Advanced Medical Techniques

Scientists at POSTECH University in South Korea have developed an injectable gel capable of naturally regenerating bone. Made from algae extracts and mussel proteins, the material hardens when exposed to regular light, creating a solid base that integrates with existing bone. The body gradually absorbs the gel as bone cells grow into it, allowing damaged areas to be restored without the need for invasive surgeries or bone grafts. Laboratory tests have been successful, paving the way for faster, safer, and less painful treatments for people with bone injuries or diseases.

The Ilizarov Apparatus: A Revolutionary Medical Innovation Developed in the 1950s by Dr. Gavriil Ilizarov, this external fixation device has transformed orthopedic surgery worldwide. The Ilizarov apparatus is a system of metal rings, rods, and fine wires that pass through bone, forming a stable external frame. It allows surgeons to gradually realign bones, correct deformities, and even lengthen limbs. Initially designed to treat complex fractures, it is now widely used for: Correcting bone deformities Limb lengthening Healing poorly healed fractures (nonunions) Treating severe bone infections The underlying principle is "distraction osteogenesis" — slowly separating bone segments to stimulate the natural growth of new bone tissue. Interestingly, the Ilizarov apparatus is also used in cosmetic surgeries, particularly for limb lengthening procedures. In countries like Russia, India, China, Turkey, and the United States, some individuals choose it for cosmetic height enhancement — a procedure that can add several centimeters to a person's stature. What makes the Ilizarov method remarkable is not just its mechanical precision, but its ability to unlock the body's regenerative potential — restoring mobility, correcting disabilities, and even changing lives in unexpected ways. #MedicalInnovation #Orthopedics #Healthcare #Ilizarov #Bones #Surgery #RegenerativeMedicine #Medicine #CosmeticSurgery #FollowMe #NowYouKnow

A 34 year old male patient presented to my office for a second opinion after undergoing a TLIF at an outside facility one year ago. He had been told that “nothing was wrong,” but his pain never improved. After listening to his concerns, we obtained new imaging studies, which showed several significant issues. There was a pseudoarthrosis—meaning the bones never fused—and the TLIF cage had migrated (or was inadvertently placed) into the spinal canal. The pedicle screws were also malpositioned, including screws placed into the disc space and neural foramen. These findings explained his continued pain and neurologic symptoms. An EMG done preoperatively revealed an acute L5 radiculopathy. Given the severity and location of the problems, I offered surgical intervention. We approached this using a “back–front–back” reconstruction. We revised the screws, removed the migrated TLIF cage through an anterior approach, and performed an ALIF to restore alignment and stability. There was no osseous union at the prior level, confirming that the original fusion never healed. The goal of the reconstruction was to decompress the nerves, correct the hardware issues, restore disc height, and finally achieve a solid fusion so he could return to normal quality of life. ALIF procedures have several advantages over TLIFs in select patients. ALIFs allow for more complete disc space preparation, placement of larger interbody cages, and better restoration of lumbar lordosis and foraminal height. The anterior approach also avoids working around the nerves, reducing the risk of nerve retraction injury compared to a posterior approach. This often allows for improved fusion rates and more predictable alignment correction. TLIFs can be excellent procedures when performed accurately, but they also carry potential downsides. Because the surgery is done through the back, the working space is narrow, and the nerves must be retracted to place the cage. Improper visualization can lead to complications such as malpositioned pedicle screws, cages entering the canal, violation of the foramen or disc space, and incomplete disc preparation that increases the risk of pseudoarthrosis. These complications are exactly how this patient presented—persistent symptoms, hardware in the wrong place, and a fusion that never healed. This case is a reminder that persistent pain after spine surgery should never be ignored. A second opinion can be critical, especially when symptoms don’t match what a patient is being told. As surgeons, our job is not just to operate—it is to listen, evaluate carefully, and help patients understand all their options so they can make informed decisions about their spine health. www.antoniowebbmd.com

Lateral tibial plateau fracture with severe depression in a 53 year old. I find these cases very gratifying to fix, because you take such a bad deformity and can make it much better. These seem intimidating given the amount of depression. But here’s 10 steps and tips and tricks I’ve learned through the years that can hopefully be helpful: 1- Anterolateral approach. Make a submeniscal arthrotomy and look for the lateral meniscus. If you don’t see the white meniscus then it’s probably stuck in the depressed segment. 2- Put horizontal mattress sutures through the meniscus. You’ll pass them through the capsule at the end of the case. 3- Open the lateral plateau fragment so you can see the depressed articular surface. If the lateral plateau isn’t broken create an osteotomy and book it open so you can see inside. 4- Once you see the articular fragments there’s usually metaphyseal bone attached to it. Use an osteotome to mobilize the articular fragment and elevate it. 5- Elevate the fragments as high as you can go, until it hits the meniscus. Then secure it with a k-wire. You can see the reduction directly at the joint level. 6- Use calcium phosphate cement in the void to support the elevated fragments. (You could use bone graft or calcium sulphate, but studies show calcium phosphate is superior) 7- Close the lateral plateau fragment, and secure with k-wire. 8- Put a plate on and fill in with screws. I personally use non locking screws for these. This plate has cancellous screws that really help proximally compress the plate down and gives great purchase. Don’t forget to use a kickstand screw. 9- Repair the meniscus. I use a free curved needle and put the sutures in the meniscus through the capsule and tighten down. 10- Early motion!! I allow immediate range of motion post-op, and WBAT at 6 weeks post-op Here it is 6 weeks post-op with 0-90 deg motion. Used with patient permission. #orthotrauma #orthopaedics #orthopedics #lateralplateau #tibialplateau

🔬 New publication in Arthroscopy Techniques 🎯 The Quad 2.0 Technique: A Single Rectus Femoris Autograft Solution for Combined ACL and Double-Bundle ALL Reconstruction Proud to share our latest surgical innovation: the Quad 2.0 technique, using a single rectus femoris tendon autograft for anatomical reconstruction of both the anterior cruciate ligament (ACL) and the anterolateral ligament (ALL) — particularly suited for revision ACL surgeries. 💡 Why is it a breakthrough? • Avoids additional femoral/tibial tunnels for ALL • Preserves hamstring tendons • Reduces donor site morbidity and anterior knee pain • Effective in multiligament knee injuries • Optimizes valgus stability • Allograft-free revision strategy A precise, reproducible, and minimally invasive technique for challenging ACL cases. 📎 Open access article: https://lnkd.in/e7s98K_N With: Victor Sonnery-Cottet, Dany Mouarbes Ali Alayane MD, FEBOT ,Regis Pailhe #ACLreconstruction #Quad20 #ALLreconstruction #KneeSurgery #Orthopedics #SportsMedicine #Innovation #CHUToulouse #Cavaignac #Arthroscopy

As our surgical techniques evolve, long spinal fusions, especially those extending to the sacrum/pelvis for adult spinal deformity (ASD), remain biomechanically demanding and prone to complications like rod fractures and pseudarthrosis, with complication rates reaching as high as 30%. These patients undergoing long fusions experience high mechanical loads at the lumbosacral junction (LSJ), and the existing literature highlights that this is a significant risk of implant failure. Multi-rod constructs (MRCs) have emerged as a solution, offering increased stability, reduced rod strain, and improved fusion rates, initially shown in cases involving three-column osteotomies, which we first published over 10 years ago (https://lnkd.in/gwSW8JR5). Yet with MRCs, defined as 3 or more rods, the field lacks data comparing the differences within MRCs across the LSJ, specifically three-rod (3RC) vs four-rod constructs (4RC) in long ASD fusions, and their impact on rod failure and the need for revision surgery. In our recently published study in Clinical Spine Surgery, we analyzed 145 ASD patients who underwent long fusions to the sacrum /pelvis (3RC=57, 4RC=88) with ≥2 years follow-up. After adjusting for BMI, surgical complexity, and alignment changes, we found that 4RCs were associated with nearly 5x lower odds of rod fracture and while they experienced a decreased rate of revision due to pseudarthrosis, the rates of revision surgery were not significantly different between the groups. Our findings suggest that 4RCs may offer biomechanical protection against rod failure in these high-risk ASD surgeries, especially in cases involving complex osteotomies and long-segment fusions to the sacrum/pelvis . While revision rates remained similar, improved structural integrity with 4RCs may reduce complication rates over the long term. In addition to the presented 4RCs, we have also modified them to be joined to 4 pelvic screw constructs, which has become our new standard for over 3 years now for lumbar and LSJ construct fixation and has shown to be effective against implant-related reoperations and pelvic screw breakages within the 2-year postoperative period (https://lnkd.in/gz4JXWt6). Link to the full study below: https://lnkd.in/gqn9XvwQ Fthi M. Hassan, MPH Sarthak Mohanty Erik Lewerenz Christopher Mikhail Stephen R. Stephan, MD Joshua Bakhsheshian MD MHA Nathan J. Lee, MD Justin L. Reyes Joseph Lombardi Zeeshan Sardar Ron Lehman, MD Columbia University Irving Medical Center Columbia Orthopedics

Microbial trojan horses: disrupting the tumor microenvironment Solid #tumors are complex tissues gone wrong. Many different components comprises the tumor microenvironment. The extracellular #matrix (the fibrotic material provides the structural integrity to any #tissue) of tumor is heavily cross-linked than in normal tissues, making it very hard to penetrate, even for #immune cells. Solid tumor’s physical barriers and the way that it can biochemically affect the behavior of other cells makes them difficult to target with #immunotherapies. Non the less, #solidtumors are excellent sites for bacteria, as the tumor microenvironment is nutrient rich, heavily hypoxic, acidic and free from immune cells. However, in return, #bacteria offer the potential to be effective vessels for #therapeutic purposes due to their small size, mobility and their desire to live in tumors. Bacteria can be #engineered to produce and release an #enzymatic payload once they’re within a solid tumor, which breaks down some of the fibrotic components in the tumor’s extracellular matrix. By designing and constructing a #microscopic trojan horse that can naturally infiltrate tumor sites and break down the #extracellular matrix, the physical barrier that blocks #drug efficacy in solid tumors can be overcome. There are a number of therapeutics either commercially available or in advanced development stages that have curative potential, but don’t work in solid tumors because of these barriers to #infiltration. Bacteria can be designed with unique #genetic sequences that code for promoters that are active in the tumor. The tumor-induced activation of synthetic #biosensors then can trigger the production of an engineered #payload. Bacteria can express #enzymes that precisely modify specific components of the extracellular matrix, reducing its stiffness and increasing tumor irrigation. These payloads can be linked with secretion systems to ensure that they are released into the extracellular space of the tumor, targeting the extracellular matrix directly. Recent research shows that #synthetic biology platform can enable full responses in mouse models of breast cancer that previously did not respond to immunotherapies, by sensitizing them with bacterial products prior to drug delivery. Researcher found that remodeling the tumor with synthetic products enables full remission in response to immunotherapy. The animal experiment resulted in 100% survival. References: [1] https://lnkd.in/ecwAqDtF; [2] https://lnkd.in/eVNK6GwW [3] https://lnkd.in/ewAQY7V2; [4] https://lnkd.in/e238jZwm

The Ilizarov method remains one of the most advanced and effective #orthopedic techniques for #bone lengthening and deformity correction. Originally developed by Dr. Gavriil Ilizarov, this circular external fixation system uses the principle of distraction osteogenesis—stimulating new bone growth through gradual, controlled tension. Whether treating congenital limb length discrepancies, post-traumatic deformities, or complex non-unions, the Ilizarov technique provides unmatched precision in bone regeneration and alignment. Its success lies in biomechanics, biology, and patient-specific customization—an intersection where orthopedic science meets surgical artistry. #medicaldevices #healthcareleaders

Interested in a reproducible, minimally invasive, partial-thickness Quad Tendon autograft harvest? Check out this revolutionary technique developed by Trey Remaley MD and Kenton Panas MD in Tampa. https://lnkd.in/epsMgBDE In this technique, Dr. Remaley describes identifying, dissecting, and harvesting the rectus femoris tendon. The proximal-to-distal harvest approach seems a bit counter-intuitive, however it offers several distinct advantages, including: ‣ Reducing the risk of an undersized graft. No tapering or thinning as seen occasionally with distal-to-proximal harvest. ‣ Maintains a partial thickness graft harvest for the entire length by harvesting only the rectus tendon. ‣ Minimizes the risk of an inadvertent arthrotomy. ‣ Minimizes the bleeding risk that can occur working distal to proximal. You can also learn more about this technique from their technical note in Arthroscopy Journals: https://lnkd.in/ewt68mwQ AOSSM Journals American Academy of Orthopaedic Surgeons (AAOS) American Orthopaedic Society for Sports Medicine Arthroscopy Association of North America The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) ESSKA - European Society of Sports Traumatology, Knee Surgery & Arthroscopy Florida Orthopaedic Institute USF Health HCA Healthcare HCA Florida Healthcare #aclinjury #acltear #aclrehab #quadacl #qtacl #quadtendonacl #rectusfemoris #sportsmed #sportsmedicine #kneeinjury #orthopedics

Scoliosis: A Complete Guide to Causes, Diagnosis & Treatment Options (Including Bracing, Physiotherapy Techniques & Surgical Interventions) 1. Definition  - Abnormal lateral curvature of the spine (≥10° Cobb angle) in the coronal plane, often with vertebral rotation.    - Diagnosed in childhood/adolescence; involves 3 planes: coronal, sagittal, axial.  2. Clinical Presentation   - Uneven shoulders/hips, rib prominence, asymmetrical waist.    - Possible back pain, reduced pulmonary function (severe cases).  3. Epidemiology    - Affects 2-3% of the population.    - Females 8x more likely to progress to severe curves.  4. Etiology    - Idiopathic (80% cases): Infantile, juvenile, adolescent subtypes.    - Congenital: Vertebral malformations.    - Neuromuscular: Secondary to conditions like cerebral palsy.  5. Diagnosis   - Physical exams: Adam’s Forward Bend Test.    - Imaging: X-ray (Cobb angle measurement), MRI/CT for complex cases.  6. Management   - Conservative:    - Bracing (e.g., Milwaukee brace) for curves 20-40°; worn 23 hours/day.     - Physiotherapy:   - Schroth Method: 3D postural correction, breathing exercises.   - SEAS Exercises: Active self-correction and stabilization.   - Core strengthening, flexibility training.   - Surgical: Spinal fusion for curves >45-50° or rapid progression.  7. Milwaukee Brace   - Components: Pelvic girdle, neck ring, thoracic pads, adjustable metal bars.    - Indication: Curves 20-40° in growing children/adolescents.    - Protocol: 23 hours/day wear; gradual weaning post-skeletal maturity.    - Physiotherapy:     - Exercises within brace (stretching, core stability).     - Posture training, psychological support.  8. Key Notes   - Cobb Angle: Determines severity; ≥10° for diagnosis.    - Bracing Efficacy: Reduces progression risk by 70-90% if compliant.    - Exercise Focus: 3D correction, muscle balance, pulmonary function.  Physiotherapy Highlights   - Schroth/SEAS: Customized exercises for derotation and alignment.   - Breathing Techniques: Improve lung capacity in thoracic curves.   - Holistic Approach: Addresses pain, posture, and psychological well-being.  Surgical Intervention - Reserved for severe/progressive cases; spinal fusion most common.   - Growing rods for young children to allow spinal growth.  Prognosis   - Early detection and conservative management improve outcomes.   - Regular monitoring essential during growth spurts.