Doctors rely on cutting-edge tools, techniques to shorten patients' recovery times
Jay Cutler's fractured right thumb has left Bears fans feverishly computing competing timelines: how long it will take the quarterback to heal versus the number of weeks left in the season.
Over the last several decades, doctors and scientists have built an arsenal of cutting-edge tools to help speed recovery time, which could allow a professional quarterback to use his throwing hand just weeks after breaking a thumb.
Over the last several decades, doctors and scientists have built an arsenal of cutting-edge tools to help speed recovery time, which could allow a professional quarterback to use his throwing hand just weeks after breaking a thumb.
Cutler suffered a Bennett's fracture, a break in the metacarpal bone where the thumb meets the wrist, according to an NFL source. He is scheduled to undergo surgery Wednesday morning in Vail, Colo., according to sources.
Exactly what treatment he will get is not known, but doctors have an array of high-tech techniques at their disposal.
Tiny metal screws and molded plates are now able to squeeze and hold tiny bone fragments together. Compresses transmit ultrasonic waves to injured areas, which some think aids in healing. New bone-building protein and plasma treatments also are said to quicken recovery.
"Years ago, this would have been season-ending," said Dr. Neal ElAttrache, an orthopedic surgeon and sports medicine specialist at Kerlan-Jobe Orthopaedic Clinic in Los Angeles who reconstructed the knee ofNew England Patriots quarterback Tom Brady. "Now, they will likely have him moving it within a couple of weeks."
The NFL source who identified Cutler's break as a Bennett's fracture said a four-week recovery might be possible. There are six weeks left in the NFL regular season.
Other orthopedic surgeons, none involved in treating Cutler, said such a break typically takes six to eight weeks to mend.
In decades past it might have taken months to recover from that type of break, ElAttrache said.
Sixty years ago, orthopedics had a reputation for being one of the crudest and most limited of surgical professions. Doctors would immobilize a fracture by wrapping the break in tape, a splint or a cast. For extreme cases, such as a splintered femur, the preferred treatment was traction.
But the field blossomed during the Vietnam War, when doctors started using different limb-salvaging techniques like microsurgery and skeletal fixation. In the 1970s and 1980s, advances in fiber optics popularized arthroscopy, a minimally invasive procedure that allowed doctors to fix damaged tissue.
Each succeeding decade brought further technological leaps, either in detection, through the use of MRIs and CT scans, or in the engineering and manufacturing of screws, plates and other pieces of fracture-stabilizing hardware.
"I don't think it is overly dramatic to say the advances in orthopedics in recent decades have been on par with the introduction of antibiotics to treat bacterial infections," ElAttrache said.
While the technologies have changed, the biology of bone healing remains the same.
When bones fracture, the embedded blood vessels tear, creating a blood clot. That hematoma accumulates specialized cells, which begin to build delicate bridges of cartilage and woven bone between the pieces of broken bone. Eventually that bridge will become as hard as the original bone.
Doctors still use splints, casts and pins, but depending on the type and location of the break, metal screws and plates are also a common option.
Most of that hardware used to be made from stainless steel. Now doctors also use different types of metals, such as titanium, which more closely mimics the rigidity of bone. Doctors also have the choice of using smaller screws, some only 1 millimeter wide, and plates that have been molded to fit specific bones.
For athletes, the tailored fit allows for greater mobility throughout recovery, diminishing rehabilitation time.
"It is only in the last several years that we have had very small, effective screws that are used to fix small hand bones," said Dr. Mark Cohen, director of hand and elbow surgery atRush University Medical Center. "We need these small implants, especially in injuries like Jay Cutler's."
Exactly what treatment he will get is not known, but doctors have an array of high-tech techniques at their disposal.
Tiny metal screws and molded plates are now able to squeeze and hold tiny bone fragments together. Compresses transmit ultrasonic waves to injured areas, which some think aids in healing. New bone-building protein and plasma treatments also are said to quicken recovery.
"Years ago, this would have been season-ending," said Dr. Neal ElAttrache, an orthopedic surgeon and sports medicine specialist at Kerlan-Jobe Orthopaedic Clinic in Los Angeles who reconstructed the knee ofNew England Patriots quarterback Tom Brady. "Now, they will likely have him moving it within a couple of weeks."
The NFL source who identified Cutler's break as a Bennett's fracture said a four-week recovery might be possible. There are six weeks left in the NFL regular season.
Other orthopedic surgeons, none involved in treating Cutler, said such a break typically takes six to eight weeks to mend.
In decades past it might have taken months to recover from that type of break, ElAttrache said.
Sixty years ago, orthopedics had a reputation for being one of the crudest and most limited of surgical professions. Doctors would immobilize a fracture by wrapping the break in tape, a splint or a cast. For extreme cases, such as a splintered femur, the preferred treatment was traction.
But the field blossomed during the Vietnam War, when doctors started using different limb-salvaging techniques like microsurgery and skeletal fixation. In the 1970s and 1980s, advances in fiber optics popularized arthroscopy, a minimally invasive procedure that allowed doctors to fix damaged tissue.
Each succeeding decade brought further technological leaps, either in detection, through the use of MRIs and CT scans, or in the engineering and manufacturing of screws, plates and other pieces of fracture-stabilizing hardware.
"I don't think it is overly dramatic to say the advances in orthopedics in recent decades have been on par with the introduction of antibiotics to treat bacterial infections," ElAttrache said.
While the technologies have changed, the biology of bone healing remains the same.
When bones fracture, the embedded blood vessels tear, creating a blood clot. That hematoma accumulates specialized cells, which begin to build delicate bridges of cartilage and woven bone between the pieces of broken bone. Eventually that bridge will become as hard as the original bone.
Doctors still use splints, casts and pins, but depending on the type and location of the break, metal screws and plates are also a common option.
Most of that hardware used to be made from stainless steel. Now doctors also use different types of metals, such as titanium, which more closely mimics the rigidity of bone. Doctors also have the choice of using smaller screws, some only 1 millimeter wide, and plates that have been molded to fit specific bones.
For athletes, the tailored fit allows for greater mobility throughout recovery, diminishing rehabilitation time.
"It is only in the last several years that we have had very small, effective screws that are used to fix small hand bones," said Dr. Mark Cohen, director of hand and elbow surgery atRush University Medical Center. "We need these small implants, especially in injuries like Jay Cutler's."
Cohen has treated hand injuries for White Sox and Bulls players. When Carlos Boozer of the Bulls broke his hand before last season, Cohen used the smaller screws and pins to get him back on the court in six weeks.
ElAttrache said it's likely that doctors would use small screws to stabilize Cutler's broken bone. The danger with a Bennett's fracture is the possibility of displacement and arthritisof the thumb, a major concern for a quarterback, ElAttrache said.
ElAttrache said it's likely that doctors would use small screws to stabilize Cutler's broken bone. The danger with a Bennett's fracture is the possibility of displacement and arthritisof the thumb, a major concern for a quarterback, ElAttrache said.
No one can say for sure how long Cutler's recovery will take. Some breaks don't heal correctly or as quickly as might be expected. Some doctors said Cutler's Type 1 diabetes may slow the process.
"Have we gotten people back sooner with these new technologies? Certainly we have," said Dr. Seth Levitz, an orthopedic surgeon specializing in hand and upper-extremity surgery at NorthShore University HealthSystem. "But every fracture, every person, is a bit different."
Some doctors now prescribe such therapies as ultrasound and various cell treatments, which are controversial in the orthopedics community.
Ultrasound is believed to work by mimicking the natural vibrations that course through the body's bones when a person walks. The idea is that those waves can get the bone to remodel and strengthen as they would with exercise, said Dr. Daniel Mass, director of hand and upper-extremity surgery at theUniversity of Chicago Medical Center.
Certain cell treatments, such as therapy using known bone-building proteins, platelets and stem cells have also been used in special circumstances, but are not as well understood.
Golfer Tiger Woods told reporters that he received platelet-rich plasma treatments — intended to boost the body's response to an injury by injecting the site with platelets — following knee surgery.Indianapolis Colts quarterback Peyton Manning also reportedly sought stem cell treatment abroad recently for his injured neck.
Many in the field hope that these treatments will open the door to the next frontier of orthopedic medicine: rebuilding bones without using any foreign materials like metal or plastic.
"For orthopedics, that's the Holy Grail," ElAttrache said. "Getting the body to heal itself."
http://www.chicagotribune.com/news/local/ct-met-bones-20111123,0,2946641.story?page=2
"Have we gotten people back sooner with these new technologies? Certainly we have," said Dr. Seth Levitz, an orthopedic surgeon specializing in hand and upper-extremity surgery at NorthShore University HealthSystem. "But every fracture, every person, is a bit different."
Some doctors now prescribe such therapies as ultrasound and various cell treatments, which are controversial in the orthopedics community.
Ultrasound is believed to work by mimicking the natural vibrations that course through the body's bones when a person walks. The idea is that those waves can get the bone to remodel and strengthen as they would with exercise, said Dr. Daniel Mass, director of hand and upper-extremity surgery at theUniversity of Chicago Medical Center.
Certain cell treatments, such as therapy using known bone-building proteins, platelets and stem cells have also been used in special circumstances, but are not as well understood.
Golfer Tiger Woods told reporters that he received platelet-rich plasma treatments — intended to boost the body's response to an injury by injecting the site with platelets — following knee surgery.Indianapolis Colts quarterback Peyton Manning also reportedly sought stem cell treatment abroad recently for his injured neck.
Many in the field hope that these treatments will open the door to the next frontier of orthopedic medicine: rebuilding bones without using any foreign materials like metal or plastic.
"For orthopedics, that's the Holy Grail," ElAttrache said. "Getting the body to heal itself."
http://www.chicagotribune.com/news/local/ct-met-bones-20111123,0,2946641.story?page=2
