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| Consulting
Doctor |
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| Click the image
to
view the Biodata and other details. |
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| Dr. Sandeep
Patwardhan |
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| Days and Timings: OPD Timing : 13.00 to 14.00 pm Mon to Sat |
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| Click
here to see the ‘Scope of Paediatric
Orthopaedic Services' |
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| Paediatric Orthopaedic Services |
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| Paediatric Orthopaedics - An Emerging
Specialty. |
| Dr Sandeep A. Patwardhan |
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Associate Professor (Orthopaedics) & Paediatric
Orthopaedic Surgeon,
Sancheti Institute for Orthopaedics & Rehabilitation |
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Paediatric age group (0-16) presents some
unique orthopaedic problems. Growth disturbances of bones,
limb inequalities, congenital anomalies, scoliosis, infections,
deformities, osteochondrosis form bulk of the problems.
In addition to epiphyseal injuries, other complex traumatic
conditions are managed using innovative approaches. Correction
of complex foot deformities with differential distraction
techniques popularised by Ilizarov, are practiced by Dr.
B. B. Joshi . Early Surgery for reduction of spasticity
for gait improvement in cerebral palsy is practised. Social
work for polio and cerebral palsy patients is also done
by way of charitable camps all over Maharashtra . |
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The word Orthopaedics was
coined from orthos & paedia meaning crooked limbs in
a child. Nicolas Andre, a Pediatrician from France wrote
a treatise on Guidelines to Parents of Children with Crooked
Limbs and used the word orthopaedia for the first time
in 1739. |
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The
early orthopaedics revolved round managing children with
rickets, scoliosis, polio, osteomyelitis & tuberculosis.This
was the true orthopaedics which was essentially a Paediatric
specialty. |
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With
industrialization and wars, the number of accidents & casualties
went up and Orthopaedicians became busier with traumatology.
The A.O.group in Germany was responsible for reorganizing
the concept of trauma and popularizing internal fixation
for fractures. |
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The 1960's saw the emergences of joint replacement
surgery and arthritis assumed an important place in orthopaedics
especially with increasing life expectancy and the concept
of imporving quality of life. |
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Back problems also increased and more aggressive
spinal treatment became the preferred approach. Spine surgery
emerged as a specialty in its own right. |
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So
the Orthopaedician became a traumatologist, spine surgeon & arthritis
(scopist/joint replacement) surgeon, primarily out of
need and commercialization of medicine. |
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Paediatric orthopaedics was pushed in
the background. |
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Howeve, in the recent past, Paediatric orthopaedics
has been emerging as a specialty in its own right especially
in the western world. It is being accepted that the childhood
orthopaedic problems are unique and the pathohysiology
is quite different from that of an adult. One cannot treat
a child as niniature adult. Special training and experience
is needed to address Paediatric orthopaedic problems. |
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| What then, is the scope of Paediatric
orthopaedics ? |
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| Mainly it takes care of the orthopaedic Problems
from birth to 16 years. The disorders may be categorized
as |
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Trauma |
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Congenital |
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Developmental |
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Neuromuscular |
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Infections |
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Tumors |
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Metabolic |
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Miscellaneous |
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| Let us consider these individually |
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Trauma : Childhood
injuries form bulk of routine orthopaedic practicce. These
are mainly greenstick fractures which are treated conservatively
with plaster. However growth plate injuries, femoral fractures
in a child, birth injuries, open fractures, pathological
fractures need expertise and special care in effective
management. |
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Congential : Clubfoot,
cdh, hemimelias, torticollis, scoliosis, polysyndactyly.
etc are formation defects which need good experience
to treat as they can behave unpreductably and can be
a cause for disability in the future. Newer techniques
and early intervention can make these children near normal.
Limb lengthening techniques are needed for hemimelis. |
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Developmental : Perthes
disease, dysplasias, osteogenesis imperfecta, flatfeet,
genu varum etc form the bulk of disorders which would need
long term observation and follow-up for effective treatment. |
Neuromuscular : Polio,
cerebral palsy, Muscular dystrophies, Erb's palsy, spinal
dysraphism, etc form a large bulk of patients needing skilled
and highly specialized multidisciplinary care. |
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Infections : Neonatal
septic arthritis, osteomyelitis, tuberculosis in a child
are quite common and more than just antibiotics are needed
for proper treatment. Early diagnosis and drainage forms
an effective treatmetn & longer follow ups are neede
to ensure avoidance of growth problems. |
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Tumors : Sarcomas,
hematological malignancies are real challenges for limb
salvage surgery. Benign bone tumors like cysts, osteoma,
and exostosis are effectively treated if diagnosed early. |
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Metabolic : Rickets,
scurvy, hyperparathyroidism, can lead to growth disturbances
in a child causing deformities which need correction. |
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Misc : Juvenile Arthritis
and other genetic syndromes with Orthopaedic manifestations
are rare but treatable with limitations. |
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Thus, Paediatric orthopaedics covers the
entire gamut of neuro-musculo-skeletal problems in a
child and it is just a matter of time before it emerges
as a specialty in India. |
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Thus, Paediatric orthopaedics covers the
entire gamut of neuro-musculo-skeletal problems in a child
and it is just a matter of time before it emerges as a
specialty in India. |
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There are a few speciality centers in India
catering to the Paediatric orthopaedic patient and it is
our endeavor to make our centre at sancheti institute one
of the best in the country. |
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| The future for children in Pune is bright. |
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