General orthopaedics
Orthopaedics is a specialty that focuses on the diagnosis, correction, prevention, and treatment of patients with skeletal deformities – disorders of the bones, joints, muscles, ligaments, tendons, nerves and skin. These elements make up the musculoskeletal system.
Your body’s musculoskeletal system is a complex system of bones, joints, ligaments, tendons, muscles and nerves and allows you to move, work and be active. Once devoted to the care of children with spine and limb deformities, orthopaedics now cares for patients of all ages, from newborns with clubfeet, to young athletes requiring arthroscopic surgery, to older people with arthritis.
Role of the general orthopaedic surgeon
Orthopaedic surgeons use medical, physical and rehabilitative methods as well as surgery and are involved in all aspects of heath care pertaining to the musculoskeletal system. It is a specialty of incredible breadth and variety. Orthopaedic surgeons treat a immense variety of diseases and conditions, including fractures and dislocations, torn ligaments, sprains and strains tendon injuries, pulled muscles and bursitis ruptured disks, sciatica, low back pain, and scoliosis knock knees, bow legs, bunions and hammer toes, arthritis and osteoporosis, bone tumours, muscular dystrophy and cerebral palsy, club foot and unequal leg length abnormalities of the fingers and toes, and growth abnormalities.
The general orthopaedic surgeon is skilled in the:
- Diagnosis of your injury or disorder
- Treatment with medication, exercise, surgery or other treatment plans
- Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function
- Prevention with information and treatment plans to prevent injury or slow the progression of diseases
Typically, as much as 50 percent of the orthopaedic practice is devoted to non-surgical or medical management of injuries or disease and 50 percent to surgical management. Surgery may be needed to restore function lost as a result of injury or disease of bones, joint, muscles, tendons, ligaments, nerves or skin.
The orthopaedic surgeon also works closely with other health care professionals and often serves as a consultant to other physicians. Orthopaedic surgeon are members of the teams that manage complex, multi-system trauma, and often play an important role in the organisation and delivery of emergency care.
A field known for innovation
Like other branches of medicine, remarkable technological advances have significantly shaped the field of orthopaedics in recent years.
- Arthroscopy – the application of visualising instruments to assist in the diagnosis and surgical treatment of internal joint diseases – has opened new horizons of therapy
- Great advances have occurred in the surgical management of degenerative joint disease. For example, orthopaedic surgeons can replace a diseased joint with a prosthetic device (total joint replacement).
Orthopaedic Trauma Services
DR PR de Bruin has the expertise, training and 26 years experience in private practice to treat these trauma injuries and will typically see and treat patients within 24 hours and/or quickly arrange hospital-to-hospital transfers.
Orthopaedic trauma care covers the spectrum of simple isolated fractures to severe life threatening accidents with multiple broken bones. While many fractures can be treated very well by general practitioners, some can benefit from orthopaedic specialists.
More significant injuries with multiple broken bones, compound fractures and fractures near a joint, and fractures of the pelvis are more difficult to treat, and benefit the most from specialised care. Additionally, problems with healing including non-unions, infections (osteomyelitis) and healing with poor alignment (malunion) are often treated.
What is Orthopaedic Trauma?
Orthopaedic trauma is a branch of orthopaedic surgery specialising in problems related to the bones, joints, and soft tissues (muscles, tendons, ligaments) of the entire body following trauma. The main goal of this specialised area in orthopaedics is the healing of the fractured bones, as well as restoring the anatomic alignment of the joint surfaces to allow for recovery and return to maximum function of the injured body part.
comprehensive orthopaedic trauma capabilities include:
- Surgery for fractures
- Treatment of nonunions and malunions
- Pelvis and acetabulum surgery
- Treatment for infected fractures and osteomyelitis
- Limb lengthening
- Bonegrafting
- Complex soft tissue reconstruction
- Complex upper extremity reconstruction
Hip & Knee Arthroplasty/Replacement
In 1994, Dr PR de Bruin was the 1st orthopaedic surgeon in Rustenburg to start hip and knee replacements at Life Peglerea Hospital, Bleskop Mine Hospital and Netcare Ferncrest Hospital.
Arthroplasty is a surgical procedure performed by an orthopaedic surgeon that alters or completely replaces a joint in the body, usually to restore normal motion and relieve pain in a malformed or diseased joint, such as the hip, knee, shoulder, elbow or ankle. Arthroplasty may also be required due to cartilage that wears out, limb/joint malalignment, joint space narrowing, a stiff joint, disease, or other degenerative or traumatic conditions.
Depending on the severity of the problem with the joint and other factors, resection arthroplasty, interpositional arthroplasty or total joint arthroplasty may be performed.
In resection arthroplasty, the orthopaedic surgeon removes a minimal amount of tissue surrounding the joint in an attempt to restore joint function. This may be successful as a first surgical treatment or interpositional arthroplasty can be done. During interpositional arthroplasty the joint is surgically reshaped and, to provide better contact between the sides of the joint, a material (such as metal, plastic, ceramic or the patient’s own soft tissue) is positioned at the site where the joint articulates.
Total joint arthroplasty is a surgical procedure that replaces or treats both sides of the joint articulation or the total joint. Hemi-arthroplasty is performed to treat a problem with just one side of a joint. Total joint arthroplasty is typically indicated after a conservative, nonoperative course of therapy has failed.
During total joint arthroplasty, the orthopaedic surgeon uses special instruments to remove damaged portions of the joint and replaces them with artificial components. Stems or pegs on the artificial joint components are fitted into the healthy, remaining part of the bone and kept in place with either bone cement or a special coating on the implant that fosters new bone growth in the area. The fixation method used is based on the patient’s age, bone quality and activity level.
Resurfacing arthroplasty replaces or “resurfaces” only the damaged, extreme end of a joint. The goal of resurfacing is to maintain the remainder of the joint and preserve more of the patients own anatomy.
Orthopaedic surgeons have several types of arthroplasty implants or prostheses to choose from to replace or resurface the joint. Different implants and materials have distinct success rates in clinical use.
Following arthroplasty surgery, patients should expect to undergo a rest and rehabilitation period. Then, under their doctor’s direction, they will gradually begin to regain strength and flexibility in the area surrounding the replaced joint, and re-learn how to use the joint.
Orthopaedic surgeons follow up with their patients at regular intervals after surgery with a physical examination and X-rays or other types of imaging. This process helps ensure the arthroplasty procedure and devices are performing as expected.
Occasionally, patients develop complications following total joint arthroplasty, such as an infection or a loose implant, and the prosthesis or device needs to be removed along with the surrounding damaged or infected tissues. The procedure to implant a new arthroplasty device in place of the original or primary component is called a revision arthroplasty.