Department of OrthopaedicsCensus: 2011-2012

JPNATC, AIIMS

1

INTRODUCTION

JPN Apex Trauma Centre started functioning in Dec. 2006.

Dept. of Orthopaedics started working to its full capacity from Jan. 2007.

2

Emergency Department

TOTAL ORTHO CON-SULTATIONS

TOTAL DISCHARGES FROM CASUALTY

0

5000

10000

15000

20000

25000

30000

35000

40000

2010-11

34738(95/day) 29152

(80/day)

33076(90/day) 28800

(79/day)

3

EMERGENCY DEPARTMENT

05000

1000015000200002500030000350004000045000 2011-12

2011-12

82%6%

100%

4

21%

73%

Minor procedures in emergency department

POP APPLICATION SUTURING(Combined)0

2000

4000

6000

8000

10000

12000

2010-11

5840(112/wk)

7300(140/wk)

9882(190/wk)

9382(180/wk)

5

ADMISSIONS

ADMISSIONS0

200

400

600

800

1000

1200

1400

2010-11

972(19/wk)

1301(25/wk)

6

REGRET, NO BED AVAILABLE

DIAPH

YSEA

L #

SMAL

L BO

NE #

ARTI

CULAR #

COMPO

UND #

SPIN

E & P

ELVI

S0

200

400

600

800

1000

1200

2010-11(2304)2011-12(2124)

48 %

34 %%

1116

125

11%

4%

1.5%

53%

35%

7%

5%

7

1126

252

Operation theatre

(Total-1708)

8

surgeries

General/Re-gional an-aesthesia

284(17%) 142

4(83%)

SURGERIES2010-11 2011-12

AXIAL SKELETON N=198(14.2%)

AXIAL SKELETON N=187(13%)

APPENDICULARSKELETON N=1202(85.8%)

APPENDICULARSKELETON N=1237(87%)

9

SPINE

0

10

20

30

40

50

60

ANTERIOR APPROACH POSTERIOR APPROACH

2010-11(N=63)

2011-12(N=66)

24%

76%

44%

56%

10

15

48

29

37

PELVI-ACETABULAR TRAUMA

ANTERIOR APPROACH POSTERIOR APPROACH

0

10

20

30

40

50

60

70

80

90

2010-11(N=115)

2011-12(N=121)

42%58%

48

83

68%

32%

11

67

38

FEMUR

PROXI

MAL

FEM

UR

INTE

RLOCK

NAILING

DISTA

L FE

MUR

HEMIR

EPLA

CEMEN

T0

40

80

120

160

2010-11(N=308)2011-12(N=379)

42%

43%

31% 22

%

4%

26%

28%

4%

12

LEG AND FOOT

PROXI

MAL

TIB

IA(I/

A)

NAILING

DISTA

L TI

BIA

& ANKL

E

TALU

S

CALCAN

EUM

0

20

40

60

80

2010-11(N=191)2011-12(N=253)

28% 32

% 2

36%

23%

3%

10%31

%27%

2%

8%

13

UPPER LIMB TRAUMA

PROXI

MAL

HUM

ERUS

SHAF

T HUM

ERUS

DISTA

L HUM

ERUS

FOREA

RM

DISTA

L RAD

IUS

0

20

40

60

80

100

120

2010-11(N=226)2011-12(N=333)

18%

13%

18%

43%

8%

13%

15%

28% 27

%17%

14

COMPOUND FRACTURES

DEBRID

EMEN

T

DEBRID

EMEN

T & E

X. F

IX

AMPU

TATI

ON

DEBRID

EMRNT

& DEF

INIT

IVE

FIXA

TION

0

40

80

120

160

200

2010-11(N=397)2011-12(N=374)

18.5%

1.5%

3%

46%

34%

44%

34% 19

%

15

ARTHROSCOPY

0

5

10

15

20

25

30

35

40

45

50

KNEE SHOULDER

2010-11(N=54)

2011-12(N=42)81%

19%

87%

13%

16

OTHER FRACTURES

HAND FOOT PATELLA CLAVICLE0

10

20

30

40

50

60

2010-11(N=119)2011-12(N=105)44

%

21% 4

%

31%

42%

28% 27

% 3%

17

COMPLEX INTRAARTICULAR FRACTURES(EXCLUDING PELVIS & ACETABULUM)

DISTA

L FE

MUR

PROXI

MAL

TIB

IA

PROXI

MAL

HUM

ERUS

DISTA

L HUM

ERUS

DISTA

L RAD

IUS

SCAP

ULA

CALCAN

EUM &

TAL

US

DITAL

TIB

IA &

ANKL

E0

20

40

60

80

100

2010-11(N=327)

27%

12%

1%

9%

21%

12% 5

%

8%

13%17

%

12% 5

%

18

20%

18%

17%

OTHER PROCEDURES

IMPL

ANT

REMOVA

L

BONE

GRAFTI

NG

ILIZ

AROV

TENDON R

EPAI

R

BONE

MAR

ROW IN

JECTI

ON0

20406080

100120

2010-11(N=137)

19

AGEWISE DISTRIBUTION OF SURGERIES

0-3 yrs 4-18 yrs 19-60 yrs

> 60 yrs0

200

400

600

800

1000

1200

1400

1600

2011-12(N=1708)

2011-12(N=1708)

20

MONTHLY DISTRIBUTION OF SURGERIES

21

CRITICAL CARE ADMISSIONS

048

1216

2011-12(N=37)

2011-12(N=37)27%

41% 11

%4%

22

46%

CRITICAL CARE ADMISSIONS

DEATH =11 SHIFTED TO WARD=26

ADMISSIONS=37

23

ICU DEATHS DATA-2011-12S.NO AGE SEX DIAGNOSIS1 51 M MULTIPLE LONG BONE #

2 75 F INTERTROCHANTRIC FRACTURE

3 65 M PELVIC # WITH HEAD INJURY(frontal contusion)

4 47 M MULTIPLE LONG BONE# WITH CHEST TRAUMA

5 79 M INTERTROCHANTRIC FRACTURE

6 25 M MULTIPLE LONG BONE# WITH CHEST TRAUMA& HEAD INJURY

7 3 F PELVIC # WITH VASCULAR & ABD INJURY

8 63 M MULTIPLE LONG BONE# WITH CARDIOMYOPATHY

9 55 M PELVIS WITH SHAFT FEMUR #

10 26 M PELVIC #

11 27 M L3 # WITH ELBOW DISLOCATION

24

OPD REGISTRATIONS

OLD R

EGIS

TRAT

IONS

NEW R

EGIS

TRAT

IONS

0

2000

4000

6000

8000

10000

12000

2010-112011-12(N=12982)

57/opd

45/opd

25

93/opd 61/

opd

OPD PROCEDURES(MINOR)

DRESSI

NG

SUTU

RE REM

OVAL

EX F

IXAT

OR REM

OVAL

K-W

IRE

REMOVA

L

DEBRID

EMEN

T

OTHER

S

POP

PROCED

URES0

400

800

1200

1600

2000

2011-12(N=4843)

2011-12(N=4843)

26

Procedures : opd

dressing Suture removal

Ex fix removal K wire removal

debridement others total

Jan 102 87 8 9 2 3 211

Feb 80 103 1 3 1 5193

March 96 96 7 6 2 4211

April 80 84 9 4 1 2180

May 86 112 6 8 0 9221

June 99 71 2 5 2 8187

July 88 88 1 0 1 8186

August 111 113 6 5 4 7246

Sep 180 106 4 7 3 7307

Oct 217 140 6 16 2 11392

Nov 183 98 5 10 4 12312

Dec 187 110 9 12 4 6328

Total 1509 1208 64 64 26 822974

27

ACHIEVEMENTS

Highest number of pelvi-acetabular surgeries in India

(121 in 2011).

Total of 1708 surgeries:

Complex Intra-articular Fractures: 33% of surgeries

Compound Fractures: 26%

Latest principles of fracture management.

10 indexed publications involving Orthopaedics team in

2011.

28

Challenges ahead …..

Geriatric patients : silent epidemic on the rise! Establishment of geriatric trauma ward. Managing medical co-morbidities.

Need to increase bed capacity in wards Regretted patients (2124)

Dedicated 24 hour Ortho OT

29

Team (Orthopaedics)

• Senior Residents : 16

• Consultants : 4

• Assisted by :

Entire Trauma Centre!

30

THANK YOU………

Census: 2011-201231