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Sunday, 6 February 2011





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Safe home could prevent orthopaedic trauma

Dr. Narendra Pinto Past President, The College of Surgeons of Sri Lanka Resource Personnel, Medicare 2011, National Healthcare Exhibition

Orthopaedics is a branch of surgery for conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumours, and congenital disorders. One such surgeon is Dr. Narendra Pinto, who has been at the forefront of Orthopaedic surgery in Sri Lanka for a long time. "I remember even during a difficult and violent period in our recent history, the emergency ward of the General Hospital was never shut down and this proved how dedicatedly the doctors worked to ensure the well-being of the patients", he said.

In Sri Lanka, orthopaedic surgery has seen great improvements in keeping abreast with the advancement in this field the world over. In our country, access to free medical healthcare contributes immensely to many of our patients to overcome their afflictions. Dr. Narendra Pinto is the President of the SAARC Surgical Care Society, Immediate President of the Sri Lanka Orthopaedic Association, Past President of the College of Surgeons who counts over 30 years of extensive experience in the field of orthopaedic surgery.

"This involves diseases of the bone, joints, cartilage, muscles, tendons and nerves and moreover, orthopaedic diseases also encompass congenital deformities and developmental abnormalities and inflammations too", he said. "Certain inflammations like rheumatoid arthritis especially at the end stage when it affects the bones and joints permanently may require orthopaedic surgical intervention", said Dr. Pinto.

"In Sri Lanka, trauma is the primary cause of admission of patients to only emergency and orthopaedic units but also the leading cause for admissions to hospitals in Sri Lanka. Trauma could result from - Road traffic accidents, home accidents, occupational injuries, trauma resulting from acts of violence and sports injuries. Trauma due to warfare has now come to an end in our country to the relief of all communities", said Dr Pinto.

He further added, "Road traffic accidents today account for the major cause of orthopaedic injuries. Occupational mishaps occur in people working with machinery and construction industry and could be largely prevented by adhering to safety precautions and protective gear.

With many national sports going into professional level in recent times there has been a growing increase in incidence of sports injuries and sportsmen seeking treatment for such conditions and injuries."

"Whatever the cause of trauma may be, prompt first aid treatment is needed to stabilise the victim, securing a patent airway is mandatory to save life, most of the external bleeding can be controlled by applying direct pressure with a piece of cloth over the bleeding site.

Mishandling can trigger more severe complications", he said. In the event of a severe traumatic condition, the family and friends of the patient should get him admitted to the nearest hospital rather than worrying about getting the patient to a specialised hospital which may be far away. "For instance, if a patient is admitted to a base hospital, the medical staff can transfer the patient to a hospital with better care facilities after initial assessment and care", said Dr. Pinto. "If there is a trauma casualty, I would advise that the patient be placed in a horizontal position to protect the spine, splint any apparent fractures and be transport the patient to hospital in the same position" said Dr. Pinto.

This is why our paramedics need to be properly trained and people should know that if there is an accident, the victim shouldn't be handled in such a way that they get a "second accident".

In case of any accident within Colombo city limits, an ambulance service is available within a very short time by dialing 110 twenty-four hours a day. Public should be aware that emergency services are available right through the day and night even on weekends and public holidays.

"Home accidents are also a major cause of orthopaedic trauma. People should be careful when getting onto unsafe platforms and ladders for reasons such as changing of electric bulbs and fixing TV antennas. I have seen many sad instances of paralyses resulting from such falls.

The elderly people living in our houses may get serious fractures even from trivial falls due to the osteoporotic nature of their bones. Making the home environment safe, correcting any vision defects supervising their medications to ensure that they are not over sedated and providing walking aids will go a long way in preventing such injuries", said Dr. Pinto.

"There have been vast advancements in the field of joint replacements. Hip, knee replacement surgeries are commonly carried out in most of the orthopaedic units all over the country. These replacements are mostly carried out for degenerative diseases and also following trauma to the hip joint. In fixing fractures many treatment options are available.

Bones could be lengthened, large defects bridged by way of special external fixators. Arthroscopy has come to stay as a useful tool of minimally invasive surgery in knee and shoulder joint conditions", said Dr. Pinto.

"The primary malignant neoplasms affecting bones in the early stages can be resected, preserving the limb by bridging the deficit by allograft available from human tissue bank or by other means in many instances", concluded Dr Pinto.

Early detection could avoid sight - loss

Dr. (Ms) Dharma Irugalbandara, Immediate Past President, College of Ophthalmologist Resource Personnel, Medicare 2011, National Healthcare Exhibition.

If you ever find yourself losing your eyesight gradually, take heed and notice the warning signs instead of ignoring it. "Always check with an ophthalmologist if you have any problem with your eyes because it is important to detect eyesight loss early instead of keeping it till the last minute" said Dr. Dharma Irugalbandara, the Immediate Past President of the College of Ophthalmologists.

She said that glaucoma is a disease where the optic nerve is damaged, leading to a gradual and irreversible loss of vision which is often, but not always, associated with increased pressure of the fluid in the eye.

"Glaucoma occurs when the aqueous solution in the eye builds eye pressure and this condition affects the optic nerves" said Dr. Irugalbandara. Usually, this aqueous solution is drained from the eye internally in a proper method but due to the inability for the eye to drain this solution properly, the optic nerves become damaged little by little eventually causing glaucoma.

"The two conditions of glaucoma is acute angle closure and open angle glaucoma" said the doctor. "Closed angle glaucoma can affect suddenly and is often painful loss of vision leading the patient to channel an eye doctor immediately before permanent damage occurs. Open angle, chronic glaucoma tends to progress more slowly and the patient may not notice that they have lost vision until the disease has progressed significantly" said Dr. Irugalbandara.

"The age group for common glaucoma patients is 40 to 60 and so we ask anyone above the age of 40 to get an ophthalmologist to check their eyes" said the doctor. While using reading glasses, if they feel any vision problems coming on, they should immediately check it without waiting for the last minute till they lose their vision. Sometimes, glaucoma can be hereditary and those who have family members stricken with glaucoma should also get their eyes checked. "There is no evidence to say that you too will get it if it is in the family but it's always better to check early to avoid complications later in life," warned Dr. Irugalbandara. Glaucoma can be hereditary and so immediate family members of a patient with glaucoma must get their eyes checked.

Dr. Irugalbandara also said that there can be children affected by glaucoma but they can be detected early on in a child where treatment could be given promptly. There are rarely any symptoms in the early stages of chronic open angle glaucoma, so regular eye checks by qualified professionals are important. Ophthalmologists and optometrists will diagnose glaucoma on the basis of intraocular pressure, visual field tests and optic nerve head appearance. "Patients will sometimes notice patchy loss of peripheral vision. They can develop photophobia which is they are uncomfortable when they see bright light, they may tear and they can develop corneal opactity where the cornea becomes white" said the doctor.

Symptoms of angle closure glaucoma includes pain in or around the eye ball, redness, headache, nausea or vomiting and visual disturbances, for example halos around lights. In some cases there are no symptoms. Dr. Irugalbandara said, "The important advice I can give anyone diagnosed to have glaucoma is to continue the medication given by the doctor". She further added, "The life-long medication thereafter only preserves the optic nerves but doesn't improve the vision. Often patients stop using the medication if they don't see a vision improvement but they must understand the aim of treatment, to preserve the nerves and maintain whatever vision they have "The disease is common among the elderly , it is always advisable to check your eyes with an ophthalmologist" concluded the doctor. Other factors can cause glaucoma, known as "secondary glaucomas," including prolonged use of steroids, conditions that severely restrict blood flow to the eye such as severe diabetic retinopathy and central retinal vein occlusion, ocular trauma and uveitis.


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