Dr. Yatin Desai

Back on His Feet

• An elderly gentleman around 82 years hailing from Mumbai was on a social visit to Ahmedabad.
• Just couple of days into his visit, he was unfortunate to have developed massive convulsive attack. The worried family rushed him to Zydus hospital as he was unable to stand.
• Also a known case of chronic kidney disease (CKD), he had sustained bilateral transcervical intracapsular neck femur fractures, which is sparingly described in orthopedic literature – to simplify fractures on both the hips.
• As we did the investigations needed, his x-rays indicated that his aged bones showed symptoms of severe osteoporosis.
• A team of clinicians was involved which include a nephrologist and a physician – they must clear the patient for any surgery before we proceed considering the condition of his kidneys and of course the fragile age.
• As the team cleared him fit, the orthopedic team under my headship operated him the following day. He underwent a bilateral cemented hemiarthroplasty in approximately (in simple words – Hip replacement for both the hips). The daunting task was accomplished in 1.5 hour. At that age, every minute could extra is like walking a thin rope.
• The surgery was un-eventful and the gentleman stood with walking aid support on the 3rd day of surgery. It was a feeling of contentment that cannot be put in words, we all knew – we have not just saved a life but also changed many lives.
• Scientific abstract
• Post-convulsive bilateral fracture neck femur is very rarely described (mostly around 10 cases in international literature), but managing it by cemented hemiarthroplasty in single sitting is very rare and is not described in available Indian orthopedic literature.
• However, we could find one case in international literature.
• It is always challenging and demanding to do such hip surgeries in single sitting, but at ZYDUS HOSPITAL Ahmedabad where we have all specialities available round the clock with CCU facilities, hence we could successfully managed this case.

A School Boy With Recurrent Bone Tumour In Thigh

• A school boy from bavla age 8 years presented at ZYDUS hospital with pain in right thigh and hip following playing cricket. On X ray child had fracture right upper femur bone where there was a large bony tumour. He was operated for this bony tumour in 2015 elsewhere with scrapping of tumour and titanium nails fixation.

Challenges before us

• Titanium nails were inside femur bone and its ends were buried in bone, so removal of it was difficult
• Bony tumour was enlarged considerably so scrapping would leave huge gap in bone
• how to fill the large defect ? In a growing child bone where standard modalities of bone graft would not work
• Fracture lines were extending from upper femur to mid femur bone. Fixation of this fracture with large tumour in child was challenging

• Solutions by us
• We had operated with removal of titanium nails,scrapping of tumour(removal of tumour tissue),biopsy, fibula(leg bone) bone graft from both leg to fill the defect and plate fixation During his last followup after 9 month of surgery his fracture was united, the tumour defect was filled with bone graft and no pain. He was walking normally attending school and was playing in some lite games. The child and parents were happy with the results.

For Failed multiple surgeries elsewhere we made her walk again

• A female 53 years residing at Dar es salam,Tanzania, had broken thigh bone following road traffic accident and was operated multiple times and she presented with infection and her broken bone was not joined.
• After investigations and X rays her treatment was planed in stages.
• First stage removal of implants,pus,dead tissue,bones and broken bone fixed with outside implants.( External fixator. )
• Second stage once infection controlled,removal of external implants,Fibula and bone graft and fixation with plate and screws.
• After 6 months her infection was under control,broken bone joined and she started walking again.

Story of a Teacher

• Story of a teacher who never wanted to attend his class again with artificial limb after highway accident.
• A 34 year teacher sustained Road traffic accident and crush injury(open fracture left tibia with vascular injury) was initially treated at surat with external fixator and was advised for amputation(cutting of leg) on 3rd day following injury. Somehow he came to know our name and consulted ZYDUS HOSPITAL on 4th day of his surgery.
• He underwent debridement and special dressings on 3rd day of admission and after repeated cleaning of wound and removal of dead bone.Once wound improved, he was operated for special plastic surgery, transfer of live bone with microvascular surgery, bone graft and plate fixation. He started walking with walker after 6 month of surgery.
• Abstract
• : A young teacher following crush injury was brought to us with infected open fracture operated elsewhere with external fixator who was advised amputation and he wanted to save his limb and we wanted to save his limb. It was challenging situation to treat this case as it required team effort orthopedic surgeon, plastic surgeon, vascular surgeon and ICU consultants. At ZYDUS HOSPITAL our team treated this young teacher with multiple surgeries and fulfill his aim to get back teaching with his own limb rather than a prosthesis.

At 102 Years on her Feet Again

• An elderly bengali female of 97 years was admitted at Zydus hospital with fall in bathroom and had intertrochanteric fracture neck femur right side. After investigation and getting fitness from physician we fixed this fracture. She started walking with stick after 4 months.Unfortunately after 1 year of 1st fracture she fell down again and sustained same fracture on opposite side. Her bones were osteoporotic. We again operated her for left fracture neck femur. She could sustained surgical trauma and started walking after 5-6 month. Today she is 102 years and walking with walker crutches in home only. She may be unique case in the world where in a patient being operated for both femoral neck fracture in late 90’s and had crossed 100 years and still walking with support. Our search for similiar case in international orthopedic literature could not give us any references of any such case reported !
• Abstract :-
• fracture neck femur in elderly especially in late 90’s is known to have considerable mortality rate. In this case though she had fracture on both sides at age of 97 and 98 years, at ZYDUS HOSPITAL with our dedicated physician,anesthetic, and ICU consultants available round the clock we got a good result for her. We have done around 50 fracture neck femur fixation in patient above age of 80 years with multiple co-morbid conditions. Our 1 year follow up of operated cases of fixation of fracture neck femur above 80 years of age has shown around 8% mortality rate which is well below the rate reported in western literature. Though our series is small we are happy to share this.

Both Hip Surgery in a single sitting

• An elderly gentleman around 82 years hailing from Mumbai was on a social visit to Ahmedabad.
• Just couple of days into his visit, he was unfortunate to have developed massive convulsive attack. The worried family rushed him to Zydus hospital as he was unable to stand. Also a known case of chronic kidney disease (CKD), he had sustained bilateral transcervical intracapsular neck femur fractures, which is sparingly described in orthopedic literature – to simplify fractures on both the hips.
• As we did the investigations needed, his x-rays indicated that his aged bones showed symptoms of severe osteoporosis.
• A team of clinicians was involved which include a nephrologist and a physician – they must clear the patient for any surgery before we proceed considering the condition of his kidneys and of course the fragile age.
• As the team cleared him fit, the orthopedic team under my headship operated him the following day. He underwent a bilateral cemented hemiarthroplasty in approximately (in simple words – Hip replacement for both the hips).
• The daunting task was accomplished in 1.5 hour. At that age, every minute could extra is like walking a thin rope.
• The surgery was un-eventful and the gentleman stood with walking aid support on the 3rd day of surgery. It was a feeling of contentment that cannot be put in words, we all knew – we have not just saved a life but also changed many lives.
• Scientific Abstract
• Post-convulsive bilateral fracture neck femur is very rarely described (mostly around 10 cases in international literature), but managing it by cemented hemiarthroplasty in single sitting is very rare and is not described in available Indian orthopedic literature.
• However, we could find one case in international literature.
• It is always challenging and demanding to do such hip surgeries in single sitting, but at ZYDUS HOSPITAL Ahmedabad where we have all specialities available round the clock with CCU facilities, hence we could successfully manage this case.