Ashoke Sathy, M.D. Answers Questions On: Orthopaedic Surgery

Minimally invasive can refer to arthroscopy or, especially in the trauma realm, using fluoroscopy. Arthroscopy is when you go in with a little camera and look. But I would say the vast majority of time we don’t do arthroscopy, it’s more fluoroscopic-guided percutaneous (through the skin) treatment. (Fluoroscopy is a type of X-ray that is used in the operating room.) It’s not live – we can do short bursts of live motion, but usually it’s multiple static shots, but it’s all real-time, we’re right there. We’ll make an adjustment, take another shot, see what it did, and so forth, and use that to get it lined up and put our screws in our plate, for example.

Nonunions are when the bone never heals. There’s different risk factors for nonunion. Anything that disrupts the blood supply, a bad open fracture, an infection, smoking even, could lead to a nonunion – the bones just don’t heal. You have to provide a stimulus to help it heal, usually a bone graft. And then you have to have stable internal fixation as well, usually with a nail or plate.

Malunion is when the bone did heal – it just healed in the wrong alignment. Treatment depends on the degree of deformity. If it’s a severe malunion, and if it’s symptomatic to the patient in terms of pain in adjacent joints, or if it’s severe enough that we think that over time it’ll lead to arthritis of the adjacent joints, then we’ll recommend correcting that. There are several different ways to do that. You’d go in there and basically recreate the fracture, you do an osteotomy (cutting of the bone), and then you realign it and fix it with either a nail or plates and screws.