The Reconstructive Orthopedic Center (ROC) of Houston evaluates all presenting conditions with a comprehensive approach to diagnosis followed by patient education to make sure the best treatment option for each patient is chosen. Having multiple fellowship trained surgeons in different orthopedic subspecialties from renowned centers throughout the United States, allows a patient to select the surgeon best suited for their condition in one location. Aware that making the correct diagnosis is paramount to delivering the correct treatment; our initial focus emphasizes a thorough history, physical exam and appropriate diagnostic testing followed by thorough information analysis and timely treatment decisions. Timely treatment is then initiated, knowing that a delay in treatment can cause treatment decisions to change and often be more complex because the bodyâ€™s healing mechanisms cannot be put on hold.
Triage Treatment Categories
Includes emergency, urgent and elective conditions. These categories are distinguished according to the timing treatment should be rendered and not whether treatment is necessary.
- Emergency Conditions must be performed within 24 hours of injury to avoid an increase in the complication rate or risk of failure.
- Urgent Conditions are usually done within a 1-2 week period after injury, of which broken bones (fractures), tendon and muscle lacerations are an example.
- Elective Conditions are treated at a convenient time that takes into consideration the patient’s life activities, social support structure and financial considerations.
At ROC, our treatment results are carefully documented, measured, and monitored in an electronic medical records system with the goal of creating the most reliable and predictable treatment outcomes in each and every patient. Non-operative treatment in all conditions is always chosen first when appropriate and includes the use of dietary supplements including Chondroitin sulfate, ergonomic analysis & education, medications, anti-inflammatory creams, splints, therapy, and injections (steroids , Synovist ) used to confirm a diagnosis in some instances, and as definitive treatment in others. Alternative treatment options including ultrasound, Iontophoresis, electrical stimulation, chiropractic care and acupuncture are also considered when appropriate.
When surgery is the best choice, the consideration of surgical risk, complication rate and time to obtain maximum medical improvement after surgery is calculated and explained. In planning for surgery, four parameters are considered to assist the patient in determining the prognosis and self care needs after surgery:
- Severity of the injury or pathology
- The patient’s physiological age (Age + General Medical Condition)
- Patient outcome expectations compared to what can be delivered by the surgeon
- The optimum timing for surgical treatment. The following Chart is an eight step approach taken at ROC to assist patients in deciding when an elective surgical procedure is indicated.
Once surgery is selected, we divide the surgical treatment options at our disposal into seven Categories all beginning with the letter:
Repair is the surgical reapproximation of injured tissue back to its pre-injury condition. Injured tissues include lacerated muscles, tendons, ligaments, nerves, arteries, or broken bones (Fractures). This procedure category is usually done on an urgent basis within one to two weeks after injury because further delay will not allow for a primary repair and converts a primary repair into a reconstruction which is always more complex and often carries a higher complication rate. Tissue repair for nerves, arteries and hand injuries requires specialized training in hand and microsurgery for the best outcome.
Release is the decompression or release of tight compartments surrounding nerves, arteries, tendons, and stiff joints. Tight muscle compartments develop from severe swelling following major limb trauma that may or may not involve broken bones. Nerve conditions requiring a release include carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, Wartenberg’s syndrome, pronator syndrome, suprascapular nerve compression, quadrangular space syndrome and thoracic outlet compression. Release of tight tissue compartments called a Compartment syndrome is often required after a major extremity injury. The release is done to prevent the loss of blood supply to the injured and swollen limb. Releases in most cases are done on an elective basis except when the injury affects the blood supply or produces intolerable pain, as occurs in compartment syndrome. In this situation, treatment is done as an emergency. An example of a nerve compression is carpal tunnel syndrome. In this condition, the median nerve is slowly over time compressed at the level of the wrist by swelling of the surrounding tendon linings. When conservative measures of splinting, ergonomic changes, steroid injections and vitamin B6 does not improve the symptoms, a carpal tunnel release is indicated. A Carpal tunnel release can be done through an endoscopic approach which uses a tiny incision at the level of the wrist or through the use of standard open technique when indicated in special circumstances, since endoscopic carpal tunnel release is not always the best option in all patients with carpal tunnel syndrome.
Replant is the reattachment of a severed body part back to its original normal location. We replant fingers, arms or any severed body part with the use of microsurgical techniques, meaning it requires the use of an operating room microscope. Replant procedures are always done as an emergency, typically within hours of suffering an amputation. After an amputation occurs, the severed body part must be wrapped in sterile gauze and placed in zip lock plastic bag which is then placed in an ice slush container, like a cooler while transporting it to ROC for replantation.
A Resection is the removal of tissue or a body part when that tissue or body part has no possibility of useful function, even if reconstruction techniques are used. Removal of a mangled finger is called a revision digital amputation. Reasons for a resection include a mangled limb, gangrene, or a lifeless limb secondary to complete loss of nerve connections. The latter condition can occur after a motor cycle accident resulting in the ripping of the nerves from the neck, resulting in a brachial plexus injury. Resection procedures are commonly performed electively in most cases.
A Resurfacing procedure is the most conservative type of joint replacement (arthroplasty) involving only the replacement of the actual cartilage layer of a joint. It is performed with the use of transferred interposed donor tissue or with the use of a prosthesis made of metal or other type of artificial material (i.e. pyro-carbon). In this procedure, the cartilage surface of a joint is replaced with the prosthesis or interposed tissue without the removal of the supporting bone beneath it. This procedure is commonly done for arthritic conditions of all types and is performed on an elective basis.
A Replacement, also called an arthroplasty and involves the partial or complete replacement of a joint surface by a prosthesis. The replacement can involve one side or both sides of a joint surface and often depend on the cause of the arthritis. Replacements commonly take away more bone stock than a resurfacing procedure and are performed for various types of joint arthritis. In some instances, the arthritis is accompanied by lack of muscle-tendon function and special prostheses have been developed that address this special circumstance. In the shoulder, this type of prosthesis is called reverse shoulder prosthesis and it uses the deltoid instead of the rotator cuff muscles to move the shoulder joint. Replacements are done electively.
Reconstruction, the most complex surgical treatment category, and it is what ROC, specializes in and where our name is derived. It involves the creation of alternative anatomic parts that have the intent of recreating normal anatomy and function in injuries that are more severe and cannot be treated by repair alone. Reconstructive options include the use of transferred tissues including ligament, bone, nerve, artery, skin or other tissues, with our without their inherent blood supply. When transferred tissues come from a donor, it is called an allograft, and when it comes from the same person from a different body part, it is called an autograft. Reconstructive procedures include the use of all of the other surgical treatment categories when necessary to obtain the best possible outcome. These procedures are normally performed electively and planning is critical for a good surgical outcome and for postoperative therapy.
To further understand the conditions treated at ROC, please select the body part and then the condition that you want to learn more about. Each condition treated is broken down into normal anatomy, Pathology (Abnormal Anatomy) and Treatment.