DDH is a challenging Pediatric Orthopedic problem. The earlier the treatment is started better the result generally..
In many cases even with early care and even surgery the hip still tends to deviate away from acetabulum. This results in persistent Dysplasia.
When we attempt reconstruction one of the problems we face is whether to do the osteotomy of femur and acetabulum or wait and watch for acetabulum to remodel when child is young.
Arthrogram is an excellent tool to evaluate the state of cartilage over the lateral aspect and superolateral aspect of femoral head and then decide whether we want to do the acetabular osteotomy at the same sitting or defer it.
Illustrating below a case whether the Derotation osteotomy was done first and the we decided the acetabular osteotomy based on the cartilage cover on arthrogram.
This is useful in a child younger than 2 and half years as acetabulum has good remodelling potential at that age. In older children we will need to combine the procedures.
The state of hip before the osteotomy. Open reduction was done elsewhere about a year ago. Persistent hip dysplasia was observed. The Derotation osteotomy improved the coverage but we still have to decide about the acetabular procedure. An arthrogram reveals a large cartilage cover on superolateral acetabulum. The cartilage bump is pointed to by the forceps. The C Arm image is superimposed and an artist’s impression is drawn showing what the cartilage would look like in 3D. This offers an excellent teaching tool and a 3D orientation for young surgeons and pediatric orthopedic trainees to decide whether an acetabular osteotomy is needed
The surgeon would then discuss with parents and opt to continue an acetabular procedure of take a staged approach
It was so nice to meet and talk to the parents about #cerebralpalsy and #developmentaldelay in #children at the #puthur #brc in #palakkad yesterday
Stress was on the need for #earlyintervention and adherence to #treatment especially #physiotherapy. The challenges parents face while continuing care is an eyeopener everytime I hear them out.
As in most diseases, treatment challenges in #cerebralpalsy is more to do with #social, #familial and #accessibility issues than actual lack of desire.
Most parents are willing to face the #financial challenges if it means the child will improve. Many are disillusioned with existing treatment methods and fall out because of slow progress, lack of motivation from professionals around and also pure financial pressure. Many have siblings who are healthy and would like to divert their limited resources to that child. This is such an unfortunate choice , but many parents make it.
Such talks and interaction are a wonderful opportunity to break the ice, motivate and also clear their apprehensions on the treatment of cerebral palsy.
A big thanks to Puthur BRC for organising this meeting. More to follow 🙂
Attaching below a few pictures and also a short video which the BRC officials had shared.
Mr. Shivakumar BPC, Puthur BRC Parents were enthusiastic and participated wellA compilation of photos of the day
Excited to address the #Calicut #Orthopaedic Club this Friday and speak to stalwarts, teachers and trainees on #CerebralPalsy and the #orthopaedic treatment possibilities.
I will speak on the need for early detection, treatment and also about the newly released hip surveillance guidelines.
The trainees and general orthopaedic surgeons need to understand the importance of early referral and the benefits of early treatment.
In India with its exploding healthcare facilities and young population, we need to be aware, equipped and future ready when it comes to cerebral Palsy care.
In years previous to the #COVID pandemic we at Palakkad Cooperative Hospital used this day and weeks around it to raise awareness, plan fundraising via MITRA Trust and re-dedicate ourselves tot he cause of Clubfoot care. Unfortunately there has been a hiatus in our activities for over 2 years.
Clubfoot Care Team at Palakkad District Cooperative Hospital, Palakkad, Kerala, India
This year we are re-starting everything.
What is Clubfoot ?
#Clubfoot is a #congenital#deformity of the foot which can be fully treated in most cases. The children lead a normal life after a successful treatment course.
Events
We will be oraganising events this year after a hiatus of two years to mark this day and re-dedicate our team at #Cooperative#Hospital#Palakkad to cost effective, accessible, state of the art and evidence based #Clubfoot#Care .
Medical Camp for Pediatric Neurology and Pediatric Orthopaedic Disorders
We are restarting our yearly free combined #PediatricNeurology and #PediatricOrthopaedic #MedicalCamp for #CerebralPalsy, #autism, #orthopedic #Diseases in #children this May at #Palakkad, #Kerala.
The children can consult a Pediatric Neurologist Dr. Velmurugan and Pediatric Orthopaedic Surgeon Dr. Easwar TR and also get counselling from Psychologist Mr. Toji Joseph and Physiotherapy consult from Mr. Biju Bhasker
The Medical camp is being organised as usual by the wonderful people at #Sevabharathi , #palakkad and also #LifeCarePhysiotherapyClinic, Palakkad Registration is free : 9495888879, 6238256073, 8891294916
Do share widely so that the news reaches the beneficiaries. Thank you Dr. Easwar TR Pediatric Orthopaedic Surgeon
Medical Camp for Pediatric Neurology and Pediatric Orthopaedic Disorders
This is my #NFT #Art to raise awareness on #Disability caused by #CerebralPalsy .
Importance of detecting it early and early intervention is stressed. Quite often we find that children are not referred early and treated. This results in very bad deformities that are difficult to mend.
This is part of the #ArztForACause effort by doctors to improve disease awareness among public via 🎨#Art #paintings #nftart https://t.co/OzZUu9FJCh
Cerebral Palsy is such a drastic turn of fortune for any family. The poorer the family, the more challenging. With her back to the closed door, symbolising all the lost life oppurtunities, a mother steadfastly leads her child along the well lit path of medical care with darkness of either side.
This tale repeats with so many children I see in my clinic. It is mind wrenching. Promise of quick cure lures any number of parents from that narrow path to dark streets of quackery and extorsion rackets who promise magical cures.
This is my tribute to so many parents who lead their child along the narrow lit path
Mother Leading a Cerebral Palsy Child
Even when treatment of cerebral palsy is widely available, it is not uncommon to see severe deformities due to improper or delayed referral to a treating centre, lack of awareness of simply neglect. Quite often patients live in far flung villages with poor access to healthcare or broken families compounding the difficulties.
Advanced deformity of the hand in Cerebral Palsy
I have seen that through these storms invariably the mother stands and guides the child unwavering.
#FibularHemimelia #NFT #Art for #WorldDisabilityDay
As part of our #ArztForACause effort to raise awareness of #PediatricOrthopaedic #Diseases and upcoming #WorldDisabilityDay I have made this #Art on #FibularHemimelia
Cerebral Palsy is a tough problem in Paediatric Orthopaedics. The children have spasm, contracture and variety of coordination issues , balancing issues, seizures and other symptoms like tremor, dystonia which makes treatment quite a challenge. This is more so in the younger children where we would like to have a tool that is non invasive and still helps relieve spasm.
Tone Inhibiting casts offer an invaluable tool to control spasm in a very young child that you would want to avoid surgery.
The dosage of surgery in cerebral palsy has to carefully titrated as muscle are inherently weak and over-lengthening can be disastrous.
We try to avoid overzealous initial surgery and but time when possible with plaster casting to reduce muscle spasm.
Tone Inhibiting Casts are a vanishing tool these days in medical professionals’ armamentarium but find it a great tool. In India with cost of Botox injections to relieve being very high and in the class of patients I treat many of who are from poorest strata this is a godsend.
Cast application is done under general anaesthesia so that adequate muscle relaxation is obtained and we take great care for a close , bespoke type fit with good pressure relief over bony prominences. Prevention of pressure sores is very important and technique of cast application – the fit, padding, tightness, joint position, strength of cast all play a role in the final result.
We keep child on physiotherapy all through the time child is on cast to keep up muscle strength and also aid stretching. A cast usually is kept for 6 weeks. Sometimes in severe spasm we have staged application of casts to progressively apply it lesser flexion of joints as the muscle tone decreases.
Before the pandemic struck and wrought drastic stop to treatment of children with cerebral palsy.
Two years have passed and we hobble back to restart our work and pick up pieces. Many children have lost the improvements that they had attained as they lost out of treatment due to lack of money, travel restrictions and physiotherapy.
This is October 2019 we hosted a live painting workshop at ICCONS to raise awareness about Cerebral Palsy.
Medicine is tough. Treatment slow, arduous. I feel for those who wait patiently in crowded poorly appointed waiting rooms, corridors in India’s hospital for the poor. They spend their days here by the loved ones
Back Pain Clinic - Adults and Children, Palakkad, Kerala
Happy to announce that the Spine Clinic for Children and Adults will be functioning on all days except Thursday at Palakkad District Cooperative Hospital & Research Centre, Palakkad, Kerala.
This will cater to all variety of Spine diseases in Children and Adults.
Common diseases like Disc Problems, Infections of Spine ( Septic Spondylitis ) , Tuberculous Spondylitis, Scoliosis, Spina Bifida are treated here.
I am available for consultation on all days except Thursday from 10am to 4:30 pm. Please contact Palakkad District Cooperative Hospital for details and appointment.
My Clinic restart has been delayed due to Covid situation and we have noted that children with fractures are having difficulty getting consult for emergencies.
A speciality Fracture clinic for Children run by Dr. Easwar TR is operating at Malabar Hospital Palakkad.
Treatment is provided for all types of children’s bone problems, sports injuries and fractures. The service is available around the clock in association with Orthopedic doctors at Malabar Hospital, Palakkad.
For Emergencies and Appointments please contact Malabar Hospital for appointments.
Children’s fracture clinic for bone and joint problems, fractures, sports injuries at Malabar Hospital Palakkad Kerala by Children’s Bone Specialist Dr Easwar TR
On #WorldCPDay this year, amid the pandemic, we’ve managed to launch a new rehabilitation facility in association with Karunya MVRC, Palakkad, Kerala, India ( @Karunyamvrc on Twitter )
Kerala State loves Sports, and specially loves Football. We married care for children with Cerebral Palsy and Sports, to setup a one of a kind Adaptive Sports Environment where children would be trained with Physiotherapist’s support by well known Sports Coaches.
Paediatric Orthopaedic Surgeon’s service is also available to assess these children and triage then into various categories from where they can be rehabilitated.
Our Cerebral Palsy Adaptive Sports Team
Ms. Valarmathi- Physiotherapist
Mrs. Valarmathi- Senior Special Educator
Mr. Ravindran – Retd SI and Kerala, Police state and national team Football coach
Ms. Dhanya Ravi- Change Maker, mentor, PwD, National Award winner in the Role Model Category under Empowerment of People with Disability
Mr. Anudarsan – Director , Karunya Medical and Vocational Rehabilitation Center
Adaptive Sports is a special type of Sports training given to children with special needs by adapting the requirements of sports to the specific difficulty the child faces.
This would often involve some change in rules, some Assistive device support, fall prevention and a completely tailored coaching system to enable the child to play effectively.
Why Adaptive Sports ?
Well known rehabilitation method for Cerebral Palsy is Physiotherapy. Often times children find repeated therapy sessions boring, painful at times and many fall out of care. We’ve seen this happen over the years.
Also, there are several limitations to traditional physiotherapy approach when given as a single rehabilitation modality.
Sports training allows much the same benefits of improved strength, coordination and improvement in function that we get out of Physiotherapy but also improves the quality of Physiotherapy session as the child is a willing participant because of the interest in sports.
What are the special challenges in setting up Adaptive Sports in India ?
Coaching for Adaptive Sports is a patient art and the skill is much in dearth. The Sports coach has to tailor his or her expectation to the unique medical issues of the child and training method is customised accordingly.
Often these children have profound muscle weakness, spasticity ( unusual tightness of the muscles ), contracture, ataxia ( issues with body balance ) and inability to selectively more a body part. These result in delayed improvement a ability to perform in Sports activity. These children need care and support of their team to get ahead.
The coach has to be understanding of all these aspects and train the child.
What have we launched in Palakkad ?
Details about our effort to train children in Adaptive Sports here :
Dr. Easwar T.R 