WC hospital first to use ‘aggressive’ I-nails
By Vijay Mohan
Tribune News Service

CHANDIGARH, Nov 14 — Western Command Hospital, Chandi Mandir is the first hospital in the country to introduce a radical technique wherein the treatment time for battle casualties with orthopaedic injuries is not only drastically reduced but is also highly cost effective.

The Head of the hospital's Department of Orthopaedics, Lt-Col S.M. Bhatnagar, said that in the wake of Kargil operations, the hospital adopted an ''aggressive treatment'' stance where open wounds in cases involving fractures were treated immediately using the ''inter-locking nails'' (I-nails) technique.

Earlier, in such cases, open wounds were treated first and then fixation of broken bones undertaken. ''Delay while waiting for wounds to heal increased the probability of infection and other complications,'' said Lt-Col Bhatnagar, who along with Lt-Col H.C.Talan, has prepared a paper on managing orthopaedic injuries.

The I-nail technique, which was used on a large scale here for the first time during the treatment of casualties evacuated from the Kargil Sector, does away with the need for using a plaster cast. ''Aggressive treatment'' involves cleaning the wound of bone debries (debridment) as well as dead tissues, ensures that the wound is free of infection and goes in for primary bone fixation without delay.

Introduced in the Army in 1995 at Mumbai by Lt-Col Bhatnagar himself, the I-nail technique was used to treat war casualties for the fist time. ''Though I cannot comment whether the 'aggressive approach' has been adopted by other military hospitals, we were definitely the first to do so,'' he said. This system is also used by several western armies.

Doctors said that the I-nail technique enables a patient to move his joints and permits mobilisation within a week. Patients can start moving around with the help of crutches after six to eight days of undergoing K-pin treatment and can even put their weight on the affected limb — something which induces a lot of confidence in battle casualties.

Convectional plaster-cast treatment and using plates for healing broken bones, on the other hand, keep a patient bed-ridden for at least three months, besides causing stiffness in joints.

''Using I-nails is expensive than plaster casts, but when we take into account the overall factors involved, like expenses during hospital stay, manpower costs and other treatment sundries, the technique works out to be very cost-effective,'' Lt-Col Bhatnagar said. ''The complication rate is also very low in this technique. Besides, patients can be discharged in a relatively short time, making room for other casualties coming in — a factor which has to be considered during military operations,'' he added.

Of the 523 battle casualties of Operation Vijay received here, 264 were of orthopaedic injuries, which had increased the workload of the department by about 40 per cent. These included 84 cases of simple fractures and 70 cases of compound fractures.

Of the 80 cases which underwent reconstructive surgery here, there were 10 cases of fractures and 18 cases of bone fixation. One such example was a casualty where a gunshot injury resulted in a 6-inch wide wound, shattering the thigh bone. The bone was stabilised by using interlocking nails before tissue recovery was undertaken. The treatment also required skin and bone grafting to fill in the missing parts of the flesh and bone. I-nails had to be used as plate fixation in such cases is counter-productive and likely to to result in complications, including infection.

I-nails can be used only for large bones like those of the legs and upper arms. The 'aggressive approach', like soft tissue cover and primary fixation in open fracture after emergency wound debridement, was found to be highly satisfactory, though the quality of fixation in these cases can only be commented upon after prolonged follow-up.

Army doctors discuss battle casualties
Tribune News Service

CHANDIGARH, Nov 14 — Experience in managing battle casualties in the recent Kargil conflict and some recommendations in this regard were discussed by Army doctors on the concluding day of the symposium on Critical Care Update, organised by Command Hospital, Chandi Mandir, as part of its continuing medical education programme.

Armed Forces specialists shared their experiences in various disciplines like orthopaedics, neurosurgery, ophthalmology, ENT, reconstructive surgery, blood bank management and psychiatry.

After an overview of management of battle casualties by Col S.V. Soman, Orthopaedic and neurosurgical problems in battle fields were discussed by Lt Col H.C. Talan and Lt Col H.C. Pathak respectively, while treatment of ocular injuries was deliberated upon by Lt Col B.G.R. Kunjithai.

Management of battle casualties with abdominal injuries was explained by Lt Col A. Saha, while the topic of ENT injuries was dealt by Lt Col K.B. Singh. Col B.B. Dogra and Lt Col K.K. Lahiri elucidated various aspects of reconstructive surgery and management of blood and blood components during war.

A special guest symposium on liver transplantation discussed various aspects of transplantation as well as its current trends and future directions in India. The session was chaired by Brig H.S. Gill and Lt Col A.C. Anand, while Dr. S.K Acharya, Dr. G.K. Pande and Dr.P. Sahani, all three from All India Institute of Medical Sciences, New Delhi debated upon the need, requirements and feasibility of liver transplantation. The first successful liver transplantation in India was done at the Apollo Hospital, New Delhi in 1998.

A guest lecture on ventilator associated pneumonia was also delivered by Dr. Y.P. Batra, professor of anaesthesiology from the PGIMER.