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 arthritis treamtent has made incredible imrpovements in tehncology, techniquem and success recently. Treatment options include debridement, osteotomies or cutting of bone, arthrodesis or fusion of the ankle joint, and more importnantly ankle replecment. Ankle replacement is typically performed through a single incision over the front of the ankle. After safely dissecting down to the ankle joint, attention is first… Continue Reading
Arthroscopic Repair
Repairing rotator cuff tears utilizes a type of suture made of threaded materials as well as anchors. Advances have led to the development of a suture material made of multi-stranded, long chain ultra-high molecular weight polyethylene core with a braided jacket of polyester. The quantity and pattern in which these sutures are used vary depending on surgeon preference and the… Continue Reading
Autologous Fat Transfer
Various filler materials exist, and are catered to cosmetic outcome, as well as patient goals for longevity. Filler material can broadly be separated into permanent and temporary, however most various types exist on a spectrum from months to years. There are permanent and temporary filler materials. Fat from our own body (autologous fat) is permanent filler, although it does undergo… 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
Bone Grafting
Nearly 1 million procedures are performed with the use of bone graft in the United States and continues to grow at a rate of approximately 13% per year. Bone grafts are commonly used in cases for fractures or when there are issues with bone union (healing). Grafts are also commonly used with implants for spinal fusions, joint arthrodesis, as well… Continue Reading
Botox Chemical Denervation
Botox, aka Onabotulinumtoxin A, is an example of a chemical compound used in selective denervation. It is isolated from the naturally occurring neurotoxin Clostridium botulinum. The mechanism of its action is via prevention of the release of the neurotransmitter acetylcholine at the presynaptic nerve terminal. In this way it effectively blocks neurotransmission from nerve to muscle or gland. This state… 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 Disc Replacement
Cervical disc replacement, also known as total disc arthroplasty or artificial disc replacement is a procedure where a damaged cervical disc is removed and replaced with a metal or plastic prosthetic between two vertebral levels. This technique has gained popularity in recent years as it is a safe and effective procedure at relieving cervical pain and/or compression on the spinal… Continue Reading
Cervical Laminoplasty
Laminoplasty was first performed by hinging the bone open and holding it in place with a piece of bone taken from another location. This piece of bone would be held in place by a small metal plate bent to the correct position by the surgeon. The goal with this would be for the bone that was holding the gap open… 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
Clavicle Locking Plates
Clavicle fractures are commonly treated with a plate and screws. Most implants allow for a combination of locking or non-locking screws. The evolution of locking plates has dynamical changed operative treatment of fractures. Locking screws are a type of screw that locks into the plate that allows creation of a stiff fixed angle construct. For clavicle surgery, an incision is… 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
Dermal Substitute
Adequate soft-tissue coverage prior to excision of burned tissue is necessary in order to counteract the physiologic, metabolic and psychologic costs associated with burns. Early excision of burned tissue is the key factor in achieving optimal patient outcomes following a burn. Extensive burns often render little tissue available for graft donation, or patient factors may serve as a barrier to… 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
Dorsal Column Stimulator Implantation
Neuromodulation in the spine is more commonly referred to as spinal cord stimulation or dorsal column stimulation. It involves the implantation of a small device that sends mild electrical pulses through wires (called “leads”) to specific parts of the spinal cords. These pulses mask the pain signals that are traveling to the brain. Implantation of a spinal cord stimulator is… 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 Carpal Tunnel Release
Endoscopic carpal tunnel release uses one or two small incisions near the wrist through which instruments are inserted. A small camera is used to visualize the inner wrist, specifically the transverse carpal ligament (roof of the carpal tunnel). Often the camera is attached to an instrument that contains a small cutting tool which is used to divide the transverse carpal… Continue Reading
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
Foot Fracture/Ligament Fixation – Lisfranc
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
Gastric Bands
Gastric banding was first introduced in 1978 as a treatment option for morbid obesity. In the 1980’s the concept was improved by making the band adjustable to allow for variability of the amount of gastric reduction. Later in the 1990’s, the first laparoscopic adjustable gastric band was introduced. Conventionally, laparoscopic gastric banding uses a minimally invasive technique to place an… 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
Growth Friendly Scoliosis Surgery
Traditional scoliosis surgery involved drilling screws into the strong pedicle parts of each vertebral bone and attaching them to long, straight metal rods along each side of the spinal column. The bones of the spine would then be fused together in a corrected position; no further spine growth was possible with this early scoliosis surgery technique. Lung function was often… 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
Infant Ear Splints
Ear molding consists of applying a custom-fit, soft plastic mold that corrects the ear deformity and holds the ear in a more normal position. Be wearing this device continuously (usually for 2-6 weeks), the ear can be reshaped to correct the deformity. The device is held in place with adhesives and tape; there is no pain to the infant during… 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
Injectable Enzyme Medications
Injectable enzyme medications are a class of medicines that use tiny proteins (called enzymes) used by living organisms to break down other substances. Enzymes are used by many types of organisms, ranging from bacteria all the way to human beings. They each have a particular job, such as digesting food, metabolizing medications, and absorbing vitamins and nutrients. Scientists have long… 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 Defibrillators
There are many varieties of defibrillators. The subcutaneous defibrillators are unique in that they do not require using the venous anatomy. This can be advantageous when there are other competing interests such as using those veins for hemodialysis or vascular ports (ie ports for chemotherapy). Additionally, it makes it easier to remove the wires if this ever becomes necessary. Transvenous… 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
Internal Hemorrhoidal Treatment
Internal hemorrhoidal treatment options are based on symptoms and the grade of hemorrhoid ranging from I-III. Mild cases are treated with sitz bath, suppositories and stool softeners. However internal hemorrhoids that remain prolapsed are treated more aggressively. Due to the low recurrence and complication rate of rubber band ligation, it is the most widely used technique out of the other… Continue Reading
Internal Mandible Distractors
Mandibular distraction (also known as distraction osteogenesis) involves precise cuts being made in the lower jaw bone. A device is applied to bridge the cut part of the jaw. The device is secured to the bone with small screws. On a daily basis, the device is designed to slowly separate the cut jaw anywhere from 0.3-1.0 mm a day. This… Continue Reading
Interspinous-Interlaminar Fusion Device
Interspinous-interlaminar fusion devices are intended for the fixation and stabilization of the thoracic, lumbar, and sacral spine while awaiting bony fusion to occur. These devices are designed for attachment to the posterior non-cervical spine at the spinous processes through its bilateral locking plates, and it is intended for use with bone graft material placed within the device.
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
Kerecis™
Dermal substitutes or surrogates are a rapidly expanding area of medical technology. Absent of the morbidity and mortality associated with skin grafting, these products confer various benefits when attempting to heal or cover large soft tissue defects or slowly healing wounds. Research has demonstrated the ability of these products to recruit stem cells, decrease wound healing time, serve as scaffolds… 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
Leadless Pacemaker
There are many types of pacemaker with some helping assist the sinus node by pacing the heart’s top chambers referred to as atria, some assisting by pacing in the bottom chambers called the ventricles, and some that have three wires and can pace atria as well as both ventricles. The type selected will depend on if the main issue is… Continue Reading
Ligament Repair with Reinforcement/ Augmentation
Ligament repair with reinforcement/ augmentation evolved as hand surgeons looked at ways to make the UCL stronger after surgery to repair or reconstruct it. If the post-surgical UCL is not strong enough, it can stretch out over time, allowing abnormal motion and pain to recur. When a weak UCL is subjected to sufficient force, the ligament can tear again and… 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
Local Anesthetics
There are many different types of local anesthetics. Lidocaine and bupivacaine are among the most commonly used. The medications differ primarily in the speed at which they cause numbness and how long their effect remains. Although topical formulations of local anesthetic exist (such as “numbing creams”), they typically do not have a role in reducing post-surgical pain. Local anesthetic must… Continue Reading
Lumbar Disc Arthroplasty
Lumbar disc arthroplasty started in Europe with metallic spheres used to replace the disc. This however had mixed outcomes, and was largely not accepted within the spine surgery field. However, in the mid-1980s two scientists developed the Charite artificial disc, which has provided the basis of all disc arthroplasty since. As with joint arthroplasty throughout the body, many current versions… 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
The meniscus are a C shaped discs within the knee made of fibrocartilage that essentially provide cushioning and stability to the knee joint. A meniscus tear is a very common injury and finding. Treatment is often with knee arthroscopy, either trimming away the torn menisucs( partial meniscectomy) or repairing it. Todays techniques and technologies have seen a recent revolution in… Continue Reading
Microdiscectomy
Microdiscectomy, also sometimes called microdecompression or microdiskectomy, is a minimally invasive surgical procedure performed on patients with a herniated lumbar disc. It is one of the most common spine surgeries with roughly 300,000 cases performed a year in the US. There are a number of different techniques to perform the surgery to include a small open incision, dilating tubes, and… 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
Minimally-invasive Bunion Surgery
Minimally-invasive bunion surgery arose in an attempt to make surgery less painful for patients, while still correcting the alignment problems in the foot. By using a smaller incision (one or several tiny poke-holes) and leaving more of the soft tissues intact, minimally-invasive surgery is thought to create less scar tissue during the healing process. Less disruption of the surrounding soft… Continue Reading
Negative Pressure Wound Therapy (NPWT)
Negative pressure wound therapy (NPWT) is a method of soft-tissue injury treatment in which an impervious dressing is applied to skin or soft tissue, and then connected to a vacuum-generating device. Research has demonstrated decreased rates of infection, increased rates of healing, and fewer subsequent surgeries when NPWT is used in the setting of open fractures, infection, or extensive soft-tissue… 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
Olecranon Locking Plates
Olecranon fracture are commonly treated with locking plates and screws. Each implant regardless of the manufacturer allows for a combination of locking or non-locking screws to increase the stability of the fracture fixation. Locking screws allow the formation of a fixed angle construct the plate that creates a stiff fixed angle construct. An incision is commonly made on the posterior… 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
Osteochondral Allograft or Autograft Transfer System (OATS)
Osteochondral grafting is a common method for treating injuries of the cartilage that expose the underlying bone (called osteochondral defects, or OCD lesions). During this procedure, osteochondral grafts replace both the joint surface, or articular cartilage as well as the underlying bone. These grafts can come from either the patient’s own body (called an autograft), or from a tissue donor… 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
Photodynamic Therapy
Photodynamic therapy is a type of treatment that uses a light sensitizing medication put on the skin or into the bloodstream, which is then activated by light from a laser or other light sources, to kill the desired cell type, most often cancer and precancer cells.
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
Platelet-Rich Plasma Injections
Platelet-Rich Plasma (PRP) is a substance created by spinning down a tube of blood in a centrifuge machine and separating out the portion containing a high percentage of platelet cells. Platelet cells release multiple growth factors related to the generation of soft tissue, such as during healing. When PRP is harvested and spun down, a small amount of calcium chloride… 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
Posterior Lumbar Instrumented Fusion
Posterior Lumbar Instrumented Fusion (PLIF) is a technique performed to achieve spinal fusion in the low back (lumbar spine). While there are many approaches to achieve fusion this one is performed through a direct posterior approach to the back and works by inserting a cage made of synthetic material (plastic or metal) with bone graft directly into the disc space…. 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
Radial Head Arthroplasty
Radial head fractures are commonly surgically treated with either a plate and screws or a radial head replacement. The development of radial head arthroplasty has allowed another option to restore stability to the elbow. The incision for radial head surgery regardless of implant selection is commonly made on the lateral aspect of the elbow. After surgery, there is usually a… Continue Reading
Radio-Frequency Energy (RF)
The very first technology that was used for this was radio-frequency energy (RF) which is similar to the energy that your microwave oven uses to heat up food. This requires maneuvering a wire in the heart and making dots around the pulmonary veins. As the opening of the pulmonary veins is a circular shape, a circle is made with the… Continue Reading
Retracted Skin Defect Closure
Increased intra-compartmental pressures seen in compartment syndrome often leave difficult to close wounds. Historically, surgeons have utilized a combination of vessel loops and staples, or other techniques, in order to loosely close fasciotomy sites too retracted to close primary. This method of closure, however, was not without complication, and required surgeon experience to properly tie and employ. As a result,… 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
Ringed External Fixator
Ringed external fixators use rings outside the body, connected to the bone through wires and pins that are surgically placed. With these external fixators, it is possible to control movement of the bone from outside the body with limited need for incisions. The rings outside the body are most often made of light weight metals such as aluminum or titanium…. Continue Reading
Robotic Assisted Total Knee Arthroplasty
During the procedure, real-time visual, tactile, and auditory feedback are given to the surgeon, which ideally reduces the potential for complications. Robotic-assisted surgery has been around since the 1980s, in recent years significant improvements have been made particularly in joint replacement surgery. The use of robotics in total knee replacements is increasing amongst orthopedic surgeons. Depending on the surgeon’s preference… 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
Shock Wave Therapy
Extracorporeal Shock Wave Therapy (ESWT) involves a machine which generates a current outside the body, using a spark in water or an electromagnetic coil. This current is then transmitted, via a special pad, into the tissue of the affected body part. Urologists have used this technology for kidney stones to successfully avoid surgery by applying current to break the stones… Continue Reading
Skin Filler
Various filler materials exist, and are catered to cosmetic outcome, as well as patient goals for longevity. Filler material can broadly be separated into permanent and temporary, however most various types exist on a spectrum from months to years. Juvaderm is temporary filler with multiple formulations that vary in thickness, best suited for certain locations on the face respectively. Other… 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
Spinal Growing Rods
Traditional growing rods are intended for young patients with significant growth potential and a high risk of spinal deformity progression in the setting of scoliosis. Severe spinal deformity can cause limitations in lung growth, heart problems, and other life-threatening conditions. Traditional growing rod treatment for young patients with moderate to severe scoliosis involves an initial surgery to place hooks and/or… Continue Reading
Surgical Breast Implants
Surgical implantation of material into the breast began in the early 20th century. After trial and error with numerous substances, the first silicone breast implant was developed in the 1960’s. This implant was notable for its novel design involving a tough but elastic silicone shell with a softer silicone gel filling. In the following years, this basic design was improved… 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
Thumb CMC Joint Suspensionplasty Surgery
Suspensionplasty refers to the step that some surgeons perform after removing the trapezium bone to suspend the metacarpal base some distance away from the scaphoid bone that now sits underneath it. This step is aimed at preventing the metacarpal base from settling over time, possibly leading to some recurrence of pain as the space narrows. The historic way of doing… Continue Reading
Thyroid Eye Disease Treatments
This rare complication of thyroid disease has few treatment options. Intravenous steroids are given to reduce the inflammation and pain but the anatomical changes are primarily corrected surgically. There are three primary types of surgery performed to treat exophthalmos and its associated complications. The surgeon can either remove a small section of bone and fat from within the orbit during… 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
Topical Scar Therapies
Among the preventative scar treatments mentioned, two are simple, consistently improve scars, and cost-effective: 1) Silicone – can be applied to the scar as a gel or as a sheet. Consistent application of silicone has been shown to improve scar texture, reduce color changes, and diminish scar height. Simply put, silicone therapy tends to result in a flatter, softer scar…. Continue Reading
Total Elbow Arthroplasty
There are different types of elbow replacements. The components can be made of different materials and come in different sizes. There are two main types of elbow prosthetic devices: linked and unlinked. In linked prosthetics, all parts of the replacement joint are connected. This acts like a hinge and provides good joint stability. An unlinked prosthesis comes in two separate… Continue Reading
Total Hip Replacement
Total Hip and knee replacement surgeries have been performed for over a century, with continued evolution to the surgical techniques as well as component and manufacturing techonologies . Currently the most common material used for hip replacement implants are various metal alloys that include titanium, cobalt-chrome, as well as high grade plastics known as high molecular weight polyethylene or simply… 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 for over a century and the technology and techniques 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, well as high grade plastics or polyethyelene that serve as the gliding surface, commonly known as “poly.” Total… Continue Reading
Total Shoulder Arthroplasty
The modern era of shoulder replacement began in the 1950s, but the techniques and implants we most commonly see today were developed in the 1980s. Thankfully, the technology and techniques are continually improving to what we utilize today and this procedure is one that has shown a great leap in technologic advancement. Total shoulder replacement (also referred to as “arthroplasty”)… 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. These implants are unique in that only one area or compartment of the knee is replaced, and are either a fixed bearing ( the plastic is locked into place) polyethylene( “poly” or plastic) or a mobile bearing, meaning that plastic… 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
Vertebral Kyphoplasty
Balloon kyphoplasty is a minimally invasive procedure used in the USA since 1999 for the treatment of osteoporotic vertebral compression fracture. It is designed to stabilize the fracture and help correct the deformity in the vertebral body. Patients who have disabling intolerable back pain, progressive vertebral collapse, and symptoms that persistent greater than 4-6 weeks may benefit from kyphoplasty. The… Continue Reading
Viral Testing
Influenza is primarily diagnosed clinically. Based on the presentation of symptoms, clinicians make a diagnosis and provide the appropriate treatment recommendation. If diagnosed within 48 hours of the onset symptoms, treatment may consist of anti-influenza medication along with rest, hydration, and pain relief. The limitation of a clinical diagnosis is that the symptoms of influenza can present very similarly to… Continue Reading
