Dr. Abhishek Shukla

Background: While attempting hardware removal, intraoperative challenges and hardware removal strategy vary in each case. Only a few nail removal techniques are reported in the literature. Surgeon’s understanding and resolution of these rather challenging situations improve with experience and exposure. Patients having healed tibia fracture with in-situ intramedullary nail were subjected to intramedullary nail removal. Aims and Objectives: The aim of this study was to assess the performance of novel bone-conserving C-arm-free technique of intramedullary nail removal and describe trends such as surgical timing, complications, hardware removal ratio, intraoperative fluoroscopy requirement, comorbidities, and time since the first surgery in patients undergoing the surgical procedure. Materials and Methods: This was a prospective therapeutic observational study conducted from July 2017 to December 2021. Patients having healed tibia fracture with in-situ intramedullary nail were subjected to hardware removal using a novel bone-conserving radiation-free technique. Results: Among 108 patients, 49.72 (%) were men and 50.28 (%) were women. Patient demographics: age-45 years (mean); range-18–75 years. The overall surgical timing was 117.5±2.1 min (mean/S.D). Hypertension was the most common comorbidity overall with the incidence of 32.40% (35/108 patients); maximum 50% in the age group of 46–60 years (12/24 patients). Nail retrieval was possible in all cases with a 100% hardware removal ratio. The most common complication encountered was DVT/Thrombii (7.40%, 8/108 patients), followed by surgical site infection (5.55%, 6/108 patients) and fractures (2.77, 3/108 patients), with maximum complications in the age group of 61–75 years (63.63%, 7/11 patients). Patients presented 3.8±1.1 years (mean/SD) after the first surgery for nail removal. Conclusion: In complicated situations, an extra bony window over interlocking bolt slots can be used to maneuver the nail, thus facilitating tibial or femoral nail delivery.

Introduction: In India, majority patients with musculoskeletal injuries are attended by traditional medicine treatment provider. Bone setting services data from Subcontinent is not available. Methods: Prospective epidemiological study across 10 cities. Objective: To document bonesetter's spectrum of services and work-based information; radiological services use, treatment methods, treatment cost, treatment duration, referral timing, complication incidence and success rates. Results: Study encompasses 915 Traditional Bone Setters working over area of 6725 km2. Meerut houses most bonesetters (n=130); industry dominated by men (98.5%). 55% bonesetters are of 51-70 years. Overall experience 53.75 years. 9.50 % Bonesetters have radiograph machines. 55.95% practicing bonesetters are 3rd generation lineage. 32.67% bonesetters prescribe allopathic medications. For treatment, Males visit more (55%) followed by Females (25%) and Third gender (15%) patients. Patients age group 5-94 years. 22.4 patients visit each bonesetter daily. An average treatment lasts 4-5 sessions; treatment cost 300-400 Indian Rupees per sitting (3.60-4.80 USD). Patient report 2.75 days post injury & treatment lasts 14.5 days. 90% Bonesetters take time till 3rd bandage (9-10days) to decide on referral. Patient's satisfaction is 64% and 45% complication rates. Discussion: Traditional Bone Setters form largest specialised group offering services for musculoskeletal injuries in India; attracting 25-40 patients per practitioner daily. High complication and referral rates are worrisome. Conclusion: Clientele visiting bonesetters form major chunk of patients that should be treated by Orthopaedic Surgeons. Policies should be made to integrate bonesetters into structured health services; to benefit community at larger scale with fewer complications and man hours lost to work.