Mr David Murray is an experienced Orthopaedic Surgeon who treats all hands, elbow and wrist conditions. Surgery in general has transformed over the past few years, which has led to surgeons specialising in particular areas – like Mr Murray and his specialisation in minimally invasive arthroscopic procedures, base of thumb arthritis, small joint replacement, trigger finger release, carpal tunnel decompression, Dupuytrens contracture, cyst removal and sport injuries.
However, not all orthopaedic surgeons specialise in hand treatment. There are actually six general principles relating to orthopaedic surgery – which we will cover in more detail below.
What is Orthopaedic Surgery?
Orthopaedic surgery deals with acute injuries, acquired and congenital disorders, chronic arthritic conditions, joints and their associated tissues, including ligaments, muscles and nerves. Some consultants work alongside general surgeons in accident and emergency situations, dealing with bone and soft tissue injuries.
The six general principles relating to orthopaedic surgery are:
#1 Bone Tumours
Bone tumours tend to be classified as either primary or secondary tumours. Primary tumours are identified as arising from cells which constitute the bone, and are further classified as either benign or malignant.
Primary bone tumours are very rare, with a prevalencey rate of around 1% in the UK as a whole. Bone cancer is more common in children and adolescents, and is responsible for around 5% of all cancers. Investigations into bone tumours are usually undertaken by a multidisciplinary team (MDT) before any further images are taken. Most bone tumours are managed through observation although malignant tumours tend to be treated with surgery.
#2 Component Syndrome
Component syndrome is usually defined as a painful condition which occurs when pressure within the muscles builds to a dangerous level. This pressure can decrease blood flow, which then prevents oxygen and nourishment from reaching muscle and nerve cells. It can affect any fascial compartment in the body, but the most commonly affected areas are buttock, hand, foot, forearm, leg or thigh.
Identification of component syndrome is usually through the patient describing pain which is disproportionate to the injury or pain that worsens despite treatment. It is usually treated through an open fasciotomy, where the fascia is cut in order to relieve the tension.
#3 Open Fractures
One of the most common injuries seen in an A&E department are open fractures, and these injuries require urgent assessment by the Orthopaedic team. A fracture is classified as open when there is direct communication between the external environment and the site of the fracture – usually through the skin. The most common types of open fracture are ankle, forearm, metacarpal, phalangeal and tibial.
Surgery is really the only option for open fractures, and your orthopaedic surgeon will probably work in tandem with a vascular and/or plastic surgeon to ensure the best outcome.
Osteoarthritis is the leading cause of disability and pain in the western world. For example, symptomatic knee osteoarthritis occurs in 15% of adults aged 55 or under and 80% of adults who are aged 75 years or older. It is no surprise then that it tends to be caused by the progressive loss of articular cartilage and remodelling of the underlying bone. It is also sometimes known as the ‘wear and tear’ disease.
Patients usually present with stiffness and pain in their joints, which worsens with activity and eases when rested. Clinical diagnosis will depend on the joint involved and the condition will either be managed conservatively or through the use of surgery.
Osteomyelitis is an infection of the bone, which tends to be bacterial in origin. Patients at increased risk also tend to be suffering from diabetes mellitus, immunosuppression, excess alcohol consumption, or intravenous drug use.
Patients will usually complain of severe localised pain which is constant, which may also be accompanied by a low-grade fever. It can sometimes be diagnosed through MRI scans, but is usually confirmed by culture by a bone biopsy. It is usually treated with medication on a long-term basis.
#6 Sceptic Arthritis
Sceptic arthritis occurs when there is infection in a joint – and it can be found in both native and prosthetic limbs. Patients usually present with painful, tender and swollen joints and they can find it hard to put weight on the joint.
Patients who are suffering from sceptic arthritis are also at risk of developing osteoarthritis or osteomyelitis as well. Sceptic arthritis is usually treated with antibiotics, but some cases may also need surgery as well.
What does the future of orthopaedic surgery involve?
Orthopaedic surgery is developing constantly, with different materials for replacements such as ceramics, plastics and metals being trialled. Biological repair is also an area that is being explored, with material being grown from stem cells being used to replace damaged joint tissue.
If you need help with any ailments you have in your hands, elbows or arms then please contact Mr David Murray, Hand Surgeon, today. To find out more about fees and self-funding, check out the patient information page on our website.