Ortho

Treatments

Dr. SYED NADEEM SHAJAN is highly experienced and specialized in Orthopaedic fractures and complex trauma Care Management at ORTHO PLANET CLINIC, in Krishnarajapuram, Bangalore. He has treated patients of all age groups in and around Bangalore, each year providing comprehensive trauma care and follow-up care to hundreds of people, also expertise in performing a wide range of emergency surgeries.

Dr. SYED NADEEM SHAJAN treats every level of injury, from sprains and fractures to life-threatening trauma. Because severe traumatic injuries require immediate attention, he work closely with plastic surgeons and neurosurgeons to deliver the highest quality of care with interdisciplinary coordination.

Joint Replacement Surgery

It is a procedure of orthopedic surgery in which an arthritic or dysfunctional or diseased joint surface is replaced with an orthopedic prosthesis. Knee joint replacement and hip joint replacement surgeries are two of the most commonly performed surgeries.Both procedures are very successful at eliminating pain,correcting deformity and improving patient mobility so patients can regain quality of life and get back to their activities. 

Technique 

Before major surgery is performed, a complete pre-anaesthetic work-up is required. In elderly people this usually would include ECG, urine tests, hematology and blood tests.

Cross match of blood is routine also, as a high percentage of people receive a blood transfusion.

 Pre-operative planning requires accurate Xrays of the affected joint, implant design selecting and size-matching to the xray images (a process known as templating). 

A few days' hospitalization is followed by several weeks of protected function, healing and rehabilitation. This may then be followed by several months of slow improvement in strength and endurance. 

Early mobilisation of the person is thought to be the key to reducing the chances of complications[1] such as venous thromboembolism and Pneumonia. Modern practice is tomobilize people as soon as possible and ambulate with walking aids when tolerated. Depending on the joint involved and the pre-op status of the person, the time of hospitalization varies from 1 day to 2 weeks, with the average being 4–7 days in most regions. 

Physiotherapy is used extensively to help people recover function after joint replacement surgery. A graded exercise programme is needed initially, as the person's muscles take time to heal after the surgery; exercises for range of motion of the joints and ambulation should not be strenuous. Later when the muscles have healed, the aim of exercise expands to include strengthening and recovery of joint  function.

Intraarticular Joint Injections

Are medical treatments involving the direct injection of medications into a joint. These injections are commonly used to relieve pain, reduce inflammation, and improve joint function in conditions like osteoarthritis and rheumatoidarthritis, bursitis, and other inflammatory joint disorders. 

Common Medications Used: 

  1. Corticosteroids: These are powerful anti-inflammatory drugs that can provide significant pain relief. Examples include triamcinolone and methylprednisolone.
  2. Hyaluronic Acid: This substance is similar to the natural fluid found in joints and is often used in osteoarthritis to improve joint lubrication and shock absorber reduce pain. 
  3. Platelet-Rich Plasma (PRP): This involves using a concentration of the patient's own platelets to promote healing and reduce inflammation. 
  4. Local Anesthetics: Often used in combination with other medications to provide immediate pain relief. 

Commonly Treated Joints: 

  • Knee
  • Shoulder
  • Hip
  • Elbow 
  • Ankle
  • Wrist 

Procedure: 

  1. Preparation: The area around the joint is cleaned and sometimes numbed with a local anesthetic. 
  2. Guidance: Ultrasound or fluoroscopy may be used to ensure precise injection. 3. Injection: The medication is injected directly into the joint space.
  3. Post-Injection: Patients may be advised to rest the joint for a short period.

Benefits: 

  • Rapid pain relief 
  • Reduced inflammation 
  • Improved joint function 
  • Delayed need for surgery in some cases

Basic Fracture Care

It aims to ensure proper healing and function of the injured bone while minimizing pain and preventing complications. Basic fracture care involves initial management of a broken bone to ensure proper healing and minimize complications. 

Here are the fundamental steps and principles: 

Steps in Basic Fracture Care
  1. Assessment and diagnosis 
○ History: Gather information about how the injury occurred.  ○ Physical Examination: Check for deformity, swelling, bruising, and open wounds. Assess the function and sensation distal to the fracture site to rule out nerve or vascular injury.
  1. Immobilization/stabilization 
○ Splinting: Immobilize the fractured bone in the position it was found to prevent further injury. Use splints made from materials like plaster, fiberglass, or commercial splints.  ○ Padding: Apply padding to protect the skin and reduce pressure from the splint.

PATELLA FRACTURE BEFORE SURGERY

PATELLA FRACTURE BEFORE SURGERY

PATELLA FRACTURE AFTER SURGERY

PATELLA FRACTURE AFTER SURGERY
  1. Pain Management: 
○ Medications: Administer pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). For severe pain, stronger prescription medications may be necessary. 
  1. Elevation and Ice: 
○ Elevation: Elevate the injured limb above heart level to reduce swelling and apply ice packs wrapped in a cloth for 20 minutes at a time to         decreaseswelling and pain.
  1. Medical Evaluation: 
○ Radiological Imaging: X-rays and CT scan, MRI are typically used to    confirm the fracture and assess its severity and exact location. 

WRIST FRACTURE BEFORE PLASTER APPLICATION

WRIST FRACTURE BEFORE PLASTER APPLICATION

WRIST FRACTURE AFTER PLASTER APPLICATION

WRIST FRACTURE AFTER PLASTER APPLICATION

Types of Fractures: 

  • Closed Fracture: The bone is broken, but the skin remains intact.
  • Open (Compound) Fracture: The bone breaks through the skin, increasing the risk of infection.
  • Simple Fracture: A single break in the bone. 
  • Comminuted Fracture: The bone is shattered into multiple pieces.
  • Greenstick Fracture: An incomplete fracture where the bone bends, common in children. 
  • Stress Fracture: A small crack in the bone due to repetitive force or overuse. 

WRIST FRACTURE BEFORE SURGERY

WRIST FRACTURE BEFORE SURGERY

WRIST FRACTURE AFTER SURGERY

WRIST FRACTURE AFTER SURGERY

Treatment Options: 

  • Casting: Immobilization with a cast to keep the bone in proper alignment during healing. 
  • Traction: Using weights and pulleys to align bones or maintain alignment. 
  • Surgery: In cases of severe or complex fractures, surgical intervention may be necessary to realign and fix the bones using kwires, plates, screws, or rods. 

Follow-Up Care: 

  • Monitoring: Regular follow-up visits to monitor healing progress via physical examination and imaging. 
  • Rehabilitation: Physical therapy to restore strength, flexibility, and function once the bone has healed sufficiently. 
  • Prevention: Education on avoiding future fractures, especially in individuals with conditions like osteoporosis. 

Complications to Watch For: 

  • Infection: Particularly with open fractures. 
  • Nonunion or Malunion: When the bone does not heal properly or heals in an incorrect position. 
  • Compartment Syndrome: Increased pressure within a muscle compartment that can restrict blood flow and cause damage to muscles and nerves.

Complex Fracture Care

Complex fracture trauma refers to severe bone injuries typically resulting from high-energy impacts such as car accidents, falls from significant heights, or sports injuries. These fractures are often accompanied by damage to surrounding tissues, blood vessels, and nerves, making their management more challenging.

Complex fracture trauma requires a comprehensive and multidisciplinary approach involving orthopedic surgeons, trauma specialists, physical therapists, and other healthcare professionals to ensure the best possible recovery and minimize complications.

Initial Management:

  1. 1. Emergency Assessment and Stabilization:
  • Primary Survey (ABCs): Ensure airway, breathing, and circulation are stabilized. Address life-threatening conditions first.
  • Secondary Survey: Detailed examination of the injury, assessment of other potential injuries, and history taking.
  1. 2. Initial Imaging:
  • X-rays: To identify the fracture and assess its severity.
  • CT Scans: Often used for more detailed imaging, especially for complex fractures.
  • MRI: May be used to assess soft tissue, ligament, and tendon injuries.
  1. 3. Temporary Stabilization:
  • Splinting or Traction: To immobilize the fracture and prevent further injury.
  • Pain Management: Administer pain relief using medications such as opioids, NSAIDs, or regional anesthesia.

Definitive Treatment:

  1. 1. Surgical Intervention:
  • Open Reduction and Internal Fixation (ORIF): Surgical alignment of the bone fragments using hardware like plates, screws, and rods.
  • External Fixation: External devices used to stabilize the bone, particularly useful for open fractures or when immediate internal fixation is not feasible.
  • Debridement: For open fractures, removing dead tissue and cleaning the wound to prevent infection.
  • Vascular and Nerve Repair: If blood vessels or nerves are damaged, surgical repair may be necessary.
  1. 2. Soft Tissue Management:
  • Repair of Muscles, Tendons, and Ligaments: Addressing injuries to surrounding soft tissues to promote overall recovery and function.
  • Wound Care: Managing any open wounds to prevent infection and facilitate healing.

SHOULDER (PROXIMAL HUMERUS FRACTURE) BEFORE SURGERY

SHOULDER BEFORE SURGERY


SHOULDER (PROXIMAL HUMERUS FRACTURE) AFTER SURGERY

SHOULDER AFTER SURGERY

Post-Surgical Care:

  1. 1. Monitoring and Follow-Up:
  • Regular Check-Ups: Frequent visits to monitor healing progress through physical examinations and imaging.
  • Infection Prevention: Using antibiotics and proper wound care techniques, especially for open fractures.
  • Monitoring for Complications: Watching for signs of nonunion, malunion, or hardware issues.
  1. 2. Rehabilitation:
  • Physical Therapy: Essential for restoring strength, flexibility, and function. Tailored rehabilitation programs based on the specific injury and patient needs.
  • Occupational Therapy: Especially important for upper extremity injuries to regain fine motor skills and perform daily activities.
  1. 3. Pain and Inflammation Management:
  • Medications: Ongoing use of pain relievers and anti-inflammatory drugs as needed.
  • Non-Pharmacological Methods: Techniques like ice, elevation, and electrical stimulation to manage pain and swelling.

Long-Term Management:

  1. 1. Bone Health:
  • Nutrition: Ensuring adequate intake of calcium, vitamin D, and other essential nutrients.
  • Lifestyle Modifications: Avoiding smoking and excessive alcohol, which can impair bone healing.
  1. 2. Monitoring for Late Complications:
  • Osteoarthritis: Increased risk in joints affected by complex fractures.
  • Functional Assessment: Ensuring the return of as much function as possible and addressing any residual disability.
  1. 3. Secondary Prevention:
  • Fall Prevention: Especially in older adults to prevent future fractures.
  • Bone Density Testing: For patients at risk of osteoporosis, to guide preventive measures.

THIGH BONE (FEMUR FRACTURE) BEFORE SURGERY

FEMUR FRACTURE


THIGH BONE (FEMUR FRACTURE) AFTER SURGERY

FEMUR FRACTURE

Complications to Watch For:

  • Infection: Particularly in open fractures.
  • Nonunion or Malunion: When the bone does not heal properly or heals in an incorrect position.
  • Compartment Syndrome: Increased pressure within a muscle compartment that can restrict blood flow and cause damage to muscles and nerves.
  • Vascular Injury: Potential damage to nearby blood vessels.
  • Nerve Damage: Potential damage to nearby nerves.

HIP BONE FRACTURE BEFORE SURGERY

HIP BONE FRACTURE BEFORE SURGERY


HIP BONE FRACTURE AFTER SURGERY

HIP BONE FRACTURE AFTER SURGERY


Examples of Complex Fractures:

  • Comminuted Fractures: Bone shattered into multiple pieces.
  • Segmental Fractures: Multiple fractures within the same bone.
  • Intra-articular Fractures: Fractures extending into the joint space.
  • Fractures with Displacement: Significant misalignment of bone fragments.
  • Open (Compound) Fractures: Bone breaks through the skin, increasing infection risk.

Implant Removal Surgery

Implant removal surgery involves taking out medical devices that were previously placed to support the healing of bones or other tissues. These devices can include plates, screws, rods, and pins and k wires commonly used in orthopedic surgery. Implant removal may be necessary for various reasons, including pain, infection, hardware failure, or after the bone has sufficiently healed.

Indications for Implant Removal:

  1. Pain or Discomfort: Persistent pain at the implant site can necessitate removal.
  2. Infection: Infection around the implant may require its removal to allow for proper treatment.
  3. Hardware Failure: Broken or loosened implants may need to be removed.
  4. Soft Tissue Irritation: Implants causing irritation or impingement on surrounding soft tissues.
  5. Bone Healing: Once the bone has sufficiently healed and the implant is no longer necessary.
  6. Allergic Reactions: Rare, but allergic reactions to the implant material can occur.
  7. Growth in Children: In pediatric patients, implants may need to be removed to accommodate growth.

Preoperative Considerations:

  1. Medical Evaluation: Thorough medical history and physical examination.
  2. Imaging: X-rays or other imaging studies to assess the position and condition of the implant and surrounding bone.
  3. Laboratory Tests: Blood tests to check for infection or other underlying conditions.
  4. Medication Review: Adjusting medications that may affect bleeding or anesthesia.

The Procedure:

  1. Anesthesia: The patient is given general or regional anesthesia.
  2. Incision: The surgeon makes an incision over the site of the implant.
  3. Exposure: Soft tissues are carefully moved aside to expose the implant.
  4. Removal: The implant is carefully removed. In some cases, special tools may be needed to extract broken or embedded hardware.
  5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Postoperative Care:

  1. Pain Management: Pain relief medications, including NSAIDs or opioids, as needed.
  2. Wound Care: Keeping the incision site clean and dry. Follow instructions for changing dressings.
  3. Activity Restrictions: Limiting weight-bearing or specific movements to protect the surgical site.
  4. Physical Therapy: Rehabilitation exercises to restore strength and mobility, if necessary.
  5. Follow-Up: Regular check-ups to monitor healing and address any complications.

Potential Complications:

  1. Infection: As with any surgery, there is a risk of infection.
  2. Bleeding: Risk of bleeding during or after surgery.
  3. Nerve Injury: Potential for nerve damage during the procedure.
  4. Incomplete Removal: Difficulty in removing all parts of the implant, especially if it is embedded.
  5. Fracture: Risk of fracturing the bone during the removal process.

Outcomes and Considerations:

  1. Relief from Symptoms: Successful removal can relieve pain, infection, or irritation caused by the implant.
  2. Bone Health: Monitoring bone healing and ensuring proper function post-removal.
  3. Recovery Time: Varies depending on the complexity of the surgery and the patient's overall health.
  4. Future Surgeries: In some cases, new implants may be required if further stabilization is needed.

Implant removal surgery is generally safe and effective when performed for appropriate indications. The decision to remove an implant should be made in consultation with a healthcare provider, considering the patient's symptoms, implant condition, and overall health.

Osteomyelitis or Bone Infection

Osteomyelitis is an infection of the bone, usually caused by bacteria, but it can also be due to fungi. The infection can reach a bone by traveling through the bloodstream or spreading from nearby tissue. It can also begin in the bone itself if an injury exposes the bone to germs.

Types of Osteomyelitis:

  1. Acute Osteomyelitis: Develops rapidly and is often caused by a bacterial infection. It typically occurs within two weeks of an injury, surgery, or the onset of an infection elsewhere in the body.
  2. Chronic Osteomyelitis: Develops more slowly and can persist for months or years. It may occur if acute osteomyelitis is not properly treated or as a result of a persistent infection.

Causes:

  • Bacterial Infections: Staphylococcus aureus is the most common causative agent. Other bacteria like Streptococcus and Pseudomonas can also cause osteomyelitis.
  • Fungal Infections: Less common but can occur, especially in immunocompromised individuals.
  • Injury or Surgery: Direct infection from a wound or surgical site.
  • Spread from Nearby Infection: Infections in nearby tissues or joints can spread to the bone.
  • Bloodstream Infection: Bacteria traveling through the bloodstream from other parts of the body can infect the bone.

Risk Factors:

  • Recent injury or orthopedic surgery
  • Diabetes, especially with foot ulcers
  • Weakened immune system (due to illness, medication, or conditions like HIV/AIDS)
  • Poor circulation (e.g., due to peripheral artery disease)
  • Intravenous drug use
  • Sickle cell disease

Symptoms:

  • Pain: In the affected bone, which may be severe and persistent.
  • Swelling, Warmth, and Redness: Over the infected area.
  • Fever and Chills: Common in acute osteomyelitis.
  • Pus drainage: From an open wound or through the skin in chronic cases.
  • Fatigue and General Malaise: Feeling of being unwell.

Diagnosis:

  1. Physical Examination: Checking for signs of infection and bone tenderness.
  2. Imaging Tests:
  • X-rays: Can show bone damage, but changes may not be visible in early stages.
  • MRI: Provides detailed images of bone and surrounding soft tissues.
  • CT Scan: Useful for detailed bone images.
  1. 3. Laboratory Tests:
  • Blood Tests: Elevated white blood cell count and markers of infection (e.g., C-reactive protein, erythrocyte sedimentation rate).
  • Bone Biopsy: To identify the causative organism and guide antibiotic treatment.
  1. 4. Bone Scans: Using radioactive material to detect areas of high bone activity, indicative of infection.

Treatment:

  1. Antibiotics:
  • Intravenous Antibiotics: Often required for 4-6 weeks, sometimes longer, depending on the severity of the infection and the organism involved.
  • Oral Antibiotics: May follow IV treatment or be used in less severe cases.
  1. 2. Surgery:
  • Debridement: Removing infected and dead bone tissue.
  • Draining Abscesses: Draining any pus or abscesses associated with the infection.
  • Stabilization: Using hardware or other methods to stabilize the affected bone if necessary.
  • Reconstruction: In severe cases, reconstructive surgery may be needed to restore bone integrity and function.
  1. 3. Hyperbaric Oxygen Therapy: In some cases, particularly chronic osteomyelitis, this can help by increasing oxygen supply to the affected area and promoting healing.

Complications:

  • Chronic Osteomyelitis: Persistent infection that can recur.
  • Bone Necrosis: Death of bone tissue.
  • Septic Arthritis: Spread of infection to nearby joints.
  • Impaired Growth: In children, affecting the growth plates.
  • Amputation: In severe, unmanageable cases, particularly when associated with poor circulation and diabetes.

Prevention:

  • Prompt Treatment: Of infections and wounds to prevent spread to bone.
  • Good Hygiene: Keeping wounds clean and covered.
  • Manage Chronic Conditions: Such as diabetes, to prevent complications like foot ulcers.
  • Avoiding Intravenous Drug Use: Or using clean needles if necessary.

Osteomyelitis is a serious condition that requires prompt and effective treatment to prevent long-term complications. Early diagnosis and appropriate medical or surgical interventions are crucial for successful outcomes.