Ice = Broken Ankles

The fibula bone has a spiral fracture and the mortise has been disrupted. A strong stainless steel plate and 11 screws did the trick. Six weeks on crutches, followed by six weeks of PT and lots of home exercises, then this gal will be ready to hit the tennis court again.

  

 

When a Screw Comes Loose

Why do you think the lady imaged below cannot get her shoe to fit anymore ?

And yes, she truly does have a “screw loose” 😜 She presented with the screw head almost pushing through the skin as you can see in the image with the yellow arrow.

The patient had surgery about 15 years ago by another doctor and the screw is just slowly working its way out of the bone. We will have to take that out! 😷

How Screws Are Used in Orthopaedic Surgeries

How do we accurately place screws in the knee and shoulder joints when we are using an arthroscope or even in some open surgeries?

We use a technique called cannulation. A guide pin, which is quite small and commonly around 3 mm in diameter or smaller, is placed. If the guide pin is not in a perfect position it is not a big issue to readjust the guide pin and make a second entry side into the bone.

Then we use the appropriate size drill over the guide pin. So the drill is hollow therefore the guide pin can fit through the drill. After the drill is removed from the bone, the guide pin is left in the bone. The screw is also cannulated or is hollow. The screw gets placed over the guide pin, the cannulated screwdriver is seated into the screw head, and the screw is placed. This allows accurate placement within the bone. The drill bits are also marked with measurements so we know how deep the drill is going into the bone.

These images show a cannulated drill bit:

  

Top 5 Ways to Prevent Getting a Stress Fracture as a Runner

1. When ramping up your mileage do not increase your mileage more than 10% per week.
2. Listen to your body. If you start to have pain, you need to back off and increase your cross training activities.
3. Keep a detailed training log. A training log is also very useful if you get a stress fracture so you can go back and see what caused the stress fracture activity wise. You will not want to repeat that in the future.
4. Check your vitamin D levels. Have your  primary care physician check those levels. You would want them to be between 50–60 as an athlete .
5. Mix up your training surfaces and activities. It is a repetitive force on the lower extremity that can cause a stress fracture. By mixing up your training surfaces and activities you will apply different forces to your feet and your lower extremities, which will decrease the repetitive force to the pelvis, hip, legs and feet.

Broken Hip?

Yikes!!! My patient broke both hips in the same year. Where you break your hip will determine what type of surgery you will need to have performed.

On the left side she broke her hip in the intertrochanteric region of the hip joint. That type of fracture is treated with the intramedullary hip screw and is outlined below by the blue arrow. When the fracture involves the femoral neck it is treated with either a total hip replacement or bipolar hip replacement and is outlined below by the green arrow.

This x-ray shows the different regions of the hip joint. The red arrow is the femoral neck and the yellow area shows the intertrochanteric region of the hip.

The reason two different type of surgeries are performed if you fracture your hip at the femoral neck area (the red arrow) is because the blood supply to the hip bone is disrupted and that bone will commonly die. So the hip bone is taken out and replaced with a hip replacement. When the hip fracture occurs in the intertrochanteric region of the hip, the blood supply is not disrupted so the hip can be fixed with internal fixation (see the blue arrow).

Why Does Your Body Form Bone Spurs? 

When you have a joint in your body that is arthritic it is painful to move that joint. The body tries to prevent joint mobility by forming bone spurs around the joint to limit the range of motion. The body is essentially trying to fuse the joint that is painful.

Surgically going in and removing the bone spurs does not help because the body will quickly reform the bone spurs after they have been surgically excised. Imaged below is a picture of a foot. The great toe has a significant amount of bone spurs. The red circle shows the great toe joint with all the bone spurs and narrowed joint space. The third toe,with the yellow circle, shows a normal looking joint. This patient has almost no motion at her great toe joint.

National Girls & Women in Sports Day Celebration

The National Girls & Women in Sports Day dates back as far as 1987 and is a way of recognizing and honoring the contributions of female athletes. Thanks to the Athletic Department at the University of Louisville, Dr. Stacie Grossfeld was invited to take part in a celebration of the national holiday on Sunday January 27, of 2019  at the KFC Yum! Center. 

The university gathered many female business owners and mentors to participate in a round table discussion with female student athletes interested in pursuing a careers in an array of fields and specialties. Dr. Grossfeld had the pleasure of being paired with 6 pre-med students.

The students asked questions and received advice about how to study for the MCAT, what to put into their medical school application, how many hours they should be shadowing, where they should be shadowing and how to handle a medical school interview. They also learned more about what life is like as a surgeon, mom, and female in medicine, why the doctors chose a career in medicine, and more about their career pathways.

This was a great event, and unique effort to acknowledge the influence of women in sports and medicine! As always, we enjoy working with both medical residents and interns. It’s encouraging to see more and more college students choosing a career path in health and science, and we are glad to mentor them in anyway possible! To learn more about how you can participate in an internship or residency with Dr. Stacie Grossfeld, just visit our website or call our office at 502-212-2663!

 

Bio Composite Screw

Imaged below is a bio composite screw that I used in a knee. The screw will actually incorporate into your bone over time. One of the big advantages of this type of screw is if you ever need to have an MRI of the knee in the future, it will not cause any artifact. Retained metal will cause an MRI image to have streaks and make the study difficult to read.

 

What Does Knee Arthritis Actually Look Like in HD ?

My 12 year old son, poo poos it because we don’t have 4K monitors in the operating room and it’s only 1080p, however in 1080p this is what knee osteoarthritis looks like:

The first image (upper left ) is a normal knee with normal white, smooth cartilage covering the end of the femur bone. Image number two at the top right reveals a large arthritic area which is the pale orange color surrounded by the white articular cartilage. The pale orange area is the exposed bone with the cartilage missing (the definition osteoarthritis). The middle row left is my metal probe in the knee joint pointing at the area of osteoarthritis.

Middle row right reveals a chondro-pick, which has a sharp pointed tip. Yikes!!! We use this medieval looking instrument to literally poke holes in the area of exposed bone. Which I am doing in the bottom left image. Why??? Penetrating the exposed bone causes the bone to bleed. That will attract stem cells and allow stem cell recruitment therapy to enter the area, which in turn forms fibro-cartilage. This scar tissue type cartilage will fill in the area of exposed bone reversing the process. In the last image, lower right, you can see the bone bleeding. Mission accomplished.

Six weeks with no weight bearing on that leg while the new cartilage is generated. Think of it like planting new grass seed, you can’t walk on it while it is growing, or it will be destroyed. In six weeks, happy knee and happy patient!

Can you have a fracture or broken bone that doesn’t show up on an X-ray?

Yep! While X-rays are excellent at showing bones, they are bad at showing anything else.

An MRI can show not only the bone but bleeding, swelling and fluid within the bone. The detail is amazing. Imaged below to the left is a MRI view of a knee joint. The red circle reveals a stress reaction or pre-stress fracture of a tibia. You can clearly see the white area which represents bleeding or fluid within the tibial bone. 


This next image is an x-ray of the same knee. Nowhere on the image can you see the stress reaction or pre-stress fracture. The yellow circle represents the area where the stress reaction is located and is identified by the corresponding MRI scan.

When people come to the office with pain in the region of the bone and the plain x-rays are normal, our next imaging study ordered is a MRI. Very rarely will I ever see a patient with a stress fracture that is present on a plain x-ray.