Batter and Egg Yolk Make a Good Mutta (Egg) Dosa . But Why Treat Fractures With Them?

Hello and Welcome to Orthopaedics Made Simple , Making No Bones About It! And I am Naveen , Your Bone and joint Guy.

Even the greatest bone and joint surgeon  in the world cannot say "I Heal Fractures". That would be one big lie . The healing of any fracture is Nature's work. Period!

What am I trying to say? To keep it simple

Fracture . Now any break in the continuity of the bone , however small or big , is called a fracture. And bones are not some dry , dead structures. they are like any living organ and supplied with blood and nerves. So once the bone breaks the nerves that supply the outer cover of the bone called periosteum , immediately send signals to the brain in the form of pain. And the blood vessels rupture and blood accumulates. This is called fracture haematoma formation and is the first stage of fracture healing. So you can see that the fracture healing process starts right away.

The fracture haematoma has a lot of healing properties that helps in the formation of the soft tissue (callus) that converts into a hard tissue (bony callus) which then becomes bone and over a period of time that bone models into a normal bone completing the healing process.

So you can see that no man or machine is needed for fracture healing. Then what is the role of an Orthopaedician?

Now remember I have only been saying Fracture Healing is Nobody's Business , but fracture healing isn't the only aspect of patient care right? Healing happens once the fracture is stabilised or splinted but there are many conditions where one has to involve the bone and joint specialist.

Role of An Orthopaedic Surgeon

First it is in the management of open fractures known as Compound fractures where the orthopaedician's role is very very critical. These are fractures that are exposed to the outside and are prone for infections and delayed healing. These fractures could include small punctures to fractures where the entire soft tissue cover from skin to muscle can be torn apart. Washing the wound , keeping it clean , giving cover to the bone and then stabilising the fracture are some of the things that the orthopaedician needs to do. Sometimes the vessels can be damaged requiring a vascular surgeon. The skin loss could be extensive requiring a plastic surgeon's expertise to achieve cover without which healing cannot happen.

I only said bones start healing but they heal in an "as is where is" condition meaning if there is displacement , that would not be corrected. This could lead to deformity , difference in limb length and if fractures are around the joint do not heal in the correct position it could lead to reduced movement in that joint. So the next function of the orthopaedician is to see to it that the fractures heal in the right position.

Fractures heal , but they do take a considerable amount of time to do so and ideally during this time the fracture has to be immobilised and weight bearing is not allowed in the affected joint. This could mean being bed ridden for a considerable amount of time , loss of livelihood , other health problems like diabetes going out of control , bed sores , blood clots (DVT) among others and stiffness of the joints is very common. So the duty or responsibility of the orthopaedician is to get the patient on his or her feet as soon as possible and get the joint moving but making sure the fracture is stabilised and the bone union is on course. And not to forget a bed ridden patient is a burden to self and the family.

Finally in some cases the healing process takes more time than normal (Delayed Union) , sometimes the fracture unites in the wrong position (Malunion) , sometimes the fracture does not unite (Non Union) , the orthopaedician has to be called in to check out and set things right.

What does the Orthopaedician do?

Once you go to the orthopaedician with a suspected fracture , the first thing to be done will be splinting of the fracture and a painkiller will be given. If your vitals like blood pressure and pulse are alright you will be asked to get an X Ray done which would confirm the diagnosis.

Then depending on the fracture you will be treated as an out patient or be asked to get admitted. Simple fractures of the shaft that are not too displaced , especially in younger individuals and do not need prolonged immobilisation or bed rest are given a Plaster Cast and sent home and asked to review after a few days. Then again this is generalisation and is not applicable to all.

If the patient needs to get some procedure done like Wound Wash and Repair for Open fractures , fixation of fractures with rods , plates or screws , if there are signs of blood vessel or nerve damage or patients that need nursing care , they could be asked to get admitted. Each one of these is a separate blog post ,which I will talk to you in detail later.

Now coming to the core purpose of this blog . 

Where do the Traditional Bone Setters come in?

In India ,and also in other parts of the world traditional bone setters are very famous in dealing with fractures. In spite of the increase in number of hospitals , doctors and improvements in the medical field people still go to them. The reasons could be one or many of the following.

1) Fear of implants and foreign objects.
2) Faith in the spiritual powers of the bone setter.
3) Flexibility of traditional care setting. 
4) Financial cost of orthopaedic care in a hospital setting.
5) Familiarity with bone setter culture and lack of familiarity with orthopedic centers. 
6) Fear Mongering that doctors are bad.

What lets the bone setters survive?

They have to thank Nature and the Body's Own Healing Powers. Most fractures are simple ones that heal on their own. They would have healed if nothing was done to them also. So these bonesetters go tom tomming that it is because of their secret herbs and "recipes" that the bone healed.

The second reason is the ignorance of the fact that better results are possible if treated by modern orthopaedic methods . The patients going to these centres see the healing of the bone as the only goal , which would happen anyway. But they seem oblivious to the loss of time , loss of motion , loss of livelihood and loss of health.

The third reason is lack of legislative control and monitoring. The medical fraternity is hauled up even for a small minor expected complication and expected to give explanations or compensations but these bone setters are answerable to none. You do not even get a piece of paper from them and there is no proof of treatment also. Nearly impossible to question them for any complication or even get an explanation. And these people do not come under medical council or government regulation.

What Has to be Done:

The doctor community has to learn from these people. We have to question ourselves and introspect if we spend enough time with the patient , explain the condition , the various treatment options , the pro and cons of it and then let the patient make an informed decision. It is this lack of effort to communicate to the patient clearly and not giving the confidence to the patient that most of the times the patients land up there.

We all know what the traditional bone setters do ,especially the Puttur Kattu practionners , for undisplaced fractures. Some magic secret herb is rubbed on to the fracture site , some setting is done and the fracture is splinted with cloth which is strengthened using Dosa/Idly Batter and Egg. None of these items have been proven to be of any benefit in bone healing. So as doctors we should not insist on surgical fixation trying to convince the patients of the benefits of surgery. The patient need not be forced in to surgery and the doctor need be disappointed with the patient's decision. Instead the doctor should come forward and tell the patient that in case he or she doesn't want surgery , conservative methods like plaster or splinting can be done by the orthopaedician itself. There is no need to go to a bone setter. At least it would be done in accordance to modern scientific guidelines.

As a society there should be more awareness that the goal of orthopaedic treatment is to get the patient moving as fast as possible and ensuring bone healing at the same time. The benefits of this are tremendous medically and also financially. For instance a person being treated for a fracture by bone setters has to be away from work for at least two months. Now please calculate the loss of livelihood , the cost of frequent visits to the bone setter (sometimes as many as 8) and the cost of care taker. This will far exceed the cost of treatment by an orthopaedician in direct terms and I am not even calculating the indirect benefits of better and faster recovery.

Moreover , the bone setters sometimes ignore conditions like open injuries , nerve and blood vessel damage. These could lead to disastrous complications that could even result in the loss of either life or limb. Please please be aware and spread the message.

So my dear friends I would like to finish off by saying that Dosa Batter and Egg Yolk are needed to make Mutta Dosa , my favourite tiffen item and have no role in Bone Healing.  But trust the Orthopaedician to decide if Plaster of Paris or Performing Surgery is good for you. We at SCOT explain the condition in detail to the patient and leave the ultimate decision making to the patient.

Please visit www.Scot.com for more details.

And no other topic can emphasis my signing off slogan better. Keep Moving Always....Without Pain!