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OUT PATIENT CASES :COMMON ORTHOPAEDIC COMPLAINTS
The post of specialized orthopaedic surgeon exists from the very beginning in the
mobile surgical unit with the orthopaedics department playing a vital role .
If we overview the cases found in the out patient department it is seen that cases of deformities of both upper and lower limbs recorded .In the upper limb, hand deformities like Syndactyly[matted fingers],polydactyly[accessory fingers],flexion contractures[deformed and curved fingers],neglected tendon ruptures are found oftenly, whereas, in the lower limb deformities, club foot ,flat foot,eqinous foot ,cavus foot, genu recurvatum , varus and valgus deformities at knee are present more often.In addition, polio deformities are also major contributor in the lower limb deformities.
It is a well known fact that even now in the rural areas of Rajasthan and some of the urban areas fractures are treated by bone setters, as a result of which cases of non united fractures,malunited fractures[wrongly united fractures],osteomyelitis[infected bones]are found in majority.
Besides a majority of outdoor cases are general orthopaedic cases like osteoarthritis knee,low backache with or without neurological involvement,cervical spondylosis
tuberculosis hip joint,Pott's spine, tennis elbow, calcaneofascitis,frozen shoulder, retrocalcaneal bursitis,polyathritis,ganglion over wrist,etc present mainly altogether they comprises up to 50% to 70 % of the general orthopaedic outdoors although their ratio differs in various areas of Rajasthan,moreover some of the less frequently seen cases are bone tumors like osteosarcomas ,exostosis, enchondroma, Ewing's tumour etc other then this cases of hallux valgus,hammer toes, claw toes,mortons metatarsalgia,arthritis of ankle,stress fracture tibia,internal dearrangment of knee,recurrent dislocation knee,Perthe's disease of hip,avascular necrosis of hip,recurrent dislocation of shoulder and knee congenital anomalies are also reported in outdoors
AGEWISE COMPLAINTS
To elaborate more, it is analysed that in elderly patients malunited wrist and hip fractures are there ,whereas in children malunited elbow,forearm, finger fracture are recorded, In young adults malunited arm fractures, leg bone fractures, cases of bone infection,i:e osteomyelitis are found predominantly.
In addition,among children cases of compartment syndrome and ischiemic contractures are found,the cause of which is presumed to be trauma, cases improperly treated with massage or tight plasters.
SCENARIO OF RAJASTHAN AS A WHOLE
If we analyse the whole scenario it is found that in the northern area of Rajasthan like Nohar[Hanumangarh],Suratgarh [Ganganagar] congenital anomalies like polydactyl, syndactyly, club foot are found in good number.In addition, most of the outdoor patients were of low back pain with neurological involvement reason behind this could be majority of the farming community who does hard labour with lifting weight and travelling on tractor is also a major contributory factor.
In the central area of Rajasthan like Nagaur district the problem of flourosis prevails as a result of that osteoarthritis knee is very common followed by low backache.In this area fracture cases are recorded less in number which could be due to improved orthopaedic facility at centres like Ladnu ,Sujangarh, Kuchaman etc.
In the areas of Rajasthan in Chittor, Udaipur and Bhilwara district our camps are very frequent.Jogania mata,Mandafia,Bijainagar camps are major camps of mobile unit.In these camps it is observed that after osteoarthritis knee most of the cases were due to neglected fractures like osteomyelitis and non-union,other than this polio deformities are also present in good number.
In the border areas of Rajasthan like Jhalawad ,Bara district[Ataru n Sitabari camps]all types of cases were found in large numbers with congenital anomalies also being present in good number. cause behind this could be poverty, lack of orthopaedic services in rural areas and influx of patients from other nearby state
TREATMENT IN THE OUTDOOR
All the above cases which come to out door are given a proper counselling with advice of physiotherapy to the patients of osteoarthritis knee ,low back pain,stiff joints etc.Facilities of necessary investigations like x-rays, blood investigations are provided by the unit free of cost.With the help of this diagnosis are made and treatment given accordingly. For general orthopaedic patients drug treatment of 3-5 days are given with necessary advise for follow up. Patients appropriate for camp surgery admitted in the wards and all others who cannot be operated in the camps are referred further for treatment to the nearby higher centre. in many of the camps this transfer facility to the higher centres is provided by the local organizers.In this way every patient who comes to the camp is benefited.
SURGERIES IN THE CAMP
Main surgeries done in the mobile unit are deformity correction like
PMSTR and bony procedures for club foot,muscle release ,tendon transfer, osteotomies for polio corrective operations,
sequestrectomy and saucerization for osteomylities
Amputations for badly infected, ischiemic limbs
K wire fixation for minor fracture cases
Osteotomies for varus ,valgus and recurvatum deformities of knee
Z plasty for flexion contractures of finger
Excision of accessory fingers in polydactyly
Slab or caste application for acute fracture cases
Excision of ganglion
Joint lavage for osteoarthritis knee
Local steroid application for calcaneofascitis,tennis elbow,trigger point etc
Osteotomies for retrocalcaneal bursitis
Less frequently tendon repairs,arthrodesis ,etc done
RELEVANCE OF MOBILE SURGICAL UNIT IN PRESENT CONTEXT
It is a frequently asked question that in the present circumstances whether MSU is required or not, Some people think that nowadays medical facilities are so improved that utility of MSU is doubtful such views shows their ignorance about ground realities in countryside area. Only attending a camp of MSU can answer their question .In every camp of MSU a huge number of patients comes to the camp irrespective of the place, some of the camps are organized over district headquarters or tehsils where medical facilities are said to be good even on these places a lot of patients come to the camp and benefited, this shows the trust people have in MSU. Moreover a totally free and smooth service of MSU attracts patients naturally.
Other then this mobile unit provides a platform for surgeons to improve their skills. Surgeons comes from nearby places also to attend camps when such surgeons get opportunity to work with mobile team and with some experienced surgeons from medical colleges who also attend these camps regularly they take it as great opportunity to improve their skills
With the introduction of endoscopic surgery a great number of patients will get benefitted as these surgeries are not being done even on some of the teaching institutions.
GOLDEN JUBILLE YEAR OF MSU
In this year MSU is going to complete its 50 years. So its time to celebrate and for us celebration means to improve efficiency of MSU.Endoscopic surgeries are being introduced in every department of MSU and orthopaedics department is not an exception . ARTHROSCOPIC SURGERIES are being introduced in the unit in this forthcoming year. With the help of this many conditions of the joints can be treated efficiently in the least invasive manner. This is a specialized surgery available only at few centres in the state.
SUGGESTIONS
To improve functioning of MSU better instrumentation and latest techniques should be introduced. In addition, there should be a strong back up from nearby teaching institution for necessary investigations, which cannot be done in the camps.To sum up there should be a proper publicity to avoid dissatisfaction to this poor community of patients which even can not afford to reach at the camp site.
Publicity plays a major role in the success of the camp so we advise organizers and government machinery of the area to reach even remote places but the most important thing is that over publicity is also as dangerous as lack of publicity. This means that with excessive and unwise publicity people think that every condition will be treated in the camps. It is seen that patients of valve replacements cardiac surgeries, tumours also come ignorantly but as these surgeries are possible only at big centres they are not admitted hence they feel disappointed.
Other then instrumentation expertise of the surgeons plays an important role, if senior and experienced persons are motivated to work with the unit they can be a useful tool for MSU
.In addition, regular training of the surgeons in the unit should be arranged so that they can use most advanced techniques. This way more patients can be benefited as well as surgeons will be introduced to a true satisfaction when serving this poorest and neglected part of community. |
