Effective treatment for orthopaedic conditions in the paediatric population

Effective treatment for orthopaedic conditions in the paediatric population

It is interesting to note that the term Orthopaedics, coined by the 17th-century physician Nicholas Andry, meant correcting the deformity in a child. (Orthos meaning straight and Pedis meaning child). The field of paediatric orthopaedics has been proven to provide justice to the term Orthopaedics. Management of certain orthopaedic conditions in paediatric population necessitates utmost care since they have the propensity to leave a lifelong deformity or scar. With recent advances and early interventions, many deformities can be prevented or treated, giving patients a better quality of life.

Clubfoot

Clubfoot or Congenital Talipes Equinovarus (CTEV) refers to the inward deviation of the foot since birth due to tight muscles and soft tissues. The concepts put forth by Prof.Ignacio Ponsetti make the deformity easily correctable with weekly serial plaster casting. Cases where the deformity recurs or is left untreated till childhood, an external fixator device such as the Ilizarov apparatus or Joshi’s external stabilization system (JESS) help in stretching out the tight muscles and soft tissues along with tendon transfer or lengthening procedures.

Osteogenesis Imperfecta / Brittle bone disease

You may recall the villain Mr.Glass featured in Manoj Night Shyamalan’s movie. He has been portrayed to be suffering from this bone condition. Osteogenesis imperfecta, or brittle bone disease, is a rare genetic condition that makes bone fragile and easily breakable. Because of the soft nature of their bones, these patients are more prone to bowing deformities. Deformities of these long bones can be corrected and prevented with internal splintage of the bones with expandable rods or rods that grow with the bones. Fortifying the bones with Pamidronate injections helps in preventing fractures.

Slipped capital femoral epiphysis

With the rising incidence of childhood obesity, Slipped Capital Femoral Epiphysis (SCFE) is becoming more prevalent. In this condition, the growing proximal portion of the femur tends to slip due to excessive joint reactive forces. Physeal slippage results in restricted hip movements, pain, and an unsightly limp. Earlier, the treatment of SCFE was a gentle reduction with screw fixation. With recent advances in safe surgical dislocation of the hip, as proposed by Prof. Reinhold Ganz, we can restore the hip anatomy to near normal.

Knock knees or bow legs

Limb length discrepancy and angular deformities of limbs, such as knock knees or bow legs, occur following trauma, metabolic causes, infection, nutritional deficiencies, or congenital disorders. Earlier osteotomy (surgical breakage of the bone) and fixation of the bones in the corrected position were done. Recent advances with growth modulation plates or staples allow the surgeon to correct such deformities with minimally invasive techniques.

Hip dysplasia

In developmental dysplasia of the hip, a child’s hip joint subluxates or dislocates due to breech delivery or other causes. The diagnosis of hip dysplasia is often delayed since the parents fail to note the signs until the child is of walking age. Early screening of children suspected to have hip dysplasia with ultrasound enables prompt diagnosis and early intervention with the use of a Pavlik harness or other non-operative treatment means. The Biologic Plasticity potential is lost in children beyond 10 years. Hence early diagnosis ensures correction by minimally invasive interventions rather than multiple surgical interventions which is warranted due to late diagnosis.

Cerebral Palsy

Cerebral Palsy is caused by brain damage before, during or after birth that causes the loss of control of the arms and legs. Children with cerebral Palsy have difficulty ambulating due to excessive muscle tone (spasticity) or floppiness (atonia). Management of cerebral Palsy often comprises a multidisciplinary team approach. The involvement of physiotherapists, orthopedists, neurologists, paediatricians, and orthopaedic surgeons helps improve the patient’s quality of life. For more information, contact: Dr. Gopi Manohar, D.Ortho, DNB, MNAMS Ortho Fellow in Paediatric Orthopaedics (CMC Vellore) Visiting Orthopedic Consultant at Christian Mission Hospital, Madurai .Call : 9786018575

Saving the fetus in complicated cases

Fetal therapy involves the diagnosis and treatment of fetal abnormalities. Fetal therapy offers an intervention before birth for correcting, treating, or reducing the damaging effects of a fetal condition. Michael Harrison founded the fetal treatment centre at the University of California, San Francisco, in early 1980. Since then, fetal therapy has expanded to treat multiple conditions and become the standard of care.

Need for precise diagnosis

The fundamental concept of fetal therapy is considering the fetus as a patient. The fetus has the right to live. Some of the intra-uterine challenges pose a threat to the life and well-being of the fetus. Issues that require fetal therapy are discovered during routine prenatal exams. The first trimester now serves as a window period in which more than 40% of congenital anomalies are predicted. Accurate therapy can be instituted if the diagnosis is precise, which is now possible with advanced higher-end ultrasound equipment.

Advantages of fetal therapy

Uterus offers a comfortable dwelling for one fetus, and it can hold two with mild discomfort for the mother. But if it is more than 2, it will expel prematurely in most cases. With advanced ultrasound technology, the diagnosis of multifetal pregnancies can be done very early. It helps predict the nature of placental support. The intracardiac injection can reduce the extra fetus under ultrasound guidance, resulting in a cardiac standstill. The reduced fetus slowly gets compressed by the normally allowed-to-grow fetus. This way, it helps in multifetal pregnancy reduction. Similar to this, selective feticide of anomalous fetuses can be done.

How is fetal therapy administered?

Fetal therapy can be either direct or indirect through the transplacental route. Indirect fetal therapies include Dexa / betamethasone administration to the mother to prevent neonatal respiratory distress. Similarly, indirect methods are used to prevent cerebral palsy, fetal arrhythmia, congenital adrenal hyperplasia, fetal alloimmune disorders, and fetal cardiac rhabdomyoma. Direct fetal therapies include treating fetal anemia in cases of RH incompatibility by intra-uterine transfusion. This requires immobilizing the fetus by administration of drugs and anesthetic as the fetus also feels pain. Afterward, fetal venous access is obtained carefully under ultrasound guidance, and O-ve compatible irradiated, leuco-depleted, packed RBCs are transfused. We can repeat the procedure for up to 35 weeks to avert the harmful effects of anemia in the neonatal period. With this, neonatal jaundice and kernicterus can be avoided. We can treat fetal bladder outlet obstruction to prevent back pressure effects on the fetal kidneys. Fetal pleural effusion and conditions like cystic pulmonary airway malformation are treated by placing a shunt tube under ultrasound guidance after fetal paralysis.

Saving fetes in twin pregnancies with common placenta

Twin pregnancies that share a common placenta are referred to as Monochorionic twins. If left untreated, vascular anastomosis will result in unequal circulation distribution and can cause increased fluid in one sac and decreased fluid in another. It can cause anemia in one fetus, cardiac failure in another, and death in both. We use a fetoscopic laser photocoagulation procedure to save both fetuses or at least one. We use ultrasound-guided procedures to prevent such a situation, and the exact nature of the procedure is determined based on the gestational age. All these procedures require highqualit
y ultrasound equipment for precise and accurate placement of the needle tip and guidance of the therapeutic equipment and trained personnel. Post-procedure care and follow-up are equally important as the procedure itself. With all available avenues of fetal therapy, we can ensure the right of the fetus to come out of the complex situations it faces in utero. For more information, contact: Dr. S. Manohar MD RD Doppler Scans 197, Kamarajar Salai Madurai, 9787772224, 0452 2626290

Cardio v/s lifting: What you should do and know

Some of us prefer cardio while others prefer strength training, but all of us are aware of the importance of the two and how each is equally important in order to strike a balance in one’s workout regime. But in addition to this, did you know that the sequence in which exercises are done also affects the body and its functions. Mostly, it may seem that it is a question of choice or simple, preference, in order to decide which out of the two should be done first, but here is what experts have to say about the two forms of workout and when and how they are to be done for the best possible results.

Strength training

Lifting weights or simply strength training helps the body to build strength and increase muscle tissue, bone density and improve the condition of joints. It also helps the bone density, movements and overall motility. However, with a regular practice there are other benefits that start becoming prominent. Improved blood pressure, increased metabolic rate and tolerance are some other benefits that are derived from muscle training. In addition to these, a better glucose storage and better muscular foundation are the direct result of strength training. As we grow up, our muscles could shrink and since muscles are integral for movement, it is important to perform strength training for keeping the muscles intact.

Cardio

When it comes to performing cardio exercises, most of us are familiar with the benefits that it has, like increased lung capacity, stamina, endurance, faster weight loss and a better heart rate. Cardio is short for cardiovascular and greatly benefits the heart because performing these exercises helps maintain heart rate, prevent heart attacks, diabetes and cholesterol. It helps the heart pump more blood and thus transport oxygen efficiently to all parts of the body thereby increasing the efficiency of most organs and the body’s ability to recover from strenuous workouts.

What to prioritize?

Even though it may seem like a question with a definitive answer, there is no definite answer to this question. A runner would always be inclined towards performing cardio exercises first whereas a bodybuilder would go for strength training first. It is however advised by experts to choose the activity that will take you closer to your current objective. If you wish to work on your endurance, go for cardio first for doing cardio first has shown people to have lower heart rates. Doing cardio first can ensure the right intensity for a workout to happen. For those who wish to lose weight, strength training should be prioritized because lifting would help increase muscle mass and burn more calories than fat. Strength training therefore goes a long way in helping you burn calories. You can manage both the forms on the same day and make the most out of your time.

ADVANCED DENTAL TREATMENTS TO ENSURE HAPPY AND HEALTHY SMILES

For over 14 years, AA Sastha Dental Care has been recognized as one of the most advanced and preferred dental care service providers in the city of Madurai. The clinic takes pride in being well-equipped with some of the latest technology in the dental practice. AA Sastha Dental Care focuses on maintaining the overall health of the patient, by prioritizing oral health. The clinic undertakes all kind of dental procedures in s digitalized manner. It is one of the most sought-after dental centres, with well-trained experts in varied fields of dentistry, offering sophisticated procedures, using cutting edge technology.

BID FAREWELL TO TEETH ALIGNMENT WOES

Gone are the days when teeth alignment meant bulky metallic braces. Today, AA Sastha Dental Care offers advanced dental treatment like aligners, which is uses customized orthodontic appliances to correct malalignment, malocclusion and unaesthetic smiles in a comfortable and accurate way with fewer number of visits to the clinic. The aligners recommended are designed by USA based Sure Smile.

SMILE WITH CONFI – DENCE

Dental implants provide a solution to a missing tooth or multiple teeth and solves the problem of uncomfortable dentures. AA Sastha Dental Care uses a sophisticated method to replace a single tooth and makes the patient flash a happy smile in just 1 hour. For those who require full mouth rehabilitation, the team can replace the full set of teeth with implants and make the patient chew in 3 days. Even diabetic patients can benefit and be more comfortable with implants.

SAVE YOUR TEETH

At AA Sastha Dental Care saving the tooth is the first priority. The two most common causes for tooth loss are pain and mobility. Pain caused by caries can be treated with root canal treatment. The clinic undertakes advanced microscopic root canal treatment which ensures high accuracy and less tooth structure damage. Mobility of teeth is caused because of gum and bone diseases and can be treated with cutting-edge hard and soft tissue lasers which ensure fast and painless healing with less bleeding.

COMPREHENSIVE DENTAL CARE ACROSS ALL AGES

Pediatric (child) and geriatric (old age) patients are most challenging in dentistry. However, AA Sastha Dental Care offers comfortable and painless treatment for such patients in the easiest way, by trying to avoid injections and instead opting for hard and soft tissue laser (Waterlaze – Germany and Biolaze – Germany), which helps reduce the pain and bleeding and enhances the healing.

FLASH THE SMILE OF YOUR DREAMS

AA Sastha Dental Care is also specialized in smile designing and has the advanced digital equipment to show the patient their post-operative smile, even before the treatment is initiated. This technology is very helpful for patients to get a better understanding and to plan the treatment. Most of the diagnosis, treatment planning and measurement procedures at AA Sastha Dental Care are done in a digitalized manner, using the Intra Oral Scanner (3 Shape Denmark) which gives a highly precise outcome of the treatment. All these facilities within the clinic ensure multiple treatments are completed or initiated in just a single visit. The sophisticated dental treatment offered at AA Sastha Dental Care, using advanced and digitalised technology have been recognized by International Awards of Excellence and Asia Health Care Awards who awarded the ‘Prestigious Best Dental Clinic Award 2022’ to the clinic. For more information, contact: AA Sastha Dental Care Dr. A. Bamaselvakumar M.D.S., Orthodontist and Dentofacial Orthopedician Dr. R.P. Gomathi Bamaselvakumar M.D.S., Periodontist and Oral Implantologist Address, 14a/1, Gokhale Road, Chokkikulam, (Opp. Booma Hospital), Madurai – 625002. Phone No.: 9655015015, 0452-2536576 Website: www.aasastha.com