The Telegraph
Since 1st March, 1999
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Surgery over, crack same
- Worry over bone doctors’ botch-up

New Delhi, Nov. 12: Orthopaedic surgeon John Bera was once forced to amputate a forearm of a patient with a simple fracture and he has gazed in astonishment at X-ray images of a fracture before and after surgery with no change in bone position.

A complication in surgery done to correct the simple fracture had rendered the forearm of the patient, a man in his early 20s, useless. The patient could neither move the forearm nor did it have any sensation.

“The forearm had been reduced to just bones and skin — no muscle. The man had been begging us to amputate it,” said Bera, assistant professor at the All India Institute of Medical Sciences (AIIMS) in Delhi.

India’s top tertiary care hospital, AIIMS, has always been besieged by patients with complications in virtually all disciplines of medicine. But orthopaedic surgeons are worried about the sheer proportion of what they view as “avoidable problems”.

While there is no nationwide data on trauma injuries or illnesses that require corrective surgery on their bones, doctors estimate that tens of thousands of people in India would require bone surgery each year.

“In our experience, one in three patients has a history of neglect or bad management of an orthopaedic injury,” said Prakash Kotwal, professor of orthopaedics at the institute.

Because AIIMS is a tertiary care hospital, Kotwal said, it is unlikely that this 30 per cent figure reflects a nationwide trend. The proportion of mismanagement of bone injuries may be much lower on a nationwide basis because the patients who get well after treatment in private clinics and smaller government hospitals would never show up at tertiary centres such as AIIMS.

Nevertheless, the one-in-three figure encountered at AIIMS is disturbing, said Bera.

He cited the case of a patient with a fracture in the leg, who had undergone surgery in a private hospital, but showed no improvement at all.

“We saw X-ray pictures before and after the surgery and we could sight no change in the fracture,” Bera said. “So instead of one operation, the patient had to undergo two or three surgeries to correct the fracture,” he said.

Such concerns have prompted the Indian Orthopaedic Association to publish “white papers” on standard techniques to manage fractures and other bone injuries and circulate them to its 6,500 members nationwide. The 51st annual conference of the association that begins here later this week is expected to address these concerns.

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