ACL Reconstruction
The first ACL reconstruction techniques were done by suturing the graft directly to the bone, however this did not allow for tensioning the graft and was overall a poor fixation technique. Tension on the reconstructive graft is extremely important for it to provide stability. Later, sutures that were attached to the graft were fixed to the bone by a screw…. Continue Reading
Anatomic Distal Fibula Plate
There are many ways to surgically repair a fracture of the distal fibula. One such technique is to utilize an anatomic distal fibula plate to hold the correct aligned or reduced fracture fragments in place. These plates are anatomically contoured to specifically fit to the natural or native alignment of the distal fibula. The plates are most commonly applied to… Continue Reading
Anatomic Distal Fibula Plate
There are a few different options when deciding how to operatively manage a lateral malleolar fracture. The modality most commonly utilized by orthopaedic surgeons is applying an anatomic distal fibula plate. These plates are often contoured to match the native anatomy of the distal fibula. After reducing the fracture in the operating room, a single plate is applied to the… Continue Reading
Ankle Replacement
Ankle replacement is typically performed through a single incision over the front of the ankle. After safely dissecting down to the joint line the bone cut in the tibia is typically planned first. This can be performed either by alignment rods at guides at the time of surgery or by custom 3D printed guides based off of a pre-operative CT… Continue Reading
Biceps Tendon Repair
Reattaching the biceps tendon to the arm bone in a tenodesis procedure can be done by several techniques including bone tunnels, interference screws, and suture anchors. These techniques are all performed through an open approach, meaning an additional incision on the upper arm to reattach the tendon. The bone tunnel technique is done by drilling two holes in the bone,… Continue Reading
Breast Cancer Localizers
Better screening and improved breast cancer awareness has led to some cancers being identified before they are able to be felt through the skin. In such cases, it is necessary to “mark” the cancer prior to surgically removing it. In the early 2000’s, this was accomplished by inserting a wire into the cancerous area under radiologic guidance. This was sometimes… Continue Reading
Breast Implants
Watch below as I discuss the different types of breast implants. The first “breast augmentation” surgery was done in 1895 when a lipoma (benign fat tumor) was successfully removed from a patients torso and transplanted to the breast following a mastectomy procedure for breast cancer. What followed for the next half-century was the experimentation of different materials used to augment… Continue Reading
Carotid Artery Stents
During the first attempts at CAS, the embolic stroke rate was higher than standard CEA. Attempts at reducing this risk were first trialed with distal protecting devices. Initially, a balloon was inflated downstream to the carotid lesion which would prevent emboli from traveling onward to the brain. However once the balloon was deflated there still posed a stroke risk. In… Continue Reading
Cervical Total Disc Arthroplasty (TDR)
Cervical arthroplasty was first developed in 1966. At the time, ACDF was gaining popularity due to reports of great clinical success. The interest in cervical arthroplasty arose because it offered patients a movement-preserving procedure in comparison to the ACDF. However, they were largely abandoned shortly thereafter due to high complication rates experienced with early designs. It wasn’t until the 1980s… Continue Reading
Coblation
Coblation stands for controlled ablation. The technology uses radiofrequency in combination with low temperatures to “ablate” tissues, commonly using a saline rinse to wash away ablated tissues. The temperature of coblation instruments ranges from 60 to 70 degrees Celsius, whereas electrocautery instruments may exceed 400 degrees Celsius. It has been proposed that this method causes less bleeding and postoperative pain… Continue Reading
Cosmetic Botulinum Toxin Injection
The use of botulinum toxin on humans was pioneered in the 1980s. It’s use to treat wrinkles, rhytids, is now widespread and it is by far the most commonly performed cosmetic procedure. Botulinum toxin injections are not only used to approve cosmetic appearance but also to treat conditions of muscle spasticity. The toxin injected is taken from bacteria Clostridium Botulinum,… Continue Reading
Distal Biceps Tendon Repair
Suspensory cortical buttons are also another option to secure the tendon. These devices function by placing a metallic device through a hole drilled in the radial tuberosity. The metal “button” is secured to the tendon edge by suture and passed through the hole in the radius. Once it reaches the other side of the radius, the “button” is flipped so… Continue Reading
Distal Humerus Open Reduction Internal Fixation
There have been considerable advances in the treatment of distal humerus fractures that allow for better outcomes. The widespread use of computed tomography helps surgeons preoperatively plan the method of fixation best suited for each patient. Modern fixation techniques are designed to improve mechanical stability of the construct through pre-contoured periarticular plates and the use of interlocking screws, or screws… Continue Reading
Distal Radius Volar Locking Plate
The advent of volar locking plates has seemed to solve some of these issues. Popularized in the early 2000s, these plates allow for stable fixation of the fracture so that patients may begin early range of motion to prevent stiffness of the wrist joint and also do not irritate the tendons of the wrist because of their low-profile design. Additionally,… Continue Reading
Dorsal Bridge Plate
“Internal” distraction fixators (dorsal bridge plates) were originally designed in an effort to mitigate the pitfalls of external fixators. These function to the same extent as external fixators, utilizing traction and ligamentotaxis (applying a longitudinal force to ligaments which then helps to pull the bone they are attached to into the right place) for restoration of the articular surface of… Continue Reading
Dynamic Uniplanar External Fixation
Treatment to reverse the debilitating soft tissue contractures has traditionally been ineffective with splints, which are limited by the ability of the skin to tolerate pressure at the skin-splint interface. Serial casting, another labor intensive option, has the complication of limiting flexion in adjacent joints.
Endoscopic Hiatal Hernia Repair Systems
Most recently, the endoscopic hiatal hernia repair has been developed, which involves specialized cameras and staplers. Going through the mouth (transoral route), surgeons travel down the esophagus and into the stomach to perform the repair, avoiding external incisions altogether. With few small or no incisions, patients have quicker recovery times and less post operative pain. With respect to the hiatal… Continue Reading
Endoscopic Sinus Irrigation System
Endoscopic sinus irrigation systems allow for directed, higher-powered irrigation of sinus contents directly where disease is located. Over the counter sinus irritations are often unable to reach diseased areas when there is advanced obstruction, and without articulating and curved instrumentation, would not be capable of dislodging mycetomas. These systems can replace more invasive surgical approaches to the paranasal sinuses, and… Continue Reading
Femoral Nailing
Femoral nailing is an attractive option for the treatment of hip fractures. This is a minimally invasive technique only requiring small incisions of the skin and does not require the large dissection needed for other techniques. A metal rod (or nail) is placed within the femur, spanning across the fractured segment and is secured into place, most of with screws…. Continue Reading
Femoral Neck Open Reduction And Internal Fixation
Historically they have treated with independent screws placed into the femoral neck, but this provides no compression to encourage bone healing. There have also been many plating systems, but these often require a large dissection that can put the blood supply to the femoral head at risk and may hasten osteonecrosis (bone death due to a lack of blood supply)…. Continue Reading
Glucose Monitoring
Physicians are able to help their patients taking insulin manage their diabetes by reviewing home blood sugar readings. With diabetes on the rise and the increased risk of cardiovascular disease and infections as a result of this chronic illness, patients are encouraged to maintain well-controlled blood sugar readings and achieve desired hemoglobin A1C results. Blood Glucose Meters (BGM) have been… Continue Reading
Hernia Mesh
Mesh was first introduced in the late 19th century when Witzel first used silver mesh in a groin hernia surgery. Many other materials were tested but none surfaced as the standard of care until the development of polypropylene mesh in 1954. The advantages of mesh for hernia surgery included decreased postoperative pain and decreased hernia recurrence. While this has generally been… Continue Reading
Hip Prosthesis
Hip prostheses were first developed to treat chronic infections within the hip joint in 1891 using ivory to replace the femoral head. Later designs used glass and stainless steel to replace the femur. The problem with this procedure is that the pelvis side (acetabulum) of the hip joint was left alone, and therefore areas that could be causes arthritic pain… Continue Reading
Inguinal / Femoral Hernia Mesh
Surgical mesh for the repair of hernias was introduced over a century ago. The first generation of surgical mesh prosthetics were notorious for a variety of postsurgical complications including infections, recurrence, rejection of the mesh, and development of dense scar tissue. Today, more than 80% of hernia repairs use some form of surgical mesh to reinforce the defect in the… Continue Reading
Inhalers
The design of inhalers has continued to change over time. From large disks to meter dose pumps, efforts have been made to increase adherence to inhalers by simplifying how it is used. Counters were also added to inhalers to inform patients how many pumps they have remaining in their devices. The counters also allowed the provider to determine how many… Continue Reading
Insulin
Insulin was discovered in 1921 and it was not until 1982 when the first commercially available biosynthetic human insulin was sold. For many years insulin was self-administered from a vial. Patients would use a 28 to 31 gauge needle to place on a syringe and draw up a designated amount of insulin. Insulin would then be injected into their abdomen,… Continue Reading
Internal Elbow Joint Stabilizer
A recently developed novel technology to address the aforementioned shortcomings of chronic elbow instability is the internal joint stabilizer (IJS). This device is implanted subcutaneously about the elbow joint, allowing unrestricted joint motion while avoiding the complications inherent to other methods. First developed in the early 2000’s, the latest technology on the market is based on the design created 2014…. Continue Reading
Intramedullary Screw
Intramedullary screws are type of implant designed to sit within the bone being fixated. Benefits of intramedullary fixation include little to no hardware prominence, ease of implantation, and the allowance of micromotion about a fracture site to provide stronger bony healing. Intramedullary screws can be fully-threaded, partially-threaded or variably-threaded, depending on fixation strategy utilized. They are often cannulated, which allows… Continue Reading
Intraoperative Navigation
Much research and development has been performed regarding the utilization of existing and new technology for hip arthroscopy. Intraoperative navigation systems have been developed to aid surgeons in determining the adequacy of bony resection. Traditionally, adequacy of bony resection was determined through traditional intraoperative fluoroscopy. These new intraoperative systems not only provide intraoperative feedback, but allow for the generation of… Continue Reading
Joint Replacement
Joint replacement of the hand has continuously advanced as better implant materials have been developed. Metal hinge joints were initially developed, but were wrought with complications. Joint replacement today has two main categories: silicone and PyroCarbon implants. Silicone implants are a single rubber piece that bridges the joint after removing the destroyed cartilage ends of the bone that is able… Continue Reading
Jones Fracture Intramedullary Screw
Intramedullary screws are type of implant designed to sit within the bone being fixated. Benefits of intramedullary fixation include little to no hardware prominence, ease of implantation, and the allowance of micromotion about a fracture site to provide stronger bony healing. Intramedullary screws can be fully-threaded, partially-threaded or variably-threaded, depending on fixation strategy utilized. They are often cannulated, which allows… Continue Reading
Laser Skin Resurfacing
Laser resurfacing is a technique used to reduce acne scarring by “selective phototheromolysis.” This concept employs the use of specific energy fluence, wavelengths, and laser time, in order to reach specific dermal and epidermal layers. Two different types of popular ablative lasers are the C02 (10,600 nm wavelength) and Er:YAG (2940 nm wavelength) lasers. These lasers penetrate deeper than superficial… Continue Reading
Laser Skin Resurfacing
Many nonablative laser skin resurfacing types target hemoglobin as their chromophore. This reduces the damage to deeper skin layers, and is absorbed more readily by pigmented and erythematous lesions. A popular type of superficial resurfacing laser is broadband light (BBL) laser, which uses light of different wavelengths in the visible light spectrum. This is a nonablative type laser, unlike Er:YAG… Continue Reading
Lisfranc Fixation
Suture bridge and other suspensory fixation methods typically refer to constructs that consist of a very strong piece of suture between two different structures. In the case of Lisfranc injuries this suture bridge holds the medial cuneiform and second metatarsal together. The suture bridge itself can be held in place with either a metal plate sitting against the bone or… Continue Reading
Medial Patellofemoral Ligament Reconstruction
Suture anchors are the mainstay of treatment for reconstructing a new MPFL. These suture anchors are a type of orthopaedic implant that attach to the ligament via a suture material and screw into the bone itself. Suture anchors are used initially to attach the new ligament to the patella and then tensioned and secured to the femur. Additionally, in situations… Continue Reading
Meniscus Repair
All-inside meniscal repair techniques have gained popularity in recent years as a practical way to repair and secure meniscal tears. The advantages of this technique are that it allows for quicker and more minimally invasive surgeries mitigating the need for those larger accessory incisions seen in inside-out repairs. This technique first begins with the surgeon placing a camera within the… Continue Reading
Minimally Invasive Achilles Tendon Repair
Advancements in tethering material has led to the development of FiberWire, which is the suturing material utilized in most modern day achilles repair system. FiberWire is constructed of a multi-strand, long chain ultra-high molecular weight polyethylene core with a braided jacket of polyester. Although open techniques have historically been utilized for the repair, this approach is often complicated by wound-healing… Continue Reading
Nerve Allograft
A nerve allograft (a graft from a donor) may be used from a living or dead donor. If the allograft is inserted fresh, with all the nerve cells intact, the patient, like an organ recipient, will often have to be on medication that reduces the activity of the immune system. Otherwise, the patient’s immune cells will attack and destroy the… Continue Reading
Nerve Stimulation Monitoring
Nerve stimulation during thyroidectomy has been described in the 1940s, where palpation of the larynx during recurrent laryngeal nerve stimulation was used as a confirmatory measure. In the 1980’s, palpation of the posterior cricoarytenoid muscle, with concurrent nerve stimulation, was described as an intraoperative measure. These measures are grouped into the category of intermittent intraoperative nerve monitoring. In the early… Continue Reading
Operative Table
Hip arthroscopy is widely regarded as the most difficult joint to perform arthroscopy on, and demands optimal patient positioning, surgical instrumentation and, most importantly, surgeon skill and experience. Traditionally, labral repair and/or reconstruction, when performed arthroscopically, were done on a traction table. Through the use of traction and a perineal post, surgeons were able to distract the hip joint enough… Continue Reading
Patella Fracture Open Reduction Internal Fixation
Given the high complication rate with metal wires, alternative methods of fixation were developed. Included among these was the advent of dense and durable sutures which function in a similar fashion as the metal wires. The theoretical benefits of this technique is that patient’s will have less painful hardware and decreased need for revision surgeries compared to wire fixation. Ultimately,… Continue Reading
Patella Tendon Repair
Suture anchor technology is one of the more modern ways surgeons fix a torn patellar tendon back to the patella itself. The overall function of these devices is to fix tendons and ligaments to bone. While originally developed more than 3 decades ago, suture anchors have undergone multiple modifications to increase its strength and applicability. From shoulders, to hips, to… Continue Reading
Plantar Plate Repair
Plantar plate repair has continued to evolve as a treatment option for plate ruptures due to specialized guides and tools used to work within the confined space of the MTP joint. Before the advent of these technologies, fusion procedures using plates and screws were the more common option. While fusion procedures are reliable at relieving pain, patients can no longer… Continue Reading
Plate and Screw Fixation
Plates and screws are commonly utilized for fracture fixation in long bones and some short tubular bones of the hands and feet. Some of the basic principles of fracture fixation are as follows: fractures should be reduced to restore anatomic alignments fractures should be treated with a fixation method that provides stability there must be enough blood supply to allow… Continue Reading
Post Operative Healing / Breast Marker
The cavity left over from the removed tissue often fills with fluid that eventually scars down over several years. This healing process may worsen the appearance of the breast and may also make post-operative radiation more difficult since the remaining tissue is distorted. Recently, technologies have developed to place a 3- dimensional marker into the cavity. This marker may prevent… Continue Reading
Proximal Humerus Fracture Open Reduction Internal Fixation
The development of locking plate technology has established a gold-standard for proximal humerus fracture fixation in the non-geriatric adult population. The locking plate allows screws, often with threads on the circumference of the head, to engage into the plate and create a rigid fixed angle construct. The surgical incision is either through the front or side of the shoulder. The… Continue Reading
Proximal Tibial Locking Plate
Fixation of the tibial plateau is usually performed using plates and screws. Due to the poor quality of bone in the tibial plateau, however, normal plates and screws have been insufficient for fixation in some patients, and special locked plates are usually used. Locked plating was introduced in the early 19th century and popularized in the 1960s. Locked plates describe… Continue Reading
Quadriceps Tendon Repair
Suture anchor repair has demonstrated to be a viable option for treating quadriceps tendon ruptures. These suture anchor-based repairs have the strength equivalent to bone tunnel repairs and avoids the potential complication of postoperative fracture. Likewise, the anchors can be placed through a smaller incision than using tunnels. Thick, tough sutures can be used to improve the strength of the… Continue Reading
Reverse Shoulder Arthroplasty
The development of locking plate technology established a gold-standard for proximal humerus fracture fixation, however the treatment was still limited to an acceptable fracture reduction and relying on that bone to heal, making it not ideal in older patients. Another option is replacing the humeral head with a spherical metal implant and allowing the implant to articulate with the native… Continue Reading
Robotic Bariatric Surgery
Robotic Surgery was first introduced in 1985 when a robotic surgical arm was used in a neurosurgical biopsy. Shortly thereafter, in 1987, the first robotic gallbladder surgery was performed. Over the next three years, the robot’s umbrella expanded to include other operations and with different competing robotic systems. In 1990 the FDA approved the first robotic endoscopic procedure, and in… Continue Reading
Scaphoid Open Reduction Screw Fixation
The guiding principle for operative treatment of scaphoid fractures is an anatomic reduction and compression across the fracture. There have been many developments to simplify techniques and minimize destruction when fixing it. Passing a small wire from either the front or back of the scaphoid along its long axis, checking its position with the aim to be as center as… Continue Reading
Scaphoidectomy and Four Corner Fusion
The scaphoidectomy and four corner fusion was developed to limit the painful motion between the carpal bones in the hand by removing some of the articulations and replacing them with fused joints. Early techniques involved holding the bones in place with Kirschner wires (K-wires), however compression was difficult to maintain, and so screws fired across the individual joints was trialed,… Continue Reading
Sliding Hip Screw
The technology used to repair or fix the hip has evolved significantly. Initial repair methods used basic plate and screw constructs that required prolonged periods of nonweightbearing on the injured leg. However, as our understanding of hip fractures has evolved it has become apparent that any method we use to fix the hip needs to allow for immediate ability to… Continue Reading
Surgical Navigation Systems
Surgical navigation systems are popular tools during sinus and skull base surgery, which allow the surgeon to upload CT scans of individual patients into a computer. The scans are then synchronized with the surgical instruments, so that the exact location of the surgical instrument can be visualized in relation to its whereabouts on the patients 3D CT scan rendering. This… Continue Reading
Suture Anchor
Suture anchors are the technology of choice when performing labral repair. A variety of suture anchor types exist, each with their own benefits and limitations. Suture anchors contain three components: the anchor, the eyelet and the suture. The anchor can be a screw mechanism, or an interference fit. Materials used for anchors include various metals or bioabsorbable composites. The eyelet… Continue Reading
Syndesmosis Fixation
Syndesmosis fixation can be performed for those injuries indicated to undergo operative intervention. There are multiple methods of syndesmotic fixation to include both screw fixation as well as fixation with a suture button or tension wire construct. At this time there is no definitive evidence that either method is superior to the other. When screw fixation is utilized, a 3.5-4.5mm… Continue Reading
Tendon Suture Anchors
The suture anchor is another method of attaching tendon to bone. Using a small drill, two anchors are inserted into the thickest portion of the bone. One end of the suture is attached to the two suture anchors. The suture anchors serve to anchor the suture to the bone. The other end of the suture is again attached to the… Continue Reading
Tibial Shaft Intramedullary Nail
The most commonly employed device for surgical fixation of tibia shaft fracture are intramedullary nails. However, tibial intramedullary nails may also be used for the following: corrective osteotomy for pseudoarthrosis (fibrous tissue that grows between bone ends), impending pathologic fractures/tumor resection, and non-unions or malunions of the tibial shaft. These nails are essentially metal rods that are inserted from the… Continue Reading
Total Hip Replacement
Joint replacement surgeries have been performed for hundreds of years and techniques as well as component technologies and manufacturing techniques continue to evolve. Currently the most common material used for hip replacement implants are various metal alloys to include titanium, cobalt-chrome, and stainless steel as well as high grade plastics known as high molecular weight polyethylene or simply “poly”. Most… Continue Reading
Total Knee Replacement
Total knee replacement surgeries have been performed since the late 1800’s and fortunately technology has continued to advance throughout the history of the procedure. Currently the most common material used for components are various metal alloys to include titanium, cobalt-chrome, and stainless steel as well as high grade plastics known as polymers. Most systems consist of three parts, the femoral… Continue Reading
Total Knee Replacement
Total knee replacement surgeries have been performed since the late 1800’s and fortunately technology has continued to advance throughout the history of the procedure. Currently the most common material used for components are various metal alloys to include titanium, cobalt-chrome, and stainless steel as well as high grade plastics known as polymers. Most systems consist of three parts, the femoral… Continue Reading
Total Shoulder Arthroplasty
The modern era of shoulder replacement began in the 1950s, but was the techniques and implants we most commonly see today were developed in the 1980s. Total shoulder replacement (also referred to as “arthroplasty”) involves removing the arthritic portions of the shoulder joint. Once they are removed, metal implants are placed within the humerus and glenoid. These implants may secured… Continue Reading
Unicompartmental (partial) Knee Replacement
Partial knee replacement components are designed and manufactured by many different companies in the United States and throughout the world. All currently utilized components have a long track record of success and have been thoroughly tested and approved by the Food and Drug Administration. Currently the most common material used for components are various metal alloys to include titanium, cobalt-chrome,… Continue Reading
Vascular Closure Device
The benefits of needle sticks versus large incisions include shorter operations, shorter hospital stays, less pain, and fewer bleeding risks. Unfortunately, it does not avoid all complications. The vascular access-site, where the needle punctures the artery, is the main focus of these complications which can include things like bleeding, arterial wall ballooning (pseudoaneurysm), and separation of the layers of the… Continue Reading
