Trauma Advances in India Dr Yogesh Salphale

India ….as it is… HAS 28 STATES AND 7 UNION

TERRITORIES Has 1.17 BILLION PEOPLE

APPROXIMATELY. THE MOST DIVERSE IN TERMS OF

LANGUAGES AND RELIGIONS. INDIAN GOVERNMENT RECONIZES

22 LANGUAGES WHICH IS THE MAXIMUM THAN ANY OTHER COUNTRY IN THE WORLD.

INDIA HAS SECOND LARGEST HUMAN RESOURCES IN THE WORLD

65 yrs since IndependenceAdvances in the field of

Biology & Biomechanics of Musculoskeletal fixation

Innovation in fixation devicesRight use of technologyCompetent and skilled surgeons at par with

their International colleagues

The India Story…..The synchronous advancement of trauma in

India compared to the west. With good disposable income and the

spending capacity treatment available at par with the western standards.

Well trained surgeons practising latest techniques .

Expanding Orthopaedic Implant market.

The India Story …. Healthcare is city centric.Highly skewed in favour of urban population,

which is 28% of Indian population.

What caused the paradigm shift?

How does it benefit the vast population ?

Trauma …..Thought process and understanding

of… Golden Hour Damage control Orthopaedics Innovation in Implants.

Awareness & a need to excel in the limited infrastructure

Trauma essentials – “The Golden hourrr”The concept comes from U.S. military wartime

experience, particularly in the Vietnam War.The golden hour is the first 60 minutes after the

occurrence of a major multisystem trauma. It is widely believed that the victim’s chances of

survival are greatest if he or she receives definitive care within the first hour..

The golden hour can be summarized by the 3R rule of Dr. Donald Trunkey, an academic trauma surgeon, “Getting the right patient to the right place at the right time.”

Trauma essentials -Damage control OrthopaedicsAn approach that contains and stabilizes

orthopaedic injuries so that the patient’s overall physiology can improve.

To delay definitive fracture repair until a time when the overall condition of the patient is optimized.

Its purpose is to avoid worsening of the patient’s condition by the “second hit” of a major orthopaedic procedure

Evolving concepts-Damage control Orthopaedics The Focus: on control of hemorrhage, management of soft-tissue injury, Achievement of provisional fracture stability

esp with the use of external fixation …while avoiding additional insults to the patient.

Transport to the health centres

Transport to the health centres

The Journey… Imaging The old Xrays…….. still holds a place

Backbone of Imaging Have stood the test of timeGradually been

replaced by …

Advances in Imaging

Digital Processors which provide Better visualisation Better data retrieval Immediate image preview and

availability; Elimination of costly film processing steps A wider dynamic range, ( forgiving for over-

and under-exposure); The ability to apply special image

processing techniques that enhance overall display of the image.

Advances in Imaging CT Scan

• Whole body CT• Spiral CT• Multi detector CT• The Low dose CT• The128 slice low dose

CT• PET Scan

•MRI Scan State of art 3 tesla Open MRI

Advances in Imaging

Computer aided surgery Improvement in accuracy.CAOS technologies allow the surgeon to:-Plan the component placement in advance,

including determination of the appropriate component sizes;

Measure the intra-operative placement of the components in real time, making sure that the plan is adhered to;

Measure the post-operative result

Computer aided surgery The procedure only combines the surgeon’s

skill with computer technology.

Computer aided surgery --EvidenceCurrent evidence shows no advantage with

CAOS in trauma cases compared with conventional methods.

Prospective randomized trials and clinical outcomes are lacking.

Medical tourism: Accreditions essential…. Joint Commission International (JCI) is based in the USAustralian Council for Healthcare Standards

International (ACHSI) is based in AustraliaThe QHA Trent is based in the UKHealthCare Tourism International (HCT) is based in

the USAccreditation Canada is based in CanadaThe United Kingdom Accreditation Forum is based in

the U.K.Temos is based in Germany 

Fracture fixation…Evolving concepts from rigid flexible fixation, from conventional locked

intramedullary nailing, from reamed “unreamed” nailing, and finally from compression plating

to the internal fixator

Total Hip Replacement Surgery (THR)

Birmingham Hip Resurfacing Surgery (BHR)

Computer Assisted Surgery

Minimally Invasive Hip Joint Surgery

Hip replacements

Healthcare trends-India  Healthcare is city centric.Highly skewed in favour of urban population,

which is 28% of Indian population.

Networking- Telemedicine Telemedicine is the use of 

telecommunication and information technologies in order to provide clinical health care at a distance.

It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

Telemedicine has special significance to India considering its vast geographical spread and predominant rural population.

With the penetration of rural telephony and Braodband at the remotest location,the benefits can be reaped at any level.

Bone grafts & Substitutes…The ideal bone-graft substitute is

biocompatible, bioresorbable, osteoconductive, osteoinductive,

Structurally similar to bone, easy to use, and cost-effective.

It is reasonable that not all bone-graft substitute products will perform the same.

Bone grafts & Substitutes…Synthetic bio-inert materials

An alternative to autogenous bone graft. Calcium hydroxyapatite (HA) and Beta tri-calcium phosphate (β-TCP), which belong to the calcium phosphate ceramics group, are biocompatible and osteo-conductive.

These implants conduct new bone formation not only around the implants but also into the pores in a very short period.

e-Governance initiative of Govt. of Indiatowards citizen centric services. The application of e-governance in health care

*can monitor and improve the quality of health care services,

*make the system efficient, transparent and cost effective as it will bring healthcare providers, policy makers, professionals and the public on a common platform.

. 

Originality and Innovation from Indians.  The disease burden of orthopaedic surgery is

completely different from the rest of the world.

o It Varies ino its disease spectrum,

patient expectation, affordability and other socio economic factors.   

Surgeons contribution A drive to excel within the framework

Promote indigenous means which are economical and user friendly

Results which can be corroborated with International standards.

Surgeons contributionIngenuity and Innovativeness

Dr. Brij Bhushan Joshi was one of the pioneers of hand surgery

Devised an External fixator.Revolutionised the treatment of

trauma ,the correction of various congenital

and acquired deformities, burns contractures and reconstruction of the thumb.

His work on simple and economic splints for the hand (using scrap materials like rubber tubing, chicken wire, aluminum strips and rubber bands) bears the hallmark of his genius.

Surgeons Contribution..

No replacement for human tissue? — just as long as there is steel

A new pathway for innovation???...............

Surgeons contributionDr. Mayil Vahanan Natarajan.•First surgeon to perform 1,500 cases of custom mega prosthetic replacement for bone tumours for a period of 21 years•Significant impact on the lives and limbs of a number of people affected by bone cancer and trauma.

Economics…….Implants Less than 10$

Results at par with International standards

Respect to the Soft tissueGentle handlingAwareness of cost constraints

Year : 2010  |  Volume : 44  |  Issue : 4  |  Page : 448-452Percutaneous osteosynthesis of Galeazzi fracture-dislocationWasudeo M Gadegone, Yogesh Salphale, DS Magarkar

Autologous chondrocyte transplantation

The goal -is to allow people suffering from articular cartilage damage to return to their old lifestyle; regaining mobility, going back to work and even practicing sports again.

Autologous chondrocyte transplantation Autologous Chondrocyte Implantation

procedures aim to provide complete hyaline repair tissues for articular cartilage repair.

Over the last 20 years, the procedure has become more widespread and it is currently probably the most developed articular cartilage repair technique.

The technique also seems promising with regard to long-term results.

The hurdles-Trauma CareLack of initiative by the

*Policy makers* Medical professional*Media* Ever Increasing population

*No mechanism for accreditation of

………trauma centers & ………..professionals exists.

What ails the Rural India –Trauma service delivery?

*Varied topography, *Financial constraints, and *Lack of appropriate health infrastructure.

There is no national lead agency to coordinate various components of a trauma system.

The hurdles-Trauma Care• Priority to communicable diseases, maternal

and child health, and population control continue to be government priorities.

• Lack of uniformity in training/Teaching &

proper trauma registry•  

Emergency CareATLS/ALS coursesThe concept of emergency medicine as a

speciality is catching up across the country. As many as 45 medical colleges are in various stages of the process of starting Medical Council of India (MCI) recognised MD course in emergency medicine and many more are in the pipeline,"

The future Organisations dedicated to improvement in

Trauma and Emergency Care in India.Create awareness and promote Trauma and

Emergency Medicine as  medical specialties.

The futureAccomplish this through National Trauma Management Course

(NTMC™), Cardiac Life Support, Disaster Preparedness Course., Other educational programmes, Consultation, Research and Training  for

doctors and health care professionals in India with national and global perspective."

I conclude….

Specialised traumacentres and surgeons practising trauma exclusively is an urgentneed today and the medical profession, politicians and the publicmust apply their minds to rectifying the situation before it istoo late.

Education in trauma life-support skills has only recently become available.

10 Interesting facts about India:The famous board game, called Chess, was invented in India.In India's 100,000 years of history, it has never invaded any other country.India is the 7th largest country in the world, the largest democracy and one of the oldest civilizations.India was one of the richest countries in the world before the British invasion in 17th century.The value of "pi" used in mathematics was first calculated by the Indian mathematician Budhayana in 6th century.India is one of the largest exporter of computer software products. It exports software to over 90 countries.India is home to the world's largest pilgrimage destination called the Vishnu Temple. The temple is located in the city of Tirupati. About an average of 30,000 people visit this temple donating about $6 million US dollars, everyday.India originated Yoga about 5,000 years ago.India has the most number of mosques. It has 300,000 mosques which is much more than the Muslim world.Christians and Jews have been living in India since 52 A.D. and 200 B.C. respectively