Orthopedics

We always talk about treatment of problems, and often forget about prevention. But isn't prevention the best treatment of all? We know to stop smoking and eat right, but what can be done to prevent orthopedic conditions?

If you really want to avoid the problems associated with an orthopedic injury, try to put your efforts in preventing the problem altogether. Here are five conditions that cause problems, but can be avoided. It takes some effort, and maybe some choices that you don't like, but you can avoid these problems.

Broken bones in kids are not the same as broken bones in adults. The approach to treating a child is very different to treating an adult with a fracture. The reason for the difference in treatment is the fact that the bone are different in children and adults.

Understanding how a child's bone is different from an adults can help explain the difference in treatment. Learn about what makes your kid's bones different!

Related: Growth Plate Injuries | Treatment of Growth Plate Injuries

When deciding to have ACL reconstructive surgery, the type of graft used to reconstruct the ACL can be one of the most difficult questions for patients do answer.  Different surgeons have preferences, and patients sometimes have preferences.  So what does the research show?

A recent study found similar results when comparing long-term (8 year) results in patients having either hamstrings or patellar tendon grafts.  The study did not look at donor (cadaver) grafts, only ACL grafts that came from the patient having the reconstruction.  The research shows that both grafts work exceptionally well, will little difference between the graft types.

The only major difference was that patients with patellar tendon grafts had more complaints when kneeling.  Interestingly, there was no difference in kneecap pain, only differences when actually kneeling.

This research confirms the notion that patellar tendon and hamstring grafts are equally effective.

What type of ACL graft did you choose, and why?

Sources: Barenius B, et al. "Quality of Life and Clinical Outcome After Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Graft or Quadrupled Semitendinosus Graft" Amer Journal Sports Medicine vol. 38 no. 8 1533-1541

Tight fitting shoes are thought to be the cause of bunions in about 90% of patients. Shoes such as high heels are particularly damaging to the toes. These shoes have a sloping foot piece and a narrow toe box. The slope causes the front of the foot to be pushed with force into the narrow toe box.

Don't believe me? Consider the following:

• The average woman in the U.S. wears a dress shoe that is 2 1/2 sizes too small.

  
  

• Bunions occur in about 3% of the population in countries where people wear non-Western style shoes. They occur in about 33% of the population in Western countries.

If you have a bunion, try the following:

• Step 1: Get your nicest dress shoes
• Step 2: Set your shoe on the floor and stand next to it

  
  

• Step 3: Decide which is bigger--odds are the shoe is smaller than the foot

If the picture here looks at all like your feet and shoes, you may have found the source of your problem.

Related: More About Bunions | Other Toe Problems

Image © Jonathan Cluett, MD

The American Academy of Orthopaedic Surgeons estimates that the number of knee replacements performed in the United States will increase by 600% in the next decade.  This means, that with over 500,000 knee replacements performed every year at present, in 10 years over 3 million knee replacements will be performed every year.

Because of this staggering need, many hospitals are forming joint replacement centers, adding specialty staff to serve the needs of these patients, and developing programs to drive this business through their doors.  The good news for patients, is that knee replacement surgery is becoming more standardized, and leading to better outcomes and results.

Sources: "Knee Replacement Needs"

Icing of injured and sore muscles has long been used as a treatment for sprains, strains, and other common injuries.  Thought to help reduce swelling, decrease pain, and speed healing, the application of ice is often considered a part of standard treatment.  Any trainer, athlete, or coach knows that "R.I.C.E" treatment should be initiated as soon as possible after injury--with the I in RICE telling you to ice the injury.

However, athletes should use caution, as studies show that icing during an athletic event, and then returning to the event can be detrimental.  The study found that even after icing, muscle strength and power, as well as fine motor movements were impaired.  Athletes should use caution with icing, and probably should limit the application of ice to the completion of their competition.

Related: Treatment of Sore Muscles | Ice Application

Source: "Why Ice May Be Bad for Sore Muscles"

Many patients show up in my office asking for an MRI test.  There is a feeling among many patients that without an MRI, a diagnosis may be missed or delayed, the wrong treatment may be recommended, or further damage could occur.  So do we overuse MRIs?  or are we doing too many MRIs?

insurance companies would certainly make us think that MRIs are done too often.  In fact, many insurance companies have strict criteria and steps necessary if an MRI is allowed.  However, now some very well-known doctors are stepping forward and joining the discussion saying that we shouldn't be doing so many MRIs.

A recent article in the New York Times quoted famous sports medicine orthopedic surgeon Dr. James Andrews as being among the physicians against the overuse of this diagnositic test.  Why would a surgeon be against ordering an MRI?  It turns out, the MRIs often find problems, but not problems that need solving.  They frequently lead to more tests, and even surgery, that may not be necessary.  A good examination costs less, is often more accurate, and may not lead to unnecessary procedures.

Do you think doctors order too many MRIs, or are doctors too reluctant to order an MRI test?  Leave your comments below...

Related: Do You Need an MRI?

Source: Sports Medicine Said to Overuse M.R.I.'s

Viscosupplements are commonly used injections for the treatment of osteoarthritis of the knee.  Commonly sold under the trade name of Synvisc, Orthovisc, Euflexxa, or others, these injections are often described as a joint lubricant.

Only approved for treatment of the knee, many patients with arthritis in other joints wonder if they might be effective for treatment in hip, ankles, or shoulders.  Recent research has tried to determine if they might be effective.

A recent study found that these injections were not helpful for shoulder arthritis.  This study was a good quality study meaning that patients were randomly selected to receive either the lubrication shot or a placebo injection.  In addition, those performing the injection and assessing the results did not know which injection was being given.  Lastly, the study was performed at different sites by different providers.  These so-called double-blind, randomized trials are the highest quality types of medical studies.

That is not to say the data are 100% accurate, but the study certainly should help guide doctors and patients looking for effective treatment of shoulder arthritis.   In this case, the study suggests doctors and patients should look for other treatments.

_{Source: "Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial"}

Kobe Bryant sustained one of the fears of aging athletes on Friday night--a torn Achilles tendon.

An Achilles tendon tear usually occurs in athletes well beyond their college years, most often in middle-aged athletes.  Treatment of athletes who tear their Achilles tendon is most commonly surgical, although there are options for treatment.

This injury will sideline Bryant for at least 6-9 months--but talk to any athlete who has torn their Achilles and they will likely tell you it took much longer than that to fully recover.

I read a column on the Internet recently advocating patients with implanted metal bring x-rays to the airport to assist the TSA in screening. My opinion: Bad idea.

Many patients with implanted metal will set off airport metal detectors. Implants including plates, screws, rods, and joint replacements can all set off airport metal detectors. However, the TSA is staffed by security specialists, not doctors. Taking x-rays to the security personnel is a waste of your time and effort. Here are the problems:

• Identity Issues
  Security personnel cannot (and should not) assume that an x-ray belongs to the person holding it. If that were the case, anyone could simply bring an x-ray of a metal implant as their reason for setting off the metal detector.




• Hospital Records
  X-rays are part of your hospital record, and removing them makes your record less complete. If those x-rays get lost on your trip it could affect your medical care down the road. Sometimes having previous x-rays for comparisons is essential, especially when dealing with implants.

  
  

• Cost
  Every time an x-ray is taken, and printed, medical costs go up. If patients are constantly getting extra x-rays taken and printed for travel purposes, this wastes medical resources.

I think this column has great tips for travel security--except the advice to bring your x-rays to the airport. Instead, use the advice of the TSA, and leave your x-rays at your doctor's office.

Related: Do metal implants cause metal detectors to go off? | TSA Recommendations