Dr. Lipsker is not quick to choose invasive surgical procedures. Instead, she does everything in her power to try and exhaust more conservative treatments before opting for the surgical option. Of course, this is for cases in which surgery is just one of the treatment options found in professional literature. Her comparative approach, developed over many years, has led to many significant successes.
Dr. Lipsker has developed various surgical procedures including unique procedures such as the following examples from which one can better understand her approach:
1. Intra Articular comminuted fractures in young and middle aged people, treated with precise and anatomical reconstruction of the joint area.
Alternative medical treatments that speed up bone fusion and fracture healing can be incorporated into the treatment regime to reduce the plaster cast immobilization period and, at the same time, reduce pain.
On the other hand, with older patients, the literature and Dr. Lipsker’s experience prove that functional results are good, in most cases, even without surgery and with some anatomical irregularity of the joint line. Approximately one year after the fracture event, the patient’s range of motion amongst the elder patients ranges is sufficiently good and usually with no pain. The only disadvantage of this method is that it could result in a cosmetic deformity of the forearm.
In cases where there is a deformity and shortening of the bone, it is possible to perform closed surgery with a regional anesthesia and using x-ray screening . This allows for an improvement in the positioning of the fractured bone and immobilization using pins that are inserted externally. It is also possible to inject a supportive material (containing calcium phosphate) into an osteoporotic fracture.
2. Joint pain in the hands as the result of degenerative changes (Osteoarthritis):
A range of operations, such as repairing or reconstructing joints, are available to treat painful joint diseases (that cause weakness and a loss of function). These surgical methods require a long recovery period with the effected limb immobilized in a plaster cast and an extended rehabilitation period aided by braces and physiotherapy. Lipsker uses a conservative combination method that provides a suitable solution for much of this population segment by significantly reducing pain without the need for surgical intervention.
3. Various chronic tendon inflammations such as internal and external Epicondylitis, (golf and tennis hand) and Tendinitis of the wrist tendons –
treated with a combination of physiotherapy, supportive splints, alternative medical treatments, injections and avoidance, as much as is possible, of invasive procedures.
4. Scar treatment –
preliminary, conservative treatments given to patients with a tendency to hypertrophic scaring. The treatments involve the use of pressure gloves, silicon sheaths, oils, stretching braces and, where necessary, the use of injections to level and make the scar tissue more elastic rather than the use of plastic surgery techniques.
Dr. Lipsker has, over the years, developed rehabilitation methods and techniques and acquired a great deal of experience in these treatments. Following an operation, her patients are constantly monitored throughout the rehabilitation treatments. They are also provided detailed instructions for any rehabilitation center to which they they are referred, and an exact plan for the entire recovery and rehabilitation period.
Rehabilitation plays a vital role in hand surgery and is responsible for as much as half of the success potential. This is why knowledge and close supervision are required both before and after the operation. The patient must be provided with a work plan and instruction whilst at home – this is of great importance in the achievment of a good result. Dr. Lipsker provides all of these requirements, increasing the chances of success for the various treatments.
Dr. Lipsker cooperates with specialists in Children's Neurology and Neuro-surgeons specializing in children suffering from spastic paralysis and with occupational therapy clinics who also specialize in this field.
This is an extremely complex issue to treat and requires a deep understanding in the disease’s development, in its dynamics and an understanding of the factors that contribute to the success or failure of surgical or conservative treatment.
Dr. Lipsker has a great deal of experience in the surgical treatment of children deformities (lengthening of fingers, lengthening of the forearm, treating serious deformities and provides conservative and surgical treatment according to a pre-defined program). Dr. Lipsker cooperates with specialists in pregnancy ultra-sound tests to determine the nature of a deformity that has been discovered and explain the possibilities for future treatment.
Dr. Lipsker accompanies her patients throughout the treatment process, providing support, helping maintain communications with rehabilitation centers, providing information regarding referrals to the best specialists in their field, recommendations for occupational therapists, social workers and in providing training and instruction regarding recommended modifications in the patient's work environment.
Every patient should know that no surgical procedure is without its risks. It is not possible to guarantee 100% success for every patient. Complications can occur with any doctor, and the professional literature extensively mentions complications in almost every chapter. It is important to be aware of the factors which could adversely affect treatment and to do everything possible to minimize the risks and complications that exist in all treatments and surgical procedures.
Developing surgical procedures - specialized operations
Developing surgical procedures – specialized operations
Dr. Lipsker has developed several surgical procedures including unique procedures such as the following:
1. Releasing trapped nerves in the elbow (entrapment neuropathies) using a unique treatment that provides exceptionally good results.
2. Releasing wrist nerves in an operation with minimal incisions.
3. Revisional operations to release nerves that have already been operated on with the transfer of fatty tissues to coat the affected nerve and prevent the reappearance of internal scaring. This procedure enjoys a high success rate and in some cases the functioning of muscles which had been injured due to nerve damage is restored.
4. Operations to restore inflammatory tendon tunnels and reconstruction of Pulley rings responsible for the distribution of tendon strength along the finger’s flexor tendon tunnels. A unique release procedure that allows for immediate, controlled motion which is fundamental in preventing the tendons from sticking to the skin and to the nerves.
This method is especially effective in serious cases where tendon tunnels and anatomical rings are totally destroyed. This occurs mainly in cases of severe infection which endangers the functioning of the entire hand. Functional results are very promising.
5. Dr. Lipsker has improved the well know method for transplanting tendons in two stages thus reducing scaring around the areas where tendons anastomose during the first stage of surgical rehabilitation. This also makes the second stage of surgery, to strengthen the initial suture area and maintain blood supply to the affected area, technically easier and enables earlier use of the fingers.
6. Dr. Lipsker has transformed a rare method for the treatment of finger syndactyly (a deformity where fingers are fused together in a common skin sleeve). Treatment of syndactyly is a complex
technique – in severe cases fingers are joined in common soft tissue. The method includes, at the first stage of the operation, the use of external apparatus to extend the skin and expand the quantity of skin being treated. This allows a reduction in the use of skin grafts which cause thick scaring, ugly appearance and rigidity and enables the achievement of better aesthetic results.
7. Dr. Lipsker has refined surgical procedures and methods for the treatment of spastic hands which develop in cerebral palsy patients (in children as well as in adults following a stroke).
Dr. Esther Lipsker
Tel Aviv University 1966-1972 School of Medicine – M.D. (1972)
Hebrew University 1965-66 Biology, 1 year
Residency – Orthopedics:
Hillel-Yaffe Hospital, Hadera , Israel
1973 – 1978: incl.: General Surgery, Orthopedics Dept., Anesthesia
Kaplan Hospital, Rehovot, Israel
Orthopedic surgery (hand) 3/1977 – 9/1977
Basic Science (Pathology) 4/1982 – 9/1982
Sheba Medical Center, Tel Hashomer, Israel
Plastic Surgery 6/1978 – 8/1978
Neurosurgery 8/1979 – 10/1979
• Kaplan Hospital, Rehovot, Israel: I worked as a senior (attending) physician in the Hand Surgery Department from 1979 where I completed my orthopedic residency in this field. In April 1990, I was recognized as a specialist in hand surgery with the professional status of consultant. I continued there as a senior (attending) physician until December,1999.
• 1977 – 1988: Director of the Institute for Hand Rehabilitation at Kaplan Hospital.
• Soroka Hospital, Beer Sheba, Israel : 1986 – 1987: Directing the Hand Surgery Service of the Plastic Surgery Department.
• Consultant at the Head Trauma Dept. at Levinstein Hospital, Raanana, Israel 1990 – 1995.
• Established and headed the Hand Surgery Unit at Barzilai Hospital, Ashkelon, Israel, from February, 2000 to December, 2002.
• Director of the Hand Surgery Unit at the Shaare Zedek Medical Center, Jerusalem, Israel, from December, 2002 to January, 2015.
• Previously – National Consultant for Hand Surgery for the Maccabi HMO and a national consultant for the Le’umit HMO.
1. A participating consultant at the " Movement clinic " and part of an interdisciplinary team from various institutions in Israel.
2. Participated in a multi-disciplinary clinic for the treatment of pre-natal deformities (Part of the Gynecological Ultra-Sound Unit).
3. Established a monthly clinic for soldiers at the “HaBira Clinic” at Mount Scopus, Jerusalem, Israel.
Advanced Study Courses:
1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A. – March,1983.
2. Medical tour lasting four months at 13 Hand Surgery Centers/Departments in the United States between September and December, 1991. During the tour I gave a number of guest lectures on a variety of subjects. (Septic Hands, Arthrolysis of the Elbow, Child Deformities and Hand Extension).
3. Course in Total Elbow Implants with Dr. Souter at Edinburgh, Scotland, U.K., in June, 1992.
4. Medical course on Injuries to the Brachial Plexus with Prof. Boom at the Groote Schuur Hospital, Capetown, South Africa .
5. Study visit and lecturing at the Department of Hand Surgery at New York University, New York .
1. 1975 – X-ray Bone Pathology given by Prof. Murray from the United Kingdom in Safed, Israel.
2. 1974 – 1976 3 courses in internal fixation given by AO in Israel.
3. 1988Micro-surgery course at Sheba Medical Center, Tel HaShomer, Israel
4. 3/1999 – Advanced course in the treatment of wrist diseases given under the auspices of the Hand Rehabilitation Foundation and Jefferson Medical College of T.J. – University of Philadelphia, Pennsylvania, U.S.A.
5. 4/2000 AO course in hand surgery – Cyprus.
Conferences and Scientific Meetings
The Annual Meeting of the Israel Association of Hand Surgery:
Dupuytrens Contracture in Israel •
Birth Palsy •
Panel Treatment of Open Meracarpal Fractures and •
Arthrolysis of Elbow •
Indications for Neurovascular Island Flap •
Greens Procedure in Spastic Hand •
The Surgery of Soft Tissue Sarcoma of the Hand
Distraction Lengthening Of the Thumb •
Non Specific Inflammation of Tendons; Clinical and •
Secretans Disease – A New Trend of Treatment •
Proximal Row Carpectomy •
Calcinosis Circumscripta •
Clasped Thumb •
Pronation Osteotomy of Forearm •
Toxic Palm Infection to the Hand •
Vascularized Bone Graft of Scaphoid Bone •
PLR of the ulnar nerve in the cubital tunnel •
Intra-articular fractures of distal Radius •
The surgical outcome of scaphoid fractures in SZMC •
The Coban Compression Bandaging technique •
Israel – America International Meeting, 1979, Tel-Aviv, Israel:
Proximal Row Carpectomy
Rare Tumors of the Upper Extremity
American-Bulgarian International Meeting, 1988, Bulgaria:
• Management of Irritated Nerves by Silicon Sheath Protection
The Fourth International Congress of Hand Surgery. April 1989, Tel-Aviv, Israel
• Distraction Lengthening of the Forearm
• Pronation Osteotomy of the Forearm
• Participating In Panel: Osteoarthritis of the Thumb
The Fifth International Congress of Hand Surgery, May 1992 – Paris, France
Panel: The Spastic Hand & causes of treatment failures of the surgical treatment of the spastic hand
1. Lecturing to students from the Hebrew University of Jerusalem Medical School.
2. Head of the Hand Surgery Course at the School of Physical Therapy at Sheba Medical Center, Tel HaShomer, Israel -1986 – 1988.
3. Head of Upper Arm Rehabilitation Course at the School of Physical Therapy at Tel Aviv University Medical School – 1986 -1996.
4. Post-graduate course for physical therapists and occupational therapists at the School of Physical Therapy at Tel Aviv University (the course was held twice).
5. Guest lecturer at post-graduate courses in the Orthopedic and Hand Surgery faculties of at the Tel Aviv University Medical .
6. Courses for family physicians at Kaplan Hospital in Rehovot and Shaare Zedek Medical Center in Jerusalem.
7. Hand Rehabilitation Course – School of Occupational Therapy, Hebrew University of Jerusalem, Mount Scopus, Jerusalem 2003 – 2004.
8. Guest lecturer before jurists on Medical Malpractice and Wrist Related Surgical Problems.
9. Lectures and courses for physical therapists at regional centers across Israel.
10. Guest Lecturer at Hand Units and Departments in the United States, 1993, 2010.
11. Yearly lectures to hospital medical staff.
1. Tsur H, Lipsker E: Epithelioid sarcoma of the hand ann surg 8: 420, 1982.
2. Hecht O, Lipsker E: Median and ulnar nerve entrapment caused by ectopic calcification: report of two cases. J Hand Surg 5:30 1980.
3. Tsur H, Lipsker E: multiple linear spiradenomas: Plastic and reconstructive surgery. 68: 1981.
4. Lipsker E.: Synovialsarcoma with radial nerve involvement .Journal of
Hand Surgery 11(1) 1986
5. Lipsker E, sagi A: Extraarticular chondromatosis of the hand. Acta Orthop Scand 59:728, 1988.
6. Lipsker E, Weizenbluth M: Surgical treatment of the Clasped Thumb. J Hand Surg 14B:72 1989.
7. Lipsker E, Weizenbluth M: Calcinosis circumscripta: indications for surgery. Bull Hosp. Joint Dis 1989.
8. Weizenbluth M, Lipsker E: Arthroysis of the elbow. Acta Orthop Scand 60: 642, 1989.
9. Lipsker E: A modified technique for flexor tendon repair. J Orthopaed Surg Tech ,1989
10. Lipsker E: Weizenbluth M: Silicon sheet cover for treatment of irritated nerves. J Orthopaed Surg Techin. 5:173-178, 1990.
11. Karev A, Lipsker E, Kessler I: Simultaneous centralization of radial club hand and lengthening of the forearm – a new technical Approach. Orthopaed Surg Tech, 5 (3) 113-121, 1990.
12. M. Sterenfeld, E. Lipsker, & co.: Trigger finger relieved by activation of distal ashi points in area of pericardium and heart meridians Am. J, Acupuncture: 19 (4), 319-322, 1991.
13. E. lipsker, M. Weizenbluth: Derotation osteotomy of the forearm in management of paralytic supination deformity, J. Hand Surg 18:1069-1074, 1993.
14. Abstract of the 12th publication in: info-Med orthopedics vol 2, abstracts, 1994.
15. E. Lipsker: Causas de los errors quiruricos en la mano espstica Revista Espanola de cirugiade de la mano, 44(19):21-26, 1992.
Quotes of Dr. Lipskier articles Text books