In a new approach to joint fractures in India, doctors at Indian Spinal Injuries Hospital, New Delhi, have used an arthroscope even while fixing a simple ankle fracture.
This the first time such a surgery is being done in Delhi. When a patient comes in with a joint fracture, a tiny camera is used to go inside the joint, to help doctors understand internal damage. "Usually, we simply align the bone so it sets; we don't really look at cartilage damage. Naturally, on impact, the cartilage may also be broken-a complication of the fracture. So we open up the joint, sending in an arthroscope, to understand any other damage.
Previously, we would fix the bone, and the patient would often get recurring pain. After several months, doctors would realize that there has been damage to the cartilage as well. By then, it is difficult to treat and the pain becomes a lifelong problem," said Dr Maninder Singh, Senior Consultant Orthopaedic Surgeon, Chief-Foot & Ankle Unit, Coordinator Sports Injury Unit, Indian Spinal Injuries Centre, New Delhi.
Within the Foot and Ankle Unit, it has become the protocol to do the arthroscopy. The hospital is now carrying out a study on the level of success of the surgery, again one of the first in the country. "Once we know the extent of the damage to the cartilage, we can take suitable action, such as the shaving off any tiny shards of cartilage, so that it does not float around the joint and cause immense pain.
Sometimes, the extent of breakage is so great that it needs a microfracture. This is a surgical technique wherein holes are drilled into the underlying bone in order to stimulate cartilage regrowth. The body's own stem cells will grow into new cartilage" said Dr Singh. The arthroscopic-assisted ankle fracture fixation ensures that the surgeon is better able to understand how an accident or even a twist in the ankle that causes a fracture have impacted the joint in its entirety.
It helps the doctor prescribe the best possible treatment for the patient's unique case, thereby getting the best patient outcomes. While the surgery at Indian Spinal Injuries Hospital was done on the ankle, this can be performed on other joints as well.