JPNATC orthopedics aduit -2012

1. Department of orthopedics
Census - 2012
JPNATC,AIIMS

2. ORTHOPEDIC TEAM
• Consultants : 4
• Senior Residents : 22
• Junior residents : 4+2
• Beds : 46
• Assisted by :
Entire Trauma Centre!

4. ED-ORTHO CONSULTATIONS
0
10000
20000
30000
40000
50000
60000
TOTAL PATIENTS
IN E/D
RED AREA YELLOW AREA GREEN AREA
2011 2012
24%
7% 9%
84%
6%
10%
84%
4
TOTAL ATTENDENCE
ED
TOTAL ORTHO
CONSULTATIONS
RED AREA
CONSULTATIONS
YELLOW AREA
CONSULTATIONS
GREEN AREA
CONSULTATIONS
2011 42539 34738 2343 3171 29224
2012 55698 42974 2756 4507 35711

5. Emergency Department
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
TOTAL ORTHO
CONSULTATIONS
DISCHARGES TRANSFER OUT
2010
2011
2012
2%
13%
2010 2011 2012
ORTHO CONSULT 33076 34738 42974
DISCHARGES 28800 29152 35312
TRANSFER-OUT 2304 2124 1458
17%

6. ADMISSIONS-2012
0
50
100
150
200
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
2011 (N=1076+225)
2012 (N=1580)
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2011 88 65 71 73 61 65 97 118 112 121 111 94
2012 115 111 128 134 154 133 154 139 148 130 121 113

7. ADMISSIONS-2012
0
200
400
600
800
1000
1200
1400
1600
2010(N=972)
2011(N=1076+225)
2012(N=1580)
1580
(29/WK)
972
(19/wk)
1301
(25/wk)
7
26%

8. DISCHARGES-2012
0
50
100
150
200
JAN
FEB
MARCH
APRL
MAY
JUNE
JULY
AUG
SEP
OCT
NOV
DEC
2011 (N=1052)
2012 (N=1566)
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2011 63 62 73 76 61 71 101 117 116 114 109 89
2012 106 119 132 127 153 136 149 129 151 122 124 118

9. DISCHARGES-2012
0
200
400
600
800
1000
1200
1400
1600
2010 (N=964)
2011 (N=1052)
2012 (N=1566)
964
(18/WK)
1052
(20/WK)
1566
(29/WK)
25%

10. ADMISSION/DISCHARGES/DEATH
0
500
1000
1500
2000
2010
2011
2012
ADMISSIONS
DISCHARGES
DEATH
26%
25%
ADMISSIONS DISCHARGES DEATH
2010 972 964 13(1.3%)
2011 1076 1052 12(1.1%)
2012 1580 1566 18(1.1%)

11. TRANSFER OUT cases-2012
2012 (N=1458)
ORTHO(1397)
MIXED(47)
MAIN AIIMS(4)
3% 1%
96%

12. REGRET, NO BED AVAILABLE
0
200
400
600
800
1000
1200
DIAPHYSEAL # SMALL BONE
#
ARTICULAR # COMPOUND # SPINE &
PELVIS
2010 (N=2304)
2011 (N=2124)
2012 (N=1458)
47%
35% 35%
30%
10%
5%10%
5%6%
11%
2% 1% 1%
53
%
2010 2011 2012
DIAPHYSEAL# 1116 1126 692
SMALL BONE # 792 749 435
ARTICULAR# 252 125 148
COMPOUND # 108 98 165
SPINE &PELVIS 36 26 18
48%53%

13. CRITICAL CARE ADMISSIONS

14. CRITICAL CARE ADMISSIONS-2012
0
5
10
15
20
25
30
2011 (N=37)
2012 (N=74)27% 15%
51%35%
11%
26%
11%
24%
2011(N=37) 2012(N=74)
MULTIPLE
LONG BONES
10 11
PELVIS/CHEST
/ABD
19 26
SPINE 4 19
GERIATRIC 4 18

15. CRITICAL CARE ADMISSIONS-2012
ORTHO(74)
MIXED(121)
62%
DEATH =18 (24%) SHIFTED TO WARD=56 (76%)
ORTHO ADMISSIONS=74
38%

16. ICU DEATHS DATA(AGE 15-60)-2012
SNO AGE SEX DIAGNOSIS DIED ON DAY CAUSE OF DEATH
1 32 M B/L; A/K ,AMPUT:LEFT A/E AMPUT POD1 HYPO SHOCK/ACIDOSIS
2 25 M B/L ;A/ K ,AMPUT/ABD INJURY POD 1 HYPO SHOCK/ACIDOSIS
3 35 M B/L ;A/ K, AMPUT/ABD INJURY POD 1 HYPO SHOCK/ACIDOSIS
4 32 F B/L; A /K AMPUT/PELVIS POD 1 HYPO SHOCK/ACIDOSIS
5 41 M POLYTRAUMA/PELVIS/ABD/CHEST DAY 3 MET ACIDOSIS
6 30 M PEVIS/MULTIPLE LONG # 2 WEEKS VENT ILATER ASSOC
PNEUMONIA/ARDS/SEPSIS
7 42 F PELVIS/SPINE/CHEST TRAUMA 6 DAYS VENTILATOR ASSOC
PNEUMONIA/ARDS/SEPSIS
8 38 M POLY TRAUMA DAY 4 ?FAT EMBOLISM
9 24 M C4# QUARIPARESIS DAY 2 CARD/RESP ARREST
10 32 M C5C6 DISLOCATION,QUADRI DAY 3 CARD/RESP ARREST

17. ICU DEATHS DATA(AGE >60)-2012
S.
N
O
AGE SEX DIAGNOSIS DIED ON
DAY
CAUSE OF DEATH
11 75 F INTER TROCH FRACTURE/DM/HT/IHD 12 IHD/THROMBOEMBOLISM
12 65 M C7 # QUADRIPARESIS/HT 2 CARD/RESP ARREST
13 73 M C5# QUADRIPLEGIA POD 20 ARDS/SEPTIC SHOCK
14 87 M INTER TROCH #/DM/HT/IHD POD 2 CARD/RESP ARREST
15 72 M DISTAL TIBIA #/DM/HT 15 ?THROMBOEMBOLISM
16 80 M INTER TROC #/DM/HT/IHD POD 5 CARD/RESP ARREST
17 90 F NECK FEMUR/IHD/DM/HT POD 6 CARD/RESP ARREST
18 75 M INTER TROC #/HT/IHD POD3 CARD/RESP ARREST

18. OPD CENSUS-2012

19. OPD CENSUS-2012
TOTAL OPD REGISTRATIONS 2012(N=31306)
ORTHOPEDICS(N=17912)
SURGERY(N=7263)
NEURO SURGERY(N=6131)
23% 57%
20%

20. OPD REGISTRATIONS
0
5000
10000
15000
OLD REGISTRATIONS NEW REGISTRATIONS
2010 (N=15933)
2011 (N=12982)
2012 (N=17912)
39%
20
2010 2011 2012
OLD REG 9645 7235 7622
NEW REG 6294 5747 10290
MON/TUES AVERAGE 96 PATIENTS/OPD
WED/THUR AVERAGE 47 PATIENTS/OPD
61%
36% 42%
44%
58%

21. OPD - MINOR PROCEDURES

22. OPD PROCEDURES(MINOR)
0
1000
2000
3000
4000
5000
6000
7000
8000
2011 (N=7259)
2012 (N=12318)
24%
17%
17%
1% 0.8%
4%3%
55%
22
2011(N=7259) 2012(N=12318)
DRESSING 1609 2929
SUTURE REMOVAL 1285 2147
EX FIX REMOVAL 64 72
K WIRE REMOVAL 84 104
DEBRIDEMENT 46 7
OTHERS 282 342
POP PROCEDURES 3869 6717
23%
1%1%
1%0.2%
53%

23. Procedures : opd-2012
DRESSING SUTURE
REMOVAL
EX FIX
REMOVAL
K WIRE
/SCREW
REMOVAL
DEBRIDEM
ENT
OTHERS POP
PROCED
JAN 250 177 1 07 - 14 666
FEB 178 136 1 12 1 20 554
MARCH 215 216 4 10 3 34 586
APRIL 185 184 8 7 - 31 542
MAY 242 243 5 10 - 40 502
JUNE 185 129 10 11 - 37 596
JULY 325 243 9 15 1 30 545
AUGUST 249 219 17 06 - 27 519
SEP 255 129 7 04 - 25 546
OCT 310 210 8 06 2 34 552
NOV 276 148 8 08 - 15 532
DEC 259 113 4 08 - 35 577
TOTAL 2929 2147 72 104 7 342 6717

24. Procedures : opd
DRESSING(24%)
SUTURE REOMAL(17%)
EX FIX REMOVAL(0.3%)
K WIRE/SCREW
REMOVAL(0.6%)
DEBRIDEMENT(0.1%)
OTHERS(3%)
POP PROCEDURES(55%)
55%
24%
17%
PROCEDURES (N=12318)

25. Operation theatre

26. SURGERIES MONTHLY CALENDER 2012
0
50
100
150
200
250
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2012 (N=2197)
2011(N=1708)

27. ROUTINE/EMERGENCY CASES
0
200
400
600
800
1000
1200
1400
1600
2011(N=1708) 2012(N=2197)
ROUTINE CASES
EMERGENCY CASES29%
28%
71%
72%

28. DEMOGRAPHIC PROFILE

29. DEMOGRAPHIC PROFILE
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0-3 yrs 4-18 yrs 19-60 yrs > 60 yrs
2011 (N=1708)
2012 (N=2197)
1%
6%
84%
9%
1%
81%
29
9% 9%

30. SEX DISTRIBUTION
SEX DISTRIBUTION(N=2197)
MALES (N=1775)
FEMALE(N=422)
81%
19%

31. SURGERIES
AXIAL SKELETON
APPENDICULAR SKELETON
2010 (N=163)
2011 (N=191)
2012 (N=219)
2010 (N=1093)
2011 (N=1517)
2012 (N=1978)

32. SPINE

33. SPINE SURGERIES
0
10
20
30
40
50
60
70
ANTERIOR APPROACH POSTERIOR APPROACH DISCECTOMY
2010 (N=48)
2011 (N=70)
2012 (N=82)
60%
53%
2010(N=48) 2011(N=70) 2012(N=82)
ANTERIOR APPROACH 15 29 12
POSTERIOR APPROACH 29 37 64
DISCECTOMY 4 4 6
31%
41%
15%
78%
9% 6%
7%

34. PELVI-ACETABULAR FRACTURES

35. PELVI-ACETABULAR FRACTURES
0
10
20
30
40
50
60
70
80
90
ANTERIOR APPROACH POSTERIOR APPROACH
2010 (N=115)
2011 (N=121)
2012 (N=137)
42%
67%
47%
2010(N=115) 2011(N=121) 2012(N=137)
ANTERIOR APPROACH 48 83 65
POSTERIOR APPROACH 67 38 72
58%
33%
53%

36. LONG BONE - FEMUR

37. FEMUR SURGERIES
0
50
100
150
200
250
300
350
PROX FEMUR IL NAILING DISTAL FEMUR HRA/THR
2010 (N=308)
2011 (N=379)
2012 (N=604)13%
53%
42%
37
2010(N=308) 2011(N=379) 2012(N=604)
PROX FEMUR 81 163 322
IL NAILING 130 118 169
DISTAL FEMUR 87 84 80
HRA/THR 10 14 33
26%
43%
31%
28%
28%22%
4% 4%
6%

38. LEG BONES

39. LEG AND FOOT
0
10
20
30
40
50
60
70
80
90
PROX
TIBIA(I/A)
NAILING DISTAL TIBIA
& ANKLE
TALUS CALCANEUM
2010 (N=191)
2011 (N=253)
2012 (N=268)
8%
2010(N=191) 2011(N=253) 2012 (N=268)
PROX TIBIA(I/A) 54 78 76
NAILING 69 68 79
DISTAL TIBIA&ANKLE 43 82 82
TALUS 5 4 5
CALCANEUM 20 21 26
28%
31%28%
36%
27%
29%
23%
32%31%
3%2% 2%
10%
10%

40. UPPER LIMB TRAUMA

41. UPPER LIMB TRAUMA
0
20
40
60
80
100
120
PROX
HUMERUS
SHAFT DISTAL
HUMERUS
FOREARM DISTAL
RADIUS
2010 (N=226)
2011 (N=333)
2012 (N=263)
41
2010 (N=226) 2011 (N=333) 2012 (N=263)
PROX HUMERUS 40 42 42
SHAFT 30 51 38
DISTAL HUMERUS 41 92 69
FOREARM 97 90 67
DISTAL RADIUS 18 58 47
18%13%
16%
13%
15%
14%18%
27%
26%
43%27%
25%
8%
18%
19%

42. COMPOUND FRACTURES

43. COMPOUND FRACTURE PROCEDURES
0
50
100
150
200
DEBRIDEMENT DEBRIDEMENT
& EX. FIX
AMPUTATION DEBRIDEMRNT
& DEFINITIVE
FIXATION
2010 (N=397)
2011 (N=374)
2012 (N=327)
24%
46%
43
2010(N=397) 2011(N=374) 2012(N=327)
DEBRIDEMENT 182 164 161
DEB+EX FIXATER 134 127 80
AMPUTATION 75 71 77
DEB+DEFENITIVE
FIXATION
6 12 9
44%49%
34%34%
19%19%24%
1% 3% 3%

44. Arthroscopy

45. ARTHrOSCOPY
0
5
10
15
20
25
30
35
40
45
50
KNEE SHOULDER
2010 (N=54)
2011 (N=42)
2012 (N=45)
85%
81% 78%
15% 19% 22%

46. COMPLEX INTRAARTICULAR FRACTURES
(EXCLUDING PELVIS & ACETABULUM)

47. COMPLEX INTRAARTICULAR FRACTURES
(EXCLUDING PELVIS & ACETABULUM)
0
10
20
30
40
50
60
70
80
90
100
2010 (N=327)
2011 (N=466)
2012 (N=429)
8% 5% 7%
13%
18% 19%
47
2010(N=327) 2011(N=466) 2012(N=429)
DISTAL FEMUR 87 84 80
PROX TIBIA 69 78 76
PROX HUMERUS 40 42 42
DISTAL HUMERUS 41 92 69
DISTAL RADIUS 18 58 47
SCAPULA 4 5 6
CALCANEUM AND TALUS 25 25 31
DISTAL TIBIA AND ANKLE 43 82 82
27%18%
17%
21%
17%18%
12%9%9%12%
20%
16%
6%
12%
12%
1% 1% 1%

48. OTHER FRACTURES
0
10
20
30
40
50
60
HAND FOOT PATELLA CLAVICLE
2010 (N=119)
2011 (N=105)
2012 (N=106)
2010(N=119) 2011(N=105) 2012(N=106)
HAND 52 44 35
FOOT 37 29 18
PATELLA 25 28 48
CLAVICLE 5 4 5
44%
42%
33%
31%
28%
17%
21%
27%
45%
4%3% 5%

49. OTHER PROCEDURES
0
20
40
60
80
100
120
140
160
2010 (N=137)
2011 (N=114)
2012 (N=224)
2010(N=137) 2011(N=114) 2012(N=224)
IMPLANT REMOVAL 103 65 145
BONE GRAFTING 15 18 29
ILLIZAROV 12 11 15
TENDON REPAIR 5 13 9
BM INJECTON 2 7 11
PRPP INJECTION 0 0 15
75%
57%
64%
11%
16%
13%
9%10%
7%
4%11%
4% 1%
6%
5% 7%

50. CWG –OT CALENDER 2012
0
5
10
15
20
25
CASES

51. CASES IN CWG 0.T
CASES(N=177) FRACTURE
FIXATION(N=62)
IMPLANT
REMOVAL(N=50)
DEBRIDEMENT(N=14)
STSG/FLAP(N=13)
MANIPULATION UNDER
ANESTHESIA(N=12)
IMPLANT REVISION(N=9)
BONE GARFTING(N=9)
REVISION
AMPUTATION(N=5)
ARTHOSCOPY(N=2)
35%
3.5%
1%0.5%
28%
8%
7.5%
7%
5%
3%

52. ACHIEVEMENTS….
• HIGHEST NUMBER OF PELVI-ACETABULAR SURGERIES IN INDIA (137 IN 2012).
• TOTAL OF SURGERIES:
– COMPLEX INTRA-ARTICULAR FRACTURES: 43% OF SURGERIES
• LATEST PRINCIPLES OF FRACTURE MANAGEMENT.
• VARIOUS RESEARCH WORK IN DIFFERENT TOPICS STARTED IN 2012
• GOLD MEDAL IN IOACON 2012-CHENNAI FOR TOPIC “BIOLOGICAL FIXATION OF
SUBTROCHANTERIC FRACTURES WITH PROXIMAL FEMORAL LOCKING PLATES”
• 2 ND PRIZE IN POSTER PRESENTATION IN TRAUMA 2012 FOR TOPIC” AUTOLOGOUS PRPP
INJECTION IN WOUND HEALING OF OPEN FRACTURES-A REGENERATIVE THERAPY”
• 8 INDEXED PUBLICATIONS INVOLVING ORTHOPAEDICS TEAM IN 2012.
52

53. CHAllENgES AHEAd …..

54. 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 (1458)
DEDICATED 24 HOUR ORTHO OT,
--routine(72%)/emergency(28%)
TO INCREASE THE OPD TIMINGS/OPD ROOMS
--57% opd patients
ORTHO REGISTRY