Orthopedic Surgery — Town Hospital

Orthopedic surgery at Town Hospital: an overview

The orthopedic surgery department at Town Hospital in the Fifth Settlement, New Cairo, diagnoses and treats injuries and conditions of the bones, joints and ligaments, in both adults and children. Its work covers fracture treatment and surgical fixation, Ilizarov external fixation, knee arthroscopy, ACL reconstruction, knee and hip replacement, shoulder and hand surgery, and children's orthopedics. For most patients, care starts with a clinic visit to an orthopedic doctor to find the cause of the pain or injury, followed by a discussion of the right treatment, whether non-surgical or surgical.

The department works within one system that brings together emergency care, imaging, the laboratory, operating theatres and intensive care, so a patient can be followed from diagnosis through treatment and follow-up in one place. The emergency department is open 24 hours a day, and an orthopedic surgeon is on call day and night for fractures and urgent injuries. The hospital also works with 41 contracted insurance and healthcare payers.

What the orthopedic surgery department treats

Below are the main conditions and procedures the department handles. The right treatment for each patient is decided by the surgeon after examination, a review of the imaging and a discussion of the options with the patient.

Fractures and fracture fixation

Not every fracture needs surgery. Many stable, undisplaced fractures heal in a cast or splint, with follow-up X-rays. Fractures that are displaced or unstable, or that extend into a joint surface, may need surgery to put the bone back in position and hold it with plates and screws, or with an intramedullary nail placed inside the bone. An open fracture, where the bone breaks through the skin or there is a wound over the break, is an emergency and usually needs urgent surgical cleaning of the wound before the fracture is fixed. The surgeon chooses the method based on the type and location of the fracture and the patient's age and general health.

Ilizarov external fixation

The Ilizarov frame is an external fixator: metal rings around the limb, connected to the bone by fine wires or pins, that hold a fracture steady from outside the skin. It is generally used for some complex or open fractures with wounds, and for some fractures that are slow to heal or have not healed. While the frame is on, the pin and wire sites need regular care, and the patient is followed closely by the surgeon until the frame is removed once the bone has healed. Redness, discharge or increasing pain around the pins or wires, or a fever, should be reported to the surgeon without delay.

Knee arthroscopy and meniscus tears

In knee arthroscopy, the surgeon passes a camera and fine instruments through small openings to look inside the joint and treat some injuries. One of its most common uses is a torn meniscus, which may be repaired or trimmed, depending on where the tear is and how large it is. Not every tear needs arthroscopy; some small tears improve with conservative treatment. Read more about meniscus injuries of the knee.

ACL injuries and reconstruction

A torn anterior cruciate ligament (ACL) is one of the most common sports injuries. It often starts with a pop, followed by swelling and a feeling that the knee is giving way. Not every tear needs surgery: the decision depends on how complete the tear is, how active you are, and whether the cartilage is also injured. When surgery is recommended, the ligament is rebuilt using a replacement tendon (a graft), usually by arthroscopy, once the swelling has settled and the knee has regained some movement. Details in Cruciate Ligament Injury: Symptoms, Causes and Treatment.

Knee osteoarthritis and knee replacement

Knee osteoarthritis begins with gradual wear of the cartilage that lines the joint. In the early stages, symptoms often improve with weight control, muscle-strengthening exercises and medication chosen by the doctor. When the wear is advanced and pain keeps limiting walking and sleep despite an adequate period of conservative treatment, knee replacement may be considered: the worn joint surfaces are replaced with an artificial joint. The surgeon discusses the expected benefits and the possible risks with you before any decision. Read Knee Osteoarthritis: Symptoms, Grades, and Treatment Options.

Hip osteoarthritis and hip replacement

Hip joint pain is usually felt at the top of the thigh or in the groin, and it is easily mistaken for back or knee pain. Treatment of hip osteoarthritis usually starts with non-surgical steps, while hip replacement may be considered in advanced cases that seriously affect movement and quality of life. Joint replacement may also be used for some fractures of the neck of the femur in older people; the surgeon chooses the most suitable option based on the type of fracture and the patient's condition. More in Hip Osteoarthritis: Causes, Symptoms, and Treatment.

Shoulder surgery

Shoulder pain has many causes, including tendon inflammation and tears, a stiff (frozen) shoulder, dislocation and fractures, and many of them improve without surgery. Some cases may need an operation, such as certain shoulder fractures, repeated dislocation, and tendon tears that do not respond to conservative treatment. The surgeon decides whether surgery is needed, and which kind, after examination and imaging, and may request an MRI to assess the tendons. A freshly dislocated shoulder needs the emergency department. Sudden shoulder pain, especially on the left, that comes with chest pain or pressure, shortness of breath or sweating may come from the heart and needs an ambulance (123) or the emergency department straight away.

Hand surgery

Hand surgery calls for particular precision, because any loss of movement in the hand directly affects daily life. Hand surgery includes fixing some fractures of the hand and wrist, repairing some tendon injuries, and treating other conditions that limit finger movement. Any cut to the hand that leaves you unable to bend or straighten a finger, or with a numb, cold or pale finger, or bleeding that does not stop with pressure, and any bite wound or crush injury to the hand, needs urgent assessment in the emergency department, because delay in treating these injuries can affect how well movement returns.

Children's orthopedics

Children's bones differ from adults': they are still growing and have growth plates near their ends, so fractures in children are assessed and treated differently. Conditions commonly assessed in children's orthopedics include fractures and play injuries, limping or a change in the way a child walks, and some congenital conditions of the hip or foot. The doctor takes the child's age and stage of growth into account when planning treatment, and the family is involved in every decision. A child who will not stand on or move a limb, or who limps with a fever, severe pain, swelling or redness, should be taken to the emergency department straight away, even if there was no obvious injury.

Osteoporosis and related fractures

Osteoporosis is a loss of bone density that makes bones more likely to break, even after a minor fall, and it usually causes no symptoms until the first fracture. It is usually diagnosed with a bone-density test. The orthopedic surgeon treats the fractures it causes, such as wrist and hip fractures, and assesses the patient's risk factors; putting together a prevention and treatment plan may involve other specialties. Read Osteoporosis: Symptoms, Causes, Prevention, and Treatment.

Slipped discs and spine problems

At Town Hospital, slipped (herniated) discs in the back and neck and spine surgery are handled by the neurosurgery department. If back or neck pain spreads into an arm or leg, or comes with numbness or weakness, the right specialty to assess it is the neurosurgery department. Back pain with difficulty passing urine or being unable to pass it, loss of bladder or bowel control, numbness around the groin and buttocks, increasing weakness in one or both legs, or a fever, and back or neck pain that starts after an accident or a hard fall, need emergency care straight away.

When is orthopedic surgery needed, and when is it not?

Not every bone or joint problem needs an operation, and non-surgical treatment comes first in many cases, including:

• Stable, undisplaced fractures that can be treated in a cast or splint.
• Early osteoarthritis of the knee or hip.
• Some small meniscus tears and partial ligament tears.
• Many causes of shoulder pain, such as tendon inflammation and a frozen shoulder.

On the other hand, surgery may be the better option for a fracture that is displaced, unstable or extends into a joint, an open fracture, a knee that repeatedly locks (suddenly gets stuck bent and will not straighten), an unstable knee after an ACL tear in people who play sport or do physical work, or advanced osteoarthritis that has not responded to treatment. The following signs need emergency care straight away:

• An obvious deformity of a limb, bone showing through the skin, or a wound over a possible fracture.
• Being unable to move a limb or put weight on it after an injury, or hip pain with inability to walk after a fall, especially in older people.
• A limb that is cold, pale, bluish or numb after an injury.
• Severe pain that keeps getting worse, with swelling and tightness out of proportion to the injury, especially after a cast has been applied.
• A swollen, hot, red joint, especially with a fever or feeling unwell, or a child who will not stand on or move a limb, or who limps with a fever, severe pain or swelling.
• After orthopedic surgery: pain and swelling in the calf, sudden shortness of breath or chest pain, or a red wound with discharge and a fever.

After a serious accident, or if a neck or back injury is suspected, call an ambulance on 123 and do not move the injured person unless they are in immediate danger. Being able to move a limb does not rule out a fracture; only an examination and imaging can settle that.

Your care, step by step: from clinic visit to follow-up

• Clinic visit: the doctor asks about your symptoms and how any injury happened, examines the joint or limb, and reviews any previous scans or reports. Clinic times are listed in the published clinic schedule.
• Imaging: the hospital has a 128-slice CT scanner and a Philips 3 Tesla MRI on site, and radiology and the laboratory run 24 hours a day. CT helps assess complex fractures, while MRI shows injuries to ligaments, cartilage and tendons.
• Decision: the surgeon explains the options, surgical and non-surgical, with the benefits, risks and expected recovery time of each, to you and your family before a decision is made.
• Surgery: operations take place in the hospital's operating theatres after the necessary pre-operative assessment; the surgeon chooses the fixation method, the type of artificial joint or the use of arthroscopy according to the case.
• Intensive care: many orthopedic patients do not need intensive care, but some may after major surgery, or if they are older with long-term health conditions; the medical team decides case by case.
• Follow-up: the surgeon checks how the wound and bone are healing, with X-rays when needed, and tells you when you can start putting weight on the limb, which activities are allowed and which exercises suit each stage.

Emergency care and an on-call orthopedic surgeon, 24/7

Town Hospital's emergency department is open 24 hours a day, an orthopedic surgeon is on call day and night, and imaging and the laboratory never close. This allows prompt care for fractures, dislocations, road and sports injuries, and hip fractures in older people, where treatment should usually not be delayed.

Before you see an orthopedic doctor

Many people look for an orthopedic doctor in New Cairo close to home, but what makes the first visit useful is clear information and a careful examination. The list of doctors on this page shows the hospital's orthopedic doctors and their specialties. These points will help you get the most from your visit:

• Bring previous X-rays, scans and reports, and a list of the medicines you take, especially blood thinners.
• Describe when the pain started, how any injury happened, and what makes the pain better or worse.
• Ask about the diagnosis, about non-surgical options before surgical ones, and about the expected recovery time.
• If surgery is suggested, ask what it aims to achieve, what the possible risks are, and what may happen if it is postponed.
• For major surgery, and for older people or those with long-term conditions, it helps to have the operation where emergency care, imaging and intensive care are available if needed.