These are very common injuries, usually caused by poor friction between feet and ground. They affect all ages. Treatment may range from simple cast/splint immobilisation for fractures that are in a good position for healing (undisplaced), through to manipulation under anaesthesia (MUA), Kirschner or K-Wiring (simple pins often left out through the skin) or internal fixation with a plate.

There has been much debate in recent years as to the best treatment, and all are valid. But surgery is all about choosing interventions wisely and you will be advised carefully about the choices.

The advantage of surgery is the attraction of being able to put the pieces back together and hold them there. This often means that a cast is unnecessary and rehabilitation is quicker. However, the downside is that surgery has risks, such as infection, nerve injury, tendon tethering. You and your surgeon will be able to make a balanced decision about the right treatment for you, and your particular fracture during your consultation.

Here is a video of the open reduction and internal fixation operation being performed by Mr Phillips.

The post Fixation of Wrist fractures appeared first on London Sports Orthopaedics.

These are troublesome injuries caused by forced hyperextension of the wrist. The main trouble is that they can often fail to heal, and cause persistent pain and weakness. The original injury often feels like a common sprain. Initial X rays are often normal. An early MRI will establish the presence or absence in cases of doubt. Most undisplaced fractures will heal in a cast. Displaced fractures are best fixed. High risk fractures (displaced, small proximal pole fragments) may benefit from supplementary treatment with Low Intensity Pulsed Ultrasound to increase success rates and reduce time to healing.

Here is a video of a proximal pole fracture being fixed through a keyhole (percutaneous) approach by Mr Phillips.

The post Fixation of Scaphoid fractures appeared first on London Sports Orthopaedics.

The majority of patients referred to a hand surgeon will not require hand surgery. Specialised physiotherapy or and therapy can often be a great help and help to settle down many conditions. Splintage may be required. Steroids can often be helpful either as definitive or adjunctive treatment. Sometimes a combination of local anaesthetic and steroid is used as a diagnostic aid and may well treat the condition as an added bonus.

Trigger finger release

This is only indicated if steroid injection has failed to cure the condition. It is performed under local anaesthetic as a simple daycase procedure. Below a video of LSO surgeon Mr Mark Phillips performing the surgery.

Carpal tunnel release

This is a very effective surgical treatment with the vast majority of patients being pleased with the outcome. This operation is carried out for patients with numbness or pain in the hand with a diagnosis has usually been proven by clinical examination and nerve conduction studies. A steroid injection may be used to reinforce the confidence of the diagnosis as well as a temporary treatment. Steroid injection for this condition is not normally curative.

Dupuytren’s Contracture

When the condition is bad enough to warrant intervention, an injection of an enzyme to dissolve the cord followed by rupture of the cord at 24 to 48 hours later should be considered first. Another option would be to consider cutting the cord with a needle under local anaesthetic. For more difficult contractures open surgery is indicated and often provide a better long­ term result than the more conservative options listed above. Below Mr Mark Phillips is performing the operation on video.

Ganglion surgery

Ganglions can be excised as a relatively simple operation as a day case. This can be done under local or general anaesthetic. A fairly prompt recovery can be expected but recurrence rates are fairly high at 20 to 30%.  Here is a video of LSO surgeon Mr Phillips performing an operation to remove a ganglion.

Wrist arthroscopy

This is occasionally indicated as an investigation for patients with wrist pain. It is used as an investigation when clinical examination and x­rays and MRI scans have not established the diagnosis. It can be used as a treatment for TF CC tears and ganglions. It is sometimes required before proceeding to more major surgery to establish which operation would be more appropriate.

Trapezectomy

Excision of the bone at the base of the thumb is currently the best treatment for families arthritis. This has been the case for many decades. Joint replacement surgery does not appear to be superior at the moment. The results from this operation are generally very good with about 90% of patients feeling pleased they had it done. Some patients suffer with persistent pain after surgery. It takes about 3 months before the benefit is felt.

More details of what to expect after surgery performed by Mr Mark Phillips can be obtained from his own information sheets provided here.

DeQuervains Tendinitis

If injections fail to control symptoms for this condition, surgery is sometimes indicated. Only about 10% of patients require this. It is usually performed under local anaesthetic. Here is a video of Mr Philips performing this operation.

CONSENT

These Videos of my work to be used for teaching and for patient information only

Patient consent for these purposes has been obtained and all are anonymised.

Mark Phillips

Hand & Wrist Surgeon

The post Common hand treatments appeared first on London Sports Orthopaedics.

I commonly perform injections of steroid into tendon sheaths and joints in the hand, wrist and elbow.

Some areas are difficult to access without ultrasound guidance and occasionally a referral to ultrasound is necessary. However the vast majority of tendons and joints in the elbow, hand and wrist can be felt clearly under the skin and are easily accessed in the clinic.

I typically inject 40 mg of DepoMedrone and 0.25% Bupivacaine. I use about 1 ml of Bupivacaine which normally causes local numbness for about 2 hours.

I do not insert the local anaesthetic before the steroid because this is just as painful as doing both at once.

These injections are often diagnostic as well as therapeutic and if no relief of pain is forthcoming then it is likely that the pain is not coming from that particular area.

I warn all my patients about steroid flare. This is a well recognised complication of steroid injections. The majority of patients will have some pain for 24 to 48 hours after the injection. This typically starts the next day after the injection. There is sometimes an area of redness or swelling in association with this. Standard painkillers, elevation and application of ices usually all that is required. Some patients find it difficult to work under the circumstances and taking a day off is perfectly reasonable.

Relief of symptoms usually comes on at 2 to 7 days. It can occasionally take slightly longer. The DepoMedrone is usually present within the soft tissues for 6 to 8 weeks. Symptoms may recur when the steroid has all disappeared.

The majority of patients who experience symptom relief most conditions will not need a 2nd injection but subsequent injections are occasionally required.

We discourage patients from having more than 2 or 3 injections into one area and the minimum interval is usually about 3 months. The main problem with more frequent injections is one of skin thinning, loss of pigmentation or weakening of tendons resulting in tendon rupture. Infection is a very rare complication that has been reported. It is no more than a few in 1000 cases.

I perform these injections across the desk in the consulting room. It normally takes no more than a few seconds after preparing the skin with antiseptic. It is normally a little more painful than having a blood test and some patients feel a little faint and are asked to lie down.

For most conditions in the hand and wrist 80% of patients will not require a further injection.

The post Steroid injection in the hand and wrist appeared first on London Sports Orthopaedics.