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| Shoulder Surgery |
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Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.
Depending on the nature of the problem, nonsurgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.
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Bursitis or Tendinitis
Bursitis or tendinitis can occur with overuse from repetitive activities, such as swimming, painting, or weight lifting. These activities cause rubbing or squeezing (impingement) of  the rotator cuff under the acromion and in the acromioclavicular joint. Initially, these problems are treated by modifying the activity which causes the symptoms of pain and with arehabilitation program for the shoulder.
Impingement and Partial Rotator Cuff Tears
Partial thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.
The conservative nonsurgical treatment is modification of activity, light exercise, and, occasionally, a cortisone injection. Nonsurgical treatment is successful in a majority of cases. If it is not successful, surgery often is needed to remove the spurs on the underside of the acromion and torepair the rotator cuff.
Full-Thickness Rotator Cuff Tears
Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity is successful in a majority of cases.
If pain continues, surgery may be needed to repair full- thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff, and repair of some tears.
Both techniques require extensive rehabilitation to restore the function of the shoulder.
Instability
Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments.
The two basic forms of shoulder instability are subluxations and dislocations. A subluxation is a partial or incomplete dislocation. If the shoulder is partially out of the shoulder socket, it eventually may dislocate. Even a minor injury may push the arm bone out of its socket. A dislocation is when the head of the arm bone slips out of the shoulder socket. Some patients have chronic instability. Shoulder dislocations may occur repeatedly.
Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital. Arthroscopic surgical repair is often done on an outpatient basis. Following either procedure, extensive rehabilitation, often including physical therapy, is necessary for healing.
 Fractured Collarbone and Acromioclavicular Joint Separation
A fractured collarbone and acromioclavicular separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated nonsurgically with slings or splints. Severe displaced fractures or acromioclavicular joint separation may require surgical repair.
Fractured Head of the Humerus (Arm Bone), or Proximal Humerus Fracture
A fractured head of the humerus is a common result of falls on an outstretched arm, particularly by older people with osteoporosis. If fragmented  or displaced, it may require open surgical repair and possibly replacement with an artificial joint (prosthesis).
Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tearing of the capsule or the rotator cuff. Osteoarthritis occurs when the articular surface of the joint wears thin. Rheumatoid arthritis is associated with chronic inflammation of the synovium lining which can produce chemicals that eventually destroy the inner lining of the joint, including the articular surface.
Shoulder replacement is recommended for patients with painful shoulders and limited motion. The treatment options are either replacement of the head of the bone or replacement of the entire socket. Your orthopaedic surgeon will discuss with you the best option.
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| Knee Surgery |
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If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.
Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure.
Anatomy
 The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities.
The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.
The menisci are located between the femur and tibia. These C-shaped wedges act as "shock absorbers" that cushion the joint.
Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.
All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee.
Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.
Cause
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
- Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
- Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."
- Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
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| Ankle Surgery |
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A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are broken.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.
Broken ankles affect people of all ages. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers."
Anatomy
 Three bones make up the ankle joint:
- Tibia - shinbone
- Fibula - smaller bone of the lower leg
- Talus - a small bone that sits between the heel bone (calcaneus) and the tibia and fibula
The tibia and fibula have specific parts that make up the ankle:
- Medial malleolus - inside part of the tibia
- Posterior malleolus - back part of the tibia
- Lateral malleolus - end of the fibula
Doctors classify ankle fractures according to the area of bone that is broken. For example, a fracture at the end of the fibula is called a lateral malleolus fracture, or if both the tibia and fibula are broken, it is called a bimalleolar fracture.
Two joints are involved in ankle fractures:
- Ankle joint - where the tibia, fibula, and talus meet
- Syndesmosis joint - the joint between the tibia and fibula, which is held together by ligaments
Multiple ligaments help make the ankle joint stable.
Symptoms
Because a severe ankle sprain can feel the same as a broken ankle, every ankle injury should be evaluated by a physician.
Common symptoms for a broken ankle include:
- Immediate and severe pain
- Swelling
- Bruising
- Tender to touch
- Cannot put any weight on the injured foot
- Deformity ("out of place"), particularly if the ankle joint is dislocated as well
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| Trauma Surgery |
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| Trauma is the branch of surgical medicine that deals with treating injuries caused by an impact. Many trauma patients are the victims of car crashes, stabbings and gun shot wounds. Trauma can also be caused by falls at home in the toilet, bathroom, is in bed or fall from the bed or any small injuries after can involve certain bones & certain joints. Most common fractures that we treat in this institution are, Fracture neck of the Femur & other fracture around the shaft of the femur, distal end of the femur proximal knee joint involving knee joint, proximal tibia shaft distal tibia, Proximal Humerus that means shoulder or elbow, wrist all are very common fractures due to minor injuries from fall or low impact. In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones) and other surgeons as needed. |
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| Trauma procedures that are performed by me on a regular basis are as follows : |
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AFN
PFN
LC LCPS
Locking Platform
Locking nails
Pelvic Fracture Surgery
Poly Traumas |
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| Elbow Surgery |
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Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and repair problems inside a joint.
The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint." During elbow arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your elbow joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities.
Elbow arthroscopy has been performed since the 1980s. It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Improvements to elbow arthroscopy occur every year as new instruments and techniques are developed. |
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| Anatomy |
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The elbow is a complex joint formed by the joining of three bones:
- The humerus (upper arm bone)
- The ulna (forearm bone on the pinky finger side)
- The radius (forearm bone on the thumb side)
 The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and acts as a natural cushion to absorb forces across the joint. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.
On the inner and outer sides of the elbow, thicker ligaments (collateral ligaments) hold the elbow joint together and prevent dislocation.
The elbow joint is surrounded by muscles on the front and back sides. In addition, the three major nerves that cross the elbow joint are located close to the joint surfaces and capsule and must be protected during arthroscopic surgery.
The elbow joint allows two basic movements: bending and straightening (flexion and extension) and forearm rotation (pronation — palm down, and supination — palm up).
Normal bending and straightening motion occurs at the joining of the humerus and ulna bones. Forearm rotation occurs at the joining of the ulna and radius and is also influenced by muscles and ligaments further down the forearm and at the wrist joint.
When Elbow Arthroscopy Is Recommended
Your doctor may recommend elbow arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body's normal reactions to injury or disease. In an injured or diseased elbow joint, inflammation causes swelling, pain, and stiffness.
Injury, overuse, and age-related wear and tear are responsible for most elbow problems. Elbow arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint. Elbow arthroscopy may also be recommended to remove loose pieces of bone and cartilage, or release scar tissue that is blocking motion.
Common arthroscopic procedures include:
- Treatment of tennis elbow (lateral epicondylitis)
- Removal of loose bodies (loose cartilage and bone fragments)
- Release of scar tissue to improve range of motion
- Treatment of osteoarthritis (wear and tear arthritis)
- Treatment of rheumatoid arthritis (inflammatory arthritis)
- Treatment of osteochondritis dissecans (activity related damage to the capitellum portion of the humerus seen in throwers or gymnasts)
There are several elbow surgical treatments that are currently most effective when done as an open, traditional procedure. These include surgeries to:
- Treat golfer's elbow (medial epicondylitis)
- Repair the collateral ligaments
- Fix many fractures
- Replace the elbow joint
- Decompress the ulnar nerve (funny bone nerve)
Some advanced surgeries combine arthroscopic and open procedures in the same setting. For example, in a severe case of osteochondritis dissecans, a loose piece of bone may be removed arthroscopically, and the damaged area of the humerus may be treated with a bone graft using an open surgical technique. |
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| Hip Surgery |
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| A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture. |
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| Anatomy |
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The "hip" is a ball-and-socket joint. It allows the upper leg to bend and rotate at the pelvis. An injury to the socket, or acetabulum, itself is not considered a "hip fracture." Management of fractures to the socket is a completely different consideration.
Causes :
 Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting.
Symptoms :
The patient with a hip fracture will have pain over the outer upper thigh or in the groin. There will be significant discomfort with any attempt to flex or rotate the hip.
If the bone has been weakened by disease (such as a stress injury or cancer), the patient may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, the leg may appear to be shorter than the noninjured leg. The patient will often hold the injured leg in a still position with the foot and knee turned outward (external rotation).
Treatment :
Considerations
Once the diagnosis of the hip fracture has been made, the patient's overall health and medical condition will be evaluated. In very rare cases, the patient may be so ill that surgery would not be recommended. In these cases, the patient's overall comfort and level of pain must be weighed against the risks of anesthesia and surgery.
 Most surgeons agree that patients do better if they are operated on fairly quickly. It is, however, important to insure patients' safety and maximize their overall medical health before surgery. This may mean taking time to do cardiac and other diagnostic studies.
Nonsurgical Treatment
Patients who might be considered for nonsurgical treatment include those who are too ill to undergo any form of anesthesia and people who were unable to walk before their injury and may have been confined to a bed or a wheelchair.
Certain types of fractures may be considered stable enough to be managed with nonsurgical treatment. Because there is some risk that these "stable" fractures may instead prove unstable and displace (change position), the doctor will need to follow with periodic X-rays of the area. If patients are confined to bed rest as part of the management for these fractures, they will need to be closely monitored for complications that can occur from prolonged immobilization. These include infections, bed sores, pneumonia, the formation of blood clots, and nutritional wasting.
Surgical Treatment
Anesthesia for surgery could be either general anesthesia with a breathing tube or spinal anesthesia. In very rare circumstances, where only a few screws are planned for fixation, local anesthesia with heavy sedation can be considered. All patients will receive antibiotics during surgery and for the 24-hours afterward.
Appropriate blood tests, chest X-rays, electrocardiograms, and urine samples will be obtained before surgery. Many elderly patients may have undiagnosed urinary tract infections that could lead to an infection of the hip after surgery.
The surgeon's decision as to how to best fix a fracture will be based on the area of the hip that is broken and the surgeon's familiarity with the different systems that are available to manage these injuries.
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