Pioneering surgery helps Southampton man back to work and play

February 20th 2017

Pioneering surgery helps Southampton man back to work and playA Southampton man has undergone one of the first operations of its kind thanks to a surgeon at Southampton NHS Treatment Centre.

Father of two, Nicholas Busutill, 42, from Thornhill, had spent years carrying out heavy manual work, including spending many years working on the railway and using heavy power tools.

He said: “In 2015 I developed a problem with my right wrist. It was swollen and very painful and it looked as if I had half a golf ball on my wrist. I lost a great deal of movement and I was very concerned because I struggled at work and playing with my young son.”

X-ray and MRI scans revealed that he was suffering from not one but two unusual problems. He had destruction of a ligament inside his wrist and arthritis inside the wrist. He had scapholunate dissociation and there was another unusual situation; a very large cyst on the bone in the centre of the wrist. The pain was coming from bone rubbing again bone as the cartilage had perished.

Nicholas discussed the options with his surgeon Vasileios Kefalas, who despite many years as a specialist surgeon had not seen the highly unusual combination of issues.

Mr Kefalas said: “A four-corner fusion is one of my favourite operations. The vast majority of the surgeons in the UK use conventional materials such as steel or titanium plates, K-wires or compression screws. I have tried all these methods during my fellowships in hand surgery and I was never 100 per cent happy. 

“With these methods, the patient has to stay in a cast for at least six weeks with a non-fusion rate of between 15- 20 per cent. When I started to work at Southampton NHS Treatment Centre I carried out some research about memory staples. I had a brief experience of these in Greece and they are very popular in the US.”

It was a success and Mr Kefalas presented the teams experiences at international congresses as well as writing a major review of the results. 

He said: “It means we use minimal metalwork and, as we have a very rigid fixation, we do not need to use a full cast. Physiotherapy starts two weeks after the operation and our rate of non-union is now zero.”

Without the method Nicholas would have been left with radically reduced movement in his wrist. Mr Kefalas carried out the fusion, removed the cyst and carried out a bone graft. The results were excellent and a year after the operation, he felt that he had improved significantly.

What happened next was even more surprising for surgeon and patient. Just before his first operation he mentioned to Mr Kefalas that he had started to have pain in his left wrist. An MRI scan revealed something surprising.

Nicholas said: “The odds of me winning the lottery were significantly lower than what happened. I had the same problem on my left wrist.”

So a year after the first operation, the team carried out the same operation on the left hand. 

Mr Kefalas said: “I am pleased to say that I saw Nicholas last week, nine months since his last operation and his x-rays are very satisfactory. I am extremely pleased that we managed to help him and I am also very pleased because I managed to help him to continue his manual work in the building industry. I am also very happy that he did not have to sacrifice anything with regard to the wellbeing of his family and his personal wellbeing.”

Nicholas said: “I cannot speak highly enough about the team at the centre, it is like you are being cared for by your own family, the really look after you and they are kind and professional. Nothing is too much trouble and even when they had to wake me at night to check my vitals they were polite and always asked me if I wanted a drink or something to eat. I came back with chocolates for all the nurses they took such good care of me.”