Orthopaedics

The Department of Orthopaedics was established at R.L. Jalappa Hospital and Research Centre in 1988 and has progressed well from its initial stages, to a fully equipped department with skilled faculty providing compressive trauma care and sub-speciality services. The Dept. has 3 Units and each unit has 2 OPD along with speciality clinics and 2 OT days per week.
Orthopaedic wards have total bed strength of 110. We have exclusive Orthopaedic operation theatres with laminar air flow, with C-Arm’s and all the required instrumentation and implants.

Head of department’s message

It is an honor and privilege to serve as Chair for our storied Department. Our rich history provides a solid foundation for us to further grow our Mission. With reverence to our past, we are looking to our future as leaders of musculoskeletal health care. Earlier this year, the faculty developed a strategic plan to guide us for the next five years. We have quite an ambitious agenda and need support to realize all we would like to do to grow and enhance our mission.
Our department includes fellowship-trained subspecialists in all major areas of orthopedic surgery, including arthroplasty, foot and ankle, spine, pelvis and acetabular surgeries, sports medicine, and orthopedic oncology. Additionally, our team includes highly trained physicians specializing in non-operative treatment of musculoskeletal ailments and injuries. We pride ourselves on a multidisciplinary approach to ensure every one of our patients receives personalized care tailored to their condition and circumstance.
The Department of Orthopedic Surgery is not only committed to providing expert care today but is also dedicated to discovering the most effective musculoskeletal treatments of tomorrow. Every year, eight promising medical students are selected from a pool of over thousands of NEET passed candidates to enter into our three-year comprehensive Orthopaedic surgery training program. Our dedicated faculty are committed to ensuring that future surgeons are prepared to provide the highest level of care to meet their patients' needs in an ever-changing and complex health care system.
When you receive treatment at R L Jalappa hospital and research Centre, your healthcare team will stand by you from diagnosis through post-operative care. Thanks to our residents, physical therapists, social workers, and other specialized doctors, we are poised to lead you on the road to recovery. With a dedication to your long-term well-being, our team will be with you every step of the way as you make your transition from treatment at R L Jalappa hospital and research Centre to your return home and back to your daily life.

Treatments and Procedures

Arthroscopy & Arthroplasty

Arthroscopic surgery of various joints, sports medicine and arthroplasty.
Arthroscopic ligament reconstruction of ACL & PCL, arthroscopic avulsion fracture fixations
Arthroscopic stabilization for recurrent dislocation shoulder, Rotator cuff repair and SLAP tears
Arthroscopic meniscal surgeries including meniscal repairs
Arthroscopic assisted surgery for recurrent dislocation of patella
Complex repairs and reconstructions of multi-ligamentous injuries of knee
Joint replacement surgeries of hip, knee and shoulder
Primary and revision surgery of hip and knee
Management of peri prosthetic fracture, prosthetic joint infection

Complex trauma and spine

Polytrauma patient management
Management of closed and open fractures
Management of complications of fractures and dislocations
Acetabular fracture fixations
Management of ankle & foot injuries and deformities
Minimally invasive procedure for intra-articular fractures
Limb reconstruction surgeries
Backpain management
Stabilization of spine fractures
Pedicle screw fixation

Hand and Paediatric surgery

Treatment and rehabilitation of traumatised wrist, hand and elbow pathologies.
All hand and upper limb fracture management
Open carpal tunnel release
Trigger finger, De Quervain’s tenosynovitis and tennis elbow surgeries
Correction of club foot and DDH
Deformity correction of lower limb and limb lengthening
Tumour resection and limb reconstruction
Deformity correction of knee: High tibial osteotomy
Osteomyelitis, septic arthritis and their sequelae management

Facilities and Services

OPD
Minor OT Procedure

IPD
Prstoperative and Surgical intensive care

Emergency Services
Musculoskeletal injuries

Infrastructure
Three Operating Theatres

Infrastructure

Three operating theatres are equipped with 2 Arthroscopy Instrumentations from Smith & Nephew, Arthrex. There are 4 C-arms of which two are state of the art German made C-arms.

Operation Theatre is equipped with 8 AO instrumentation sets for carrying out surgeries.

Saw bone models with instrumentation for training in skill lab.

Faculties

Unit 1

Dr. Arun H S Professor & HOD

Dr. Manohar P V Professor

Dr. Vinod kumar Assistant Professor

Dr. Jagadish Senior Resident

Dr. Hrushikesh Senior Resident

Break through Cases

Case 1

A 30-year-old class 2 obese (BMI: 35.4) male patient presented with an alleged history of road traffic accident sustaining injury to his right hip. The patient was unable to bear weight over his right lower limb since the injury. Warmth and tenderness were felt over the right hip with limb shortening on the right side. A swelling was also palpable over the right hip. Flexion, adduction, and internal rotation of the right lower limb were seen with a history of decreased range of movements. Range of movements could not be elicited in the patient as a result of pain. However, the range of motion at the ankle joint was full. Active toe movements were present. No distal neurovascular deficits were noticed. Plain radiograph of the right hip showed fracture of head of right femur with posterior dislocation of right hip.

Case 2

A 10-year-old female patient was brought to our tertiary care center at Kolar, Karnataka, with an alleged history of a fall when she sustained an injury over her left upper limb three weeks following the initial injury. The patient presented with swelling and pain over her left elbow with the inability to move her left little finger since the fall. She had no history of injuries elsewhere in her body. On examination, the left elbow joint was tender, grossly swollen, and in a slightly extended position. The three-point relation could not be assessed due to the swelling. The range of motion at the left elbow joint was painful and restricted. Sensation was lost in her left little finger, and extension of all other fingers was present. Brachial artery pulsation was palpable, and no vascular deficits were noticed. Anti-edema measures were taken through limb elevation over the pillow, above elbow plaster of Paris slab application in extension, and medications. Analgesics and prophylactic antibiotics were started, and the dosage was as per the weight of the child. The patient was sent for a plain radiograph of the left elbow joint. Radiographs showed left supracondylar fracture with gross rotational anterolateral displacement, as shown in Figure 1. As a trial, closed manipulation was attempted, and it failed as expected. After obtaining proper written, informed consent from her guardian, the patient underwent open reduction and internal fixation with two criss-cross Kirschner wire fixations, as shown in Figure 2, and above-the-elbow slab immobilization for four weeks.

Case 3

We present a 45-year-old male to our tertiary care facility in Kolar, India. Three years old infected non-union of distal femur with locking compression plate in place treated in various hospitals. With the support of the stick, the patient was partly weight-bearing. When examined, the distal left thigh portion - swelling, tenderness and abnormal mobility was present. The range of motion was 45-120 degrees of flexion at the left knee joint. The extensor lag was 45 degrees. There were no distal neurovascular deficits found. The patient was sent for a left thigh radiograph showing non-union distal femur with locking compression plate in in-situ as shown in Figure 1. The patient underwent locking compression plate removal with distal femoral nail fixation with allogenic bone grafting after written/informed consent. Patient was put on six weeks above knee slab immobilization. Hospital treatment: the patient received cephalosporin group intravenous antibiotics twice daily for seven days, followed by oral cephalosporin antibiotics twice daily for seven days, depending on the patient’s post-operative weight. In Figure 2, post-operative radiography of the left thigh was seen. There was an uneventful post-operative time. The site of surgery healed well. The range of motion at the knee joint was 0-120 degree flexion at discharge. After six weeks, partial weight-bearing was started. At the last follow-up, six months radiography, the fracture site is uniting as shown in Figure 3 and the patient is partially weight-bearing without any trouble.

Case 5

A 52-year-old male patient presented at our tertiary care hospital, in Kolar, India, with pain and swelling over the heel, pain during rest, and more during ambulation. Mulholland deformity/Haglund's deformity was diagnosed clinically and radiologically on examination. The patient’s lateral ankle radiograph is shown in Figure 1. The patient was initially treated conservatively for six months using anti-inflammatory drugs, analgesic agents, physiotherapy, and soft sole heels. The conservative medication did not relieve the pain. Patient underwent surgical operation via the removal of the calcaneal spur following informed and written consent. A lateral technique was used. An incision of 5 cm was made. The insertion of Achilles tendon found was resected along the lateral border revealing the prominent calcar tuber. The spur was removed using the osteotome and the edges smoothed using rongeur and rasp. The post-surgical phase was uneventful.

In terms of hospital treatment, the patient required intravenous amoxicillin-clavulanate twice daily for seven days, followed by oral amoxicillin-clavulanate potassium twice daily for seven days, depending on the patient’s post operative weight. Figure 2 demonstrates the postoperative lateral view radiography of the ankle joint. A short leg splint was put on the patient. For two weeks, nonweight bearing ambulation was prescribed to the patient and accompanied by suture removal. The surgical wound was healthy. With the walker, partial weight-bearing was initiated. And later on, weight-bearing began to be tolerated. The patient recovered from pain due to bilateral calcaneal spur/exostosis at final follow up, six months after surgery. The visual analog scale was eight. The discomfort was greatly diminished in the final follow up. Without any pain or discomfort, the patient would be able to do his everyday activities.

Case 6

A 22-year-old left-handed male patient, a painter by occupation, presented to RL Jalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India. The patient gave the alleged history of the road traffic accident while traveling in a four-wheeler, which toppled and caused the patient sustained an injury to both his shoulders. On examination swelling, crepitus, and tenderness were present over the junction of the middle and lateral third junction of the right and left clavicle. The range of motion of both shoulder joints was painful and restricted. No distal neurovascular deficits were found. The patient was clinico-radiologically diagnosed as having closed bilateral clavicle fractures without neurovascular deficits, as shown in Figure 1. The patient and his relatives got an explanation about the severity of the injury, associated complications, and the need for surgery in their own understandable language. The patient was kept on the shoulder arm pouch on both sides with ice pack application and started on analgesics, anti-edema measures like bromelain, trypsin, and rutoside tablets. The patient and his relatives were asked about their demographic details, and surgical options were explained to them by a team of orthopedicians. The rehabilitation protocol, complications associated with both conservative versus non-conservative management were explained. After obtaining consent, the patient had surgery on the open reduction and internal fixation with a locking compression plate for the left side clavicle. The patient was not willing to get surgery for the right clavicle due to his financial constraints. The right clavicle fracture was treated conservatively by using a shoulder arm pouch application for three weeks. Range of right-shoulder activity limited to two weeks of pendulum exercise and active movements up in the horizontal plane during the first six weeks.

Post-operation of the left clavicle, the patient was able to raise the right arm above his shoulder. The patient was started on analgesics, anti-edema medications, and intravenous administration of augmentin 1.2 g twice daily for two days and started prophylactically oral amoxiclav 625 mg twice a day for seven days to prevent surgical site infection. Active ranges of motion were full with reduced pain. During one month follow-up, the radiograph over the left side showed better uniting of the fracture than the right side. The patient was allowed to return to work to his normal activity of painting three months post-operation. Figure 2 demonstrates the plain radiograph of the chest with bilateral shoulder anteroposterior view at six months follow up. Clinical picture comparing the range of motion over operative (left) versus non-operative (right) side shown in Figure 3. He was discharged from the follow up at six months.

Case 7

A 31-year-old male patient with no known comorbidities was brought to our tertiary care center at Tamaka, Kolar, Karnataka, South India. The patient revealed a history of road traffic accident, due to which he sustained injury to the right lower limb. The patient had been unable to walk since then. He underwent native treatment for about six weeks and was brought to our hospital for further management. On examination, his vitals were stable. Local examination of the right leg showed swelling and tenderness present over the proximal third of the right leg. Range of motion at the right knee joint was 10-30 degrees. Assessment of range of motion at the ankle joint revealed that dorsiflexion was absent. Capillary refill time was normal. All other long bones and joints were found to be clinically normal.
The patient was initially managed with intravenous administration of amoxicillin- potassium clavulanate 1.2 g prophylactically. The patient was then temporarily stabilized with an above-knee fiberglass splint. He was sent for preoperative imaging, as shown in Figure 1. Plain radiograph of the right knee showed split fracture involving the lateral tibial condyle extending into the articular surface, with lateral displacement of fracture fragments, and oblique fracture of fibular head with caudal displacement of fracture fragments. MRI of the right knee showed a high-grade tear in the proximal aspect of the lateral collateral ligament and a grade 2 medial collateral ligament tear. In addition, the patient was counselled regarding expectations and outcomes. After obtaining informed consent, the patient was operated under spinal anesthesia. Open reduction and internal fixation with proximal tibia locking compression plating with autologous bone grafting from the ipsilateral iliac crest (corticocancellous graft) along with lateral meniscectomy and arthrolysis of the knee joint was performed under spinal anesthesia, as shown in Figure 2. The post-operative period was uneventful.

Fig 2 - Intra-operative picture showing high-grade tear in the proximal aspect of the lateral collateral ligament and grade 2 medial collateral ligament tear, which was treated with open reduction and internal fixation with proximal tibia locking compression plating with autologous bone grafting from the ipsilateral iliac crest.
Post-operatively, the patient received intravenous amoxicillin-potassium clavulanate 1.2 g twice daily for seven days and amikacin sulfate 500 mg twice daily for five days followed by oral amoxicillin-potassium clavulanate 625 mg twice daily for seven days. Post-operative radiograph of the operated knee joint was taken on post-operative day 2, as shown in Figure 3. An above-knee slab support was applied, and the patient was advised strict non-weight bearing for six weeks. Culture and sensitivity from surgical site showed staphylococcus epidermidis, which was sensitive to tetracycline and doxycycline. The patient was started on tablet doxycycline 100 mg twice a day for 14 days. All staples were removed on post-operative day 14, and the surgical site was found to be healthy. The patient underwent physiotherapy in the form of muscle stimulation test 15 minutes daily till he recovered from the foot drop. The guarded continuous passive motion was also started for the patient. At discharge, range of motion at the knee joint was 0- to 120-degree flexion after one month of physiotherapy. Tinel sign was positive 1-cm along the common peroneal nerve distribution at the level of the middle third of the leg. The patient had recovered from the foot drop (possibly due to neuropraxia). Partial weight bearing was initiated after six weeks. The patient was allowed full weight bearing at three months. At the last follow-up, six months post-injury, he was walking without any difficulty.

Post-operatively, the patient received intravenous amoxicillin-potassium clavulanate 1.2 g twice daily for seven days and amikacin sulfate 500 mg twice daily for five days followed by oral amoxicillin-potassium clavulanate 625 mg twice daily for seven days. Post-operative radiograph of the operated knee joint was taken on post-operative day 2, as shown in Figure 3. An above-knee slab support was applied, and the patient was advised strict non-weight bearing for six weeks. Culture and sensitivity from surgical site showed staphylococcus epidermidis, which was sensitive to tetracycline and doxycycline. The patient was started on tablet doxycycline 100 mg twice a day for 14 days. All staples were removed on post-operative day 14, and the surgical site was found to be healthy. The patient underwent physiotherapy in the form of muscle stimulation test 15 minutes daily till he recovered from the foot drop. The guarded continuous passive motion was also started for the patient. At discharge, range of motion at the knee joint was 0- to 120-degree flexion after one month of physiotherapy. Tinel sign was positive 1-cm along the common peroneal nerve distribution at the level of the middle third of the leg. The patient had recovered from the foot drop (possibly due to neuropraxia). Partial weight bearing was initiated after six weeks. The patient was allowed full weight bearing at three months. At the last follow-up, six months post-injury, he was walking without any difficulty.

Case 8

A 40-year-old male patient was brought to R. L. Jalappa Hospital & Research Centre affiliated to Sri Devaraj Urs Medical College, Kolar, Karnataka, South India. The patient presented with an alleged history of road traffic accident, sustaining an open injury to his right foot. It involved the bipolar dislocation of the proximal phalanx of the third toe with extensor digitorum longus tendon injury and fracture of the neck of the fourth proximal phalanx of the right foot. Range of motion of the metatarsophalangeal joint of the third and fourth digits was painful and restricted. Active first, second, and fifth toe movements were present. No distal neurovascular deficits were noted. All other bones and joints were clinically normal. It was an isolated injury with no evidence of intracranial, thoracic, abdominal, or pelvic injury on clinical or radiographic examination. A focused assessment with sonography in trauma showed no signs of hemorrhage.
On arrival, tetanus prophylaxis was administered to the patient. Triple antibiotic prophylaxis consisting of amoxicillin-potassium clavulanate 1.2 g, amikacin sulfate 500 mg, and metronidazole 100 mL were administered in the emergency department. A brief bedside irrigation with 6 L of sterile saline was given, and the wound site was dressed with moist gauze. The patient was then provisionally stabilized with a short leg splint and sent for preoperative imaging. Clinical image and preoperative radiographs are provided in Figures 1, 2, respectively. After imaging was completed, a trial closed manipulation failed as expected, as shown in Figure 3. The patient was operated under spinal anesthesia. Three liters of sterile saline was then used to irrigate the wound. Gross wound contaminants were removed. The patient underwent wound debridement with extensor digitorum longus tendon repair of the fourth digit, and internal fixation with K-wire fixation for the third and fourth digit was performed. Post-operative image is shown in Figure 4. The post-operative period went uneventful. The superficial and deep wound infection never occurred at any point of time. This included physical signs (erythema, malodor, gross purulence, etc.) and hematological signs (rising of white blood cell count, erythrocyte sedimentation rate, C-reactive protein etc.). Post-operatively, the patient stayed in the hospital for seven days for wound monitoring. Daily physical and occupational therapy was routinely performed by the patient. The surgical site healed well. Active toe movements of the first to fifth digits were present.

Post-operatively, the patient received intravenous amoxicillin-potassium clavulanate 1.2 g twice daily for seven days, amikacin sulfate 500 mg twice daily for five days, and metronidazole 100 ml thrice daily for three days followed by oral amoxicillin-potassium clavulanate 625 mg twice daily for seven days. Analgesics and anti-edema measures were given. Protein-rich supplements along with personal hygiene measures were provided. A below-knee slab and strict non-weight bearing ambulation for six weeks were recommended. The K-wires were removed after six weeks, and partial weight-bearing was started with the help of a walker. Full weight-bearing was permitted after six months. The patient was being followed up at regular intervals. The patient returned to his work with no limitations on the activity or complications after his final follow-up.

FAQs

What is orthopaedics?

Orthopaedics is a medical specialty dealing with the diagnosis and treatment of conditions, disorders, and injuries of the muscles, bones, joints, tendons, ligaments, and nerves. A doctor who specializes in this medical specialty is called an orthopaedic surgeon.

What is arthritis?

The word arthritis literally means “joint inflammation.” Arthritis refers to a group of more than 100 rheumatic diseases and other conditions that cause pain, stiffness, and swelling in joints.
Rheumatoid arthritis is a disease that damages the lining surrounding our joints while also destroying our bones, tissue, and joints over time. Osteoarthritis is a progressive condition that slowly damages the cartilage surrounding the ends of bones and is common in the hip, knee, or spine.

What is bursitis?

Bursitis is an inflammation or irritation of a bursa, which is a fluid-filled sac located around joints. Bursitis causes a reduction in or a loss of motion at the affected joint. Bursitis typically occurs in the heel, hip, knee, shoulder, or thumb.

What is cartilage?

Cartilage is a soft, rubbery, gel-like coating on the ends of bones, where they articulate, that protects joints and facilitates movement

What is a ligament?

A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint

What is a tendon?

A tendon is a band of tissue that connects muscle to bone.

Will I need surgery?

Although orthopedic surgeons are trained and experienced in providing surgery, they do not always prescribe this treatment. Non-surgical options like R.I.C.E. (rest, ice, compression, elevation), casting, physical therapy, and injections can be sufficient in many situations.

Surgical treatment options will vary depending upon your needs and may be used as a last resort.

Arthroscopy, joint replacement, ligament reconstruction, fracture repair, and hand surgery are just some of the most common orthopedic surgeries.

How do injections work for orthopedic health issues?

Orthopedic injections aren’t like numbing shots from the dentist or a flu shot. These can be used for relief from pain, stiffness, and inflammation. Some common conditions they treat include arthritis, nerve pain, and tendonitis. Orthopedic injections can even be used to help diagnose health issues

What is arthroscopic surgery?

This surgery is a non-invasive diagnostic and treatment option that is especially popular in sports medicine. The surgeon will make a small incision with thin needles and use special tools to conduct the procedure. You can have this surgery in a hospital or outpatient facility and it usually doesn’t require more than a day.

What do I need to know about joint replacement surgery?

Joint replacement is a surgical procedure, so it is not for those who could benefit more from non-invasive treatments. During this procedure, the orthopedic surgeon will replace the damaged joint with a prosthesis. These can be ceramic, plastic, or metal.

Doctors typically recommend joint replacement surgery in cases of debilitating joint pain and damage where lifestyle changes, physical therapy, and injections don’t work.

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