Trauma

Introduction

Trauma can vary from subtle injury to the finger to domestic falls to high-velocity road traffic accidents. Subtle injuries with no underlying fractures can easily be treated with household remedies and respond very well to these remedies.

Domestic falls are very common amongst old people. These group of patients are very prone to fractures because of their poor bone quality. The most common being hip fractures. Fractures if treated on time can really give excellent results and prevent a dependent life.

High-velocity Road traffic accidents can really be a threat to life or limb. Disabled life or wheelchair bound life can have a long-lasting traumatic impact on the young minds.

The most crucial factor in such cases is delayed intervention.

Pinnacle orthocentre is well equipped to provide comprehensive, multidisciplinary emergency treatment to all victims of trauma the best possible chance of survival and recovery. Our surgeons routinely provide extensive gamut of core that includes pre-operative evaluation to post-operative rehabilitation. We have engendered such sophisticated procedures in our system which minimizes post-operative infection to the least values.

MEET THE EXPERTS

Dr. Yogesh R. Vaidya

Dr Yogesh vaidya is a consultant knee replacement surgeon at Pinnacle Orthocentre specialising in “ Computer-assisted Knee Joint Replacement”.

Dr yogesh Vaidya has done his MBBS from LTMGH Hospital, Sion, Mumbai and completed his MS-Orthopaedics from KEM Hospital and Seth G. S Medical College in the year 2003.

Dr Yogesh Vaidya brings with him wealth of experience as a knee replacement surgeon since 2003, having done over 2000 hip and knee replacement surgeries over the past 14 years.

Dr Yogesh Vaidya has attended the Biomet Visiting Surgeons Programme at New Albany Hospital, Ohio, USA under Dr Adolf Lombardi and Dr Keith Barand.He has completed a certified course in Total Hip Replacement at Chula Long Corn Hospital, Thailand.

This experience enables him to offer surgeries for Total knee replacement using muscle preserving techniques with no compromise on alignment and balance

SURGICAL PROCEDURE

UPPER LIMB

Clavicle bone, also known as shoulder bone, fractures most commonly due to fall on the outstretched hand. Most of the times these fractures are treated conservatively using a figure of “8” bandage.

  • Indications for surgery: Displaced fracture, Suspected injury to the neuro-vascular bundl
  • Fixation: The fracture is aligned and fixed using a plate and screws.
  • Possible Complications if surgery refused: Persistent pain
  • Elbow joint comprises of three bones, Humerus (arm bone) and two forearm bones (radius and ulna).
  • Fractures around the elbow joint are usually complicated. They may involve a single bone or all the three bones.
  • More common in children and mostly occur while playing due to fall on the folded hand.
  • The method of fixation varies in children and adults.
  • In children the fracture is reduced and fixed using percutaneous wires (no incision required) but in case of adults, a proper open reduction done and fracture fixed using one or more plates and screws.

Common Complication if Surgery refused:

  • Fracture unites in the wrong position resulting in deformity and stiffness of the joint.
  • Persistent Pain.

A knee Replacement (Arthroplasty) is a surgical procedure in which a damaged joint is removed and replaced by metal and plastic implants. There are four basic steps to a knee replacement procedure.

  • Forearm Bones are called Radius and Ulna.
  • Fractures commonly occur due to fall when the entire weight of the body is transferred to the forearm.
  • Most commonly treated surgically using plates and screws and supported by POP cast for 4-6 weeks.
  • Complications are very rare. Occasionally can go into non-union.

Humerus or the Arm Bone, most commonly fractures due to fall, RTA (road traffic accident) or trivial trauma in old patients due to osteoporosis.

Common Sites for fracture:
  • 1. Just Below the ball of the humerus (medically called surgical Neck
  • 2. Shaft or body of the humerus

Fracture Fixation

Usually done using plate or screws. In case of fractures at multiple sites an interlock nail can also be used which is a minimally invasive technique but requires an advanced imaging machine called C-Arm to be used intra-operatively.

Commonest Complication

Radial Nerve Palsy which results in wrist drop (inability to lift the palm) but in most of the patient it recovers on its own.

Possible Complication if surgery refused
  • 1. The fracture can remain non-united resulting in persistent pain and inability to use the hand.
  • 2. The fracture can unite in a wrong position (mal union) resulting in deformity and inability to use the hand even for day to day activities.
1. Colle’s Fracture

These are commonest fractures in the elderly people. The commonest mode of injury is fall while walking. The presenting feature is pain and deformity. Fixation Techniques: In most of the patients the fracture is reduced under General Anaesthesia and fixed by passing Wires thru the fracture fragments. These wires are stabilized by POP Cast for 4-6 weeks after which the wires are removed.

2. Volar Barton’s Fracture

This is a displaced fracture of the lower end of the forearm and wrist bones. Fixation usually done using plates and screws.

LOWER LIMB

Ankle fractures can are very common in both the young as well as elderly group. May occur following a trivial trauma or a simple twisting injury. Fixation done using K-wires, Screws or sometimes plate and screws depending upon the complexity of the fracture and no of bones involved

Femur fractures often result as a result of high-velocity RTA in young patients. In older patients, shaft femur fractures are uncommon but often result due to osteoporosis.

Shaft femur can be fractured at three sites;

  • Subtrochanteric( just below the neck of the femur)
  • Shaft (body) of the femur
  • Fixation is usually done using either long Proximal Femoral Nails for sub-trochanteric fractures or interlocking nails for shaft or body of the femur.
  • For supra-condylar fractures usually, plates and screws are used.

Fracture Neck Femur is one of the commonest fractures in old patients especially in patients with osteoporosis (decreased bone calcium). Commonest modes of injury are domestic falls. They are best treated by joint replacement.

Joint Replacement can be:
  • Partial (Hemiarthroplasty), in which only the ball which has been fractured is only replaced. The cup or the acetabulum is kept intact. .
  • Total Hip Replacement – Both the cup (acetabulum) as well as the ball is replaced by a prosthesis

Your orthopaedic surgeon will assess the condition of the patient as well as the joint and take a decision whether to do a partial or total knee replacement.

With surgery the patient can be mobilised in bed immediately and can be made to walk in one or two days.

Complications if surgery Refused:
  • Patient will be bed ridden for prolonged period which will result in bed sores and downhill course of the patient.
  • The patient will be unable to move the fractured leg. Hence the blood flow (venous blood) would be reduced giving rise to clots in the veins of the limbs. This condition is called DVT. DVT gives rise to pain and redness in the cal
  • The clots in the veins can get dislodged and get impacted in the veins of the heart or the lungs. This is called embolism resulting in complications and even pose a risk to the life.

There is always a dilemma in the minds of the relatives regarding the surgery because of many times these patients present at extreme age, sometimes more than 90 years. The commonest concern usually is the age and the second is the cost associated with the surgery. It is always better to give the benefit of surgery to the patient rather than subjecting the patient to a bedridden, morbid life.

Mode of Injury is usually RTA in both young as well as elderly people. Fixation usually done using interlock nail and locking bolts. For fractures of the upper end, fixation is done using plates and screws.

Knee injuries can occur due to fall or high impact sports. Injuries can involve the bones or the ligaments. Commonest fracture is the fracture of Patella or Knee cap which can be fixed using K wires or circlage wires. Ligament injuries are very common in people involved in high impact sports and usually treated arthroscopically or keyhole surgery. Arthroscopy is a specialised branch in itself

Intertrochanteric Fracture Neck Femur is also one of the commonest fractures in old patients especially in patients with osteoporosis ( decreased bone calcium). Commonest modes of injury are domestic falls. They are best treated by fixing the fracture. Fixation is usually done either by using plates and screw or Proximal Femoral Nail with locking bolts. In case if the fracture is into multiple parts then hip joint replacement can be considered. Your orthopaedic surgeon will assess the condition of the patient as well as the joint and suggest you the best treatment modality. With surgery the patient can be mobilised in bed immediately and can be made to walk in one or two day.

Complications if surgery Refused:
  • Patient will be bed ridden for prolonged period which will result in bed sores and downhill course of the patient.
  • The patient will be unable to move the fractured leg. Hence the blood flow (venous blood) would be reduced giving rise to clots in the veins of the limbs. This condition is called DVT. DVT gives rise to pain and redness in the calf.
  • The clots in the veins can get dislodged and get impacted in the veins of the heart or the lungs. This is called embolism resulting in complications and even pose a risk to the life.

There is always a dilemma in the minds of the relatives regarding the surgery because of many times these patients present at extreme age, sometimes more than 90 years. The commonest concern usually is the age and the second is the cost associated with the surgery. It is always better to give the benefit of surgery to the patient rather than subjecting the patient to a bedridden, morbid life.