Advances in Hand and Elbow Surgery
The latest and most advanced techniques in hand and elbow surgery were presented at a medical conference held in Miami on March 19th and 20th. Seventeen experts offered presentations at the event, three of whom were local and the rest came from different places in the United States and the world, including Hong Kong, Paris and Buenos Aires.
"The conference is the only existing forum specifically devoted to upper extremity joint reconstruction. This includes advances in minimally invasive surgery. Currently, it is possible to use arthroscopy, not only for knees and shoulders, as we've done in the past, but also a miniature camera can be inserted in the wrist, or at the base of the thumb, allowing physicians to offer very specific diagnoses," said Dr. Alejandro Badia, an orthopedic surgeon -whose subspecialty is surgery of the hand and the upper extremity, and who is in charge of organizing the event. He is affiliated with Kendall Regional Medical Center of Miami.
Dr. Badia regreted that too much money is spent in the United States on MRIs, which in many cases do not shed light on what is causing the patient's pain, and he added, "It is best to perform minimally invasive surgery on an outpatient basis, using local anesthesia and a minute camera to view the joint, determine exactly what the problem is, and solve it all at once."
The main disease that causes pain and deformation of the hands is arthritis.
According to official statistics reported by the United States Center for Disease Control and Prevention (CDC), one in five adults suffers from arthritis. The impact of this disease is significant. Approximately 38 percent (16 million) of the more than 42 million patients with doctor-diagnosed arthritis report arthritis-attributable limitations to their normal activities, and about 31 percent (over 8 million) report arthritis-attributable work limitation. This disease equally affects all ethnic groups, but it is more common in women than in men.
Arthroscopic surgical treatment of hand and elbow arthritis, by means of a special instrument measuring 1.9 mm or 2.7 mm in diameter, is a new technique, and for this reason it was the conference's main theme.
"Many surgeons do not use these new techniques because they are not aware of them. What we are now doing for the wrist is similar to what was done in knee surgery thirty or forty years ago," Dr. Badia explained.
One example of the available new options is minimally invasive knuckle surgery.
"Some of these topics are new even for specialists; for example, metacarpal arthroscopy, something in which I am particularly interested. There is no one performing this type of procedure in Latin America. I know this because I travel throughout the area speaking at conferences, and we have surgeons who come here from different countries for training. The conference makes it possible to develop these concepts, because even among specialists, there are many who do not understand them well and, therefore, choose not to use them, making it impossible for the public in general to benefit from the progress made in this field," Dr. Badía said.
One of the topics generating great interest at this event was that of advances made in prostheses for elbow replacement. Dr. Mark Baratz, from Pittsburg, lectured on this subject. These prostheses are new and are used for treating arthritis which causes pain and deformity. "The first hip replacements were performed in England forty years ago, and everybody knows about them; however, elbow prostheses are not only unknown to the public in general, but also many colleagues are not aware of their existence," Dr. Badia added.
Another topic of particular interest was the use of arthroscopy on the ulnar side of the wrist (the external side where a small bone protrudes). There is cartilage in that area which can now be repaired in a less invasive way. Dr. Pak Cheong Ho, from Hong Kong, was in charge of presenting this topic.
Minimally invasive treatment of synovial cysts of the wrist -that is, without making an ugly hand incision and with the added benefit of speedier recovery- was also dealt with at the conference. Dr. Carlos Zaidenberg, from Buenos Aires, was the one making this presentation.
At this conference, Dr. Badia presented advances made in surgery to the base of the thumb. These include the use of prostheses to replace that part of the human anatomy, in patients who have arthritis, a very common condition. This implant is very similar to the one used for hips. It consists of a metal head or ball that articulates in a plastic cavity.
Surgical demonstrations were performed illustrating various approaches to elbow, wrist and hand reconstruction. Of particular interest was an elbow arthroscopy case which was transmitted live to the hotel ballroom for open discussion with Dr. Badia and participants.
Ninety doctors took part in Miami's first hand symposium. Over 200 participated in this second year. Not only hand surgeons were attending the conference, but also orthopedic surgeons in general, physical and occupational therapists, hand therapists, medical students and residents. The Web page for the conference was www.miamihandcourse.com.
By Alfredo Arango