Fracture – when to operate and when not to?

A Fracture is a break in the bone resulting in loss of function and pain. A few decades back all fractures were managed by, Plaster of Paris castor treated with weights hanging from bed. With improvements in metal technology, advances in anesthesia, and research more and more surgeries are performed for fracture. But does all fracture need surgery? Can we still use Plaster of Paris?

Many fractures like wrist fractures in old people, children’s fractures (called greenstick fractures), arm bone fractures, some spine bone fractures (without spinal cord injury) can be treated without surgery. Some fractures definitely need surgery and some can be managed by both forms of treatment.

Generally speaking, fractures through joints(called intra-articular fracture)  definitely require surgery. Because the joints which are a place where two bones meet and give movements require smooth surfaces. If the surfaces are rough and uneven due to fractures, then the smooth movement of the joint is lost and result in pain. Hence, perfect positioning of fracture fragments is necessary to get the best result in fractures through joints. Common fractures through joints which require surgery are ankle fractures, Knee fracture, forearm, and wrist Joint fracture. So to reiterate ”All Fracture Through The Joints Require Surgery”.

Some fracture which heals quicker and better with surgery compared to Plaster of Paris immobilization. For Example, fractures of the collar bones are healed better with surgery than bandages. Similarly, fractures of the thigh bone, hip bone, leg bone are better operated than treated with the plaster cast. The bone fragments may not be correctly aligned inside plaster cast and reduction will be lost. This can lead to deformities like bending of bone or angulations at Fracture Site. Also, hip fractures will either not heal or heal in a deformed position if treated without surgery. Hence surgery is a better option here. For fracture, surgery is done using metallic plates and screws or long rods inserted into the bone or sometimes with pins and rods outside the bone and skin (External fixator). Surgery is done under local or general anesthesia depending on the site of a fracture.

Fracture Surgery

 Advantages of Surgery:

  • The better positioning of broken bone fragments.
  • Reliable fixation of bone ends when compared to plaster cast fixation of bone ends.
  • Quicker healing times.
  • Precise maintenance of reduction in fractures through joints.
  • Avoiding plaster helps in moving joints near the fracture.
  • No itching or skin dryness under the cast.

Disadvantages of Surgery:

  • Scar
  • Infections
  • Failure of healing

Native bone setters:

Native bone setters are there in all parts of our state from Putthoor to thalavoor. People flock to them fearing surgery and high medical costs. Though they can get away with fractures away from joints, joint fractures are a total failure in traditional bone setters. Many times people end up with deformities and non-healing of fractures. Also, excessive tight bandages can lead to stopping of blood supply in injured limb and cause the death of cells, sometimes leading to amputation. Hence better to avoid quacks and traditional bone setters who do not set bones precisely.

Your orthopaedician is the best judge to decide whether a particular fracture requires surgery or not.

Liposuction – Sculpting Your Body

What is Liposuction?

Liposuction is a surgical procedure designed to remove pockets of fat beneath the skin to contour specific areas of the body. Fat is removed using suction and a small tube called a cannula and then a small incision will be made near the area to be treated to allow the cannula to fit through the skin. Using suction, the surgeon will remove unwanted fat cells. Then the incision will be closed.

Is liposuction used as weight reduction procedure?

Liposuction is not meant for weight loss, but it is to reshape areas of the body through the removal of fat deposits.

What are the benefits of liposuction?

Liposuction can eliminate small deposits of fat from stubborn areas that are unresponsive to diet and exercise. And it also provides a way to override genetics and take control of the shape of your body.

The amount of fat to remove:

Fat removal is limited to 3,000 to 5,000 cc per operation for safety reasons. If there is a need to remove additional fat, then subsequent surgeries may be necessary.

Will the fat reaccumulate after liposuction?

Liposuction removes the fat cells from specific areas of the body. These fat cells will not be formed again. However, if the patient does not follow a healthy diet and exercise regularly, the remaining fat cells could expand and lead to weight gain in the other areas of the body.

Procedure:

Various types of anesthesia can be used for liposuction procedures. Liposuction can be performed under local anesthesia. However, the local anesthesia is usually used along with intravenous sedation to keep the person more relaxed during the procedure.
Regional anesthesia like epidural or spinal can be a good choice for more extensive procedures. However, some patients require general anesthesia, particularly if a large volume of fat is being removed.
The time required to perform liposuction may vary considerably, depending on the amount of fat being removed, the size of the area, the type of anesthesia and the technique changed.

How do we do liposuction?

We use the Power-Assisted Lipoplasty( PAL) Device to perform this procedure. It uses powered cannula at 2 mm, reciprocating movement at 4000 cycles per minute to facilitate the procedure. This means that less force is required, especially in areas with more fibrous tissue. The PAL is not ultrasonic. No heat is generated by the instrument or cannula, so burning isn’t a concern.

Post Operative Care
Post Operative Care

Patient Benefits:

  • Less Trauma, Better Results.
  • No Heat means No Risk of Burning.
  • Liposuction done by this method is very safe.

Post-operative:

The local anesthesia injected into the tissue greatly reduce post- operative pain. After liposuction, most patients are generally conscious and alert. Patients are encouraged to walk immediately after surgery. Patients can usually return to a desk-type job within a few days. Mild physical exercise may be resumed three to seven days after the procedure. The stitches if any are removed or dissolved on their own within the first week to 10 days. To control swelling and to help your skin better fit its new shape, Pressure elastic garments are needed for 8 weeks.

 

What are the different liposuction techniques?

  • Suction assisted lipectomy.
  • Ultrasound-assisted liposuction.
  • Power assisted liposuction.

Areas Treated with Liposuction:

Abdomen.
Male Breast enlargement.
Hips.
Breast reduction.
Inner thighs.
Chin.
Outer thighs.
Outer 2/3 of buttocks.

Will liposuction eliminate stretch marks and cellulite?

Liposuction is generally not used for elimination of Cellulite and Stretch marks.

Age Limitations:

The patient should be an adult. There is no upper age limitation although the younger age gives the better results. Patients over 50 years of age are at increased risk for loose hanging skin and skin irregularities (dimpling or rippling of the skin).

Persons Not Suitable for Liposuction:

Avoid Liposuction for Lactating Mothers.
Avoid Liposuction for Lactating Mothers.
  • A person who is on anticoagulants.
  • Persons with bleeding tendencies.
  • A person with Lidocaine (Local Anaesthesia) Allergy.
  • Pregnant Ladies and Lactating mothers.

What risks are associated with liposuction?

Liposuction is a surgical procedure as a result, it carries the same risks as any other surgery. Serious but rare complications are Pulmonary embolism, Perforation of organs, Anaesthetic complication, Lidocaine toxicity, Fluid imbalance. Bleeding, Bruises, Seroma, Infection, Pigmentation, Burns, Scars, Nerve injuries, etc. are less common. However, with experience and all necessary precautions, the complication rate is 1-2 % only.

Your new look:

You will see a noticeable difference in the shape of your body quite soon after surgery. However, the improvement will become even more apparent after about four to six weeks when most of the swelling has subsided. Any persistent mild swelling usually disappears after about three months, and the final contour will be visible.

Enthesopathy

Enthesopathy is an inflammatory disorder affecting the site where muscles and ligaments attach to the joints and bones.
The exact cause of the disease is not known but it is associated with rheumatic conditions such as seronegative spondylitis, Crohn’s disease, and ankylosing spondylitis. However, these enthesopathies flare up due to repetitive stresses on these areas where tendon or ligaments or fascia attach to bone. Also, these inflammatory conditions can be treated effectively.

Tennis Elbow:

Tennis elbow is one of the most common enthesopathies where the muscles to the hand and fingers are attached to the outer aspect of the elbow. Those who suffer from this condition have pain on playing tennis or shuttle, badminton, gripping objects while washing clothes or cleaning dishes.

Treatment includes x-rays to rule out any other cause of pain, and blood tests to find out for rheumatic conditions. Anti-inflammatories, physiotherapy, and exercises normally are sufficient. Sometimes in intractable pain, steroid injections locally can be given for relief.

Treatment For Enthesopathy.
Treatment For Enthesopathy.

Plantar Fasciitis:

This is a painful condition of the heel, where a person gets pain after getting up from bed or getting up after prolonged sitting. This is due to pulling off a sheet of tissue from the heel bone and the site gets inflamed. Usually, the pain subsides with rest but many times anti-inflammatory drugs, physiotherapy and special footwear would be required for treatment. Very rarely, surgery may be done if all conservative management fails.

This is a painful condition of the heel, where a person gets pain after getting up from bed or getting up after prolonged sitting. This is due to pulling off a sheet of tissue from the heel bone and the site gets inflamed. Usually, the pain subsides with rest but many times anti-inflammatory drugs, physiotherapy and special footwear would be required for treatment. Very rarely, surgery may be done if all conservative management fails.

Ta Insertional Tendinitis:

Tendo Achilles is the largest tendon in the body and it connects the calf muscle to heel bone. Inflammation at this site leads to pain and swelling. Calcium deposits tend to occur stimulating new bone formation. This is commonly due to stand for longer time or overweight, again special footwear, rest, anti-inflammatory drugs, and physiotherapy should give relief

Rotator Cuff Tendinopathy:

Extracorporeal shockwave therapy.
Extracorporeal shockwave therapy.

Inflammation at site rotator group of muscles inserted on the shoulder joint is called rotator cuff tendinopathy. This is a repetitive stress injury where the tendon gets inflamed due to overhead activities. Athletes, workers who do overhead work many develop this condition. Strengthening muscles, healing tendons, and rest will relieve the symptoms. In older individuals, arthroscopic surgery may be indicated.

Despite all these measures, sometimes the pain persists or recurs as the tendon and enthesis fail to heal. Various treatments are used to promote the healing of tendons. To treat plantar fasciitis and calcific rotator cuff tendinopathy, Extracorporeal shockwave therapy (ESWT) has been used. These shockwaves decrease the conduction of signals along fibers that are responsible for the sensation of pain, hence resulting in pain relief. Furthermore, the shockwaves stimulate the release of chemicals that causes the growth of blood vessels important for the healing process.

Another more recent technique called platelet-rich plasma is used to harvest the platelets in the person’s blood and inject them into the area which is to be treated. Platelets take part in the natural process of healing by forming a clot to seal off an area of injury and also release chemicals that help of healing. The procedure thus augments the body’s natural healing process.

In severe cases where the pain is persistent despite the above treatment, surgery may be necessary to relieve the painful conditions.

Polycystic Ovarian Syndrome,Infertility and Obesity

Polycystic Ovarian Syndrome (PCOS)  is a major health problem for women of all ages through its effect on fertility during the reproductive years and its gynecological and metabolic effects in both the reproductive years and thereafter.But it is a syndrome that also encompasses the metabolic, cardiovascular, dermatological and psychological conditions.PCOS is the most common endocrine syndrome affecting women of reproductive age with a prevalence of between 4% and 18%. Generally, it can affect up to 50% of South Asian Women. PCOS is more prevalent in obese women than those who are lean. It substantially contributes to infertility.

SYMPTOMS POLYCYSTIC OVARIAN SYNDROME:

How to recognize symptoms of Polycystic Ovarian Syndrome
Symptoms of PCOS

The principal presenting symptoms of the woman suffering from PCOS are oligo or anovulation and or infertility as well as excess androgen production. Symptoms tend to be present at the time of menarche with less frequent or complete lack of menses. Other symptoms of excess androgen production are acne, hirsutism, alopecia, overweight or obesity, acanthosis nigricans.However, 20% cases of PCOS may be asymptomatic.

HORMONAL CHANGES:

The effects of PCOS are manifested via deranged hormonal profiles, primarily an excess of circulating testosterone, androstenedione, luteinizing hormone (LH) and insulin as well as a relative deficiency of Follicle Stimulating Hormone (FSH).Insulin Resistance and hyperinsulinemia are central to the pathophysiology of PCOS.

 

EFFECT OF PCOS:

Irregular menstrual cycle and infertifity.
Oligomenorrhea — menses occurring at intervals of 35 days to 6 months.
Secondary ammendhoerea — absence of periods for greater than 6 months. Often women require assisted fertility to conceive.
Lifestyle modification, weight reduction, increasing physical activity are important as the first line of management prior to medications.

PREGNANCY COMPLICATIONS:

Even if these women conceive with the treatment, they are at the increased risk of gestational diabetes, pre-eclampsia, preterm birth, prenatal mortality, and morbidity during pregnancy.

OBESITY:

causes of obesity
Effect of obesity

A woman diagnosed with PCOS are more likely to be overweight or obese and obesity. Obesity has wide-ranging effects of developing metabolic syndrome, diabetes mellitus, cardiovascular disease, musculoskeletal problems, depression, cancer, pregnancy-related complications, miscarriage, and infertility. Even a modest loss of weight in the order of 5-10% can result in a 30% reduction in central adiposity and a marked improvement in symptoms.

CARCINOGENIC:

Women with PCOS are at increased risk of endometrial hyperplasia and endometrial Cancer. Other effects are

  • Metabolic
  • Androgenic
  • Dermatological and Psychologic

KEY POINT:

Losing weight is probably the single most important factor that can confer beneficial effects across the spectrum of abnormalities that constitutes PCOS and therefore improve symptoms and reduce the metabolic and other consequences of this syndrome. Lifestyle advice, encouraging hypocaloric and low glycemic index diets with increased physical activity, hyperinsulinemia prior to starting medicines or along with medications if needed.

Diabetic Kidney Disease

India is the country with most of the people having diabetes, with a current figure of 50.8 million (data from International diabetic federation). Diabetes mellitus accounts for 31% of total kidney failure patients in India. Of these patients, around 60 to 70 % of them are in their earlier stages, were in another 30% in the terminal stage of renal failure, who usually come for treatment (what physicians see is the tip of the Iceberg). Kidney function measured in terms of GFR (glomerular filtration rate) normally is 125 ml/min. Symptoms of kidney failure usually manifest only when GFR falls by less than 10 ml/min. Those patients in the initial phase of kidney failure, if identified earlier and treated properly, can be prevented from progression to severe kidney disease.

Who are all prone to develop Diabetic kidney disease?

The risk of development of kidney failure is 30 to 40 percent in diabetic patients. If a relative (especially first degree) of a diabetic patient affected by kidney failure, the risk of developing kidney failure in this patient is 83 %. Urine excretion of protein (precursor of kidney failure) is very much increased in children of diabetic patients with kidney failure. Other risk factors include children born to diabetic mother and low birth weight children when they grow up. Dietary factors include intake of foods rich in added sugars.

The usual progression of Diabetic kidney disease:

Diabetic kidney disease usually starts with protein loss in urine, initially with a smaller amount (microalbuminuria), later with a larger amount of protein loss (macroalbuminuria), further leading to a gradual decrease in kidney function culminating in an increase in renal parameters like urea and creatinine. These processes usually take about 15 to 20 years from the time of onset of diabetes mellitus. Recent studies have shown that there are about 30% of people who progress to renal failure without having the phase of protein leak in urine.

Precipitating factors for progression of Diabetic kidney disease:

  • Hypertension is an important risk factor in the progression of diabetic kidney disease. Usually, blood pressure decreases during the night in a normal person, which doesn‘t happen in diabetic kidney disease patients and usually the first marker of disease progression.
  • Diabetic patients with persistent protein loss in urine are at greatly increased risk for progression of overt Kidney failure. Severe protein loss occurs after 10 years of onset of diabetes.

Who are all to be screened for the presence of kidney disease, in a diabetic person?

  • Persons with diabetes developing swelling of legs.
  • Patients having frequent urination at night, especially with a well-controlled blood sugar levels.
  • A gradual decrease in urine output.
  • Passing frothy urine, red colored urine.
  • The family history of kidney disease.
  • Those who have burning or pins and needle sensation in the foot.
  • Patients who have a diminution of vision and advised to undergo laser therapy.

High Blood Pressure and Diabetic Kidney Disease

Factors that can prevent progression of Diabetic kidney disease:

  • Achieve and maintain healthy body weight.
  • Avoiding high protein intake, normally protein rich foods will be more acidic, most them will be handled by the kidneys. In kidney failure, this acid will accumulate and precipitate progression of kidney failure. Especially animal protein must be restricted to prevent the progression, which not only provides more acid to the body but also produces more uric acid, which is a product of metabolism, causing hypertension and renal failure.
  • Decreasing table salt (sodium chloride) intake, as increased sodium content, leads to hypertension and perpetuating progression of kidney disease. As normal excretion of sodium occurs by kidneys, decreasing kidney function causes sodium to accumulate causing swelling of legs and face, later causing shortness of breath.
  • Avoid smoking/tobacco use.
  • Avoid unscrupulous use of analgesics, especially over the counter drugs and consumption of heavy metals as part of other modalities of treatment which can precipitate, or cause progression of renal failure.

Medicines that prevent progression of Diabetic kidney disease:

Medicines that are available which not only decrease blood pressures but also reducing pressures within the kidneys (intraglomerular hypertension) have been found to retard the progression of diabetic kidney disease. When these medicines are started early, further progression of kidney disease and worsening of renal parameters (urea, creatinine) can be halted, so the progression to dialysis can be prevented or at least prolonged.

Primary prevention of Diabetic kidney disease:

Adequate blood sugar control, blood pressure control may help in preventing diabetic kidney disease. Early screening for kidney disease may help in the institution of specific medications that may help in preventing further worsening of the disease.

Polio Vaccination

Background:

The availability of two effective vaccines against poliomyelitis for the past five decades has ensured a remarkable decline in the global burden of diseases. They were developed in the USA during 1950, first the inactivated polio vaccine (IPV) by Jona Salk and later the live oral polio vaccine (OPV) by Albert Sabin. The global polio eradication initiative was launched in 1988 using oral polio vaccine as the eradication tool and employing a foot pronged strategy comprising high routine immunization coverage, supplementary nutrition, pulse immunization, AFP surveillance and Mop-up immunization.

Age Group: Affects child under 5 years

Transmission:

  • Through person to person contact
  • Virus Enters through the mouth
  • Virus Shed through the faeces
  • Can be spread when food or drink is contaminated by faeces

Oral Polio Vaccine (OPV):

  • A trivalent vaccine consisting of attenuated poliovirus types 1, 2, 3 grown in monkey kidney cell culture stabilized with magnesium chloride.
  • Monovalent OPV, that means containing either type 1 or type 3 viruses have been introduced in India since 2005.
  • Bivalent OPV containing type 1 and type 3 viruses have been introduced since 2010 for pulse immunization.
  • The dose is 2 drops orally.

IPV vaccine
IPV Vaccine

Inactivated Polio Vaccine (IPV):

  • It is formaldehyde killed poliovirus grown in human diploid cells/monkey kidney cells.
  • Currently used IPV vaccines are enhanced potency IPV which contains 40, 8 and 32 D antigen units of type 1,2, 3 respectively.
  • The vaccine should be stored at 2- 8 degree and the dose is 0.5ml intramuscularly.
  • Highly immunogenic, seroconversion rates are 90-100% after two doses.
  • It contains trace amounts of streptomycin, neomycin and polymyxin B, and antimicrobials.

OPV vs IPV:

OPV                                                                         IPV
Good IgA response (Mucosal immunity)         Low IgA response
Lower humoral response                                    Strong humoral response(IgG)

What is Mucosal Immunity?

It refers to the resistance to mucosal infection by wild poliovirus due to prior infection with WPV. Mucosal immunity decreases the replication and excretion of the virus and thus provides a potential barrier to its transmission.

What is Humoral Immunity?

It refers to IgG antibodies which have an inhibitory influence on local infection.

Herd effect with Polio Vaccines:

Herd effect means the phenomenon of immunized individuals affecting the epidemiology of infection in the unimmunized segment of the population.

  • In OPV effect is mainly due to its excellent gut immunity.
  • In IPV due to induction of high levels of antibodies.

Recommendation for combined use of OPV and IPV:

  • Excellent immunogenicity, efficacy, and safety.
  • The risk of VAPP is extremely low.
  • Better mucosal and humoral immunity together.
OPV during birth
OPV During Birth

Doses and Schedule:

  • OPV at birth.
  • OPV and IPV at 6, 10, I4 weeks.
  • OPV at the sixth and ninth month.
  • OPV and IPV at 15-18 months.
  • OPV at 5 years.

Catch-up Vaccination:

IPV may be preferred as catch-up vaccination for children less than 5 years of age who have completed primary immunization with OPV. IPV can be given two doses at 2 months interval.

Immunodeficient Children and their close contacts:

  • IPV is preferable in patients with B cell immunodeficiency.
  • OPV should be avoided.
    Vaccinate your baby with polio vaccines and make your baby grow stronger with no disabilities.

Osteoporosis

Osteoporosis is a disease of bone characterized by low bone mass and weakness of bone. This, in turn, leads to brittle bones and painful fractures. It can occur in one in two women after the age of 45 or post-menopausal age. Men over 60 years of age can also be affected.

The bone is a living organ which is constantly built and taken down. Diet, exercises, hormones and age are the factors which favor for building bone. To maintain a healthy bone, a balance of bone building and bone take down is required. When this balance is broken, then osteoporosis or weakness of bone results.

The disease is a silent killer because there are no symptoms. A fracture may be the first symptom of osteoporosis. Common fractures of the spinal bones after trivial falls, after traveling in a bus on a bumpy road or even coughing can cause this painful fracture.

Similarly, wrist bone fractures due to falling on an outstretched hand, hip fractures due to falls at home can also occur due to osteoporosis. Osteoporotic fractures are difficult to treat as they occur usually in elderly populations and healing potential of fractures are also poor. Also, the plates and screws used for fixing these fractures don’t hold well on a soft bone. Hence there will be a loss in fracture reduction and failure to unite.

Diagnosing osteoporosis by X-Rays
Diagnosing osteoporosis by X-Rays.

PREVENTION OF OSTEOPOROSIS:

As with many diseases, prevention of osteoporosis is better than undergoing the pain of fracture and costly treatments after that. Osteoporosis fractures are preventable if osteoporosis is diagnosed early.

Diagnosing osteoporosis is by simple tests with x-rays, DEXA scans, ultrasound scan or MRI. Ultrasound scan of the heel is commonly done to screen the population for osteoporosis. The more sensitive test for osteoporosis is a DEXA (Dual Energy Xray Absorptiometry) scan, which is done for the whole body as well as places where fractures frequently occur, namely hips and spine.

World Health Organisation (WHO) has classified the risk of fracture occurring on a graph and according to the bone density compared to a normal person, the risk is given and treatment must be started accordingly.

TREATMENT OF OSTEOPOROSIS:

Treatment is aimed at strengthening the bone by either reducing the bone turnover or by building up the bones. Many treatments have been tried and a group of drugs called bisphosphonates is effective in improving the quality of bone in osteoporosis.

Another new drug is synthetic parathyroid, which is given as an injection on a day to day basis for several months. This drug helps in building up the bone and hence improves the strength.

Myths About Osteoporosis
Myths About Osteoporosis

MYTHS ABOUT OSTEOPOROSIS:

1. Osteoarthritis (wear and tear of joints) is a result of osteoporosis. This is not true as they both are caused by different problems. Though they can coexist, they are not the reason for each other.

2. Vitamin D deficiency causes osteoporosis. Again, this is not true as explained earlier, the reason for osteoporosis is not vitamin D deficiency.

3. Calcium supplements can cause side effects. This is partially true as overdoses may lead to certain heart problems and kidney stones in those who already have a propensity for kidney stones disease. Consult your doctor for correct dosage of calcium supplements.

Its consequences are preventable, if you have an adequate diet, do regular exercises and perform a DEXA scan every year in post-menopausal age group. Treatment is indicated if there is a decrease in bone mineral density.

VITILIGO (LEUCODERMA)

Vitiligo (Leucoderma) is a condition where white patches appear in different parts of the body. It is relatively higher amongst the Indian population. It is a matter of concern as misconceptions about the disorder are higher and so is rejection in society.

Which part of the body can be affected?

Any part of the body can be affected such as hands, legs, head (scalp), soles, lips and mouth (Oral cavity) too. Any part of the skin and mucosa can be affected.

What causes these white patches?

The disease is autoimmune. One‘s own immune system destroys the melanocytes (pigment cells) in the skin. Genetic predisposition can happen for children whose parents have the disease are more likely to develop it. At times, deep injuries or burns where the deeper layers of the skin are affected can also cause vitiligo (Leucoderma). Emotional stress can cause a flare condition or trigger the disease process. It is associated with hyperthyroidism or hypothyroidism.

Which age groups gets affect?

Any age group can develop vitiligo. This disorder affects all races and sex equally. White skin people usually don’t bother much about it as it doesn’t show as much as in darker skin individual. In India, the prevalence rate is higher (2%).

Itching During Vitiligo Spread.
Itching During Vitiligo Spread.

How to assess if it will spread all over the body?

There is no way to predict the course of the disorder. For some patients, the patches just remain stable. Few experience rapid spread of the condition. Some patients complain of itching during spread. Physical and emotional stress can aggravate the condition. There are many ways to control the spread of the disorder. So the earlier, the patient approaches the doctor is better.

Myths about vitiligo:
Vitiligo is not a contagious and does not spread through touch. This is not a life threatening disorder and does not affect any other system in one’s body.

Treatment:
Treatment modalities for vitiligo are many. The goal of the treatment is usually to stop the spread of the disorder and restore lost skin color.

 

 

NonSurgical Methods:

Cosmetic makeup:
Cosmetic makeup is done to color your skin and these can help the patient get back their confidence. Self-tanners are also available and have to be used regularly to retain the color.

Oral medications:
Oral medications are available which stop the white patches from spreading and oral psoralens also help re-pigmentation. These medications should be prescribed by registered doctors.

Topical applications:
Topical applications like cream help re-pigmentation. Topical psoralens solutions are also used to re-pigment the skin. There are a lot of constraints in using topical applications. Small parts are more effective and usually face helps more than limbs or body parts which are less exposed to sunlight.

Light Therapy:
Light therapy is very effective. PUVA therapy has been used for many years and is outdated now. It has a few side effects and is very slow in repigmentation.

Narrow Bend Ultra Violet B (UVB):
Narrow Band Ultra Violet B (UVB) is the latest in Light therapy and has minimum side effects. Re- pigmentation is faster and it also helps to control the spread of the disorder.

High power Narrow Band UVB:
High power Narrow Band UVB is the most effective in re-pigmentation but is limited to smaller areas.

Suction Blister Technique
Suction Blister Technique

Surgical Procedures:

Suction Blister Technique:
Blisters are made with special equipment on the normal skin and the top layers of these blisters are used as skin grafts, which are fixed on the white patches. The skin around the lips and eyelids (skin is very thin) are ideal for this technique as cosmetic results are very good.

Split Skin Graft:
It is a very common procedure. A graft is taken from the normal skin with special knives and transferred to the white patches. Very large areas cannot be treated with this procedure.

Melanocyte Transfer Surgery:
The advantage of this surgery is that the larger area can be treated with small grafts. White patches up to 100 sq.cm can be treated in one session. This procedure needs only a short time and repigmentation is done within a short time span of 3-6 months.

There are laser treatment and some medications which are used very judiciously in resistant cases (patients not responding to any treatment).
Vitiligo is one disorder which does not affect a person physically but the mental trauma caused is unfathomable.

JOINT REPLACEMENT SURGERY

Joint Replacement Surgery is being done for people suffering from painful joints (mostly hips & knee) due to arthritis for various causes. Commonly, people above the age of 50 suffer from wear and tear of the knee or hip joints leading to osteoarthritis – pain & swelling. After all measures of medical treatment with injections, tablets, physiotherapy etc, if the person still has pain, then they may be considered for joint replacement surgery. Normal joint contains two or more bones covered by cartilage causing smooth movements. Due to wear and tear, the cartilage gets damaged and the person gets pain and swelling. Similarly, cartilage can be damaged due to injury, which can also lead to arthritis. So, in all these conditions, joint replacement is the preferred treatment, and after treatment, medicines have no side effects.

Hip joint Replacement surgery
Hip Joint Replacement

Hip and Knee joints are the most commonly replaced joints. Other joints like shoulder, elbow, wrist, finger and ankle joint are also replaceable but less frequently. Once a person decides to have a joint replacement, he/she undergoes full body checkup to prepare for surgery. When all is well, then they are given either regional or general anesthesia and the joint replacement is performed on the affected joint. In the hip, it is a ball and socket joint, so both the parts are replaced by artificial materials. The affected hip is removed and the artificial cup made of metal or plastic is fixed to the bone. The metal cups is lined with plastic or ceramic on the inside. The metal cup is initially fixed by screws and eventually, bone grows over its outer surface and keeps it in position. In older individuals where the quality of bone degrades the plastic cup be fixed with bone cement. The ball part of the hip is replaced by a metal or ceramic ball which is attached to a stem and it is inserted into the thigh bone. Here also, in older individuals, bone cement can be used to hold the stem in position. Normally, a cemented hip replacement lasts for 10 years to 20 years, whereas an uncemented hip replacement can last up to 30 years. The use of ceramic (toughened) cups and the ceramic ball has made the hip replacements last much longer than before. In the knee joint, the lower end of the thigh bone and the upper end of the leg bone are shaped so that it can hold the artificial joint.

computer assisted navigation in orthopaedic surgery
Computer Assisted Orthopedic Surgery

The artificial knee joint is held by bone cement. After the surgery, the person is given adequate pain relief and by the second day after surgery, the person is made to walk, bend the knee or hip. Physiotherapy is given meticulously to ambulate the person as quickly as possible. Once walking well with the support of walking aid – walker / Sticks, the person is discharged to home in a week and sutures are removed by the second week. The person can continue to walk with the support of walking aids for 3-6 weeks after which, they can walk freely. The success rate for joint replacement is approximately 98% with infections and DVT being possible complications. Infections are controlled by operating in 0% bacteria operation theaters and antibiotics. DVT or clotting of blood can be prevented by thinning the blood during and after surgery for a few days with medicines. Latest advancements in joint replacement surgery include computer assisted orthopedic surgery, patients specific instrumentation (customized for each patient), and newer materials which last, longer.

Computer Assisted Orthopaedic Surgery (CAOS) was started at DMH as early 2005 (One of the First in India) and is still done due to its accurate placement of implants which in turn leads to longer life for the implant. Newer materials like ceramic oxonium and highly porous metal surfaces lead to longer life of the implant. So a well-done surgery should relieve the symptoms of pain and deformity for someone suffering from arthritis and get the person back to normal life, pain-free and fully mobile.

Prenatal Screening

Be informed about your baby’s health during pregnancy. Pregnancy is a wonderful time filled with excitement, curiosity, and anticipation of a new addition to the family. Early weeks of pregnancy is exciting and anxious too. Pregnant mothers would want reassurance that baby is normal and healthy.
At various stages of pregnancy, several tests are made to ensure that mother and baby are in a healthy condition and baby is developing normally.

What are Chromosome Conditions?

It occurs when there are extra or missing chromosomes or a rearrangement of pieces of chromosomes. Physical and intellectual development can be affected because of this. Down syndrome is the most common condition. People with down syndrome have 47 chromosomes instead of 46.

Why Prenatal Testing needed?

While most babies are born healthy, only 2 or 3 out of 100 newborns may have major birth defects. For the majority of defects, the cause is unknown. However, there are certain birth defects that can be tested in pregnancy before the baby is born.
The first-trimester screening popularly known as FTS is performed to rule out the possibility that you are at increased risk of having a baby with down syndrome, Trisomy 18 or Trisomy l3.

Understanding Down Syndrome?

In our country the baseline awareness of Down Syndrome is low and that for the screening test is even less. Down Syndrome is a Chromosomal abnormality where the child is born with an extra Chromosome 21. Down Syndrome occurs in about 600 to 700 pregnancies all over the world. Any women can have a baby with Down Syndrome. The risk varies with the mother’s age. 70% of babies with down syndrome are born to younger mothers and therefore screening is offered to all women.
Down syndrome results in developmental problems and a higher risk of conditions including heart defects, mental retardation, breathing and hearing problems and also childhood leukemia. The severity of these conditions varies greatly from individual to individual. No treatment is available for down syndrome. Counseling and support to manage the baby are the only hope.

What is Trisomy 18 and Trisomy 13?

Trisomy 18 and 13 are comparatively rare and severe forms of the chromosomal abnormality associated with severe developmental delay and a physical problem with life-threatening complications in a baby‘s first month and years. No treatment is available for Trisomy 18 or 13.

Performance of Prenatal Screening
Performance of Prenatal Screening

Why prenatal testing important?

Being tested during pregnancy allows you to be informed about the health of your baby even before birth.

How is prenatal screening performed?

Various methods are practiced. The screening can be done in the first trimester, second trimester or in both trimesters. The screening takes into account of mother’s age, a blood test and a special ultrasound test.

What is First Trimester Screening and when is it done?

Optimal time is from 11 weeks to 13 weeks 6 days. It involves a blood test and ultrasound. The ultrasound confirms your baby’s age and measures the amount of fluid behind the baby’s neck (Nuchal Translucency or NT Scan).
The first-trimester Nuchal translucency scan offers several additional benefits. Other abnormalities like cardiac anomalies, diaphragmatic hernia, skeletal dysplasia, abnormal lymphatic drainage, neuromuscular disorders are associated with increased NT. Hence detailed anatomic survey and fetal echo are needed.

 

 

What is Second Trimester Screening?

If the pregnant patient has missed the opportunity of first trimester screening. She should undergo second-trimester screening. Yet the detection rates for down syndrome is lower than FTS around 65-70%. Second Trimester Screening also checks for open neural tube defects such as spina bifida, a condition of improper development of the brain and spinal cord.

Post-test counseling:

Once the screening is done. The result is again explained. If screening is positive, then the details of invasive testing are discussed like amniocentesis or CVS (Remember, a screening test does not confirm the Chromosomal problem, a positive test should be followed by a confirmatory test).

Be sure to discuss these additional confirmatory test with your doctor. Most babies are born healthy. Early, more accurate screening gives peace of mind during pregnancy.