HRI: United Nations Arts Initiative
MILLENNIUM MEDICINE PROJECT
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.
Contact:
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
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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.
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References:
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-
probes-improving-care-for-pregnant-women-in-villages/833478
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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