HRI: United Nations Arts Initiative

Orthopedics: July 2010

Our inability to address the challenges presented by industrial  trauma, train and traffic accidents, are due to the lack of basic surgical services, presenting a major challenge to the economy of underdeveloped countries.  Traffic Injuries cause 1 million deaths and 30 million severe and disabling injuries annually worldwide. [1]  It is the objective of  the Sports Medicine & Science Institute [2] to facilitate strategic planning and development of resources and support to address the needs of the rural clinic/surgical care center.  Current strategic planning and development discussions include access to:
  • Low-Cost Ultrasound Technologies that include Low-Cost USB-based Ultrasound Probes [3] and Ultrasound imaging now possible with a smartphone [4] 
One of the chief advantages of having ultrasound available in the trauma setting is rapidly identifying trauma victims who would benefit from more aggressive surgical treatment or transfer to a facility with additional trauma services.  The FAST (Focused Assessment with Sonography for Trauma) exam can help practitioners detect life-threatening injuries in the trauma patient. With portable ultrasound machines, the FAST exam can be performed during the primary or secondary surveys, and new studies are exploring the utility of trauma sonography used by paramedics in the field.

The four views in a FAST exam are the RUQ view of Morrison’s pouch, the LUQ or spleno-renal view, the suprapubic bladder view, and a subxiphoid view of the heart. With just 4 views, an number of critical injuries can be identified, including liver laceration, perforated viscus, splenic laceration, and hemopericardium. At the very least, free fluid within the abdomen identifies patients who would benefit from more aggressive surgical management or transfer from a rural to an urban hospital.

Furthermore, the eFAST or extended FAST exam includes additional views of the pleura and lung parenchyma to assess for hemo- or pneumothorax.

Apart from the trauma setting, emergency department ultrasound can be used to quantify and qualify cardiac contractility in chest pain patients (essentially functioning as a bedside echocardiogram), long-bone fractures, joint effusions, renal and gall stones, urinary retention, and more.

Dynamic sonogram techniques also facilitate the performance of procedures. Both peripheral and central venous access can be visualized, and placement confirmed with emergency department ultrasound. The drainage of pericardial and pleural effusions, and the assessment of pregnant patients (both trauma and non-trauma) endorses a heightened technology and accuracy, using equipment that can easily be integrated into rural practices.

Note: Special Thanks to Jennifer Galjour, MD for this overview on the FAST technologies.

Pediatric applications include the use of ultrasonography to assist early diagnosis of developmental dysplasia of the hip (DDH). [5, 6, 7, 8, 9]

Early diagnosis of DDH is only a service for our babies and an investment for the future.  The global objective is to train sonographers and technicians instead of medical doctors. Sonographers and technicians can perform the examination with a standardized out-coming diagnosis with medical doctors are responsible for the last diagnostic and therapeutic check up.
  • Low cost Universal Mini External Fixator JESS and FIX CLIP technologies for the rural surgeon.
In regards to low cost surgical supplies for humanitarian operations in rural settings, Joshi’s External Stabilization System or JESS developed by Prof. Brij Bhushan Joshi  [10, 11, 12, 13, 14] costs 2-3 dollars, when a clip that has the same function is sold by major medical corporations for $450. The Fix Clip can replace a metal plate in the rural setting, so the local surgeon can operate on the patient and set the fracture better.  In these places the patient has to buy the hardware for hard cash. -- Aziel Benaroya, MD [15]

In cooperation with the HRI:UNArts - Millennium Medicine project,  JESS Research & Development Society, headquartered in India, has agreed to be an access point for manufacture and distribution of low cost (1) JESS and FIX CLIP technologies and (2) educational resources for rural surgeons.  It is our objective to have the WHO validate these JESS and FIX CLIP technologies for use in the rural medicine setting in every UN member country.


Sandhya Kaushik
JESS Research & Educational Foundation
10 ONGC Colony, Bandra Reclamation
Bandra (W), Mumbai, 400050, INDIA
Tel: 91-22-26443041/
Cell: 91-9820054832
e-mail: bbjoshi@vsnl.com

Joshi’s External Stabilization System technique used in clubfoot treatment/neuromuscular therapy  by Aziel Benaroya, MD, Clinical Instructor Orthopedics. Mt Sinai School of Medicine, St Mary's Pediatric Hospital.


1. Trauma Challenges in the New Millennium: DR.  N. S. LAUD, Laud Clinic, Sushrusha & Breach Candy Hospitals, Mumbai. PPT: PDF Url: http://www.unarts.org/news/smsi/trauma_nslaud.pdf
2. Sports Medicine & Science Institute: Url: http://www.esportsmedicine.org
3. Low-Cost USB-based Ultrasound Probes - improving care for pregnant women in villages: Wellsphere Url: http://www.wellsphere.com/general-medicine-article/low-cost-usb-based-ultrasound-

4. Ultrasound imaging now possible with a smartphone: Washington University Newsroom. Url: http://news.wustl.edu/news/Pages/13928.aspx
5. Developmental Dislocation of the Hip: Wheeless' Textbook of Orthopaedics. Url: http://www.wheelessonline.com/ortho/developmental_dislocation_of_the_hip
6. Developmental Dysplasia of the Hip:  Overview, eMedicine. Url: http://emedicine.medscape.com/article/1248135-overview
7. Developmental dysplasia of the hip: Radiopaedia.org. Url: http://radiopaedia.org/articles/developmental-dysplasia-of-the-hip
8. Hip Sonography:   Url: http://www.scribd.com/doc/25024084/Hip-Sonography
9. Screening for Developmental Dysplasia of the Hip: American Academy of Family Physicians, July 1999. http://www.aafp.org/afp/990700ap/177.html
10. Prof. Brij Bhushan Joshi: Award for Excellence, Bombay Orthopedic Society. Url: http://www.bombayorth.org/brij_bhushan_Joshi.html
11.  Role of Joshi's external stabilisation system fixator in the management of idiopathic clubfoot. Journal of Orthopaedic Surgery, Dec 2003 by Suresh, S, Ahmed, A, Sharma. Full Article: Url: http://www.josonline.org/pdf/v11i2p194.pdf
12. Gradual joint distraction of post-traumatic flexion contracture of the proximal interphalangeal joint by a mini-external fixator: J Bone Joint Surg Br, Feb 2007; 89-B: 206 - 209.S. Houshian, C. Chikkamuniyappa, and H. Schroeder. PubMED Abstract. Url: http://www.ncbi.nlm.nih.gov/pubmed/17322436
13. Chronic Flexion Contracture of Proximal Interphalangeal Joint Treated with the Compass Hinge External Fixator. A Consecutive Series of 27 Cases. J Hand Surg, August 2002; 27: 356 - 358. S. HOUSHIAN, B. GYNNING, and H. A. SCHRØDER. PubMED Abstract.  Url: http://www.ncbi.nlm.nih.gov/pubmed/12162976
14. Use of Joshi External Stabilizing System in postburn contractures of the hand and wrist: a 20-year experience. Burn Care Rehabil, Sep 2004; 25(5): 416-20.S Gulati, BB Joshi, and SM Milner. PubMED Abstract. Url: http://www.ncbi.nlm.nih.gov/pubmed/15353933
15. Aziel Benaroya, MD, Clinical Instructor Orthopaedics. Mt Sinai School of Medicine. Url: http://mountsinaimedicalcenter.net/profiles/azriel-benaroya

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