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History: 23 year-old male who injured his shoulder and collar bone while trying to jump over a fence. He had sustained a comminuted, displaced clavicle fracture.
Diagnosis: Left clavicle fracture
Treatment: Left clavicle open reduction internal fixation
Outcome: Within 1 week he had already regained nearly all motion without any pain. The photos below demonstrate his first post-operative visit. By 3 months after surgery he had returned to full activities and sports.
History: 28 year-old male injured his thumb in an automobile accident when the airbag deployed. He sustained a fracture of the thumb metacarpal base (Bennett fracture). Based on the best evidence available, he elected for percutaneous surgical treatment.
Diagnosis: Right thumb Bennett fracture
Treatment: Right thumb percutaneous pinning and cast
Outcome: After completing the cast and having the pins removed he recovered full motion and strength without any functional limitations.
History: 31 year-old male had a crush injury to his right middle finger. He worked as a registered dental assistant and it was important that he could return to wearing gloves and working as quickly as possible. X-rays showed a comminuted fracture of the proximal phalanx (finger) with more than 25 degrees of angulation in the lateral view and 15 degrees of angulation in the AP view.
Diagnosis: Right long finger proximal phalanx fracture
Treatment: Right long finger proximal phalanx open reduction and internal fixation with intramedullary screw
Outcome: The patient had surgery on a Friday morning and returned to work on Monday morning. He removed his own splint and aside from mild soreness and swelling was able to wear gloves and perform his typical work. When he arrived for his first post-operative visit 10 days after surgery he had minimal pain and nearly normal motion even before the stitches were removed.
X-rays at 10 days showed good overall alignment.
History: 51 year-old male cyclist who was hit by a car and came to the hospital as a trauma. He was found to have a severe elbow injury consisting of a comminuted intra-articular fracture of the distal humerus at the elbow. Based on the severe injury I recommended fixation.
Diagnosis: Right complex intra-articular distal humerus fracture
Treatment: Right humerus open reduction internal fixation with olecranon osteotomy
Outcome: He worked exceptionally hard with therapy and by 1 month was already doing better than expected. by 3 months he had nearly full strength and motion and was ready to get back on his bicycle. The incision healed up beautifully and was nearly invisible.
History: 62 year-old male fell in his backyard injuring his right wrist. X-rays showed a wrist fracture with displacement and angulation resulting in severe pain, swelling, and deformity.
Diagnosis: Right distal radius fracture
Treatment: Open reduction and internal fixation with plates and screws
Outcome: At 6 weeks after surgery he had regained nearly all motion, was still working on increasing his strength, and had no pain. The scar was hardly noticeable. X-rays showed the bones were in perfect alignment.
No pain and nearly normal motion at 6 weeks after surgery!
History: 20 year-old male punched a wall with his right fist and had immediate pain and swelling over the the dorsal and ulnar aspect of the hand and wrist. X-rays demonstrated a fracture of the hamate bone with the 4th and 5th metacarpal bones dislocated dorsally. Live flouroscopic imaging in the office demonstrated that they could be reduced manually but were unstable.
Diagnosis: Right 4th and 5th carpal-metacarpal joint fracture dislocation
Treatment: Right 4th and 5th CMC Closed Reduction and Pinning
Outcome: He remained in a cast after surgery for 4 weeks. After 1 month he was transitioned to a removable splint and started on exercises for motion.
By 2 months after surgery he had near-anatomic alignment of the joint, full motion, and no pain.
History: 24 year-old female Warriors dancer fell at work and injured her left wrist. She presented to the hospital and was diagnosed with a severe distal radius fracture (wrist fracture). After undergoing a closed reduction (re-alignment of the bones) in the emergency room, Dr. Franko recommended surgery to provide strength and stability to the bones and allow them to heal properly.
Diagnosis: Left intra-articular distal radius fracture with ulna styloid fracture
Treatment: Left distal radius open reduction internal fixation with tension suture for ulna styloid
Outcome: At her first post-operative visit she transitioned immediately to a removable splint and began working with hand therapy on motion and strength. Her scars healed quickly and she regained motion rapidly.
At only 10 weeks from surgery she is fully healed with nearly normal motion and strength. She will return to dancing for the Warriors just in time for playoffs!
Her incisions are healed beautifully!
History: 75 year-old male who fell and injured his hip and elbow. X-rays demonstrated a fracture of his olecranon at the elbow and he was indicated for surgery.
Diagnosis: Left olecranon fracture
Treatment: Left olecranon open reduction internal fixation with plate and tension wire
Outcome: Within 3 months he was fully healed with nearly symmetric range of motion and full strength.
History: 39 year-old female who amputated the tip of her left middle finger while doing her hobby of leather crafting. An emergency department cauterized the end of her finger to stop the bleeding and Dr. Franko saw her in the office for treatment. She had loss of the soft tissue with exposed distal phalanx.
Diagnosis: Left long finger tip amputation with exposed bone
Treatment: Operative debridement with V-to-Y advancement flap
Outcome: At 3 weeks after surgery the fingertip flap was healing and she was working on motion. Pain was minimal.
By 3 months the fingertip looked natural and the nail was growing back normally. She has full range of motion and minimal tenderness.
History: 23 year-old male who came to my office with pain in his wrist about 3 months after a fall. At the time he thought he only sprained his wrist. X-rays in the office showed a scaphoid non-union (not healed) causing his pain. Due to concern about long-term development of arthritis and pain, he elected to have surgery for treatment.
Diagnosis: Left scaphoid non-union, 3 months
Treatment: Scaphoid open reduction internal fixation with bone graft for non-union
Outcome: By 4 months he was fully healed with minimal pain and near full motion. He was very happy with the result.
