Culture and Sensitivity - Bone Chips Tips

AVN is the acronym for avascular necrosis, which mostly affects the hip bone. This complication develops when there is a loss of blood flow to the bones. Being a living tissue, bones require a continuous supply of blood, and if there is an interruption to this supply for a long time, bones suffer from avascular necrosis. The longer duration of this condition may cause bone death. Apart from the hips, AVN may also affect other sites like knees, shoulder, ankles, etc.


Symptoms -

Usually, there are no symptoms in the early stages. However, as the disease progresses, it begins to hurt as you sit down or put pressure on the hip bones. As the disease progresses unabated, the pain may refuse to go away. Progressively, the hip bone collapses along with its surrounding joint tissue. Pain becomes severe and begins to interfere with your daily activities. However, it may take several months and even a year for the bone and the surrounding tissue to collapse.


Causes -

Causes of avascular necrosis may include:

Dislocation of thigh bone affecting the blood supply to the bone. About 20% of people suffering from hip dislocation or fracture may suffer from AVN Hip.

Chronic use of corticosteroids. About 35% of patients undergoing chronic corticosteroid use may develop AVN Hip. It is considered that these drugs may interfere with the ability of the body to break down fat.

Alcohol abuse too may lead to avascular necrosis much in the same way as corticosteroids.

Blood clots, arterial damage, and inflammation may also contribute to blocking the flow of blood to bones and precipitate AVN Hip.

Other conditions that may contribute to this disease are sickle cell disease of the blood, pancreatitis, diabetes, HIV, chemotherapy, radiation therapy, long term abuse of some drugs, etc.


Treatment -

The objective of treating avascular necrosis is to improve the functioning of joints, reducing pain, and stopping bone damage. In the case of early diagnosis, treatment can be done by taking pain-relieving medicines and by limiting regular use of your hips. Taking crutches to limit weight bearing by the hips may help to relieve pain and limiting damage to the bone. You may also need to perform various range-of-motion exercises in order to ensure continued mobility of the joints.

Treatment Outcome -

Needless to say, that the damage already done cannot be reversed. This is why the earlier the problem is diagnosed, the better it is for the patients. The best outcome of treatment depends on:

Age of the patient

Stage of progression of the disease

Location of bone damage and its spread

Removing the cause of avascular necrosis, if possible, which means stopping alcohol and drug abuse, taking precautionary steps after femoral dislocations and fractures, stopping the use of corticosteroids, etc.


Take Away -

The symptoms are not visible in the early stage of the condition. This is why a consultation is advisable if a person experiences any of the above symptoms.

The bones in our body are constantly renewing themselves. The old bone tissue is broken down and absorbed by the body while new tissue takes its place. This process is known as 'remodelling'. Paget's disease is a condition that interferes with this process. Over time it can lead to the disfiguring of bones and a loss of bone density. The bones most affected by this condition are the bones of the legs, spine, pelvis and skull.

Diagnosis
Many patients suffering from this condition do not exhibit any characteristic symptoms. One of the most common complaints that can lead to a diagnosis of Paget s disease is bone pain. Other symptoms, if any, depends on the part of the body that is affected. A physical examination and imaging tests help determine a diagnosis in such cases. This includes X-rays, bone scans and blood tests. X-rays are used to look for abnormalities in the bone structure. These can be seen in the form of enlarged bones, bowing of the bones or other deformities. Similarly, a bone scan provides a clear picture of the affected bones and allows the doctor to determine the severity of the case. Blood tests are used to look for elevated alkaline phosphatase levels that are also symptomatic of this condition.

Treatment
There are two aspects to the treatment of this condition; medication and surgery.

Medication can take the form of oral or injectable osteoporosis drugs. These are usually well tolerated but in some cases, it may irritate the digestive system. In rare cases, it may also be connected to joint pain and muscle pain. It may also increase the risk of suffering from deterioration of the jaw bone. In such cases, the medication is usually withdrawn and calcitonin may be prescribed as an alternative. This can be administered as a nasal spray or as an injection.

Surgery is advised only in rare cases. This is aimed at healing fractures, replacing damaged joints, realigning deformed bones and reducing pressure on surrounding nerves. Before the patient undergoes surgery for Paget s disease, he or she may be advised to take a certain medication that helps reduce the severity of the disease. This, in turn, helps control blood loss during the surgery.

In addition to this, patients are also advised to be careful and use a cane or walker. This can help reduce the risk of fracturing a bone. A diet rich in vitamin D and calcium is also recommended.

It is considered as the medical speciality, which caters to injuries and various diseases in the musculoskeletal system of the human body. This constitutes the joints, bones, tendons, nerves and muscles that enables a human being to move, be active and work. Orthopaedic surgeons perform special problems like diagnosis of the injury or disorder, treatment with right medication, rehabilitation that is by prescribing exercises and physical therapy in order to restore back movement, function and strength and finally prevention by providing information and plans of treatment to prevent the injury or reduce the progression of the disease.

Platelet Rich Plasma Therapy (PRP)
PRP is the next generation injection method which is used commonly for conditions like knee, hip, shoulder and spine osteoarthritis, cuff tears, ACL injuries, pelvic instability, tennis elbow, back and neck injuries, ankle sprains, ligament sprains and tendinitis. It includes higher blood rate platelet concentrations and the patient experiences fewer chances of inflammatory side effects due to its pure PRP mixture.

How does it heal the body?

The human body at first responds to the soft tissues injury which is to have the platelet cells.
They are packed with healing factors that initiate repair and also attract critical assistance of the stem cells.
The process intensifies the human body s efforts which directly delivers a higher platelet concentration into the area of need.
To create the PRP, a small section of the patient s blood is drawn and it is placed into centrifuge which spins blood at a higher speed and separates the platelets from the components.
It is injected into and at around the mark of injury and it significantly strengthens the process of healing.
Just because the patient s own blood is used in the process there is no risk of transmissible infection and also has less chance of allergic reaction.
The procedure takes a couple of hours inclusive of the recovery and preparation time. It offers instant recovery as well avoids a long stay in the hospitals and application of anesthesia.

Outcome of PRP?

As the goal of PRP therapy is just to resolve pain by healing, it can prove to have long-lasting results. Initially, improvements are seen within few weeks eventually increases with the healing progress. The research studies have shown that PRP therapy is safe and effective and enables the patient to get back to their normal daily routine.

The PRP is very rich in platelets and it is a very old therapy that is adopted. It is a simple process and has multiple injections lasting 60-90 minutes and above all, it has natural end results, for example, PRP therapy is applied in hair restoration that provides natural appearing end results. It is a reliable process and therapy.

Machine injuries in hand, as the name suggests, occurs when a part of your hand the palm, wrist, or arm gets caught between machinery or sustains severe injuries under the influence of a high magnitude force.
Industrial and factory workers whose job role involves working with or around machine equipment are at risk of getting machine crush hand injuries.

Symptoms

The symptoms of machine crush hand injuries depend on the type of injury. For minor injuries, such as fingers getting trapped in a machine, the symptoms may be mild

Lacerations
Bruises
Moderate pain
For major crush injuries that happen due to high impact forces or for a prolonged time, the damages are severe and usually are seen below the skin, affecting the bones, tissues, and muscles. In case the injury leads to loss of blood supply, damage to the tissues and muscles could be grave, and in rare cases, may lead to paralysis. Symptoms include

Severe bruising
Open wounds
Damage to the skin layers
Extreme pain
If left untreated, the open wounds could become infectious and acquire deformity. In extreme cases, this may even lead to amputation. Worst cases of machine crush injuries may reveal symptoms like

Swollen skin
Paralysis of the arms
Loss of pulse in the injured hand
A tingling sensation in the injured hand
Treatment for Machine Crush Injuries

Treatment depends on the severity of the injury.

If you sustain minor damages, cleaning the wound with disinfectant and clean water should suffice. First aid is immediately required to stop bleeding and address bruises.
Applying ice packs on the injured limb or hand can help ease pain
For mild to moderate crush injuries, the doctor may prescribe antibiotics to avoid the risk of infection
Severe cases are treated with fasciotomy. It is a surgical procedure, which involves cutting the fascia to release pressure or tension and restore the flow of blood to the muscles and tissues. In some cases, multiple surgeries are required to repair the nerves, tendons, and muscles completely.
If you have undergone traumatic machine crush injuries, industrial accidents, or if your hands have been stuck between machines, under heavy weights for long hours, you are advised to consult a doctor at the earliest.

Metabolic Bone Disease is a term used for various conditions of the bones that can be caused by a number of different disorders. Most of these disorders are developed due to nutritional deficiencies, defects in the bone metabolism procedure or due to hereditary defects in the skeletal structure. Conditions that fall under the category are osteoporosis, osteomalacia, rickets, Paget's disease, parathyroid conditions, chemotherapy induced bone loss and menopauseinduced bone loss.

Causes of Metabolic Bone Diseases:



Imbalance in the level of calcium : Too much calcium or too little calcium can cause bone diseases. While the overabundance of calcium (hypercalcemia) in the body will lead to calculi formation, which can be harmful for the body, the lack of calcium (hypocalcemia) causes weakness, bone pain and restricted growth.
Deficiency of phosphorus: Low phosphorus in blood (hypophosphatemia) leads to softening of the bone tissue and bone loss. Osteomalacia is commonly caused by phosphorus deficiencies.
Deficiency of Vitamin D: Vitamin D is essential for the body to absorb calcium. Cells called osteoblasts need vitamin D in order to absorb calcium and secrete the bone tissue proteins. A deficiency of vitamin D can lead to a number of metabolic bone diseases like rickets and osteoporosis.
Over or under secretion of the parathyroid hormone:The parathyroid hormone (PTH) stimulates the secretion of an enzyme, which converts the inactive circulatory form of vitamin D into its active usable form. The hormone can also increase the circulation of free or ionized calcium (Ca2+), which is not attached to proteins. Both underproduction and overproduction of the hormone causes skeletal problems.
Symptoms of Metabolic Bone Diseases:

The symptoms of most of the Metabolic Bone Diseases are similar, such as

A dull, throbbing pain in the bones is the most common symptom. The pain is frequent and lasts for a long amount of time, but unlike muscular pain, the exact region of bone pain cannot be specified.
Severe joint pains accompanied by stiffness and swelling of the joints. The patient experience pain during regular physical activities, especially during cold weather conditions.
Frequent fractures are caused by most bone diseases because the bone mineral density decreases drastically. Severe bone injury may be caused by mild trauma.
Defects in the bones can cause bowed out legs and a bent backbone.
A general feeling of exhaustion is often caused by bone diseases.
Kidney stones are an associated complication of metabolic bone diseases.

Hi,

I am Dr. Madhur Mahna, Orthopedist. Today I will talk about the benefits of PRP therapy. It is used to treat the number of conditions not only in orthopedics but in various treatment modalities. In this, we take the blood of the patient and we centrifuge it. As a result, red blood cells and plasma get separated in which we separate platelet rich and poor plasma. They contain a large number of growth factors which help in rapid healing of tissues, joints and various other parts of the body. Before, we were waiting to worsen the condition like in osteoporosis where we require knee replacement. In such cases, PRP is the best to avoid surgery.

What are the conditions for PRP treatment? Any kind of degenerative condition like arthritis, frozen shoulder, tennis elbow, tendinitis, avascular necrosis, hip arthritis. Osteoarthritis is the common condition and in this PRP is directly given inside the joint. In this, the cartilage which has been damaged gets healed because of various growth factors. Instant result will not be noted as this is a healing procedure. The results are only visible after 3-4 weeks of giving the injection. Many times, multiple injections are required. Ideally, 3 injections are given at a gap of 6-8 weeks for proper results. So, the first prerequisite is that the patient should have an adequate amount of platelets in the blood.

In many diseases, there are adverse effects. In the case of PRP, we are taking the patient's own blood and inserting in the patient's joint. So, there are no side-effects of the treatment. Only 1 side-effect it has i.e. if PRP enters in the soft tissue, it might give the discomfort or pain for 2 days to the patient. In case of any pain or swelling, the patient may apply ice. Other then that, there is no allergic reaction or an adverse reaction. So, the final message I would like to give is PRP treatment is a natural treatment, highly effective, no side-effects and it can avoid large and major surgery.

Thank You!

Sometimes children suffer from conditions where their feet may not be in proper shape or size which can affect their posture. Most of the times the disorders correct themselves as they grow up but certainly there can be situations where medical attention is required. These conditions can be normal variations in the anatomy as well which don't essentially require treatment. Some of the common orthopedic disorders found in children include:
1. Flatfeet
While most babies are born with flat feet which develop arches as they grow, in some case the arches remain underdeveloped even after they grow older. Their feet may turn inwards while they walk due to their flat nature. There is no inherent problem in this condition unless it becomes painful. Doctors may recommend special footwear with arches inserted for support to reduce the pain.
2. Toe Walking
Toe walking is not a disorder while your child is just learning to walk. Toddlers who continue to walk on their toes after the age of 3 may require medical attention. Toe walking on one leg or persistent toe walking can be due to other medical conditions like muscle weakness, cerebral palsy or autism. It is advisable to take your child to a therapist for casting the foot and ankle which can help stretch the muscles.
3. Pigeon Toes
In toeing or pigeon toeing is common among babies when they are first learning to walk. Sometimes children above 3 years walk with their toes inwards which can be due to femoral anteversion. This happens when upper part of the leg bends more than it naturally should causing inward rotation of the feet. Specially designed shoes and braces can help to correct this condition. Usually the condition corrects on its own with age and does not interfere with sport activities which involve running.
4. Knock-Knees
It is a common tendency among children aged between 3 and 6 to develop knock-knees (genu valgum), since their bodies go through natural shift in alignment. Usually treatment is not required as the legs straighten out eventually. Knock knees on one side or persistent knock knees may require medical attention. Children with this disorder may suffer from pain hence in some cases surgery is recommended after the age of 10.

Sometimes children suffer from conditions where their feet may not be in proper shape or size which can affect their posture. Most of the times the disorders correct themselves as they grow up but certainly, there can be situations where medical attention is required. These conditions can be normal variations in the anatomy as well which don't essentially require treatment. Some of the common orthopedic disorders found in children include:
1. Flatfeet-
While most babies are born with flat feet which develop arches as they grow, in some case the arches remain underdeveloped even after they grow older. Their feet may turn inwards while they walk due to their flat nature. There is no inherent problem in this condition unless it becomes painful. Doctors may recommend special footwear with arches inserted for support to reduce the pain.
2. Toe Walking-
Toe walking is not a disorder while your child is just learning to walk. Toddlers who continue to walk on their toes after the age of 3 may require medical attention. Toe walking on one leg or persistent toe walking can be due to other medical conditions like muscle weakness, cerebral palsy or autism. It is advisable to take your child to a therapist for casting the foot and ankle which can help stretch the muscles.
3. Pigeon Toes-
In-toeing or pigeon toeing is common among babies when they are first learning to walk. Sometimes children above 3 years walk with their toes inwards which can be due to femoral anteversion. This happens when the upper part of the leg bends more than it naturally should causing inward rotation of the feet. Specially designed shoes and braces can help to correct this condition. Usually, the condition corrects on its own with age and does not interfere with sports activities which involve running.
4. Knock-Knees-
It is a common tendency among children aged between 3 and 6 to develop knock-knees (genu valgum) since their bodies go through a natural shift in alignment. Usually, treatment is not required as the legs straighten out eventually. Knock knees on one side or persistent knock knees may require medical attention. Children with this disorder may suffer from pain hence in some cases surgery is recommended after the age of 10.

Metabolic Bone Disease is a term used for various conditions of the bones that can be caused by a number of different disorders. Most of these disorders are developed due to nutritional deficiencies, defects in the bone metabolism procedure or due to hereditary defects in the skeletal structure. Conditions that fall under the category are osteoporosis, osteomalacia, rickets, Paget's disease, parathyroid conditions, chemotherapy induced bone loss and menopauseinduced bone loss.

Causes of Metabolic Bone Diseases:



Imbalance in the level of calcium : Too much calcium or too little calcium can cause bone diseases. While the overabundance of calcium (hypercalcemia) in the body will lead to calculi formation, which can be harmful for the body, the lack of calcium (hypocalcemia) causes weakness, bone pain and restricted growth.
Deficiency of phosphorus: Low phosphorus in blood (hypophosphatemia) leads to softening of the bone tissue and bone loss. Osteomalacia is commonly caused by phosphorus deficiencies.
Deficiency of Vitamin D: Vitamin D is essential for the body to absorb calcium. Cells called osteoblasts need vitamin D in order to absorb calcium and secrete the bone tissue proteins. A deficiency of vitamin D can lead to a number of metabolic bone diseases like rickets and osteoporosis.
Over or under secretion of the parathyroid hormone:The parathyroid hormone (PTH) stimulates the secretion of an enzyme, which converts the inactive circulatory form of vitamin D into its active usable form. The hormone can also increase the circulation of free or ionized calcium (Ca2+), which is not attached to proteins. Both underproduction and overproduction of the hormone causes skeletal problems.
Symptoms of Metabolic Bone Diseases:

The symptoms of most of the Metabolic Bone Diseases are similar, such as

A dull, throbbing pain in the bones is the most common symptom. The pain is frequent and lasts for a long amount of time, but unlike muscular pain, the exact region of bone pain cannot be specified.
Severe joint pains accompanied by stiffness and swelling of the joints. The patient experience pain during regular physical activities, especially during cold weather conditions.
Frequent fractures are caused by most bone diseases because the bone mineral density decreases drastically. Severe bone injury may be caused by mild trauma.
Defects in the bones can cause bowed out legs and a bent backbone.
A general feeling of exhaustion is often caused by bone diseases.
Kidney stones are an associated complication of metabolic bone diseases.

हमारे पैर में कुल 26 हड्डियां होती है जिसमे सबसे बड़ी एड़ी की हड्डी (कैलकेनियस) होती है. इंसान की एड़ी की हड्डी को स्वाभाविक रूप से पुरे शरीर का वजन उठाने और संतुलन बनाए रखने के लिए किया जाता है. जब हम चलते है या दौड़ते है तो शरीर पर पड़ने वाले वजन को एड़ी के माध्यम से ही झेला जाता है. हमारे शरीर में एड़ी का कार्य बहुत ही महत्वपूर्ण है, यदि किसी कारणवश एड़ी में कोई चोट या कोई समस्या उत्पन्न हो जाती है तो इसका प्रभाव आपके पूरे शारीरक गतिविधि पर पड़ सकता है. ऐसी ही एक समस्या है एड़ी की हड्डी का बढ़ना जिसमे एड़ी और पंजे के बीच के हिस्से में कैल्शियम जमा हो जाता है जिसके कारण एड़ी में हड्डी जैसा उभार आ जाता है. एड़ी की हड्डी बढ़ने से एड़ी में दर्द,सूजन और जलन जैसे लक्षण हो सकते है. इस समस्या का निदान करने के लिए डॉक्टर एक्स-रे और शरीरिक परिक्षण की मदद लेते है. इस लेख में हम एड़ी के हड्डी के बढ़ने के कारणों और उसके निदानों पर प्रकाश डालेगें.

एड़ी के हड्डी बढ़ने के लक्षण:
आमतौर पर एड़ी की हड्डी बढ़ने के कोई लक्षण नहीं होता है. इसके कुछ सामान्य लक्षण है जो निम्नलिखित है:
1. सुबह उठने पर आपके एड़ी में तेज दर्द होता है.
2. एड़ी के आगे के हिस्से में सूजन और जलन होता है.
3. एड़ी में गर्मी का अनुभव हो सकता है.
4. एड़ी के निचले हिस्से में हड्डी जैसा उभार दिखता है.

एड़ी में हड्डी बढ़ने का कारण:
एड़ी की हड्डी बनने का मुख्य कारण प्लैंटर फेशिया होता है, जो एड़ी और पंजे के बीच के हिस्से को सहारा देने वाला फैटी टिश्यू होता है. प्लैंटर फेशिया के ऊपर अधिक दबाब या चोट लगने के कारण एड़ी की हड्डी बढ़ता है.
प्लैंटर फेशिया में और चोट लगने से बॉडी प्रभावित क्षेत्र को ठीक करने के लिए कैल्शियम एकत्रित करने लग जाता है, जब कैल्शियम जरुरत से अधिक एकत्रित हो जाता है तो एड़ी में हड्डी जैसा उभार बन जाता है.

एड़ी की हड्डी बढ़ने से बचाव:
एड़ी की हड्डी बढ़ने से बचने के लिए पैरों पर पड़ने वाले दबाब को कभी नजरअंदाज ना करें और अपने पैरों को आराम दें.
1. एड़ी में होने वाले किसी भी प्रकार के दर्द को नजरअंदाज न करें. दर्द होने पर किसी भी भारी गतिविधि में शामिल ना हो जैसे एक्सरसाइज करना या दौड़ना या फिर जूत्ते पहने रखने से एड़ी की हड्डी बढ़ने की समस्या उत्पन्न हो सकती है.
2. अगर किसी शारीरक गतिविधि से दर्द उत्पन्न होता है तो उस प्रभावित क्षेत्र पर इचे लगाएं और अपने पैरों को राहत पहुंचाए.
3. हमेशा सही नाप वाले जूत्ते ही पहने.
4. एड़ी और पंजे पर ज्यादा दबाब वाले जूत्ते न पहनें.

एड़ी के हड्डी बढ़ने का इलाज:
एड़ी के हड्डी बढ़ने का निम्नलिखित उपचार है:

नॉन सर्जिकल ट्रीटमेंट:-
1. मौजे- जूत्ते के अन्दर विशेष रूप से बनाए गए मौजों का इस्तेमाल करें, जो एड़ी के दबाब को कम करता है.
2. जब आप नंगे पैर चलते है तो आपके प्लैंटर फेशिया पर अधिक दबाब पड़ता है, इसलिए नंगे पैर न चलने की कोशिश करें.
3. हमेशा उचित नाप और आरामदायक जूत्ते पहनें, यह आपके पैर से दबाब और दर्द को कम करता है.
4. कोर्टीसोन के टीके से प्रभावित क्षेत्र में सूजन और दर्द कम होता है. अगर दवा से कोई असर नहीं होता है तो टीका एक प्रभावी उपाय हो सकता है.
5. दर्द से निदान पाने के लिए आइस भी एक प्रभावी उपचार साबित हो सकता है. यह दर्द और सूजन से राहत प्रदान करता है.
6. दर्द होने पर प्रयाप्त आराम भी प्रभावित क्षेत्र पर दर्द और सूजन को कम करता है.
7. दर्द से छुटकारा पाने के लिए पिंडली की मांसपेशियों को स्ट्रेच करने वाले एक्सरसाइज से दर्द में कमी आती है.

सर्जिकल ट्रीटमेंट-
अगर ऊपर दिए गए उपचार से एड़ी की हड्डी बढ़ने का कोई निदान नहीं होता है तो आपको सर्जरी करवाना पद सकता है.

सर्जरी में दो तरीके अपनाए जाते है.
1.प्लैंटर फेशिया को निकाल कर एड़ी की बढ़ी हुई हड्डियों का इलाज किया जा सकता है.
2. सर्जरी के द्वारा बढ़ी हुई हड्डियों का निकाल कर भी निदान किया जा सकता है.