India has over 1 billion people and is very diverse, with 22 official languages. Healthcare is centered in urban areas which house only 28% of the population. Over the past 65 years since independence, India has seen advances in fields like trauma care, with good infrastructure and trained surgeons in major cities providing care on par with international standards. However, rural healthcare remains inadequate, and trauma care system development is still needed to address transportation barriers and prioritize emergency response nationwide.

1. Dr Yogesh Salphale

2. India ….as it is…
 HAS 28 STATES AND 7 UNION
TERRITORIES
 Has 1.17 BILLION PEOPLE
APPROXIMATELY.
 THE MOST DIVERSE IN TERMS
OF LANGUAGES AND
RELIGIONS.
 INDIAN GOVERNMENT
RECONIZES 22 LANGUAGES
WHICH IS THE MAXIMUM THAN
ANY OTHER COUNTRY IN THE
WORLD.
 INDIA HAS SECOND LARGEST
HUMAN RESOURCES IN THE
WORLD

3. 65 yrs since Independence
 Advances in the field of
 Biology & Biomechanics of Musculoskeletal
fixation
 Innovation in fixation devices
 Right use of technology
 Competent and skilled surgeons at par with their
International colleagues

4. The India Story…..
The synchronous advancement of trauma in
India compared to the west.
 With good disposable income and the spending
capacity treatment available at par with the
western standards.
Well trained surgeons practising latest
techniques .
Expanding Orthopaedic Implant market.

5. The India Story ….
 Healthcare is city centric.
 Highly skewed in favour of urban population,
which is 28% of Indian population.

6.  What caused the paradigm shift?
 How does it benefit the vast
population ?

7. Trauma …..
 Thought process and understanding
of…
 Golden Hour
 Damage control Orthopaedics
 Innovation in Implants.
 Awareness & a need to excel in the
limited infrastructure

8. Trauma essentials –
“The Golden hourrr”
 The concept comes from U.S. military wartime
experience, particularly in the Vietnam War.
 The golden hour is the first 60 minutes after
the occurrence of a major multisystem trauma.
 It is widely believed that the victim’s chances of
survival are greatest if he or she receives
definitive care within the first hour..
 The golden hour can be summarized by the 3R
rule of Dr. Donald Trunkey, an academic trauma
surgeon, ―Getting the right patient to the right
place at the right time.‖

9. Trauma essentials -Damage control
Orthopaedics
 An approach that contains and stabilizes
orthopaedic injuries so that the patient’s
overall physiology can improve.
 To delay definitive fracture repair until a time
when the overall condition of the patient is
optimized.
 Its purpose is to avoid worsening of the
patient’s condition by the ―second hit‖ of a
major orthopaedic procedure

10. Evolving concepts-Damage control
Orthopaedics
 The Focus:
 on control of hemorrhage,
 management of soft-tissue injury,
 Achievement of provisional fracture stability esp
with the use of external fixation …
while avoiding additional insults to the patient.

11. Transport to the health centres

12. Transport to the health centres

13. The Journey… Imaging
 The old Xrays……..
still holds a place
 Backbone of Imaging
 Have stood the test of time
 Gradually been
replaced by …

14. Advances in Imaging
 Digital Processors which provide
 Better visualisation
 Better data retrieval
 Immediate image preview and availability;
 Elimination of costly film processing
steps
 A wider dynamic range, ( forgiving for
over- and under-exposure);
 The ability to apply special image processing
techniques that enhance overall display
of the image.

15. Advances in Imaging
 CT Scan
• Whole body CT
• Spiral CT
• Multi detector CT
• The Low dose CT
• The128 slice low dose
CT
• PET Scan
•MRIScan
State of art 3 tesla Open
MRI

16. Advances in Imaging

17. Computer aided surgery
Improvement in accuracy.
 CAOS technologies allow the surgeon to:-
 Plan the component placement in advance,
including determination of the appropriate
component sizes;
 Measure the intra-operative placement of the
components in real time, making sure that the
plan is adhered to;
 Measure the post-operative result

18. Computer aided surgery
 The procedure only combines the surgeon’s
skill with computer technology.

19. Computer aided surgery --Evidence
 Current evidence shows no advantage with
CAOS in trauma cases compared with
conventional methods.
 Prospective randomized trials and clinical
outcomes are lacking.

20. Medical tourism: Accreditions
essential….
 Joint Commission International (JCI) is based in the US
 Australian Council for Healthcare Standards International
(ACHSI) is based in Australia
 The QHA Trent is based in the UK
 HealthCare Tourism International (HCT) is based in the
US
 Accreditation Canada is based in Canada
 The United Kingdom Accreditation Forum is based in the
U.K.
 Temos is based in Germany


21. Fracture fixation…Evolving
concepts
 from rigid flexible fixation,
 from conventional locked
intramedullary nailing,
 from reamed ―unreamed‖ nailing,
 and finally
 from compression plating
 to the internal fixator

22.  Total Hip Replacement Surgery (THR)
 Birmingham Hip Resurfacing Surgery (BHR)
 Computer Assisted Surgery
 Minimally Invasive Hip Joint Surgery

23. Hip replacements

24. Healthcare trends-India
 Healthcare is city centric.
 Highly skewed in favour of urban population,
which is 28% of Indian population.

25. Networking- Telemedicine
 Telemedicine is the use
of telecommunication and information
technologies in order to provide clinical health
care at a distance.
 It helps eliminate distance barriers and can
improve access to medical services that would
often not be consistently available in distant
rural communities. It is also used to save lives
in critical care and emergency situations.

26.  Telemedicine has special significance to India
considering its vast geographical spread and
predominant rural population.
 With the penetration of rural telephony and
Braodband at the remotest location,the
benefits can be reaped at any level.

27. Bone grafts & Substitutes…
 The ideal bone-graft substitute is
biocompatible, bioresorbable, osteoconductive,
osteoinductive,
 Structurally similar to bone, easy to use, and
cost-effective.
 It is reasonable that not all bone-graft
substitute products will perform the same.

28. Bone grafts &
Substitutes…Synthetic bio-inert materials
 An alternative to autogenous
bone graft. Calcium
hydroxyapatite (HA) and Beta
tri-calcium phosphate (β-TCP),
which belong to the calcium
phosphate ceramics group, are
biocompatible and osteo-
conductive.
 These implants conduct new
bone formation not only
around the implants but also
into the pores in a very short
period.

29. e-Governance initiative of Govt. of
India
 towards citizen centric services.
 The application of e-governance in health care
*can monitor and improve the quality of
health care services,
*make the system efficient, transparent and
cost effective as it will bring healthcare
providers, policy makers, professionals and the
public on a common platform.
.

30. Originality and Innovation from
Indians
.
 The disease burden of orthopaedic surgery is
completely different from the rest of the world.
o It Varies in
o its disease spectrum,
 patient expectation,
 affordability and
 other socio economic factors.

31. Surgeons contribution
 A drive to excel within the framework
 Promote indigenous means which are
economical and user friendly
 Results which can be corroborated with
International standards.

32. Surgeons contribution
 Ingenuity and Innovativeness
 Dr. Brij Bhushan Joshi was one of the
pioneers of hand surgery
 Devised an External fixator.
 Revolutionised the treatment of
trauma ,
 the correction of various congenital
and acquired deformities,
 burns contractures and
 reconstruction of the thumb.

33.  His work on simple and
economic splints for the
hand (using scrap
materials like rubber
tubing, chicken wire,
aluminum strips and
rubber bands) bears the
hallmark of his genius.

34. Surgeons
Contribution..
No
replacement
for human
tissue? — just as
long as there is steel
A new pathway for innovation???...............

35. Surgeons contribution
Dr. Mayil Vahanan Natarajan.
•First surgeon to perform 1,500
cases of custom mega prosthetic
replacement for bone tumours for
a period of 21 years
•Significant impact on the lives and
limbs of a number of people
affected by bone cancer and
trauma.

36. Economics…….
 Implants Less than 10$
 Results at par with International standards
 Respect to the
 Soft tissue
 Gentle handling
 Awareness of cost constraints

37.  Year : 2010 | Volume : 44 | Issue : 4 | Page :
448-452Percutaneous osteosynthesis of
Galeazzi fracture-dislocationWasudeo M
Gadegone, Yogesh Salphale, DS Magarkar

38. Autologous chondrocyte
transplantation
The goal -is to allow
people suffering from
articular cartilage damage
to return to their old
lifestyle; regaining
mobility, going back to
work and even practicing
sports again.

39. Autologous chondrocyte
transplantation
 Autologous Chondrocyte Implantation
procedures aim to provide complete hyaline
repair tissues for articular cartilage repair.
 Over the last 20 years, the procedure has
become more widespread and it is currently
probably the most developed articular cartilage
repair technique.
 The technique also seems promising with
regard to long-term results.

40. The hurdles-Trauma Care
 Lack of initiative by the
*Policy makers
* Medical professional
*Media
* Ever Increasing
population
*No mechanism for
accreditation of
………trauma centers
& ………..professionals
exists.

41. What ails the Rural India –
Trauma service delivery?
*Varied topography,
*Financial constraints, and
*Lack of appropriate health
infrastructure.
There is no national lead
agency to coordinate various
components of a trauma
system.

42. The hurdles-Trauma Care
• Priority to communicable diseases, maternal
and child health, and population control
continue to be government priorities.
• Lack of uniformity in training/Teaching &
proper trauma registry
•

43. Emergency Care
 ATLS/ALS courses
 The concept of emergency medicine as a
speciality is catching up across the country. As
many as 45 medical colleges are in various
stages of the process of starting Medical
Council of India (MCI) recognised MD course in
emergency medicine and many more are in the
pipeline,"

44. The future
 Organisations dedicated to improvement in
Trauma and Emergency Care in India.
 Create awareness and promote Trauma and
Emergency Medicine as medical specialties.

45. The future
 Accomplish this through
 National Trauma Management Course (NTMC™),
 Cardiac Life Support,
 Disaster Preparedness Course.,
 Other educational programmes,
 Consultation, Research and Training for
doctors and health care professionals in India
with national and global perspective."

46. I conclude….
Specialised trauma
centres and surgeons practising trauma exclusively is an
urgent
need today and the medical profession, politicians and
the public
must apply their minds to rectifying the situation before
it is
too late.

47.  Education in trauma life-support skills has only
recently become available.


48. 10 Interesting facts about India:
The famous board game, called Chess, was invented in India.
In India's 100,000 years of history, it has never invaded any other
country.
India is the 7th largest country in the world, the largest democracy
and one of the oldest civilizations.
India was one of the richest countries in the world before the British
invasion in 17th century.
The value of "pi" used in mathematics was first calculated by the
Indian mathematician Budhayana in 6th century.
India is one of the largest exporter of computer software products. It
exports software to over 90 countries.
India is home to the world's largest pilgrimage destination called the
Vishnu Temple. The temple is located in the city of Tirupati. About an
average of 30,000 people visit this temple donating about $6 million
US dollars, everyday.
India originated Yoga about 5,000 years ago.
India has the most number of mosques. It has 300,000 mosques
which is much more than the Muslim world.