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 Independence Advances in the field of Biology & Biomechanics of Musculoskeletal fixation Innovation in fixation devices Right use of technology Competent 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 controlOrthopaedics An 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 controlOrthopaedics 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.
The Journey… Imaging The old Xrays……..still holds a place Backbone of Imaging Have stood the test of time Gradually been replaced by …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 •MRIScan State of art 3 tesla Open MRI
Computer aided surgeryImprovement 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 --Evidence Current evidence shows no advantage with CAOS in trauma cases compared with conventional methods. Prospective randomized trials and clinical outcomes are lacking.
Medical tourism: Accreditionsessential…. Joint Commission International (JCI) is based in the US Australian Council for Healthcare Standards International (ACHSI) is based in Australia The QHA Trent is based in the UK HealthCare Tourism International (HCT) is based in the US Accreditation Canada is based in Canada The United Kingdom Accreditation Forum is based in the U.K. Temos is based in Germany
Fracture fixation…Evolvingconcepts 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
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. ofIndia towards 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 fromIndians. 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 contribution Ingenuity 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.
SurgeonsContribution.. No replacement for human tissue? — just as long as there is steelA new pathway for innovation???...............
Surgeons contributionDr. Mayil Vahanan Natarajan.•First surgeon to perform 1,500cases of custom mega prostheticreplacement for bone tumours fora period of 21 years•Significant impact on the lives andlimbs of a number of peopleaffected by bone cancer andtrauma.
Economics……. Implants Less than 10$ Results at par with International standards Respect to the Soft tissue Gentle handling Awareness of cost constraints
Year : 2010 | Volume : 44 | Issue : 4 | Page : 448-452Percutaneous osteosynthesis of Galeazzi fracture-dislocationWasudeo M Gadegone, Yogesh Salphale, DS Magarkar
Autologous chondrocytetransplantation 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 chondrocytetransplantation 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 Care Lack 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 healthinfrastructure.There is no national leadagency to coordinate variouscomponents of a traumasystem.
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 Care ATLS/ALS courses The 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 future Accomplish 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 trauma centres and surgeons practising trauma exclusively is an urgent need today and the medical profession, politicians and the public must apply their minds to rectifying the situation before it is too 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 Indias 100,000 years of history, it has never invaded any othercountry.India is the 7th largest country in the world, the largest democracyand one of the oldest civilizations.India was one of the richest countries in the world before the Britishinvasion in 17th century.The value of "pi" used in mathematics was first calculated by theIndian mathematician Budhayana in 6th century.India is one of the largest exporter of computer software products. Itexports software to over 90 countries.India is home to the worlds largest pilgrimage destination called theVishnu Temple. The temple is located in the city of Tirupati. About anaverage of 30,000 people visit this temple donating about $6 millionUS dollars, everyday.India originated Yoga about 5,000 years ago.India has the most number of mosques. It has 300,000 mosqueswhich is much more than the Muslim world.