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
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
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.
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
October 6th we will join the world at ICCONS, Shoranur , Kerala in celebrating #WorldCerebralPalsy day.
What we are lining up this month ..
We are starting the programme by joining the #GoGree4CP movement to dedicate ourselves to the care of #CerebralPalsy affect children.
We will be lighting up the entire building in green for the entire month and put prominent placards, posters and banners in local language of Malayalam and English to spread awareness about CerebralPalsy among general public.
Lined up after that is our free medical camps in both Paediatric Oethopaedics and Paediatric Neurology and Developmental Paediatrics along with cultural activities, parents education seminars, assistive technology programmes, research on Cerebral Palsy, Counselling for parents and other events.
We have dotted the events across this October to keep the awareness and dedication alive.
Attaching below is a poster and a banner of our medical camp and GoGreen4CP initiative.
Clubfoot Care Team at Palakkad District Cooperative Hospital, Palakkad, Kerala, India
I am happy to announce that we successfully organised a Clubfoot Parental Awareness and Caregiving Programme at the Palakkad District Co-operative Hospital, Palakkad, Kerala on August 31st, 2019. This was done to organise parents into a self support group and to provide parents the necessary group counselling on Ponseti Method of Clubfoot treatment.
We have been organising World Clubfoot Day programmes, Free Medical Camps of Clubfoot and assiting children from underprivileged backgrounds get Ponseti standard of care Clubfoot along with CTEV Foot Abduction Orthosis via our charity trust https://mitratrust.org. We also described out #ArztForACause art and painting fundraiser which is undertaken originally to raise funds for children with Cerebral Palsy and now extended to children with Pediatric Orthopaedic Deformities.
The programme was well attended and was co-ordinated with our Obsterician colleague and all the staff nurses who are part of the Clubfoot Care team who counselled the young mothers on Breast Feeding, Child Nutrition, Clubfoot, Braces and Ponseti Exercises.
We were pleasantly surprised at the turnout on the day as it was organised in short notice. This programme will be followed up more such programmes on Clubfoot ( sometimes called CTEV : Congenital Talipes Equino Varus ) for Staff Nurses and train them in Ponseti Care .
#Clubfoot guide and interactive session for patents at #Palakkad Cooperative Hospital is being organized on August 31st.
The program includes a lecture by me on Clubfoot for parents and a interaction with our Clubfoot Care Team , Orthosis Check, Doubts about casting, checking recurrence of deformity and general clarification on Clubfoot care.
Parents will have an opportunity to interact with other parents exchange their experience about treatment, the issues and build a support community.
Attaching the Program details below. Please call the number for registration.
Clubfoot Parental Caregiving Interactive Session at Palakkad, Kerala
We at the Palakkad Orthopaedic Club are organising a free medical camp on August 04th, 2019 to mark the celebrations of National Bone and Joint Day in 2019. We will be holding the medical camp at IMA Hall, Palakkad, Kerala on August 4th from 9.30 am – 02.00pm.
Dr. Tajan, President Palakkad Orthopaedic Club and Dr. V G Ponnirajan, Secretary, Palakkad Orthopaedic Club have been hard at work along with the other members of the local orthopaedic fraternity to organise this event.
We will be participating in this medical camp and are expecting a large turnout for the event. Brochures, Posters and Press release has been done and event has been publicised in the social media well so that maximum number of the deserving public can be reached.
Those seen at the camp and found eligible, free surgeries can be conducted at District Hospital and other local private hospital after screening. This ensures that the benefits of the event truly go to the deserving.
Please find below the poster for the event.
Bone and Joint Day Celebrations among Orthopaedic Surgeons, Palakkad, Kerala. We are organising a free medical camp
Had a great start to the #Pediatric #Sports #Injury Clinic at Rajiv Gandhi Co-Operative Hospital, #Palakkad #Kerala.
It was inaugurated as a combined event conducted by the Olympic Athletic Club of Palakkad and Palakkad District Cooperative Hospital, Palakkad. The event was organized at the Athletic Track at Government Medical College Palakkad on 15th May 2019.
It was attended by Mr Haridas the coach of the Olympic Athletic Club , Mr. Ashraf the Vice President of the Cooperative Hospital Palakkad, Sports Council of India-Palakkad dignitaries , Athletes who have participated in Olympics, Asian, Special Olympics or National Games.
The Pediatric Orthopedic and Sports Injury team from Palakkad comprising of Senior Orthopedic Surgeon Dr. Ravi G Nair, Pediatric Orthopaedic Surgeon Dr. Easwar T.R (myself !) , Dr. Nishanth V.S (Orthopedic Surgeon Fellowship trained in Arthroscopic Surgery ) and Physiotherapists Mr. Biju Bhaskar and Mr. Sivadas were present.
#Olympic, Asian, Special Olympic and National Game stars were a special attraction in the event, needless to say. Athelete stars Sree Shankar, Gokul, Abdul Rahman, Vishu Priya were honored for their achievements.
There is wonderful potential in the district and great coaching going on.
Had an excellent integration with the sports champions and kids there. It is wonderful that these athletes from very humble background are able to achieve so much from simple facilities provided to them. Gokul a Special Olympics Star and medal winner come from such a humble family that it is so awe inspiring.
The parents, coaches and athletes thought it was a wonderful initiative to set up this clinic. These children did not have such treatment facilities here at Palakkad till now and after injury have to travel long distances to other cities to get treated. The treatment is also very expensive in bigger cities.
Importance if #InjuryPrevention, early rehabilitation, sports specific physiotherapy and the difference of pediatric sports injuries from other types of injuries were counselled to these children. Impirtance of early injury detection, injury prevention and rehabilitation we’re stressed up on.
Children like Aniruddhan V (Roller Skater) who’s hard at practice with his cast on after fracturing his wrist is an inspiration to everyone. His father , Advocate Vinod , gave the introductory talk and introduced all the young athlete stars to the crowd and doctors. This was followed by talk by the other distinguished guests, athletes and Doctors.
We will be plunging into further activities soon to get the rehabilitation centre equipped for these pediatric athletes and organising camps, talks ….
Watch this space.
Meanwhile enjoy the scenes of the event ..
Dr. Easwar TR , Pediatric Orthopedic Surgeon speaking at the event
Mr. Ashraf ,Vice President Co-operative Hospital at the inauguration
Dr Ravi G Nair , Senior Orthopedic Surgeon, speaking at the event
After many years of work we finally have a #PediatricNeurologist ( Dr.Velmurugan, Hope Neuro Centre , Coimbatore ) (geared towards #DevelopmentalNeurology), Occupational Therapists, #Pediatrician (Dr. Lakshmi, Coimbatore), #Psychiatrist(Dr. Sajal), #Psychologist joining our team to treat Developmental Neurological issues in Children and Cerebral Palsy.
This is the first day of two day free medical camp. First day is dedicated to the neurological issues in children like #Autism, #Seizure disorders and second day for #PediatricOrthopedic Diseases, Limb Deformities like #ClubFoot and #CerebralPalsy.
This was in organised in association with #Sevabharathi who has been most kind in donating money, arranging volunteers etc.. The premises itself is a Lifecare Physiotherapy clinic of Biju Bhasker at #Palakkad, #Kerala.
Most kind have been Sevabharathi, it’s volunteers and Dr. Sreeram Sankar without whom this wouldn’t be possible. When me and Mr.Biju approached them with the idea 2 years ago they had a kind heart to go ahead and help us with much needed sponsorship and man power.
Watch this space. The next event would be bigger and better !!
Recently gave an interview to a popular news channel in #Kerala in #Malayalam.
The topic was “Common Children’s Orthopedic Disorders and Cerebral Palsy”.
It’s is in an interview format with patients who are interested phoning in the channel to discuss some of their doubts about these disease conditions.
The idea was to take up and discuss the most common children’s bone diseases that parents would need guidance on like Bow Legs, Knock Knees, Club Foot, TB infection of Bones, Perthes Disease of hip, Cerebral Palsy and interact with patients who may phone in.
I have great pleasure to announce that along with the launch of a Cerebral Palsy Clinic at Sri Ramakrishna Ashrama Charitable Hospital , Thiruvananthapuram, Kerala I am also starting an exclusive Pediatric Orthopedic Clinic.
This will cater to children suffering with bone and joint disorders, congenital deformities like Club Foot, Flat foot, Knock Knees and Bow legs among many others. Treatment advise for Spine problems in children like spina bifida, congenital and idiopathic scoliosis are also offered.
I am hereby attaching a video clip showing the many clinical conditions for which services are being offered here.
This hospital being a charitable one caters to the poor and these services would be of benefit to many.
Kindly share among your friends so that people are aware of the new service.
Dr. Easwar TR Pediatric Orthopedic & Spine Surgeon
I’m extremely happy to inform you that I am starting a Pediatric Orthopedic and Cerebral Palsy Clinic at Sri Ramakrishna Ashrama Charitable Hospital, Shasthamangalam, Thiruvanathapuram.
Please find below the video announcement of the same.
Cerebral Palsy Clinic at Sri Ramakrishna Ashrama Hospital, Thiruvananthapuram, Kerala
This is a subsidised care hospital which will serve the poor and help establish a sustainable care for children with Movement disorders, Cerebral Palsy and other Pediatric Orthopedic problems.
Appointments can be taken at the numbers or email listed below.
Aniruddhan with his father. His latest fracture a minor blow in his quest 
Aniruddhan V , on Roller Skates
Dr. Easwar T.R 