May 11, 2017 202
GetDoc: What is Advanced Trauma?
Dr Ramesh: Advanced trauma basically involves complex trauma – in orthopedics which means fractures and injury. In Malaysian context, in terms of our fellowship, it is divided into 2 categories. One section deals with pelvis and acetabulum fractures – a bit more complex than other fractures. The other deals with Limb Reconstruction.
What we do in Limb Reconstruction is to correct deformities; they can be present from birth or formed later in life due to any injury. So, if there are bone deformities in the hands and legs, we can correct them. If the patient has shortened arms and legs we can lengthen them. These are the 2 main scopes of advanced trauma.
GetDoc: How is this type of trauma different from say, emergency trauma that most of the general public is aware of?
Dr Ramesh: Trauma in general means any kind of injury. In some countries, you have trauma surgeons, especially in the west. They deal with patients in emergency so their scope is very wide. They fix fractures, attend to abdominal injuries and head injuries too. But advanced trauma under orthopaedics is actually a sub-speciality of orthopaedics. We don’t do abdominal injuries or head injuries, we only do what I have just mentioned - pelvis and acetabulum fractures and Limb Reconstruction . So that’s how an advanced trauma specialist is different from a trauma surgeon. In orthopaedics there are a lot of sub-specialities like spine, hand, sports so advanced trauma is another sub-speciality. In Malaysia this is our scope, not sure if people will understand when we tell them about advanced trauma surgeons.
GetDoc: So, are there only a few advanced trauma surgeons in Malaysia?
Dr Ramesh: Not many actually, probably 10 or 15 I think.
GetDoc: Wow, that’s all? Moving on… can you tell us about the usual surgical and non-surgical procedures for trauma cases?
Dr Ramesh: I do all kinds of fracture fixation. But if it specifically needs advanced trauma surgery, then it would be pelvis fractures – they are high velocity injuries. As advanced trauma surgeon, we deal with patients who are involved in big accidents which lead to their pelvis fractures; these cases are not usually dealt with by the general orthopaedic surgeons. The other common procedure we treat is deformity correction. This is a sub-speciality in itself, so not all orthopaedic surgeons would want to do deformity corrections especially if it there is a discrepancy in limb length, if there is a lot of shortening. That’s when the patients come and see us.
GetDoc: There is a saying that surgeons always like to suggest people to undergo surgery. How true is that?
Dr Ramesh: (Laughs) I cannot speak for everyone. But as a good doctor, we must always be open to the idea of non-surgical treatment. If the need arises and if the condition can only be bettered by surgery I would suggest that as the best treatment. We all want to see results, right? So we need to educate the patient and help them make the right choice.
GetDoc: What is the normal non-surgical advice you would give?
Dr Ramesh: If the case is not fracture related, if it is soft-tissue injury or pain because of muscular skeletal pain, we can always start with medication and physiotherapy. Physiotherapy is a good modality that helps orthopaedics. A lot of patients recover with medication and physiotherapy. We can also do minimally invasive procedures like injections in the clinic setting itself. So these help before we jump into a surgery.
GetDoc: What is the recovery time for different procedures?
Dr Ramesh: It depends on the symptoms and the severity of the case. If it is a mild soft tissue injury, it can take about 2-6 weeks. A major ligament injury can take up to 6 months; a fracture can take longer time – 3 to 6 months to recover.
GetDoc: What are the side-effects or risks of surgery in advanced trauma patients?
Dr Ramesh: Infection is always the number one worry for us, whatever the type of surgery. The other risk can be nerve injury or vascular injury during surgery. For some patients, healing can be an issue even after surgery. These are the basic risks associated.
GetDoc: What steps do you take as a surgeon take to mitigate the risks?
Dr Ramesh: When we take the consent from the patient, we explain to them all the risks involved, what role they play, what role the doctor plays in terms of performing surgery and risks involved. As for infection, we do ensure we maintain a sterile environment in the operation theatre. As when surgery, we have surgical techniques to reduce the infection risk, such as scrubbing our hands before the operation. Patients will be monitored closely post-surgery, while we keep them on antibiotics to reduce the infection risks.
GetDoc: Final question, what has been the most challenging case you encountered so far in your career?
Dr Ramesh: Pelvis surgeries are very challenging for me, a simple one can take 2 hours but some can take too long. A surgery I did a few months back, a complex pelvis fracture with injury to the bladder took about 8 – 10 hours. So pelvis fractures can be challenging at times!
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by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.