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The orthopedic field is one of the areas that requires
tremendous knowledge on the part of the Orthopedic Specialist undertaking these
tedious operations. It must be noted that Guyana has only two such orthopedic
specialists and they are Dr. Terrence Joseph (at Medical Arts Center) and Dr. Fawcett Jeffery
(at Woodlands or St Joseph Mercy Hospital).
Persons are cautioned to be on the look out for doctors
pretending to be orthopedic surgeons, bone specialists as we call them in
Guyana. Should anyone visit the Prasads Hospital with an orthopedic problem, the
hospital refers them to Benjie Singh who is not an orthopedic specialist, Benjie
Singh was trained in Russia and returned to Guyana as a medical practitioner, he
never qualified in orthopedics but because of fast money, Prasads hospital
allows this doctor who is not qualified in orthopedics to handle all such cases
for them. I know from first hand experience because I was fooled by this medical
institution and the doctor himself when I particularly asked if I was being
attended by a specialist and they told me "yes Benjie Singh is a bone
specialist". The only bone specialist at Prasads is the cook in the kitchen and
all he knows about is beef bone or chicken bone.
Guyanese beware, don't you take your
family to Prasads for any orthopedic cases.
Below are some illustrations of different orthopedic
operations done to various part of the human anatomy.
We found this interesting article about bone
stimulation for cases where bone healing is slow on patients, maybe our local
orthopedic specialists can make note of it and use it to their benefit.
Bone growth stimulation, definition:
Bone growth stimulation is the technique of promoting bone growth in difficult
to heal fractures by applying a low electrical current or ultrasound to the
fracture.
Purpose: Bone growth stimulation is done when satisfactory healing is not occurring
naturally or when the pace of healing is too slow. This condition is called
fracture nonunion, and it occurs more frequently among adults than children, in
people with severe or complex fractures, and in people who smoke.
The theory behind applying an electric current to fractures to stimulate healing
is based on the fact that the concave side of the bone becomes negatively
charged and the convex side is positively charged. It is believed that
artificially encouraging this charging with an electric current will speed
healing. In 1996, the Food and Drug Administration (FDA) also approved the
application of low intensity ultrasound pulses as a treatment for fracture
nonunion.
Ultrasound and electromagnetic stimulation are expensive and are used only when
healing problems exist for a substantial length of time. Each method must be
used for at least three to six months to be effective.
Precautions: Bone growth stimulation cannot be used if the gap between the ends of the
fracture is too large.
Description: Electric stimulation can be applied either from the inside of the body
(invasively) or from the outside the body (noninvasively). Ultrasound is a
noninvasive procedure. The type of stimulation selected depends on the doctor's
preference, the type and location of the fracture, and the patient's motivation
to comply with the treatment schedule. Treatment can take anywhere from three to
six months.
Invasive stimulators: Invasive electric stimulators are either fully or partially implantable. The
advantage of these devices is that they apply a direct electric current to the
fracture 24 hours a day. The fully implantable stimulator requires little daily
attention from the patient. Patients using a semi-implanted stimulator must
regulate their own treatment schedule and have to care for the external power
pack. The disadvantage of implantable and semi-implantable stimulators is that
their implantation is a surgical procedure.
Fully implantable direct current stimulators are installed in a hospital under
general or regional anesthesia. Both the stimulator and the power source are
implanted. The surgeon makes an incision and places a spiral shaped cathode
inside the bone. A wire leads to the power source and a small anode. The power
source is a battery pack that is implanted in the nearby muscle. The body
transmits electrical current to close the circuit. The incision is then closed.
Once in place, the device provides continuous direct electric current for bone
growth stimulation.
Partially implanted stimulators use cathode pins that are implanted at the edge
of each bone that is fractured. Wires lead to the surface of the skin where a
power source and the anode are located. Wires complete the circuit. The external
portion of the device is held in place by a cast. This source of stimulation
also runs continuously.
Noninvasive stimulators: In the noninvasive stimulator, external electromagnetic coils are placed on
either side of the fracture and are held in place by a strap or cuff. Locating
the coils correctly is important, and their location relative to the fracture is
usually confirmed by x rays.
The coils produce a pulsating electromagnetic field. It is up to the patient to
maintain the prescribed treatment schedule. Effective treatment requires
stimulation anywhere from three to ten hours each day in periods of no less than
one hour.
Ultrasound stimulation is the most recent treatment for stimulating bone growth.
A device that generates low intensity pulses of sound is applied to the skin
over the fracture. The advantage of this technique is that it is noninvasive and
the period of application of the sound pulses can be as short as 20-30 minutes
each day. The results of this treatment have been studied less than the effect
of electromagnetic stimulation.
Preparation: Bone growth stimulation is done only when healing has failed to occur for many
months. Before it is started, x rays are done of the fracture area. If the
device is to be implanted, standard preoperative blood and urine tests are done.
The patient may meet with an anesthesiologist to discuss any conditions that
might affect the administration of anesthesia.
Aftercare: If a noninvasive, pulsating, electromagnetic field device is used, the patient
must not put any stress or weight on the fracture until it is healed, which is a
matter of months in most cases. In all lower limb fractures, regardless of the
stimulation method used, the patient can not bear weight on the limb with the
fracture until healing is complete. This limits the patient's mobility for many
months. Patients have the responsibility for regularly making sure that the unit
works and caring for external devices and the casts that hold them in place.
Risks: Noninvasive devices have few risks associated with them. The main risk
associated with implantable devices is the development of infection at the site
of implantation.
Normal results:
Success in healing a fracture nonunion using bone growth stimulation depends on
the type, location, and severity of the fracture and the age and general health
of the patient
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