Category: Pediatric Orthopedics

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Cerebral-palsy Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

#WorldCerebralPalsyDay event !! – wonderful experience at #Palakkad, #Kerala

Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options

It was a wonderful experience to be part of the team that organised #WorldCerebralPalsyDay event to bring parents, children, caregivers, NGOs, Doctors, Therapists, Counsellors together for a day and have fun and enrich themselves.

The event was organised by Lifecare #Physiotherapy Centre, #Palakkad, Kerala along with #Sevabharathi, #Kerala at Thrupthi Hall in the centre of town.

The choice of centre was superb as it was right in centre of town allowing easy transit for children coming in from rural areas and those with limited mobility.

We assembled at the centre around 10 am and crowd had already trickled in at that time. In another hour about 40 children, parents, caregivers and health care professionals had assembled. The inauguration was a minimal affair with Dr. Sreeram Shankar starting the welcome address with respects paid to the almighty and the parents who had taken time to get here. This was followed by a medical camp by me, a painting competition and a singing competition for the children. There was a talk after that by Dr. Deepa, Psychaitrist, District Hospital, Palakkad which was followed by my parental awareness on treating #CerebralPalsy children.

Cerebral Palsy inaugural address by Mr. Kalyanaraman, Palakkad, Sevabharathi
Cerebral Palsy Event inaugural address by Mr. Kalyanaraman, Palakkad, Sevabharathi

It was a red-alert day in many places for #Kerala because of fear of inclement weather. However, rain stayed away largely apart from slight drizzle. That was a relief.

Parental counselling on treatment options in cerebral palsy
Painting Competition for Children
Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options
Adult Cerebral Palsy is becoming a major issue. I was surprised that patients had pertinent questions on that topic.
Dr. Sreeram Shankar Inaugural address
Dr. Sreeram Shankar Inaugural address
Adult Cerebral Palsy is becoming a major issue. I was surprised that patients had pertinent questions on that topic.
Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options
Painting Competition for Children
Parental counselling on treatment options in cerebral palsy

About 40 children took part in the celebrations, competitions, talks and counselling sessions. It was well appreciated by all, many who are experiencing this for the first time.

Positive vibes which would rub off into the child’s care was the key. Parents took strength from one another and participated in the awareness session. Many misconceptions about Cerebral Palsy, Seizure Disorder, Autism, Global Developmental Delay were cleared.

We are planning sessions throughout this month and hopefully improve the quality and participation of these events in the next iteration.

 

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Cerebral-palsy Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

World #CerebralPalsy Day – October 6, 2018

World Cerebral Palsy Day - at Palakkad and Shoranur, 2018
World Cerebral Palsy Day - at Palakkad and Shoranur, 2018

#WorldCerebralPalsyDay is afoot. Like last year, I am planning to conduct month long events across Palakkad and Shoranur to raise parental awareness on treatment of #CerebralPalsy.

Most of the parents who come for care of their children come late, unfortunately with joint contractures, hip subluxations, alteration in knee mechanics and foot deformities. Aside from these the problems these children have with upper limbs, hands and doing activities.

Many of these children have uncontrolled seizures, terrible difficulties communicating, speaking out their issues apart from ambulation.  Ambulation may in fact be least of their issues. This sad fact goes to show how important early referral is and how important it is to enroll the child under a care of a Pediatric Neurologist, Pediatric Physiotherapist who can then co-ordinate care with their colleagues in Pediatric Orthopedics, Pediatric Medicine, Occupational Therapy, Speech Pathology, Audiology etc ..

Cerebral Palsy care is a great team effort. No part of the team is greater than other, but the role of the General Practitioner / Pediatric Medicine Doctor, Pediatric Physiotherapist is central, at least in India. They determine the sole referral entity, a person with whom the parents spend their maximum time and trust with. They are the ones in whom they confide most of their issues with.

World Cerebral Palsy Day is a wonderful concept to reinforce these simple care giving principles. Parent education and empowerment being central to the cause of care of these children. Like 2017, we are organising activities across the district of Palakkad – in Palakkad town and neaby rural areas and Shoranur town to educate parents and also conduct early detection and intervention camps to identify children who need care.

World Cerebral Palsy Day - at Palakkad and Shoranur, 2018
World Cerebral Palsy Day – at Palakkad and Shoranur, 2018

Activities planned :

  • Free medical camps for underpriviliged children
  • Special clinics with Gait Analysis
  • Funded Orthotic programme for poor children
  • Pediatric Physiotherapy advice
  • Custom made Wheel Chair fitting
  • Parent awareness of Cerebral Palsy – lectures and symposias in rural areas
  • Notices and public handouts to improve general awareness
  • Involvement of other NGOs , social service organisations to improve public outreach

These activities would be done throughout Ocotober 2018 under aegis of the Cerebral Palsy Clinic at Rajiv Gandhi Cooperative Hospital & Research Centre and ICCONS, Shoranur

Contact Numbers for Clinic bookings  and more information:

  1. Rajiv Gandhi Cooperative Hospital, Kallekkad, Palakkad : 0491-250-9000
  2. ICCONS, Shoranur, Palakkad                                                   : 0466-222-4869
  3. Contact me                                                                                  : EMAIL

 

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Deformity Correction and Limb lengthening Pediatric Orthopedics Spine & Scoliosis Surgery

Spina Bifida and Hydrocephalus Conference 2018 NewDelhi


#IFSBHCON2018
#SPINABIFIDA
#hydrocephalus
#spinabifidafoundation
Lovely conference and lovely to see the so many families and patients viewing life with such a positive attitude https://t.co/eXqZWmuhoa

Dr. Santhosh Karmakar and Spina Bifida Foundation deserve credit for bringing together different professionals -doctors, physiotherapists and families, together for this event

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Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics Spine & Scoliosis Surgery

#CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad


Had a wonderful #CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad #Kerala organised by wonderful people at #SevaBharathi . It was well attended with parents and children braving the heavy rain.
@sevakeralam
@sevabharathitn https://t.co/Z3FT9C6RVO

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Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics Spine & Scoliosis Surgery

Free Medical Camp for Children’s Orthopedic Disorders and Cerebral Palsy


I’m conducting a free medical camp for #Childrens #Orthopedic #Disorders and #BoneDiseases , #LimbDeformities and #CerebralPalsy at #Palakkad ,#Kerala . Event is organised by #SevaBharathi .

The event will be held in the premises of Life Care Cerebral Palsy Clinic which is in centre of Palakkad town enabling easy transport to the venue.

Patients and relatives are advised to bring all old records while seeking opinion. All old x-ray, other scans and will also be needed for evaluation.

Phone number for Booking :+91-80759-21075

Contact the phone on last line of notice for appointment.
(Notice is in #Malayalam, local language of Kerala )

https://t.co/smNqhcYRRS

Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis
Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis
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General Linux Open Source & Programming Pediatric Orthopedics

Making Media rich Medical Presentations using Emacs, Org-mode and Reveal.js – Part 1


Scenario

As a practicing Paediatric Orthopaedic Surgeon, I am called to meeting to present my work. This involves presenting to peers, co-workers, patients and parents of children I care for. Each of these presentations will be with a different focus on a particular topic. 

While this is not an uncommon scenario, the solution to create a reusable presentation slides using #OpenSourceSoftware tailored to individual audience is. Most doctors are not familiar with programming environment  and shy away from anything that is not WYSIWYG. They rely on good old #PowerPoint / #Keynote to save them. At the most some of them may try and use the clunkly #LibreOffice or #OpenOffice if they want to stick to OpenSource. Recently with advent of tools like Prezi, media heavy interactive presentations have become popular. The popular presentation softwares of KeyNote, PowerPoint have also spruced up their animations and transitions to enable them to look more attractive. Still the WYSIWYG nature of these and point-and-click makes them very slow. We could achieve better, faster and more attractive results with using #FOSS tools. 

 

What I use now

For the past few years I’ve been using a combo of 

  1. #LaTeX via #beamer class 
  2. #RevealJS ,
  3. #Emacs, Org-Mode, org-reveal
  4. #HTML5 and #CSS3
  5. FOSS Image and Video editing softwares as required to arrange the media. I mainly use GIMP, InkScape, KdenLive, OpenShot, HandBrake to arrange my media and encode them. 

My choice depends on the demands of the presentation. 

For media heavy, especially video heavy presentations I use RevealJS. For presentations that are more of less static with few videos I tend to use Beamer / LaTeX. What I note below are my experiences as I tried to create a smooth workflow that could replace PowerPoint ( or KeyNote / LibreOffice ) as a tool to create #Medical Presentations. 

Overtime I have refined my workflow and now I find that I am far more productive and my slides can pack much more information than a power point slide. While the more advanced interactions would require some knowledge of JavaScript, and therefore would turn off most doctors, most of what follows require minimal programming use. 

I will detail my workflow to create simple fast layout using Emacs and RevealJS without handcoding of JS and HTML. We will be relying on the RevealJS, Emacs, Org-Mode and ox-reveal package to do the lifting. 

 

Disclaimer : Even though it doesn’t need programming knowledge, ability to use Emacs is a must for this workflow. It is preferable that one is on a Linux OS as the attempt is to go all #FOSS here. 

 

so, here goes ….

 

Aim

To create an visually impressive medical presentation using non Power Point open source (FOSS) softwares.

Tools

  1. Emacs (24.3 or greater)
  2. org-mode
  3. org-reveal
  4. Reveal.js
  5. Chrome Browser
  6. Open source video codecs on the system

Why this and not PowerPoint ?

Over the years Medical Conference presentations have got mature and old tools have got boring. Varied audiences, topics, media content , interactivity required, transitions and animations to keep audiences interested have all changed.

PowerPoint with it’s traditional set of tools is boring to say the least. The point and click interface is slow by comparison to plain text typing. This seems counter intuitive to PowerPoint pandits but I’ve found that once the media is arranged and readied, once can create more far more attractive presentations with the tools mentioned above. 

As far as medical presentations go, the video presentations embedded PowerPoint / LibreOffice have a habit of breaking on stage. I have seen numerous instances of this happening.

And, of course PowerPoint costs 💰💰

It is also Closed Source making it difficult to edit and reproduce when you are with a system where it is not installed.

 

Okay, but why Emacs, why indeed ?

Emacs is Open Source

Emacs is stable

Emacs is good

Emacs is better than #Vim

Emacs has un-paralleled number of extensions and programming support

Emacs has Org-mode… 

 

Okay, So why org-mode, what has that got to do with presentations ?

org-mode is cool

org-mode is simple text

org-mode can be manipulated anywhere with text-editor

Its FOSS

It can be extended with other tools like org-reveal

 

Hm, Okay, but why Reveal.js ?

An actively developed FOSS Tool with a community

Allows 2D stacking of slides permitting nesting

Plugins and all the JS/CSS/HTML5 goodies can be integrated

Very good slider-presenter notes

PDF export option for handouts

Very nice transitions and animations

Good builtin themes and literally infinite customisation options as per CSS

Works very well with slide-projectors and remote tools to advance slides

 

Okay, but why use org-mode / org-reveal with Reveal.js ?

Org-mode is cool, easy, transparent text typing

org-mode is structured and nested just like a regular presentations would be

One can easily do a text-only sketch of a presentations by typing out a few lines of text in org–mode formatting and out put a neatly animated stacked presentation in Reveal.js

If one were to code HTML and JS with Reveal.js, it would be considerably opaque, with HTML markup and JS obscuring the structural details of the presentation.

By integrating org-mode, org-reveal and reveal.js we are integrating all that is good in respective tools while sticking to what the non-programmer user ( an average medical professional ) would like to do – type text and structure the presentation.

 

So, How to go about making one ?

Part 1 : Preparing the ground

Step 1 :

Install GNU-Emacs > 24.3

 

Step 2 :

Update package-archives and use Melpa archive.

Update org-mode.

 

Step 3 :

Install ox-reveal package

 

Step 4 :

‘require(ox-reveal) in your .emacs file

 

Step 5 :

Download and keep the Reveal.js file in a folder.

Note down the path to the folder relative to the folder where the presentation will live.

If you have Bower installed you can just do bower install revealjs

 

Step 6 :

Create a folder where your presentation will live. 

Inside the folder create subfolders for Images, Videos, Scripts, CSS styles and other documents which may be needed for the presentation. 

Now we can create the main file of the presentation – the Org-mode file using Emacs.  Org-mode file is a simple text file which can be opened using any other text-editor. It has the extension of  “.org”. 

While using Emacs and Org-Mode, however, it provides lot of goodies. Org-Mode in Emacs has lot of extensions one can install that extends it functionality. One can for example use the same org-mode file to output HTML, LaTeX, and PDF. 

So let us create the main presentation file. I title my presentations the following way, giving it context, separated by underscores : <topic>_<audience>_<date>_<venue> . For example if I am giving a public talk on Cerebral Palsy at my home town of Palakkad, on July 30th,2019 , I would title my presentation like this : “CerebralPalsy_PublicTalk_Palakkad_30072019.org”

This allows me to keep separate org-mode files for different audience and keep using the same images, videos etc.. Therefore I am fully portable and self-contained when I have to whip up a presentation tailored to any particular audience – technical or non-technical. 

C-x C-f  in Emacs  to the file you want to create with .org extension.

C-C C-# to insert Template for a Reveal.JS presentation.

If you have ‘ox-reveal loaded it should be available as a choice.

Once chosen it will list some options at the top of the org-mode file.

We will need to provide the path to the REVEAL_ROOT directory to the place we have stored the reveal.js library. This path is relative to the folder where the file for presentation lives. 

Once these are done, It is important to get the images, videos ready. They have to be edited using FOSS tools for editing photos and videos. Once edited they’ve to be named properly so that we can reference them in our presentations. 

 

This completes the ground work required to start writing the presentation. While this may seem a lot of work, one must remember this is one time effort.

We will deal with the actual creation of  org-mode file, the options while using Reveal.JS in the next part ….

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

DDH – Its June !! It’s Dysplasia Awareness Month

Developmental Dysplasia of Hip - Left hip is dislocated
Developmental Dysplasia of Hip - Left hip is dislocated

DDH otherwise called Developmental Dysplasia of Hip is a condition where the ‘ball-and-socket-joint’ of the hip is not formed well at birth. It used to be called Congenital Dislocation of Hip.

The child is born with a slightly misfitting hip joint where the ball is slightly shifted out of cup or a hip joint where the ball is completely outside the cup and cup is also very shallow. This can occur on one side or both sides.

Developmental Dysplasia of Hip - Left hip is dislocated
Developmental Dysplasia of Hip – Left hip is dislocated

Why does it happen ?

Most times its ‘Idiopathic’ , a medical term which means – cause is not known. In many other patients, the child will be having one of the syndromes (a group of clinical features and disorders in other organs systems and external appearance) or neurological issues in the spine (like meningomyelocele) that also causes this. This second group is sometimes medically referred to as Teratogenic DDH and is much more difficult to treat.

We will discuss below the aspects as related to Idiopathic DDH. They don’t apply to Teratogenic or Neurological DDH.

How do we know the child has DDH ?

Most newborn screening procedures at the hospitals have doctors checking to see if the new born child has clinical signs of DDH. It is easiest to detect and treat it at that early stage.

Once a clinical suspicion of DDH is there the Neonatologist usually refers the child to a Pediatric Orthopedic Surgeon. In addition to establishing the clinical diagnosis by physical examination, the doctor will order an x-ray and an Ultrasound Scan of the Hips to check the dislocated hips. Several measurements need to be taken and ease of dislocation need to be established under Ultrasound scan by a procedure called Dynamic -Ultrasound. The treatment starts after these are done.

In many children, the initial diagnosis may not be made in the immediate post-delivery period. Children may be brought to the OPD by parents with complaints that the thigh skin fold dont look symmetrical and the hips don’t open out fully for parents to change diapers.

In older children parents may notice a limp when the child walks or a limb length difference may also be noted with the dislocated side being shorter.

Limb Length Difference in DDH
Limb Lengths may be noted to be different in DDH when child is older and walking. The limb with the dislocated hip will appear shorter.

How soon should the treatment start ?

As described in previous section, treatment should ideally start in neonatal period once the problem has been detected. After clinical examination and Ultrasound examination, your doctor will suggest usually a belt type device called Pavlik Harness to be applied on the child to keep the hip reduced inside the cup. This harness is to be worn full time. Parents are counselled on how this is applied and how the straps are tightened.

Ultrasound exam for a child with Hip and Knee dislocation
Ultrasound exam for a child with Hip and Knee dislocation

Once this harness has been applied, the hips are scanned with Ultrasound every 2 weeks to check for improvements. Ideally this has to be kept for about 3 months and taken off after the hip stabilizes inside the socket. A slow weaning period is there before the child can be fully taken off the Pavlik Harness. This is to ensure that the Ball ( head of femur ) stabilizes inside the socket (Acetabulum of Pelvis) and the hip is stable. The tissues around the hip also has to shrink and adapt to the new location of Head of Femur. Otherwise re-dislocation or partial slip (medically called subluxation) is a possibility.

In many cases the parents may not be willing for a device to be applied on the child full time post-delivery or the DDH itself may go undetected. This child eventually may be brought later in life by the parents with complaints necessitating surgical procedures.

What is the treatment options for DDH?

As previously described if the newborn is detected to have DDH the treatment is to apply Pavlik harness on the child after Ultrasound exam proves hip is reducible and stable in what is called a safe zone. Safe Zone is a zone where the position in which the harness has to be applied to the child does not compromise the blood supply the head of femur. This is very important decision to make.

Pavlik Harness for DDH hip needs to be fitted properly
Pavlik Harness for DDH hip needs to be fitted properly

Hip Spica Plaster in child with DDH
Hip Spica Plaster in child with DDH

Application of Hip Spica under anesthesia in DDH

If the child is brought later in life, before 1 year, the hip has to be checked for reducibility as the tissues around the hip would have become contracted and sometimes it is difficult to reduce the hip back into the socket. Usually anaesthesia would be required and the hip once reduced back into the socket is held there by application of the plaster of paris or POP called Hip Spica. This is kept for approximately 3 months until the hip has stabilised inside. A CT scan to verify whether the hip is reduced should be done while child is in POP as slippage of the hip socket is also seen when POP cast becomes loose with time.

Surgery is the only option in older children with DDH. These range from relatively simple procedures to complex hip reconstruction procedures depending on age of the child, slope of cup, angle of rotation of the neck of the thigh bone and shape of the head. These are best evaluated as per the needs of the child.

Arthrogram for DDH

Generally these surgical procedures can be grouped into a few types :

  • Open Reduction of Hip and Capsulorraphy (medical term meaning stitching up of capsule or the covering around the joint)
    • This is basic necessity. Here the hip is reduced back into the socket and the covering, the capsule, which is loose is tightened with several sutures
  • Femur Derotation Osteotomy with shortening
    • This would involve a slight shortening of the hip bone and turning it around. The bone would then be stabilied with a metal plate and screws
    • The need for your child to have this done depends on the age of the child and the angle of the ‘neck of the femur’, something medically known as Anteversion. This procedure essentially de-rotates the femur neck and allows the head of femur (the Ball) to deeply sit inside the Acetabulum (the socket). A slight shortening of the thigh bone may be needed as the child , if old enough, would have developed tightness of the tissues and hip should be sitting inside the socket slightly loose than in tension.
  • Acetabular Osteotomy
    • In many children, when they present to the clinic their Acetabulum would be shallow and not deep enough to receive the Head of Femur. In such children deepening of the Acetabulum by a surgical procedure called Osteotomy (a type called Salter Osteotomy being the most popular) may be done.

The above procedures may be combined along with Open Reduction as the surgeon sees fit after evaulating the child. These options and its pros-and-cons would be discussed with the parents before the surgery.

What happens if we don’t treat DDH promptly ?

Best time to treat the child is in the newborn period. With time the tissues around the hip gets tighter and the bone structure of thigh bone and pelvis alters since the normal growth with moulding of the ball being inside the cup doesn’t happen.

This lack of moulding results in a shallow cup. Additionally the thigh bone’s upper end would be twisted out of shape and the ball also would be misshapen since it has not been moulded by the acetabulum.

All these result in a much more complex procedure to try and restore the hip.

Left untreated DDH causes osteoarthritis or the Hip joint and Hip pain in early adulthood often requiring complex reconstructive procedures.

It is best if the treatment is not postponed and done at the earliest.

Hip Dysplasia Awareness Month – June !!

The Hip Dysplasia Awareness Month of June is to educate parents on Hip Dysplasia and its treatment methods. We hope that parents would bring children to care centers at the earliest if suspicion of hip dysplasia is there.

For more information please visit : http://livingwithhipdysplasia.com/june/ or consult your Pediatric Orthopedic Surgeon.

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Free Medical Camp for World Clubfoot Day 2018


World Clubfoot Day free medical camp concluded well and many patients had the opportunity to consult free and take advise for their child.

Attaching below is the collage .

We have a lovely Clubfoot Care team that made this event and caring for these children over team so much easier.

World Clubfoot Day
World Clubfoot Day with Children, Parents and Clubfoot Care Team

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

World #Clubfoot Day is afoot ! – Free medical camp for children with Clubfoot


I’m organising a free medical camp on June 4th at Palakkad Cooperative Hospital, Palakkad, Kerala on World Clubfoot Day.

Please do spread the news so that anybody interested can seek care.

Attaching below is a poster in local language Malayalam.

Interested patients may contact hospital Reception on following phone numbers for registration :

+91 491 252 0391

+91 491 252 2805

+91 491 253 6293

Clubfoot medical camp
World clubfoot day free medical camp

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Bracing and Orthotics for Clubfoot (CTEV)


Once clubfoot is corrected with Ponseti plaster application and tendoachilles tenotomy, it’s time to maintain the correction of foot till child is grown more and started walking well. There is risk of clubfoot recurring without proper bracing.

Recurrent clubfoot
Recurrent clubfoot without bracing

Types of braces

Steinbeck device, Iowa Brace and Dobbs Brace are commonly used clubfoot Foot Abduction Orthosis.

Dobbs brace in particular has the added advantage of providing extra mobility to the child potentially improving compliance. Comparatively it’s more expensive.

Compliance

In rural India it’s especially difficult to ensure compliance to orthosis for parents as many feel clubfoot treatment finishes with Ponseti casting. Social issues and sensitivity of going out of home with brace fitted is one of the issues that makes parent fall out. Some of them don’t spend enough time learning to put it on and take it off and give up once child starts crying. It’s an easy procedure that we teach aling with nurses and orthotists to help parents during initial days.

Steinbeck braces

Steinbeck bracing
Clubfoot Steinbeck braces

Fitting Steinbeck clubfoot brace
Foot inside Steinbeck clubfoot brace

Dobbs Bracing

Dobbs brace for Clubfoot
Dobbs brace allowing movement

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Osteogenesis Imperfecta


Osteogenesis Imperfecta is a congenital disorder of bones that has varied types and presentations. Severity varies based on the type of the genetic mutation that causes this disorder.

Regardless of the type the genetic modification cause malformed and weak bones and in some cases malformed teeth. Bone bend and deform or break easily and heals in deformed position. This results in cosmetic deformity along with issues with walking , standing for the child.

The bend of the bone if significant can cause repeated fractures either due to poor handling by caretakers or when child tries to bear weight and stand up.

Fortunately for the milder variants there’s are medications to make bones stronger and surgery to straighten bent bones. This allows child with help of walking aids and/or splints to ambulate.

For the very severe variants unfortunately clinical breakthrough is still awaited.

Categories
Orthopedics Pediatric Orthopedics Spine & Scoliosis Surgery

Torticollis or Wry Neck in Children


#Torticollis or #WryNeck is a common complaint in #children.

Children will keep neck turned and/or tilted to one side. This can be a sudden occurrence especially after sore throat or upper airway infection, fall or maybe seen after difficult birth due to stretching and injury to the neck muscle (called Sternocleidomastoid .

While many are simple spam or contracture of neck muscle some torticollis as shown in the picture below could harbour problems like compression of #spinalcord by #neck bones which have gone off alignment. These problems in the structure of neck bones occur at birth and are due to a developmental error in the shape of the neck vertebra.

#ChildOrtho
#NeckPain
#PedOrtho

https://t.co/Nf8lSN2rTG

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Cerebral Palsy Medical Camp at Shoranur, Kerala

cerebral palsy child with dislocated hips
A child with dislocated hip due to poor posturing

A free medical camp for underpriviliged children suffering from Cerebral Palsy and Pediatric Orthopaedic disorders was organised by Dr. Easwar T.R and the administrative team at ICCONS, Shoranur, Kerala on 24th, May,2018.

A gamut of problems commonly seen in children with Cerebral Palsy was observed in OPD. While some parents had the good fortune of seeking medical care and intervention early in course of disease and others were not so fortunate. Lack of parental knowledge, distance / accessible care, financial cruch, normal siblings to care for and single parent challenges were the most important issues observed on casual data collection.

The medical camp was followed by an awareness class for parents, therapists and other care givers by Dr. Easwar T.R on the various aspects of Cerebral Palsy.

Custom wheel chair and mobility solutions for needy patients was discussed with Physiotherapists and low cost solutions for the same identified. Mobility solutions continue to be a major challenge for children in rural areas with poor roads, small homes with narrow doors and steps inside homes especially with outdoor toilets.

Flat foot in Cerebral Palsy
Cerebral Palsy child with widestance and flat foot
A child with dislocated hip due to poor posturing
Pediatric Orthopedic Camp at ICCONS
In front of Dr. Easwars office
Outpatient Department at ICCONS

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

World Clubfoot Day on June 3rd


This 2018, on June 3rd, we at Palakkad District Co-operative Hospital and Research Centre are celebrating the World Clubfoot Day.

We are planning special Outpatient Clinics for children with Clubfoot disorder in and around Palakkad, Kerala.

Please find below the Malayalam Poster for the #ClubFoot Day

Screenshot from 2018-05-25 16-07-28.png

 

Categories
Pediatric Orthopedics

Paramedical Awareness of Cerebral Palsy Care


Cerebral palsy awareness lecture for paramedical personnel at ICCONS
Cerebral palsy awareness lecture for paramedical personnel at ICCONS

At ICCONS, where we have been successfully treating cerebral palsy children for over 10 years, rehabilitating them to achieve goals. It is so important to maintain the momentum of care across all departments.

Paramedical training ( physiotherapists, occupational therapists, orthotists, speech therapists, behavioral therapists, clinical psychologists, nursing team, social workers ) in cerebral palsy care, handling, treatment options and outcomes gives all those who are involved in the care of these children hope for the future. It also helps them prime parents towards realistic goals; both long and short term. The end result is a comprehensive care for these children with cerebral palsy. 

Frequent lectures are so important to keep up the spirit among team members and orienting new employees. 

A recent talk i gave at Pediatric Orthopedic & Cerebral Palsy Clinic, ICCONS, Kerala preceding the World Health Day , 2017

Cerebral palsy awareness lecture for paramedical personnel at ICCONS
Cerebral palsy awareness lecture for paramedical personnel at ICCONS

Take a look at @dreaswar‘s Tweet: https://twitter.com/dreaswar/status/850260886535020544?s=09

Categories
Pediatric Orthopedics

Cerebral Palsy Camp for underprivileged children at Palakkad, Kerala

Gait analysis and EMG in Cerebral Palsy

In association with Rajiv Gandhi co-op erative hospital, Palakkad , to enable the Cerebral Palsy clinic and Gait Lab to reach underprivileged children, I’m conducting a medical camp for  children with cerebral palsy on 25 th, February, Saturday, 2017.

Those Interested may contact me at Me or the Hospital @ +919840724924 or +914912509000

This camp will include free Pediatric Orthopedic consultation with Dr. Easwar TR, video gait analysis, walking EMG measurement. Physotherapy services and Orthotic services are also integrated.

Thank you

You can read more about Cerebral Palsy here:

1) FAQs on Cerebral Palsy

2) Importance of Splints and Gait assistors in Cerebral Palsy

3) My Facebook Paediatric Orthopaedic and Limb Deformity Community

Categories
Pediatric Orthopedics

Dedicated Clubfoot Clinic at Palakkad , Kerala, India

Club Foot
Club Foot

Among the pediatric orthopedic problems, Club Foot is one of the commonest.

 It is a curving congenital deformity of the child’s foot. The knowledge of the deformity may come to light after birth and is traumatic for the parents. Thankfully treatment is simple, streamlined and gives good result. We apply POP casts to the foot every week and usually the foot corrects by 6 plasters. A small release of the heel cord may be required after the correction to complete the initial treatment. There after the foot is placed in special shoes and mother instructed on exercises.

 We have been dealing with large number of these children, educating their parents and care givers about the clubfoot that they stick through the initial treatment and subsequent follow up till mature. 

This is important so that any recurrence which is seen occasionally after a successful correction is addressed promptly. This translates to less surgery, if possible avoid surgery totally leaving a supple, scarless and beautiful foot. 

Clubfoot Plaster
Clubfoot Plaster

As the Pediatric Orthopedic service has matured at Palakkad District Cooperative Hospital, Palakkad, Kerala, India, we have now decided to allocate Monday as the special day for clubfoot children . This enables us to streamline our services and parents to learn from each other and support each other through this. 

We hope that this will help serve them better. 

All appointments can be booked via the contact page or via the CPOS clinic / hospital through phone +919840724924 or +914912520391

Categories
Deformity Correction and Limb lengthening General Orthopedics Pediatric Orthopedics

India’s battle againt Polio…

Categories
Orthopedics Pediatric Orthopedics

Cerebral Palsy : Importance of Walking aid and Splints


This post is to stress the importance of Walking aids and Splints in Cerebral Palsy.
Very often we see children with Cerebral palsy operated upon and then they complain that even after surgery, there is no difference. On further probing they confide that there is no improvement after surgery and continuous physiotherapy. Then it slowly comes to light that due to social stigma and fear of being labelled ‘crippled’ these children / parents tend to avoid brace.
This results in children losing the improvement they would have obtained after surgery and physiotherapy and child loses muscle strength, balancing abilities and retards the improvement of the child. This results in poor self esteem, loss of confidence and the child tends not to walk. The child then enters a vicious cycle.
The video at Paediatric Orthopaedic and Limb Deformity Community at Facebook illustrates the importance of splints and walking aids in child’s gait. The left side video shows the child trying to walk without walker or splint, the center video shows child walking with only the walker and the right extreme shows the child with both splint and walker.
Thanks,
Dr.Easwar T.R
Paediatric Orthopaedic & Spine Surgeon
Coimbatore
Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Dr.Easwar’s Paediatric Orthopaedic and Limb Deformity Community started at Facebook


Paediatric Orthopaedics & Limb Deformity Spectrum
Paediatric Orthopaedics & Limb Deformity Spectrum

I have created a Facebook Community to foster awareness about Paediatric Orthopaedic Limb & Spine Deformities, Bone Dysplasias, Growth Disturbances and Rare Orthopaedic Disorders in Children.

 

Paediatric Orthopaedic Problems cover a varied spectrum of disorders that require extensive training to handle well.These include congenital (birth defects) of limbs, scoliosis, hip and foot deformities, metabolic disroders like rickets, dysplasias, bone and joint infections and trauma (fractures).

May be you would have seen a child known to you with a bone problem, or may be one of your dear ones has a problem and didnt know whom to ask. Many parents delay the treatment either because of financial constraints or delay seeking treatment thinking that nothing can be done. Awareness is very important. With a specialised Paediatric Orthopaedic and Limb Deformity Surgeons advise these children can get better results it treatment is started early.

This Community will help parents discuss matters pertaining to treatment of these conditions. I will also be posting awareness articles, images periodically.
Please visit my Facebook Page to  join, like and share the group. Please help raise awareness among general public that these children can get specialised treatment and can improve their quality of life.

Thanks,

Dr.Easwar T.R
Paediatric Orthopaedic Spine Surgeon
http://atomic-temporary-9003308.wpcomstaging.com/
http://spine-india.com/