Fractures often require metallic implants inside the body for fixation and treatment. The implants help in fracture union and can be in the form of wires, plates, screws, or rods. Is it mandatory to get them removed, or can we have them inside our bodies for a lifetime? What is the best time to get these implants removed from our bodies?

This article will discuss five conditions in which we advise the patient on hardware/implant removal.

1.    Infection

In very few cases, the fracture site or the surgery site (they can be different, especially in nailing) may develop redness, swelling, and pain after the surgery. The patient may also have pus or watery discharge from the site. In these patients, first, we confirm the presence of infection. This can be done clinically if the signs are sure or through blood tests and tests of the pus/discharge from the wound. Usually, infection is treated through antibiotics, either as tablets or through injection. When inside the body, they travel through the blood, reach the area of infection, and kill the bacteria. The implant in the body is a non-living object with no blood supply. If we give antibiotics to these patients, they cannot reach the implant and, hence, cannot eliminate all the infections. The bacteria feel safe on the implant and start making a colony known as BIOFILM. We have to remove the implant and the biofilm to treat infection on the implant. We prioritize the treatment of infection. In the presence of infection, the fracture does not unite. So infection is one condition for which we advise implant removal.

2.    Implant inside joint

Sometimes, the implant may enter the joint cavity in fractures around the joint. This can also happen later if the implant’s position gets changed due to various factors. If the implant is inside the joint, the patient has pain in the joint, and the movements are painful and restricted. This can be diagnosed on radiographs of the joint. In case of multiple plates/screws/wires, we get an exceptional CT done to check precisely which part of the implant is inside the joint. The implant inside the joint must be removed as soon as possible to prevent damage to the joint. In patients where the fracture is not fully healed, we must strike a balance between implant removal and adequate fixation strength to achieve bone union. We try to remove only the screws/wires which are inside the joint and leave the rest to help unite the fracture.

3.    Prominent Implant

Certain areas in our body, such as the wrists and ankles, have fragile tissue over the bones. Sometimes, there is just a skin cover. If fractures around these areas are treated using plates and screws, they can get prominent over time. Prominent implants can also irritate the patient. In patients where nailing is done, the nail tip can irritate. In these patients, we advise implant removal after the fracture has been united. The implant removal can be a total or only the prominent part.

4.    Broken Implant

A broken implant inside the body is another indication of their removal. This is advised even after the fracture is united. Sometimes, the fracture takes longer to unite, and the implant cannot tolerate the stress for extended periods. It can also happen due to substandard quality of the implant, where the implant may have impurities, and where the company does not do strength testing of the implant. Good-quality implants can also break, but that probability is lower.

5.    Patient’s Will

This is the most common indication we encounter in our practice. The patient wants to get the implant removed just because it is a foreign body. The fracture is united, and the implant causes no problems for the patient.

Can you keep the implant lifelong in your body?

If your bones are nicely united and the implant is not troubling you, then yes, you can keep it. (Consult your surgeon first.)

But keep this in mind….

With time, many implants, along with their instruments, get discontinued. You may be getting the best implant available right now, but 15-20 years in the future (maybe due to medical reasons), the implant may get discontinued. If you require implant removal in the future and if the implant is discontinued, the surgery will be done with alternate instruments. The success of surgery then is reduced.

Are there any implants that get absorbed in the body?

Bio-absorbable implants are available, which get absorbed in the body and are replaced by bone over are primarily available as screws and wires and are used in the surgery of tendons and ligaments.

Despite its name, Vitamin D is not a vitamin. It is a hormone that promotes calcium absorption in the body. It is present in very few foods. Our body also produces Vitamin D in the skin when exposed to sunlight.

Risk Factors for Deficiency

·Diet – Not having enough Vitamin D-rich foods

·Lifestyle – People who have less exposure to sunlight, remain ill, or lack outdoor spaces are at risk of developing Vitamin D deficiency. Excess sunscreen use is also a risk factor.

·Pollution – Highly polluted areas block UVB rays, without which the skin cannot produce vitamin D.

·Age – Increasing age decreases the body’s ability to produce Vitamin D.

·People with darker skin need more sunlight exposure to produce Vitamin D.

·Gut diseases such as Crohn’s, celiac disease, etc. These decrease the absorption of Vitamin D from the diet.

·Smoking

·BMI greater than 30

·Kidney and liver diseases

Symptoms

·Getting sick often

Vitamin D makes our immune system strong. Lower levels make the immune system weak, increasing the risk of infections.

·Bone pains, Decreased Bone density

Since Vitamin D increases calcium absorption, its deficiency causes lower calcium levels in the body. This makes them weak and predisposes them to fractures.

Vitamin D deficiency in children causes rickets, and in adults, it causes osteomalacia and osteoporosis. Older people with bone loss need to take Vitamin D with their calcium supplements.

·Muscle pains

Constant and recurrent muscular pain is a widespread and undiagnosed manifestation of Vitamin D deficiency.

·Impaired wound healing

·Hair loss

BOTTOM LINE

Vitamin D deficiency is widespread, and most people are unaware of it!

Prevention

·Increased consumption of Vitamin D-rich foods such as cereals, fortified dairy products, meats, fish, and eggs.

·Increasing sunlight exposure

Although there is no definite time advised, it is said that 15-20 minutes of exposure 2-3 times a week increases the body’s production of Vitamin D. During this exposure, sunscreen should not be used, and one should receive sunlight directly and not through a window.

·You should increase your physical activity, such as cycling, jogging, or walking, decrease your weight, and increase your sunlight exposure.

·Getting treatment for other medical conditions.

·If your Vitamin D levels do not reach the expected levels, you should take supplements to keep Vitamin D in the normal range.

(The Unknown Pandemic)

A.k.a.

Whatsapp-itis

Texting Thumb

Gamer’s thumb

In today’s fast world our smartphones are our constant companions. They are used in every sphere of our life. From sending texts, writing e-mails, managing money to scrolling Facebook, swiping Tinder, gaming, our phone is always in our hands.

One may think that these are very simple tasks but for every activity the tendons of our thumb glide in and out of tunnels, the ligaments contact and relax and the thumb goes through a whole lot of movement. These prolonged and repetitive movements can result in tendon inflammation and injury, a phenomenon known as Repetitive Stress Injury (RSI). Since an average person spends several hours on his/her phone, the magnitude of injury can be very high.

The individual usually complains of pain and difficulty in moving the thumb. The pain can also radiate to the wrist and forearm. Some patients also develop swelling at the base of the thumb.

Medically this condition comprises of tendinitis +/- De Quervain’s tenosynovitis.

Prevention

Since ‘prevention is better than cure’, start the following today!

Limit your smartphone usage.

Keep your wrists straight while holding the phone.

Type shorter texts, use abbreviations if possible.

Using autocorrect decreases the amount of typing to be done.

‘Speech to text’ apps relieve your hand altogether.

Avoid using your phone for more than 15-20 minutes at a stretch.

Keep switching hands while using your phone.

Perform wrist and finger stretching daily.

Treatment

The first and most important step of treatment is to avoid over-exerting the thumb.  You can undergo a ‘Smartphone detox’ or use the other hand for using the phone.

Initial treatment consists of a course of anti-inflammatory medicines and regular ice fomentation. If the symptoms are severe and if swelling is present, immobilization with either a splint or cast may be required.

If symptoms don’t resolve, a low dose steroid injection in the thumb may be considered.

Surgical intervention is required in the minority of patients who don’t improve with all the other intervention.

Uric acid is a waste product that forms when body breaks down chemicals called purines. Purines are natural chemicals found in the cells of the body as well as foods. Most of the uric acid dissolves in the blood and passes through the kidneys. The kidneys filter it out and the uric acid leaves the body in urine.

It is normal to have low levels of uric acid in the blood. Uric acid levels may get high due to one of the following reasons:

1. The person eats foods that are high in purines.

2. The kidneys are not able to flush out uric acid from the blood adequately.

3. The body is producing too much uric acid.

This leads to a condition called Hyperuricemia. It can lead to formation of uric acid crystals which can form kidney stones. These crystals can also settle in the joints and cause a condition known as Gout, a very painful arthritis. Untreated high uric acid levels can lead to permanent bone, joint and tissue damage, kidney disease and heart disease.

Gout

Gout, or Gouty Arthritis, is common in people with high uric acid levels. It is characterized by sudden, severe attacks of pain, swelling, redness in the joints. The most common joint involved in the base of big toe in the foot but other joints can also get involved.

What are the symptoms of Gout?

The signs and symptoms of gout mostly occur suddenly and commonly at night. The symptoms may flare up occasionally and on other times may resolve.

Intense joint pain

Gout usually affects the big toe, but can affect other joints as well. Other commonly affected joints include knees, ankles, elbows, wrists and fingers. The pain is severe within the first 12-24 hours.

Joint Discomfort

After the severe pain subsides, some amount of joint discomfort may last for a few days to a few weeks. Repeated gout attacks may last longer and may affect more joints.

Redness

The affected joints become red, warm and inflamed.

Restricted Movements

As the joints get damaged, its movements may get reduced.

Risk factors for Gout

Since gout develops due to high levels of uric acid in the body, the risk factors include all the conditions that increase uric acid levels.

Diet

Having foods rich in purines will lead to greater production of uric acid by the body.

Foods causing high uric acid levels include:

Alcoholic beverages

Meats such as red meat, lamb, pork

Seafood and shellfish including anchovies, sardines etc.

Vegetables such as asparagus, spinach, mushrooms, cauliflower, kidney beans.

Age and sex

Men have a higher level of uric acid level but women reach the same level after menopause. Men are also likely to develop gout earlier.

Family History

If other members of your family have gout, you’re more likely to develop it.

Medical conditions

Medical conditions such as untreated high blood pressure, chronic diseases such as diabetes, metabolic syndromes, heart and kidney diseases.

Medications

Certain medications such as thiazide diuretics (for hypertension), low dose aspirin, anti-rejection drugs after organ transplant, chemotherapy etc.

Recent surgery or trauma

Obesity

When to see a doctor?

If you develop sudden, intense pain in your joints, especially great toe, consult a doctor. Also if your joint is red and tender with fever, consult a doctor immediately to rule out an infection.

How to diagnose Gout?

Blood test

A simple blood test to measure uric acid level is often the first line of investigation. Sometimes it is misleading as some people have high uric acid levels but no symptoms of gout while some people have symptoms but their uric acid level is not that high.

X-rays

X-rays are important to check the joint surfaces, presence or absence of arthritis. In case of a known case of gout, joint destruction may also be seen on X-rays.

Joint fluid analysis

If your joint is swollen then some joint fluid may be aspirated using a needle and sent for examination under the microscope. In case of gout, urate crystals will be seen.

How can I reduce uric acid in my body?

How can I reduce uric acid in my body?

Most people can reduce uric acid with diet and lifestyle changes. Lowering the uric acid levels reduces the risk of gout and prevents flares in people already diagnosed with the condition.

1. Drink plenty of fluids

2. Limit purine rich foods

Since uric acid is produced from purines, limiting purine rich foods reduces uric acid production. Some purine rich foods are good for health, so it is advisable to reduce their intake rather than avoiding them altogether.

Foods with high purine content include:

Alcohol

Sugary foods and beverages

Seafood and shellfish

High fat foods

Most meats including ham, pork, bacon, red meat.

3. Eat more low-purine foods

Switching to low purine foods will lead to lower production of uric acid and hence lower levels in the body. Foods with low purine content include:

Low fat and fat free dairy products

Coffee

Most fruits and vegetables

Most nuts

It is not necessary that dietary changes alone will get rid of gout. It is also important to note that not everyone who eats a high purine diet develops gout. Other factors such as genetics, age, sex also play a role.

4. Maintain body weight

Since obesity is a risk factor for gout, reducing and maintaining a healthy body weight reduces the risk of gout. Being overweight can also cause high blood pressure and cholesterol levels which are individual risk factors for elevating uric acid levels.

If you plan to reduce your weight, it should be done slowly and gradually with a plan. Rapid weight loss also increases uric acid levels.

5. Avoid alcohol and sugary drinks

High consumption of both alcohol and sugary drinks – sodas, sweetened juices increase uric acid levels in the body. They also lead to potential weight gain which further increases the risk.

6. Drink Coffee

Some research has indicated that drinking coffee decreases the risk of developing gout and the risk decreased as the consumption increased. Since drinking too much coffee may be harmful for other body systems, it should be consumed in moderation.

7. Avoid certain medications

Certain medications such as diuretics, low dose aspirin and certain immunosuppressants raise uric acid levels in the body. Since these drugs were started to you for some essential health benefit, you should contact your doctor regarding them.

What is Tennis Elbow? 6 Tips to prevent Tennis Elbow

Tennis elbow is also known as lateral elbow pain or Lateral Epicondylitis. It is not necessarily related to tennis but can occur when the elbow is overloaded due to repetitive motions of the wrist and arm.

What is Tennis elbow?

Tennis elbow is a condition that causes pain around the outside of the elbow. It usually happens after overuse or repeated action of the muscles of the forearm which are near the elbow joint.

What causes Tennis elbow?

Contrary to the name, tennis causes only a minority of cases of tennis elbow. It can also result from other sports such as squash, cricket, fencing, weight lifting.

It also affects people with jobs or hobbies that require repetitive arm movements or gripping such as typing, carpentry, painting, knitting etc.

It is caused by overusing the muscles attached to your elbow and which are used to straighten your wrist. If these muscles are overused, tiny tears and inflammation develop in them near your elbow which causes pain and discomfort.

What are the symptoms of Tennis Elbow?

• Pain in the elbow which may be mild at first but becomes worse gradually. Pain may extend to the wrist and sometimes to the fingers also.
• Pain while lifting objects, shaking hands, squeezing an object, opening doors, jars and bottles.
• Weak hand grip

How to treat Tennis Elbow?

• Most cases of Tennis Elbow are treated successfully without surgery.
• Resting the elbow – It is very important as the break in activity allows the tears to heal. Avoid activities that strain the affected muscles and tendons. Alternatively, you may be able to change the way you do these activities so they do not cause any pain.
• Icing the elbow to reduce pain and inflammation. It should be done for 10-15 minutes 3-4 times in a day.
• Strapping or bracing – Supporting the area helps relieve pressure on the area and realigns the muscle fibers.
• Anti-inflammatory medications help with the pain and swelling. However, they may have side effects such as gastritis.
• Newer modalities such as Platelet Rich Plasma (PRP) Injection are effective in the treatment of Tennis elbow.

Platelet Rich Plasma (PRP) Injection

PRP is a promising and safe treatment for patients with tennis elbow with good outcomes. PRP treated patients report improvement in pain and elbow function. The side effects of the treatment are minimal since it uses the patient’s own platelets. It is recommended when the initial management fails to improve the symptoms.  

𝐖𝐡𝐚𝐭 𝐢𝐬 𝐏𝐥𝐚𝐭𝐞𝐥𝐞𝐭 𝐫𝐢𝐜𝐡 𝐩𝐥𝐚𝐬𝐦𝐚?

Platelet rich plasma therapy uses the regenerative ability and natural growth factors of platelets to heal tissues. Blood contains mainly a liquid called plasma and small solid components (red cells, white cells and platelets). The platelets are best known for their importance in blood clotting but they also contain hundreds of proteins called growth factors that play a very important role in healing of injuries.

PRP is plasma with platelet concentration much more than what is found in blood. Hence the concentration of growth factors is also greater.

𝐇𝐨𝐰 𝐢𝐬 𝐏𝐑𝐏 𝐩𝐫𝐞𝐩𝐚𝐫𝐞𝐝?

Blood is drawn from the patient in special tubes. These tubes are kept in a machine which separates the platelet rich plasma from the rest of the blood. These activated platelets are then injected directly into your injured or diseases body tissue. This releases growth factors that stimulate and increase the number of reparative cells your body produces.

6 Tips to prevent Tennis elbow

1. Stop doing the activities that cause pain, or find an alternative way that does not cause pain or stress.

2. Avoid using your wrist and your elbow more than your arm and the shoulder.

3. Warm up properly and gently stretch your muscles before working out and before playing a sport.

4. Get coaching advice for racquet sports to improve your technique.

5. Do exercise to increase the strength of your forearm muscles.

6. Use lighter weight tools and sports equipment with a larger grip size – this reduces the strain on the tendons.