ABOS Names New Executive Director

Nabil Ebraheim
Nabil Ebraheim MD

Serving as the chairman of the Department of Orthopaedic Surgery at the University of Toledo Medical Center, Dr. Nabil Ebraheim possesses more than 30 years of experience in orthopedic medicine. Certified by the American Board of Orthopaedic Surgery (ABOS), Dr. Nabil Ebraheim is licensed to practice in five states.

The ABOS Board of Directors recently announced its selection of Dr. David F. Martin to serve as the organization’s medical director. He had served in the role on an interim basis following the retirement of former director Dr. Shepard R. Hurwitz in early 2016. His service on the ABOS board spans a decade, and he served as president during the 2011-2012 board year.

Dr. Martin currently works at the Wake Forest School of Medicine as an orthopedic surgery professor. He formerly was the director of the school’s sports medicine program as well, and spent 18 years as a team physician for the school’s athletic programs. He is a Johns Hopkins School of Medicine graduate.

What is a Growth Plate and Growth Plate Fracture?

During childhood and adolescence, our bones grow through a process called ossification. During ossification, calcium and phosphate salts are laid down to replace cartilage or membrane.

Near the ends of each bone are areas of developing tissue that regulate and help determine the length and shape of the bone. These areas of developing tissue near the ends of the bones are known as growth plates or more technically, physis (Figure 1).

growth-plate
Figure 1

The widened part of the shaft of the bone is known as the metaphysis, while the end of the bone is known at the epiphysis.

Because growth occurs at the end of the bone, growth plates are the last portion of the body to ossify or harden. This leaves them susceptible to fractures. Injuries to the growth plates may result in limbs that are crooked or of unequal length. Therefore, immediate attention is required.

When growth is complete, growth plates close and are replaced by solid bone. However, until growth is complete, children are at significant risk for growth plate injuries. Typically, girls and boys near the end of their growth period are especially vulnerable.

Statistically, boys are twice as often as girls to suffer growth-plate injuries. This can be attributed to the female body maturing at an earlier age than boys. In addition, one-third of all growth-plate injuries occur in competitive sports such as football or basketball.

Moreover, about 20 percent of growth-plate fractures occur as a result of recreational activities such as biking, skiing, skateboarding or sledding, according to the American Academy of Orthopaedic Surgeons (AAOS). Growth-plate fractures account for 15-30 percent of all childhood fractures. They most occur most often in the long bones of the fingers, followed by the outer bone of the forearm at the wrist; tibia and fibula growth plate fractures are also common.

Growth-plate fractures are characterized by visible deformities, persistent pain, and an inability to move or put pressure on the limb. If a child or teen experiences any of these signs, they should seek medical attention.

Growth-plate injuries heal without any lasting effects in 85 percent of instances. However, there are certain factors that affect the outcome and management such as severity of injury, age, growth plate affected, and the type of fracture. If injury causes the blood supply to the epiphysis to be cut off, growth can be stunted. In addition, an open injury carries the risk of infection which could destroy growth plates. A child can also affect outcome and management. If a child is younger, growth arrest can be more serious. In addition, some growth plates are more involved in extensive bone growth.

The type of growth-plate fracture are usually categorized in six types (Figure 2).

growth-plate-salter-harris
Figure 2

A Type I fracture describes a break in the bone through the growth plate, but no shift of bone occurs. This fracture usually heals well and requires immobilization.

A Type II fracture is a break through part of the bone at the growth plate and a crack through the bone shaft. This type of fracture is the most common. It is usually treated with cast immobilization, although surgery may sometimes be required.

A Type III fracture is a break through the bone at the growth plate, separating the bone end from the bone shaft and completely disrupting the growth plate. This type of fracture requires surgical treatment in the form of internal fixation to ensure alignment.

A Type IV fracture crosses through a portion of the growth plate and breaks off a piece of the bone end. This kind of fracture is treated with surgery and internal fixation.

A Type V fixation is a break through the bone shaft, the growth plate, and the end of the bone. Fractures like this result in arrested growth and are usually treated with surgery and internal fixation.

A Type VI fracture is similar to a Type V, but the broken pieces of the bone are missing. This fracture occurs only in the case of an open or comminuted fracture. They require surgical repair and possible reconstructive/corrective surgery.

A Brief Overview of Osteomyelitis

Nabil Ebraheim

For nearly two decades, Dr. Nabil Ebraheim has served as chairman of the Department of Orthopedic Surgery at the University of Toledo Medical Center in Ohio. Over the years, Dr. Nabil Ebraheim has researched and provided treatment for a variety of skeletal conditions, including osteomyelitis.

Osteomyelitis, the medical term for a bone infection, most commonly affects the long bones of the arms and the legs, but it can develop in any bone in the body. In some cases, the infection begins in the bone itself, but osteomyelitis can also be transmitted from nearby tissue through the bloodstream. Although the condition affects people of all ages and walks of life, those with diabetes, sickle cell disease, rheumatoid arthritis, or other diseases that weaken the immune system have a higher risk of developing a bone infection.

Osteomyelitis symptoms are similar to those that accompany other infections. These include fever and chills, as well as redness, swelling, and warmth near the infected bone. Those with infection of the vertebrae often experience severe back pain, which can be worse at night. Previously considered incurable, osteomyelitis is now successfully treated with antibiotics or bone-removal surgery. A combination of the two treatments is often used for both acute and chronic cases.

What is a Nerve?

In the simplest form, a nerve is a bundle of nerve fibers (Figure1, 2) that transmits electrical messages between the brain and other areas of the body. These messages convey sensory or motor function information.

Nerves are comprised of nerve cells called neurons.

nerve
Figure 1

They receive and transmit electrical messages to and from the brain. One end of the neuron receives the message, while the other end transmits the message.

nerve2
Figure 2

When traveling from one neuron to the next, electrical messages cross a gap called a synapse. Neurons communicate with one another through axons and dendrites – projection of a neuron – that extend from their cell bodies.

 

Axons and dendrites of multiple neurons serving a similar function come together with a piece of connective tissue to form nerves.

Neurons are very similar to other cells in the body (Figure3) as they are surrounded by a cell membrane, have a nucleus that contains genes, and contain cytoplasm. However, they differ from other cells in the body because they have axons and dendrites that bring

nerve-cell
Figure 3

information to and from the cell body. In addition, they communicate with each other through electromechanical processes.

 

Nerves are part of the peripheral nervous system, which connects the central nervous system to the limbs and organs. While it is similar to the central nervous system, it differs because it is not as well protected, leaving it susceptible to toxins and mechanical injuries. There are two types of nerves: afferent nerves and efferent nerves.

1- Afferent nerves, also known as sensory nerves, convey sensory signals to the central nervous system. They receive sensory stimuli. For instance, if you stub your toe, you sense pain. These are your sensory nerves at work.

2-Efferent nerves, also known as motor nerves, send stimulatory signals from the central system to muscles and glands. Motor nerves lead to muscles and stimulate movement. For instance, when you move your arm to wave hello, your motor nerves are at work.

Damage to nerves can arise several different ways, including swelling, physical injury, infection, autoimmune disease, or failure of the blood vessels surrounding the nerve. Nerve damage may present symptoms such as pain, numbness, weakness or paralysis. An interesting aspect of pain related to nerve damage is that patients may feel symptoms in areas far from the actual site of damage. This type of pain, known as referred pain, occurs because signaling is defective from the damaged nerve area. Nerve damage is diagnosed several different ways. First, doctors rely on thorough physical examination that test reflexes, directed movements, muscle weakness, and sense of touch. Additional testing may be ordered in the form of a nerve conduction study and an electromyography.

regeneration-stages
Figure 4