disease is diagnosed between age one and three years. The disease presents when a child begins to ambulate. This disease is often bilateral and is less commonly associated with obesity.

Quite unlike the infantile Blount, late onset of Blount disease occurs in older children and is commonly associated with obesity and is often unilateral.

A combination of mechanical and biological factors influences Blount's disease to varying degrees. The mechanical forces contributing to the disease are weight of the child, age at walking, and varus deformity. The compressive forces across the medial femoral physis lead to growth retardation. Adolescent Blount does not appear to be progressive, or as common as the infantile form.

Causes

The cause of Blount disease remains controversial but it is mostly due to a combination of hereditary and developmental factors. There is increased incidence of the disease in overweight children who walk at an early age. Certain theories that mechanical overload of the proximal tibia contribute to Blount disease has been found. This mechanical overload is attributed to obesity and varus deformity. But this alone cannot be a cause as the disease is also noticed in children with normal weight.

Increasingly it is more common in people of African heritage, where kids start walking at an early age and whose family member might have had it. There is a genetic component to the disease as well, though a direct pattern of inheritance has not been clearly revealed. Hence, Blount is multifactorial and may differ in the early or late onset forms of the disease.

Symptoms

It is imperative to understand that Blount disease starts in early childhood or late teen years, the curve can get worse if not treated. Hence early diagnosis is important. The most obvious sign of Blount is bowing of the leg below the knee. While in young kids it is usually not painful, it teens it can be. It can feel like a growing pain in the knee area. The pain may come and go and many teens resort to over-the-counter pain relievers. As the lower leg bears the weight of the body, other problems such as rotation of the tibia are noticed. This causes a condition called in-toeing, wherein the feet point inward instead of straight out. Blount disease, over several years, can lead to arthritis of the knee joint and trouble walking. One leg may become slightly shorter than the other.

Diagnosis

If there is knee pain that seems to be getting worse and cannot be traced to an injury, then the doctor might possibly consider Blount. A complete physical examination will be done, and X-rays of legs taken. The doctor will look for any abnormal growth pattern at the top of the tibia - a tell tale sign of Blount. This will help the doctor measure how severe the bowing is.

Treatment

Treatment for Blount depends on the age of the patient and how far the disease has progressed. Young kids are advised braces, which are long-legged and lock the knee and need to be worn whilst weight bearing. But bracing is usually unsuccessful in girls and those with obesity. Older kids and teens will need surgery. There are different types of surgeries to correct Blount disease. These involve cutting the tibia, realigning it and holding it in place with plate and screws. This procedure is called Osteotomy. Sometimes, the damaged growth plate is removed and a device called external fixator is used to hold bones in place from the outside. In case of a twisted toe, surgeons correct the cause of it. Surgery is done under general anesthesia, and the patient might wear a cast and use crutches for a while. Physical therapy will be needed after surgery.

Smiths fracture

In the US, about 17% of the emergency room visits are due to wrist injuries. Injury of the forearm bone near the wrist joint is known as Smith's fracture. Smith's fracture is a fracture of the distal radius occurring about 2.5 cm from the wrist joint. The fracture is the result from a backward fall onto the outstretched hand. It was the orthopedic surgeon Robert William Smith who described this fracture in his book 'A treatise on fractures in the vicinity of joints, and on certain forms of accidents and congenital dislocations' published in 1847. This fracture is named after him. Smith's fracture is often described as a garden-spade deformity.

Hands perform so many tasks that are fundamental and delicate. Therefore even a minor injury to the hand and wrist can have devastating consequences. Smith's fracture is unstable as the ulnar head can be displaced dorsally and therefore requires urgent attention. The hand and the wrist are so dependent on each other. Therefore when an injury occurs, it affects both the hand and wrist. Smith's fracture are classified as:

Type I: Most stable, extra articular transverse distal radial fracture with palmar and proximal displacement.

Type II: Barton type, palmar-lip fracture of the distal radius with dislocation of the carpus
Type III: Unstable, oblique juxta articular fracture of the distal radius and tilted palmar.

• A Smith's fracture is most commonly caused by people falling onto hard surface and breaking their fall with flexed wrists.
  
• Smith's fracture most commonly occurs in older post- menopausal women exhibiting osteoporosis.
  
• Smith's fracture occurs in adolescent boys and girls with joint surface displacement.
  
• Smith's fracture can be considered as a sports injury
  
  Common complications from Smith's fracture:
• Ulnar nerve injury
  
• Carpal tunnel syndrome
  
• Post traumatic radio carpal osteoarthritis with limited range of motion
  
• Heterotopic ossification
  
• Reflex sympathetic dystrophy
  
• Tendon rupture
  
• Nonunion
  
• Radial shortening

Treatment for Smith's fracture depends much upon the severity of the fracture and other factors such as connective tissue injuries, musculoskeletal structure and neuroanatomy, and dislocations involved. If the fracture is not a displaced fracture, then it can be treated simply with a 'cast' alone. Nevertheless, casting needs close watch so as to ensure that the fracture stays in proper position.