Category Archives: Orthopedics

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Left Hip Hemiarthroplasty for Femoral Neck Fracture

Left Hip Hemiarthroplasty for Femoral Neck Fracture
Michael Akodu, MBBS; Elyse J. Berlinberg, MD; Miles Batty, MD; Michael McTague, MPH; Kiran J. Agarwal-Harding, MD, MPH
Beth Israel Deaconess Medical Center

Hip fractures are a major cause of morbidity and mortality, especially among older patients. They also account for a significant portion of healthcare spending and other non-medical costs. These fractures can be classified into various types based on the parts of the femoral head and neck affected, and fixation options are dependent on both patient and injury characteristics. In this video, Dr. Agarwal-Harding takes us through a hip hemiarthroplasty for a left femoral neck fracture, highlighting various guiding principles and surgical considerations.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table

Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table
Sarita Jamil1; Michael J. Weaver, MD2
1University of Central Florida College of Medicine
2Brigham and Women’s Hospital

Femoral fractures typically occur in two major settings: high-energy mechanisms related to trauma and low-energy mechanisms in insufficiency fractures observed in elderly patients with osteopenia. Patients present with pain, swelling, and limited range of motion.

Intramedullary nailing is the definitive surgical treatment for femoral fractures to allow secondary healing of bone. Such a repair is performed here on a patient with a diaphyseal femoral fracture. Surgeon preference was to perform a closed cephalomedullary nailing with the patient supine on a radiolucent fracture table for traction.

Orthopedics, Print Release

PUBLISHED: Peroneal Tendon Debridement

Peroneal Tendon Debridement
William B. Hogan; Eric M. Bluman, MD, PhD
Brigham and Women’s Hospital

Tenosynovitis of the peroneal tendons is a common lower extremity problem that is often mistaken for other ankle pathology. Diagnosis is suggested with thorough history and physical examination and confirmed with radiographic studies when necessary. Patients with less acute or more severe presentation may improve with rest and physical therapy alone. When conservative management fails, surgical intervention is aimed at excising inflamed synovium with debridement and repair of any tears in the peroneal tendons. Recent literature has emphasized the increased use of tendoscopic approaches to peroneal pathology, although most studies to date have been too underpowered to suggest superiority to an open approach. This article presents a case of acute tenosynovitis treated by open surgical debridement and irrigation. Tendoscopy was deferred as the size and nature of this patient’s injury warranted an open repair.

Orthopedics, Print Release

PUBLISHED: Total Knee Arthroplasty

Total Knee Arthroplasty
Thomas S. Thornhill, MD; David J. Lee, MD
Brigham and Women’s Hospital

Total knee replacement is one of the most common orthopaedic procedures performed in the United States. The most common indication for total knee replacement is osteoarthritis. Clinical signs of knee osteoarthritis include pain with walking, difficulty ranging the knee, knee instability, varus deformity, bony enlargement, extension lag, and flexion contracture. Radiologic evidence for osteoarthritis of the knee includes the presence of osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts, and malalignment.

Before considering total knee replacement, patients typically undergo a trial of less invasive treatments, including lifestyle modification, pharmacologic therapy, and injections. If these methods fail to produce satisfactory improvement in the patient’s symptoms, one should consider the benefits and risks of total knee replacement in conjunction with their surgeon. Outcomes following total knee replacement are excellent, with patients reporting greatly reduced pain, improved mobility, and improved quality of life. However, patients must be aware that there are serious risks that accompany any surgery, which include infection, pulmonary embolism, deep vein thrombosis, nerve damage, and need for further procedures.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Bimalleolar Ankle Fracture Open Reduction and Internal Fixation

Bimalleolar Ankle Fracture Open Reduction and Internal Fixation
Kiran J. Agarwal-Harding, MD, MPH; Michael Akodu, MBBS; Miles Batty, MD; Elyse J. Berlinberg, MD; Michael McTague, MPH
Beth Israel Deaconess Medical Center

Ankle injuries are common, occurring most often among young males and older females. The ankle joint is crucial for stability and gait, making these injuries a significant source of disability.

Ankle injuries are usually treated operatively when there is loss of joint congruity and stability, and in this video, Dr. Agarwal-Harding takes us through the operative fixation of a bimalleolar ankle fracture. He talks about understanding why operative intervention is recommended, techniques involved, and other considerations.

Global Surgery, Hand Surgery, Orthopedics, Pediatrics, Print Release

PUBLISHED: Bilateral Syndactyly Release of Third and Fourth Fingers

Bilateral Syndactyly Release of Third and Fourth Fingers
Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4
1Big Rapids Orthopaedics
2Carolina Regional Orthopaedics
3Columbia University
4Duke University School of Medicine

Amniotic band syndrome, or constriction ring syndrome, happens when a developing fetus gets tangled in the fibrous bands of the amniotic sac. Sometimes, fingers and toes can become trapped in these fibrous bands, with results ranging from amputation of the digits, to fusion of the fingers or toes, termed syndactyly. Syndactyly is amongst the most frequent congenital hand anomaly and is termed simple when the digits are connected by soft tissue only, and complex when one or more phalanges are fused. In complicated syndactyly, there are additional bony elements in between the digits making it challenging if not impossible to separate safely.

The patient in this case is a 1-year-old male with complex syndactyly of the left hand and simple syndactyly of the right hand. Here, both sides are released, with the left side involving a full-thickness skin graft taken from the patient’s groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.

Global Surgery, Hand Surgery, Orthopedics, Pediatrics, Print Release

PUBLISHED: Flexor Digitorum Superficialis to Flexor Digitorum Profundus (STP) Transfer, Adductor Release, and Z-Plasty for a Pediatric, Stroke-Induced Left Hand Spastic Contracture

Flexor Digitorum Superficialis to Flexor Digitorum Profundus (STP) Transfer, Adductor Release, and Z-Plasty for a Pediatric, Stroke-Induced Left Hand Spastic Contracture
Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3
1Big Rapids Orthopaedics
2Carolina Regional Orthopaedics
3Columbia University

This video article demonstrate surgical correction of a severe hand deformity in a teenage girl with spastic hemiplegia. This patient has a non-functioning hand due to severe spasticity. Correction of the deformity is indicated primarily to facilitate hygiene and improve the position of the fingers. In some patients with volitional control, a certain degree of prehension may be achieved. The basic principles of deformity correction include differential sectioning of sublimis and profundus tendons followed by repair in a lengthened position. The first web contracture is released by muscular release and a skin Z-plasty.

Orthopedics, Print Release

Shoulder Arthroscopy (Cadaver)

Shoulder Arthroscopy (Cadaver)
Patrick Vavken, MD1; Sabah Ali2
1Smith and Nephew Endoscopy Laboratory
2University of Central Florida College of Medicine

Shoulder arthroscopy is one of the most common procedures performed in orthopaedic surgery. It can be utilized to identify various pathologies including rotator cuff tears, degenerative arthritis, subacromial impingement, and proximal humeral fractures. With continued advancement in arthroscopy, patients benefit from smaller incisions, reduced risk of postoperative complications, and faster recovery compared to open surgery.

Shoulder arthroscopy is performed either in the lateral decubitus position or in the beach chair position (BCP) as seen in this video. The BCP provides greater benefits such as decreased neovascularization during portal placement, fewer cases of neuropathies, and reduced surgical time. In addition to position, there are various portals used in shoulder arthroscopy, with the posterior portal being the most common and used in this video. Complication rates from shoulder arthroscopy are low but include shoulder stiffness, iatrogenic tendon injury, and vascular injury. Therefore, proper patient selection, patient positioning, and appropriate portal selection are essential for successful shoulder arthroscopy. This article discusses shoulder arthroscopy and demonstrates the technique on a cadaver shoulder.

Orthopedics, Print Release

PUBLISHED: Five-Month Patient Results Following Ankle Ligament Reconstruction

Five-Month Patient Results Following Ankle Ligament Reconstruction
William B. Hogan1; Eric M. Bluman, MD, PhD2
1Warren Alpert Medical School of Brown University
2Brigham and Women’s Hospital

This article present the case of a female patient in her early 20’s who was seen for follow up after 5 months of rehabilitation following surgical procedures to address instability in both the medial and lateral sides of her right ankle. This patient reported achieving an excellent outcome, and her subjective sense of significant improvement after rehabilitation was aligned with her physical exam and radiographic evaluation. This case documents the improvements made by the patient during the rehabilitation process and outlines essential steps to be performed by the practitioner in the clinical examination and radiographic follow up after surgery for ankle instability.

Orthopedics, Print Release

PUBLISHED: The Use of a Magnetic Intramedullary Nail for Management of a Symptomatic Nonunion Following Shortening Osteotomy to Treat Leg-Length Discrepancy

The Use of a Magnetic Intramedullary Nail for Management of a Symptomatic Nonunion Following Shortening Osteotomy to Treat Leg-Length Discrepancy
Phillip T. Grisdela Jr, MD; Nishant Suneja, MD
Brigham and Women’s Hospital

This is the case of a 31-year-old female with a history of juvenile rheumatoid arthritis and uveitis who presented with a leg-length discrepancy and low back pain refractory to conservative management. She underwent a shortening osteotomy on her left femur around an intramedullary nail that went on to nonunion.

She underwent exchange nailing with a magnetic intramedullary nailing with autologous bone graft harvest from her affected femoral reamings. The magnetic intramedullary nail was extended 2 cm prior to insertion, and then implanted in the usual fashion with immediate compression in the operating room. Postoperatively the patient underwent a compressive program using the magnetic nail and went on to heal her osteotomy site.