Resurgence of Conservative treatment

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                            Resurgence of Conservative treatment


Case Report | Volume 9 | Issue 6 | JOCR Nov-Dec 2019 | Page 1-2 | Antao N. DOI: 10.13107jocr.2019.v09.i06.1560


Authors: Nicholas Antao[1], Ashok Shyam[2, 3]

[1]Department of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093 India.
[2]Sancheti Institute for Orthopaedics and Rehablitation, Pune, India.

[3]Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Nicholas Antao,
Head of Department of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093 India.
Email: narantao@gmail.com


While A. Sarmiento was delivering his lecture on “Physiology of fracture healing”, his senior resident was sitting at the back of the hall and reading a newspaper. Needless to say any professor of the stature of Sarmiento, was annoyed and felt disrespected. He therefore asked him, for an explanation for his behaviour. The resident remarked that he was not interested in conservative managements and wanted to be taught how to fix the fracture surgically. In another lecture on “Role of hematoma, in fracture healing”, he stressed how by open reduction, you convert a closed fracture in open surgery and lose the hematoma and its effects on callus formation. He felt that most of his patients treated with a cast, would have nearly full range of movement, perhaps with a little deformity and shortening but in turn this would not come in the way of the functional demands of the patient. A recent webinar on conservative treatment, discussed the Sarmiento technique in detail, in treating not only the humerus fracture, but also tibia, femur, and both bones forearm. The speaker effectively convinced the faculty and I am sure most of the viewers who had logged in, of the good results of simple and difficult fractures. Most importantly he mentioned about the absence of a scar, functional movements being full, and the patient is invariably happy that there is no surgery. He impressed upon how young female patients are willing and asking for conservative treatment to avoid a scar. He did mention about the importance of detailed counselling so that the patient makes a wilfully knowledgeable decision. In case of failure of conservative treatment, not getting the necessary results, one can always opt for surgical treatment. But will the doctor be taken to consumer court for want of proper care, resulting in cosmetic deformity and limitation of function? I feel certain that this webinar must have been a starting eye opener to the young orthopaedic surgeons in training whose major exposure is to the surgical management of fractures and textbooks there of. Sadly Dr. John Charnley book on “Conservative treatment of fractures” must gather dust on the library shelves. Presently elective procedures have taken a back seat with priorties being given only to emergencies. Will the role of the famed “bone setter” start coming up front?

Regards,
Dr. Nicholas Antao

References:
1. Is Socrates Dying? Agusto Sarmiento; J Bone Joint Surg Am. 2008: (90); 675-676.

How to Cite This Article: Antao N, Shyam A. Resurgence of Conservative treatment. Journal of Orthopaedic Case Reports 2019 Nov-Dec; 9(6): 1-2

Dr. Nicholas Antao
Dr Ashok Shyam

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