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November 03, 2017
dr sealey article

One of the injuries that I see increase in frequency during the winter months are foot and ankle fractures. Slippery conditions can trigger a fall, which is the usual cause of these injuries. Not only do falls occur during snowstorms or ice storms, but the snow or ice that gets left behind on sidewalks and parking lots will often result in twisting injuries around the foot and ankle that can lead to fractures. Winter sports such as skiing, snowboarding and ice skating also predispose patients to foot and ankle fractures. In fact, something called a "snowboarder's fracture" is a specific injury that occurs because of the position of the foot and ankle on a snowboard.

Foot and ankle fractures are some of the most debilitating injuries that we see in orthopedics. These injuries have both immediate and long-term effects. The majority of patients who sustain an ankle fracture will go on to develop ankle arthritis. The term arthritis means that there has been some damage or injury to the normal smooth cartilage in the joint. There are many conditions that can damage the joint surface, including an inflammatory problem (rheumatoid arthritis) or the long-term wear and tear of the joint (osteoarthritis). In the case of an ankle fracture, there is an acute and immediate traumatic event that leads to post-traumatic arthritis. This means that the patient will have some permanent mobility limitation and also some level of discomfort or achiness. While standing, the forces that ankles and feet experience can be up to 10 times the patient's body weight and this can lead to severe discomfort if arthritis develops in those joints.

There are many unique features about foot and ankle fractures that make them very different from fractures in other parts of the body. One very important thing to consider is which foot or ankle is fractured, because if it is your right side you will unable to drive for 2 to 3 months after the injury. Swelling can be a significant problem that may take up to a year to completely resolve. This not only leads to discomfort but may create some practical problems such as fitting into a normal shoe. Swelling can also lead to severe blisters that traumatize the skin around foot and ankle fractures. The blisters indicate that there has been severe injury to the skin, which can sometimes take several weeks to heal. Bruising is another feature that is very common around foot and ankle fractures—the result of bleeding from the bone that makes its way to the surface.

Seeing a specialist with experience in foot and ankle trauma is extremely important in order to have the best possible outcome after a serious injury. Any individual's treatment will depend on the severity and stability of their specific foot and ankle fracture. Most stable fractures are treated with a rigid cast, boot or shoe, and patients can begin walking immediately with some assistance. Some patients will need crutches, a walker or a cane first, until most of the pain resolves, and then, the treatment can continue in a fracture boot or shoe. Patients will usually benefit from physical therapy or a home exercise program after their fracture has healed since the period of immobilization will create atrophy.

If the fracture is unstable, however, it will require surgical treatment with orthopedic implants, such as plates and screws. A cast or splint will not be enough to keep an unstable fracture in the proper position for it to heal appropriately. Patients are often upset by the idea of surgery, but it will provide immediate stability to the bone and may allow for a more predictable recovery. Bones, on average, will take 6 to 8 weeks to heal; the timeframe for healing does not change with surgery but quicker movement is possible because of the stability provided by the hardware. Two emergencies that require surgery are an "open fracture" (in which there is an open wound or break in the skin near the site) and a joint that is dislocated along with a fracture. Open fractures lead to a high risk of infection and they need to be cleaned and stabilized immediately in the operating room. Patients also will need to take antibiotics to prevent infection. A dislocated joint must be put back in place, or "reduced," immediately and this is usually followed by surgery to keep the joint in position.

It is often important to wait for swelling to decrease before proceeding to foot and ankle surgery. It can be dangerous to operate on swollen tissues because this may lead to an infection around the incisions after surgery. It is not uncommon for a patient to have to wait 10 to 14 days after a fracture has occurred for the actual surgery to take place. Many times, x-rays are the only studies that we need before surgery, but occasionally a CT or MRI is necessary to plan the procedure.

Although foot and ankle fractures can have devastating implications on patients' immediate quality of life, it is possible to return to many of the activities they enjoyed once the injury is healed. There may be a "new normal" in terms of comfort level during weight-bearing activities, and it may be necessary to use an orthotic insert or an ankle brace for some activities.

There are some simple things that you can do to avoid foot and ankle fractures. Wearing appropriate footwear, such as winter boots with strong grip and ankle support, is a simple measure that can help you avoid injuries… avoiding unpaved walkways and surfaces without salt can also prevent slip-andfall events… and looking out for black ice during extremely cold temperatures is another step you can take to avoid injury.

About Dr. Randolph Sealey

Dr. Randolph Sealey, who is fluent in Spanish, specializes in the field of foot and ankle surgery and is the only fellowship-trained orthopedic foot and ankle subspecialist in the greater Danbury area. He completed his fellowship training and gained his ankle reconstructive surgery expertise at the world-renowned Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland. In 2008, he became the recipient of the prestigious Roger A. Mann Award, the highest clinical research honor given by the American Orthopaedic Foot and Ankle Society. He is Board-certified by the American Board of Orthopedic Surgery.

About OrthoConnecticut | Danbury Orthopedics

OrthoConnecticut I Danbury Orthopedics is the premier provider of orthopedic care in the region. Thirty-one fellowship-trained, Board-certified physicians provide care in nine office locations. The goal of the practice is to help patients regain mobility, lead active lives and attain optimal health. Offices are located in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury and Westport. To schedule an appointment with Dr. Sealey, or any of the physicians at OrthoConnecticut, please visit myorthoct.com or call (203) 797-1500.

Download article as pdf:

pdf(English) Keeping You Moving: Foot & Ankle Fractures

pdf(Español) Manteniendo su Movimiento: Fracturas de Pie y Tobillo

pdf(Português) Mantendo-se em Movimento: Fraturas nos Pés e Tornozelos

April 07, 2017

Four physicians from Danbury Orthopedics have been named Top Doctors for 2017, according to Connecticut Magazine andMoffly Media, both of which recently published their annual surveys.

In the specialty of Orthopedic Surgery, Michael Brand, MD, Joseph DiGiovanni, MD, Ross Henshaw, MD, and John Lunt, MD, were each awarded the honor for the fifth year in a row.

do top docs photo reduced size web“Danbury Orthopedics is honored to have four of our physicians recognized as the top in their specialties in Connecticut for the fifth year in a row,” said Dr. Michael Brand, President of Danbury Orthopedics. “To be recognized by your peers is an honor, and validates the time and focus we put into giving each of our patients the highest quality of care available.”

Dr. Brand is a Harvard University trained sports medicine specialist with expertise in treating knee and shoulder problems. Among his accomplishments, he helped bring state-of-the-art arthroscopic techniques to the region, helping patients achieve faster recoveries and improved outcomes. He has extensive experience in arthroscopic shoulder surgery and treating the full spectrum of knee issues.

Dr. Joseph DiGiovanni specializes in problems of the upper extremities. Trained at Mount Sinai Hospital and Hospital for Joint Diseases/NYU, he is skilled in treating nerve compressions, osteoarthritis in the hand, trigger finger, volar plate injuries (jammed fingers) as well as wrist injuries and fractures.

Dr. Ross Henshaw graduated from Johns Hopkins University and Columbia University's College of Physicians and Surgeons, followed by a sports medicine and shoulder surgery fellowship at the Hospital for Special Surgery. He is skilled in advanced arthroscopic techniques to treat shoulder, hip and knee injuries through incisions no wider than a fingernail. An athlete himself, he uses innovative techniques to help patients get back on track as soon as possible.

Dr. John Lunt, a renowned specialist in surgery of the upper extremities, trained at St. Lukes/Roosevelt Hospital and Long Island Jewish Medical Center. His fellowship was in hand surgery at Columbia Presbyterian. Using advanced diagnostic tools, he excels at recognizing rare nerve compression problems and other hard to detect nerve issues.

Moffley Media’s list is compiled by Castle Connolly Medical Ltd., a respected national medical data research group. The Top Doctors are nominated by their peers for being outstanding in their medical specialties, recognizing their abilities and professional standards. The annual list is based on survey results from more than 5,000 questionnaires that are distributed to physicians across the state that asked respondents to name providers they would recommend, other than themselves, to whom they would send a loved one for “expert medical care.” Similarly, Connecticut Magazine’s list is compiled by recommendations from other doctors in the state.

Castle Connolly Medical Ltd. is the preeminent healthcare research and information firm, led by physicians, that selects Top Doctors on a National and Regional level. The list of Top Doctors 2017 appears in the April 2017 issue of Connecticut Magazine and appeared in the January 2017 issues of Moffly Media’s publications, which include Fairfield Living, Greenwich, New Canaan-Darien, Westport and Stamford magazines.

About OrthoConnecticut/Danbury Orthopedics

OrthoConnecticut is a multispecialty practice staffed by leaders in orthopedic care, and is the parent practice of Danbury Orthopedics, New Milford Orthopedics, and Coastal Orthopedics. The practice’s Centers of Excellence provide integrated treatment, offering individualized and compassionate care by a team of board-certified, fellowship-trained specialists. The goal of the practice is to help patients regain mobility, lead active lives, and attain optimal well-being. To make an appointment with any of the practice’s specialists, please visit myorthoct.com or call 203.797.1500.

April 02, 2017

Danbury, CT — Danbury Orthopedics has opened a new state-of-the-art Musculoskeletal Center of Excellence at 2 Riverview Drive in Danbury. The new center, the first of its kind in the region, will offer the full spectrum of high-quality orthopedic services , pain management, advanced imaging including MRI and physical therapy under one roof.

Riverview Drive facility

The new 40,000-square-foot building, located in the Berkshire Corporate Park, will merge Danbury Orthopedics’ three former locations into a single centralized facility. By consolidating all of their physicians and staff into one state-of-the-art location, Danbury Orthopedics can diagnose and treat the complete range of musculoskeletal issues for all ages in one easily accessible location with minimal wait time and a more efficient patient experience.

The new Center of Excellence brings together the Danbury Orthopedics’ renowned team of specialists and subspecialists in the fields of foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine, sports medicine, and regenerative medicine. Physical therapists and pain management specialists are also on site to aid in recovery.

White Street Surgical Center Remains Open

Danbury Orthopedics’ surgical facility, the Western Connecticut Orthopedic Surgical Center, will remain at its location at 226 White Street, Danbury. This facility features three outpatient operating rooms, which allow patients to receive the highest level of surgical care and return home the same day. The satellite offices in Ridgefield and Southbury also remain open for our patients’ convenience.

About OrthoConnecticut/Danbury Orthopedics

OrthoConnecticut is a multispecialty practice staffed by leaders in orthopedic care, and is the parent practice of Danbury Orthopedics, New Milford Orthopedics, and Coastal Orthopedics. The practice’s Centers of Excellence provide integrated treatment, offering individualized and compassionate care by a team of board-certified, fellowship-trained specialists. The goal of the practice is to help patients regain mobility, lead active lives, and attain optimal well-being. To make an appointment with any of the practice’s specialists, please visit myorthoct.com or call 203.797.1500.

February 07, 2017

BETHEL, CT – Debbie Mullady snapped and dislocated her ankle in a fall heading down steps at her Bethel home in December 2001. Fourteen years of pain, limited mobility and frustration ensued until she underwent ankle replacement surgery at the hands of Dr. Randolph Sealey of Danbury Orthopedics.

news oh snap01Debbi Mullady of Bethel endured 14 years of pain after breaking her ankle in a fall at her home. She finally got relief with ankle replacement performed by Danbury Orthopedics and Dr. Randolph Sealey.

Mullady, who had the surgery in December 2015, almost 14 years to the day after the fall, is now back to full health. Her pain is gone, she has regained her mobility and even returned to the diving board with a bang. “I did a backflip last summer to celebrate,’’ said Mullady, a lifelong swimmer and diver. “I haven’t been able to do that in quite a few years.”

Mullady broke her ankle in a fall that could have been part of a Three Stooges segment. She headed down frost-covered stairs with arms full of books as she headed for work as a bookkeeper for a construction company. She slipped on the frost and tumbled down the stairs of her home’s back deck. Her left ankle caught between a step as she fell. Her son saw the accident, rushed to help and he, too, tumbled. Her husband also rushed out to help his wife and son. “I never felt it,’’ Mullady said. “My body went into shock. I could’ve won $10,000 on 'America’s Funniest Videos.' It sure was a sight to see.”

But the following 14 years were no laughing matter. Doctors outfitted her ankle with nine screws and two plates, but in June 2002 her body started to reject them. She experienced significant pain, could no longer go for walks, shop at the mall or wear high heels.

With the pain unbearable, Mullady visited Dr. Sealey in 2013. He recommended ankle replacement. And Mullady rejected it.

“The ankle is a big deal,’’ Mullady said. “It supports your entire body. I was leery. I said I’ll come back to you when I can’t walk.”

“Patients are always a little hesitant,’’ Sealey said. “There is a lot more information available now. Back then, even though it wasn’t that long ago, there wasn’t as much information available. She had to do some research. It’s a big procedure especially when someone is in pain and had surgery before, there will always be some reservations.”

Mullady endured two more years of pain before returning to Sealey. “I went to get out of bed and could not put any pressure on my left ankle,’’ Mullady said. “I was in tears. I told my husband you have to take me to the doctor now. I had a wedding that weekend, and they gave me a cortisone shot but it did nothing. I made the appointment right then and there.”

“I was happy she finally decided to have it,’’ Sealey said. “I thought she was a good candidate and that she’d do well. Ankle replacement surgery is one of my favorite procedures. It’s difficult, very challenging, but very rewarding. It’s just great to see the function people are able to attain and the change in their quality of life after the surgery.”

oh snap before afterX-rays of Debbie Mullady's ankle before and one year after replacement surgery by Dr. Randolph Sealey of Danbury Orthopedics.

Sealey said ankle replacement surgery has evolved in the past 40 years. It started in the 1970s, but improvement has been dramatic in the past few years. “Hip and knee replacement are more common because arthritis is more common in those areas,’’ Sealey said. “Ankle replacement is similar to those. The materials are the same. The technology just took more time. It presents some unique challenges.”

Sealey said the name itself scares prospective patients. The procedure, however, involves the removal of about 11 millimeters of damaged bone. Sealey and his team use metal and plastic parts to create a new surface for bearing weight.

“A better name for it is a resurfacing procedure,’’ Sealey said. “It’s like retreading a tire that has lost its tread. The remaining parts of your ankle including tendons, ligaments, and bone are left behind after replacement surgery. The average lifetime of ankle replacement is 8-10 years. The mechanical parts will wear out over time depending on a patient's activity levels. If the parts wear out many times it is possible to do a revision surgery to preserve the replacement. When I explain that to patients, you can almost see their worry and concern disappear.”

Mullady recovered quickly. Within 12 weeks, she had regained mostly normal function. The hardest part, she said, was staying confined to a rehabilitation center with no cellphone service. “I was going crazy,’’ Mullady said. “I felt like I was an animal locked in a cage.”

She returned home and got around with a scooter, walker and eventually, a cane. She pushed herself, but not too aggressively. “By June, I was a new person,’’ said Mullady, who completed her backflip about a month later.

Mullady, who also endured a bout with kidney cancer, said she wishes she had consented earlier to the procedure.

“If I had known what it was going to be like, I would’ve done it years ago,’’ Mullady said. “I told Dr. Sealey I should have listed to you and not to me. I suffered for another three years which I didn’t have to do.”

Article by Tom Renner and Karen Tensa of Danbury Daily Voice.

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