Singapore Raises the Bar with New Orthopedic Technique

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An innovative surgeon here has developed a simple yet effective technique to tackle the high failure rates associated with conventional methods of mending Acromioclavicular Joint (ACJ) dislocations.

Singapore Medicine

It made good sense to me. I said 'That's it! I'll get it done!' and didn't think twice.

Dr Lim Yeow Wai readily supports the adage that necessity is the mother of all inventions. He is, after all, a medical innovator in his own right.

A consultant orthopaedic surgeon at Raffles Hospital, Dr Lim pioneered his own method of treating shoulder dislocations after observing that conventional procedures do not offer lasting solutions.

"There have been numerous types of surgeries performed for shoulder dislocation but so far, outcomes from these various methods have not been good, especially when the acromioclavicular joint (ACJ) is involved," he says.

The joint, which is located at the top of the shoulder, is made up of two bones – the clavicle and the acromion – and four ligaments which give it stability. Depending on the severity of a shoulder injury, a person may sprain or tear one or all of the ligaments.

According to Dr Lim, shoulder-related injuries are relatively common in today's athletic society. ACJ injuries are often sustained by cyclists, as well as those who engage in contact sports such as rugby, martial arts and American football. If not properly treated, it can lead to significant loss of strength in the affected limb.

"Presently, most of the treatment methods employ rigid forms of fixation using metal implants such as hook plates, pins and screws. This bolts the bones in place, but often leads to failure because the ACJ joint is not meant to be fixed in place. It is a flexible joint which can rise and rotate during movement. Also, screws and pins are often ineffective because they usually work themselves loose after some time, due to necessary movements in and around the shoulder area," explains Dr Lim.

His dissatisfaction led him to develop the Triple Endobutton technique – a non-rigid method that allows for normal movement of the joint. All that's needed is three tiny buttons and two strands of Fibrewire suture. The buttons are made of stainless steel and are only about 1cm across.

During the operation, the suture is looped through the button holes and over the shoulder bone, resulting in a 'snow shoe' hold that allows for fluid movements while stabilizing the joint. According to Dr Lim, this method gives even greater strength compared to the natural ligaments.

The procedure takes place under general anaesthesia with the patient in a beach chair position. So far, Dr Lim has performed 30 such operations with only one failure, giving this technique a failure rate of less than five percent. This is a far cry from the 20 percent failure rate associated with conventional treatment method.

One patient who has benefitted from Dr Lim's innovative treatment is Mr John Tuffin. The 62-year-old Australian is an avid sportsman who injured his shoulder following a horse riding accident in April last year (2009). To make matters worse, he tripped and fell several months later while boarding a ferry.

In terrible pain, Mr Tuffin sought help at Raffles Hospital and was referred to Dr Lim, who confirmed the diagnosis of chronic ACJ dislocation and explained the Triple Endobutton procedure to a much relieved Mr Tuffin.

"It made good sense to me. I said 'That's it! I'll get it done!' and didn't think twice." The surgery took one and a half hours and he was discharged the day after.

"Although I was in slight pain for the first few days, I saw the benefits immediately. My sleep is no longer disrupted and rolling over in bed does not hurt anymore," says a delighted Mr Tuffin.

All in praise of Dr Lim's efficiency, he says: "Dr Lim was very thorough and did the relevant checks to ensure that my body was fit for the operation to be carried out. He is a very good surgeon and I have much faith in his hands. The results more than speak for themselves."

"My stay at Raffles Hospital was excellent! All my expectations were met and I don't think the doctors and nurses could have done anything more. Excellent!"

Currently, the Triple Endobutton technique is only performed in Singapore. The cost of the surgery is S$10,000. This compares favourably to conventional shoulder surgeries in the US, which usually range between US$20,000 and US$25,000.

About Raffles Hospital

Raffles Hospital is a tertiary care hospital and the flagship of the Raffles Medical Group, a leading private healthcare provider in Singapore and South East Asia. Located just 20 minutes away from Changi International Airport and right in the heart of the city, Raffles Hospital offers a full range of specialist, medical and diagnostic services that spans across 35 disciplines.

About The SingaporeMedicine Initiative

Launched in 2003, SingaporeMedicine is a multi-agency government-industry partnership committed to strengthening Singapore's position as Asia's leading medical hub, and promoting Singapore as a world-class destination for advanced patient care.

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Elizabeth WONG (Ms)