Turning point in patient’s life
Domestic traumatologists master bone cementing and laser treatments
By Maria Yeltseva
It’s a common scenario: you fall, then wake up in a hospital bed in plaster. The trauma ward is ranked third after the cardiovascular and oncological wards for mortality cases, as health statistics show. The figures conceal hundreds of personal tragedies and ruined families... However, the Republican Scientific-Practical Centre of Traumatology and Orthopaedics is ever improving its treatments, bringing hope to those who feel hope is lost.
Entering a room in the neurosurgical department, there are six young men with spinal injuries; each needs to spend 10-14 days in hospital. Ivan Nikolaevich has been here ten days already and is almost ready to be discharged, with a halo device keeping his spine in place for another three weeks.
“My friends and I were celebrating a birthday by the lake,” he replies, covering his eyes. “Someone suggested swimming, so my friend and I dived in. I don’t remember what happened next.”
The conversation is strained, so his neighbours finish the story. His friends fished him out and called a doctor promptly, which saved his life — a few minutes more could have been fatal.
“Ninety-nine percent of divers injure their cervical spine at some point; a few damage their spinal cord,” explains Andrey Mazurenko, the Head of the Laboratory of Spine and Spinal Cord Trauma of the Republican Scientific-Practical Centre of Traumatology and Orthopaedics. “Alas, five of the dozen people injured this season will never stand again on their own feet. In 2011, almost 60 divers out of 100 were disabled after severely injuring their spinal cord. It regains function in one case only out of ten. Even a simple spinal injury puts you out of action for 4 to 12 months, as it takes cervical vertebra three months to knit.”
Most diving injuries tend to happen in the warmer months, but other accidents can occur at any time. Alexander, 23, was hit by a car on his way home and only survived by a miracle. However, he’ll spend his life in a wheelchair. His neighbour in the hospital room, Sergey, fell from a roof while making repairs.
“About 500 Belarusians receive severe spinal injuries annually,” continues Mr. Mazurenko. “Not just diving but road accidents and falling from any great height can injure your spine.”
The method of treatment depends on the nature of the injury. If the injury is without complications, it may not require surgical intervention. A plaster cast and fixators can be used — or a halo-device. If the break is less simple, titanic structures (screws, rods and plates) may be needed to secure the spine. New methods include the vertebro-plate, for securing lumbar and thoracic vertebrae in cases of osteoporosis: bone cement is injected in through a special needle.
Laser vaporisation is another new method, using laser surgery to remove an intervertebral hernia. This is reserved for use when the usual treatments aren’t helpful and has several advantages over conventional surgery: it is performed under local anaesthesia without incision, making it less traumatic and allowing quicker recovery.
“The mobile neurosurgical team operates out of the Centre base,” explains Mr. Mazurenko. “Our specialists are sent on call countrywide, providing emergency treatment for patients with spinal injuries. This has reduced deaths from cervical spinal injuries many fold over the last two decades.
The trauma and orthopaedic department for adults is where the most difficult joint transplant operations take place, including for patients with femoral neck fractures.
Minsk resident Tatiana Vasilieva tells us, “I’ve never even displaced a bone before, let alone had a fracture. It was a huge shock to suddenly stumble as I left a shop. I fell from the acute pain and was told in hospital that I have problems with my thigh.”
Femoral neck fractures are more common in elderly people. Those over forty are young enough to knit bones together after a fracture (with metal screws used to secure bones). Those aged over sixty need prosthetic replacements.
“We always assess a patient’s condition before operating,” explains Sergey Khudnitsky, the head of the department. “If there are no contraindications, we offer endoprosthesis. Here’s a shot of a hip joint from a patient born in 1934; he has a sedentary lifestyle, so we’ve used a monopolar joint. One offering more movement is reserved for those with an active lifestyle. We replace about 10-15 hips annually and operate on 70 to 150 people with hip fractures.” Joint replacement is a complicated operation taking a few hours, requiring at least three surgeons.
Various methods of fracture treatment have been developed over the years in the department, with closed intramedullary osteosynthesis being one of the more recent. Its advantages are minimal invasion and blood loss during and after surgery, which is short in duration. A special pin is placed in the bone through a small (3-4cm) incision (made away from the fracture site, to reduce the risk of postoperative complications). Special locking pins are used to strengthen the fixing, with holes at upper and lower ends for screws to pass through the bone. The unique method allows patients movement the day after surgery.
In recent years, specialists from the Centre of Traumatology and Orthopaedics have pursued less invasive surgical methods. However, according to Dr. Khudnitsky, new techniques can only aid the healing process, not accelerate it. If it takes four months for an adult bone to knit, this cannot be sped up to two months.
Science in Action
“We try to keep up with modern trends in traumatology. In recent years, Centre experts have suggested three new methods in the field of therapeutic and diagnostic technologies, have developed three medical device prototypes and have created seven designs now commercially available (or almost ready to be launched),” emphasises Alexander Linov, the scientific secretary of the Centre of Traumatology and Orthopaedics.
He adds, “A system of surgical intervention has been launched here to help children and adolescents whose lower limbs are of uneven length; our own special fixators equalise the length of the lower extremities, with hospital time reduced to just three-five days. Another promising innovation we’ve developed are implants for osteosynthesis of calcaneus fractures.”
Naturally, such innovations not only help patients but save budgetary money, being three-five times cheaper than imported counterparts. “The scientific achievements of the Traumatology and Orthopaedics Centre are known in Belarus and abroad,” says Mr. Linov. “Citizens from over forty countries worldwide have been treated at our centre, with about 5,000 operations performed here annually; over 26,000 patients countrywide receive consultations too.
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