BOS Journal - January 1981

The Journal of Bangladesh Orthopaedic Society

January 1981	Volume 1, No 1
CONTENTS
EDITORIAL
1. History And Development of Orthopaedic Services in Bangladesh DR. R. J. GARST. Project Director, R.I.H.D. Dacca.
2. Excisional Arthroplasty of hip DR. M. S. TALUKDER. M. S., F.C.P.S., Associate Prof. of Orthopaedic, Surgery, R.I.H.D. Dacca.
3. Management of Post Polio Paralytic Foot DR. FARUQUE REZA AOLAD, M. S. Associate Prof. of Orthopaedic surgery, Chittagong Medical College & Hospital, Chittagong.
4. Fracture of the patella DR. M. S. TALUKDER. M.S., F.C.P.S., Associate Prof. of Orthopaedic Surgery, R.I.H.D., Dacca.
5. Treatment of fracture of Long Bone By Cast Brace Method DR. A. A. KHAN. D.Orth., M.S., Asstt. Prof. of Orthopaedic Surgery, R.I.H.D. Dacca. DR. M. ISHAQUE. D.Orth., D. Orth., Registrar, Rangpur Medical College Hospital, Rangpur.
COMMUNICATIONS TO THE EDITOR
6. Surgical Management of Legg-Calves Perthes’ disease DR. MD. NURUN NABI. R.I.H.D. Dacca.
7. Electrical stimulation in Non-Union DR. M. S. TALUKDER. M. S., F.C.P.S., Associate Prof. of Orthopaedic Surgery R.I.H.D., Dacca.
8. Ameloblastoma of the Mandible DR. MD. SHAMSUDDIN AHMED. F.C.P.S. Associate Prof. of Orthopaedic Surgery, R.I.H.D., Dacca.
9. Injection treatment of cystic lesions of the bone DR. M. S. TALUKDER. M.S., F.C.P.S., Associate Prof. of Orth. Surgery R.I.H.D. Dacca.

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TO THE BANGLADESH ORTHOPAEDIC JOURNAL
It is most gratifying to have the young Orthopaedist of Bangladesh start a Journal in this new nation. It is high time as we now have 24 qualified Orthopaedic surgeons working in the country. Although this is a ratio of one Orthopaedic Surgeon to 3.3 million people, it is still an excellent start keeping in mind that there was only one Orthopaedic Surgeon in the country of 75 million people in 1972. There are still many nations in the world today that have only a very few Orthopaedic Surgeons and no Orthopaedic Journals. The importance of keeping up with surgical literature can not be over emphasized. We can share our knowledge and experience in this new nation by contributing to this Journal which will be appreciated by all.

The foreign publications are prohibitive for many of our local doctors because of lack of foreign exchange and the high cost. So having our own journal will help to meet this need. Another factor will be that the articles will be primarily for meeting the needs of patients in the developing countries and for keeping in touch with the work that our co-workers are doing. Finally it is most essential that all surgeons continue their education by reading journals. Having our own journal available is a invaluable method of this continuing medical education.

George Barnard Shaw stated "Life is no brief candle to me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations". If we will write in and contribute to the journal we can help to show this torch to the world.

RONALD J. GARST, M.D.
Project Director
Rehabilitation Institute & Hospital
for the Disabled, Dacca

It is my privilege and honour to introduce the inaugural issue of "Bangladesh Orthopaedic Journal". We should have done it earlier. Attempts to organise Bangladesh Orthopaedic Society were made several times. But unfortunately many members of the society left the country for better prospects abroad. Finally we are publishing this journal from R.I.H.D. 1 hope Bangladesh Orthopaedic Society will publish it bi-annually regularly from the next issue.

The main objective behind the publication of this journal is to share our experience with others. We will try to give our people here what is modern and good. We will try to uphold the standard of the journal and maintain its aim, that is the advancement of Orthopaedic Surgery.

Treatment of musculoskeletal diseases used to be done by the general surgeons. Attempts to organise this service before remained limited to individual frustrating experience. Only after the liberation war the importance of orthopaedic service grew tremendously because of war injured. For the last eight years we had our successes and failures but had no media to convey to our people. It is during this period that orthopaedic services in Bangladesh was established firmly as a speciality and expanded rapidly to be available for whole of the country.

Eight years ago Dr. Garst started this institute in a room of S. S. Hospital to organise orthopaedic service for the war wounded freedom fighters. After eight years it has developed as the central institute of orthopaedic services and training for doctors and other paramedics for orthopaedics. At times it used to appear that this institute may not survive for long. It was Dr. Garst who pioneered it, expanded it and made it the central institute for teaching, treatment and rehabilitation. Behind him were the dedications of those locals and foreign consultants without whom it would have been impossible to survive.

It is a great honour for me to write the editorial of this inaugural issue when R.I.H.D. is going to be inaugurated and the year of the disabled is going to be celebrated. It is a great occasion for us and will be remembered with much envy by who will come after us. Many of us who shared the load of its initial setup are not here to rejoice this great occasion of opening of this hospital. I remember with gratitude those freedom fighters and patients who helped us to build this great institute in their pains and sorrow, loss and death. I remember those doctors, nurses and paramedics whose dedication and devotion motivated many more to make it the central institute of orthopaedics and rehabilitation. This inaugural issue of Bangladesh Orthopaedic Journal is being dedicated to the name of those who were with us, are now with us, and will be with us.

The year '1981' has been declared as "The year of the Disabled". There will be seminars, workshops and all the hope for our disabled people. But do we know how many people are disabled in Bangladesh? Do we know what are their problems and how they are our problems? In our estimation there are nine million disabled people who are our burden. The country is loosing Taka Sixteen hundred millions annually to keep these disabled people alive. If we could rehabilitate them, not only the immense suffering of these people could be minimised but they could be useful members of our society. "The Year of the Disabled", I believe will give new hope to our disabled.

It would have been impossible to publish this journal without the help of few young and dedicated orthopods. I am happy to say that meeting these young men and hearing them assured me that the future of Bangladesh Orthopaedics is in good hands. I can assure that you will see great progress in all the fields of orthopaedic services in future.

Dr. Ayjaz Ahmed Khan, M.S.
Editor

Ronald J. Garst
M.D. Project Director, R.I.H.D. Dacca

The history of Orthopaedic Service programme in Bangladesh runs somewhat concurrently with the development of the Rehabilitation Institute and Hospital for the Disabled.

With the War of Liberation the new nation of Bangladesh was left with a great number of war injured. Although a few of the Freedom Fighters from among the wounded were taken by foreign countries for treatment, the great bulk of the wounded including the civilians had to be taken care of by the new nation itself. The vast majority of these patients had orthopaedic problems, and at that time there was only one qualified Bangladesh Orthopaedist in the country and he left within a matter of months.

My offer to come and do what I could to help meet this need was accepted readily and cordially by the Ministry of Health. The Secretary, Ministry of Health, took me to the Sher-e-Bangla Nagar Hospital out patient building and asked me to start a 100-bedded Orthopaedic hospital and Limb Center, and to run it for one year. He gave the promise that the Government of Bangladesh would take over the financial responsibility of the hospital at the end of that time. In early June 1972, the hallways of the hospital which had been made ready as wards, were opened and 100 patients were admitted into the Orthopaedic Unit of the Sher-e-Bangla Nagar Hospital. The name Sher-e-Bangla was soon to give way to Shaheed Suhrwardy Hospital of which the Orthopaedic Department remained a part being the In-patient Hospital in this Out-patient Building upto 1 978. On 12th May 1978 the new Orthopaedic Hospital Building with facilities for 400 patients started functioning.

In those days, we had to depend mostly on volunteer staff and they came forward from all over the world. There were doctors, nurses, physiotherapists, occupational therapists, limb-makers, brace makers, secretaries, pharmacists and administrators. By July 1973 the Government of Bangladesh proved true to the promise, and assumed the financial burden of the hospital, which by that time had mushroomed to 250 beds. Government appointed staff gradually replaced the majority of .the volunteers. It became apparent, however, that if the Orthopaedic programme was to continue, young doctors of Bangladesh would need to be trained as Orthopaedic Surgeon. Volunteer Orthopaedists had been coming from England and Canada, from the onset of the work, and in 1972 Mr. J.N. Wilson had come under the auspices of the Overseas Development, Ministry of England to study the need and decide the feasibility of entering into a joint venture of training doctors in Bangladesh. Mr.Geoffry Walker followed soon after Mr. Wilson who had recommended that the O.D.M. be actively involved in securing highly qualified Orthopaedists to work along with us in the training programme. With the help of Mr. Walker, formal requirements were drawn up.

Dr. .M. S. Talukder
M.S., F.C.P.S., Associate Professor of Orthopaedic Surgery, R.I.H.D., Dacca

ABSTRACT

["Excisional Arthroplasty of hip though a salvage procedure, is acceptable and a procedure of choice in Bangladesh for neglected and destroyed hip. From 1972 to 1880 we have done 500 cases of excisional arthroplasty in R.I.H.D. in patients of ages varying from first decade to over ten decades. All of these cases were done in destroyed hip from various causes. Socio-cultural habit demands full flexion and free mobility of hips. We could not find any procedure, even total replacement which will give that amount of mobility of the hip, except properly done and managed excisional arthroplasty. Our follow up is very poor, only 60%. In infected cases, this procedure gave much better results than fracture and arthritic cases. 87% cases gave acceptable results in our hand. We now advice and advocate this procedure in neglected and destroyed hips in patients with sociooconomic and cultural background like Bangladesh".

DR. MD. FARUQUE REZA AOLAD
M.B.B.S., M. S. (Ortho), Associate Prof. of Orthopaedic Surgery,
Chittagong Medical College & Hospital, Chittagong

Poliomyelitis, the crippling disease in children is still common in the country. Prophylaxis has just been started in the country. The treatment facilities in acute and chronic stage are nil in the country, outside the city. Moreover the people are still quite ignorant about the disease and its prognosis. An Orthopaedic hospital with a post polio clinic has been established in the country and we have started treating these cases effectively and efficiently. This paper deals with the treatment of foot in convalescent and residual stage of paralysis.

Dr. M.S. Talukder
M.S., F.C.P.S., Associate Prof. of Orthopaedic Surgery, R.I.H.D. Dacca

ABSTRACT:

300 cases of fracture patella were treated from 1973-80 in R.I.H.D., among which 250 cases were available for follow-up and are discussed in this paper. They were either fixed, by AO technique or excised, depending on the type of fracture. Problems of internal fixation are described and the results are compared with those of excisional cases.

Dr. A. A. Khan
D. Ortho., M.S. Ortho, Asstt. Prof. of Orthopaedic Surgery, R. I. H. D. Dacca
Dr. Md. Ishaque
D. Ortho.

Registrar, R. M. C. H. Rangpur. Treatment of fracture of tibia arid fibula by functional cast brace is well established. The "Roots" being the trend of bone setters in Nigeria who advocated early weight bearing after any fracture. It was introduced in 1950 by Dehne in U.S. Armed force. In 1963 Augusto Sarmiente, Dehne and Browne advocated this method for fracture in femur. Later Connoly and King in 1973 widened its use in fracture of weight bearing bones at different levels with modifications.

DR, MD. NURUN NABI
R.I.H.D., Dacca

Legg-Calve-Perthes’s disease represents definite disease entity involving the femoral capital epiphysis in young children. Mainly it used to be treated conservatively all over the world. The conservative treatment requires prolonged .immobilisation by various weight relieving devices, which is very inconvenient for the child and also expensive and time consuming. The results of various methods of conservative treatments are not uniformly good. Considering the disadvantages of the conservative treatments, I have decided to perform two types of surgery - Subtrochanteric external rotation and varus osteotomy. Salter Innominate Osteotomy.

These obviate the disadvantages of the conservative treatments. As the majority of the population of our country are illiterate and poor they do not come for any medical assistance initially and that is why most of the cases under my study have come to me with the disease at its later stage, for which. I faced difficulty in selecting my cases in this series. This work was carried out in Rehabilitation Institute and Hospital for Disabled, which is the central referral hospital for Orthopaedic problems in Bangladesh. In my study, I have tried to compare the results of the two types of surgery. The aim of this study was to find out the results of the surgical treatment of Legg-Calve-Perthes’ disease.

Dr. .M. S. Talukder
M.S., F.C.P.S., Associate Professor of Orthopaedic Surgery, R.I.H.D., Dacca

Electrical stimulation in established non union and pseudoarthrosis is now a recognised method of treatment. Three types of electrical stimulation are used-invasive, non invasive and semi-invasive. These methods have obvious clinical disadvantages. In 1977 Bassett made use of the fact that pulsing electromagnetic fields induces current in conductors. Bone is a semiconductor and it has been shown that pulsing electromagnetic field stimulates union. It has been found that safe voltage of 10-30 in a pair cored coil connected in parallel and if applied on either side of the bone induces significant tissue voltage (millivolts) in and around the bone. We have started using non invasive pulsing electromagnetic field pioneered by Bassett since last year. Till now we have applied this in delayed and non union of humerus and femur in eight cases. Plaster cast is being used as the immobiliser. For control, we have strated recording the result of simple immobilisation in one group and rigid fixation by Hoffman, in another group in same type of cases.

Dr. SHAMSUDDIN AHMED
F.C.P.S. Associate Prof. of Orthopaedic Surgery, R.I.H.D., Dacca.

Although relatively rare among the locally malignant tumours of bone, the ameloblastoma of the mandible is by far the most common and significant. It usually occurs in the mandible as a multilocular swelling and arises from the enamel of the tooth. It does not metastasize but recurs locally if not radically removed. Two cases are being presented where Hemi-mandibulectomy were done and reconstructed by using rib and wire.

DR. M.S. Talukder
M.S., F.C.P.S. Associate Prof. of orthopaedic surgery, R.I.H.D.

Treatment of cystic lesions of bone by local injection of corticosteriod has been reported in the Journal of Bone and Joint Surgery (May, 1979). I have started this treatment about a year back in. R.I.H.D. Till now, I have given this treatment in four cases. Injections were given locally at the interval of 4-6 weeks Either local or general anaesthesia was used. I used Depo Medrol or prednisolone. After making a stab wound two fine drill holes were made upto the cystic lesions and needle biopsy were taken first. Then two large needles were introduced into the cysic cavity and it was aspirated. Then the cortico steroid was injected through those needles till the cavity was filled. The needles were taken out and firm pressure bandage applied. All the four cases were X-rayed before the injection and then monthly to follow the results.