The Bangkok Orthopedic Center has both the specialists and the technology required to effectively treat all manner of bone and joint injuries.
(1888PressRelease) October 22, 2011 - From complicated fractures and other severe conditions, to deep wounds with exposed bone (known as 'open fractures') to multiple fractures - with revolutionary treatments like minimally invasive plate osteoporosis (MIPO) surgery that result in fewer complications and a better quality of life.
Our comprehensive multidisciplinary medical team includes paramedics, doctors and nurses. The physicians at the center are highly experienced in their areas of specialization, with orthopedic trauma surgeons dedicated to the treatment of bone and joint fracture and dislocation utilizing both surgical and non-surgical procedures. Patient care begins at the accident site and continues during transfer to the Bangkok Hospital ER.
The center also receives patients with a variety of complications who are referred from other institutions for re-evaluation and correction, for example, cases where broken bones fail to mend or heal in a deformed position, and fractures related to osteoporosis and cancer.
Dr Suthorn Bavonratanavech, the senior director of Bangkok Orthopedic Center and a renowned orthopedic trauma surgeon, has been on the leading edge of treatment advancements for broken bones for more than 30 years. He began his training and study in the field of trauma and musculoskeletal surgery in 1978 in Davos, Switzerland, with the AO Group, which had been established in 1958 by a group of Swiss surgeons and went on to international renown, passing the AO principles and surgical techniques on to the community of orthopedic surgeons worldwide, and ultimately creating the AO Foundation in 1984.
Dr Suthorn is himself a pioneer in the field of fractured bone treatment. In the early days before the science of treating and healing bone fractures had been fully established in Thailand, complications, and even permanent disability, was commonplace. Working with the AO Foundation, Dr Suthorn became the first doctor in the country to organize a course curriculum in trauma and musculoskeletal surgical techniques for the new generation surgeons. That first course was conducted in 1985 and has continued for more than 28 years.
Today, many of the orthopedic trauma surgeons who received their early training in one of Dr Suthorn's courses are now practicing in hospitals across the country, and the doctor regularly organizes regional AO-sponsored courses for orthopedic surgeons throughout Asia. By now, Dr Suthorn is held in such high regard in the worldwide community of orthopedic surgeons that he was elected Pre-President-Elect of the AO Foundation in July 2011, the first Asian doctor ever to hold this position.
Dr Suthorn views the traffic accident as a major global problem. It is clearly the cause of most bone fracture cases, particularly in countries where driving discipline does not receive much attention. Thailand, for example, has extremely high traffic fatality numbers: in 2009, 44,000 people died in road accidents, and many suffered injuries like broken bones. If not properly treated, these injuries, which often occur in the working years, can lead to disability, which means that the country loses valuable members of the workforce and families lose a breadwinner.
Bone fractures can result from work-related accidents and sports injuries as well. They are also occurring increasingly among the elderly, whose bone quality can be so compromised and fragile that a simple fall can result in fractures to various parts of the body like the hip or spine.
If an accident is serious enough, the injury can damage blood vessels, muscle and adjacent nerve tissue, or cause a deep wound with exposed bone or multiple fractures. An especially violent accident can affect the nervous system as well as internal organs in the abdominal and chest cavities.
Dr Suthorn explains that the diagnosis of bone fracture is made through physical examination and a review of the patient's medical history. The doctor will determine where, what kind and how severe the fracture is, whether it extends into the joint (an intra-articular fracture), and whether the adjacent nerves are injured. All these findings are considered by the doctor before designing a treatment plan for a patient. The physician must also take into account the needs, age, occupation and lifestyle of the patient, Dr Suthorn says, in order to determine the appropriate course of treatment for each individual.
Broken bones are always accompanied by pain, swelling and inflammation of the tissues and muscles surrounding the fracture, and in some cases the patient may experience deformation and functional loss of movement. Orthopedic surgeons work to correct any misalignment of bones caused by an injury to assure a normal healing process that affords patients the freedom of movement required to conduct their daily activities to the greatest extent possible The cardinal principles of fracture treatment are known as five Rs.
• Recognition is the thorough diagnosis required to evaluate the nature of the fracture for treatment planning and preparation.
• Reduction is the restoration of the normal anatomical alignment of the fragments in the fracture by immobilization utilizing either external traction, orthopedic implants or internal surgical fixation.
• Retention is the maintenance of the alignment of the fragments by immobilization with a plaster cast to allow a natural healing process.
• Rehabilitation is the restoration of full muscle power and joint movement following the union of the fracture, and the overall physical and mental health of the patient.
• Reconstruction is the repair and correction of defects and wounds or complications sustained after the trauma so that the affected area can return to its previous level of functionality.
Treating Bone Fractures
The treatment of bone fractures may be surgical or non-surgical:
Non-Surgical Treatments
Casting or splinting is used in cases of simple fracture, commonly on forearms and lower legs, where the bone is broken in one place but does not protrude through the skin. The procedure involves lining up the two ends of the broken bone and holding them in place. The doctor can pull the broken bone and reposition it in its original place, then stabilize and immobilize it with a cast. This procedure can also be applied in the treatment of bone deformities in children to re-align the bones in the normal position without the need for surgery.
Traction is used to realign broken bones that cannot be fixed with a splint, such as a broken thigh, or fracture areas where pulling action is needed to counteract muscle tension.
There are two types of traction: skin traction and skeletal traction.
Skin traction is non-invasive and involves attaching weights to the skin to indirectly apply a pulling force to the underlying bone. Depending on where traction is needed, weights of up to 5kg are attached with tape, straps, boots or cuffs, generally for a short period of time.
2. Skeletal traction is used in cases where heavier traction is required and uses pins, screws or wires that are driven into the bone. The weights used in skeletal traction are generally not heavier than one-sixth of the patient's weight.
Both types of traction require that patient lie still in bed for a long period of time to prevent dislocation of the fractured bone. In some cases, the cost of traction is as high as surgical treatment. In elderly patients, bone traction poses the risk of a number of complications from the prolonged immobility such as bedsores and possible fatal respiratory, urinary and circulatory problems.
Surgical Treatments
Surgical fixation of bone fractures is used only when the orthopedic surgeon considers such treatment to be the most likely means of restoring the normal alignment of a broken bone that would otherwise result in permanent movement disability. Fractures that could require surgical intervention include those that extend into a joint, causing overlapping joint fragments and broken bone that protrudes through the skin, or a wound that penetrates down to the broken bone. This latter type of fracture is particularly serious because, once the skin is broken, thorough cleansing and surgical fixation must be performed to prevent infection in both the wound and the bone that may impair healing. Some fractures, for example pelvic fractures, are also associated with a high risk of considerable bleeding, which can lead to fatal shock if surgical fixation is not performed.
The patient can usually move the injured limb immediately following surgery. However, he or she must refrain from heavy lifting or putting their full weight on the area for one or two months. In some cases, a bone splint may be necessary to immobilize the fractured bone for some time as well.
Bone fixation devices used in internal and external fixation surgery are divided into three categories, depending on the location and size of the fractured bone.
Intramedullary Nails
This device consists of long hollow rods of various sizes that are selected to fit in the hollow center of the bone. They are generally used in fractures at the center of long bones such as the forearm, thigh and lower leg. With these nails, open surgery is not necessary as the skin over the top of the bone is slit and the nail of appropriate size is beaten down from the top with a special hammer through the center of the bone, down through the crack, and into the other end with the aid of an X-ray machine.
Plate and Screw
In this procedure, steel plates the length and width of the fractured bone are drilled into both ends of the bone. After they are realigned, locking screws are used to fix the plate. This technique is most often applied in cases of forearm fracture or fracture at the tip of the bone that obviate use of nails. Today, patients have the option of a method that surgically inserts the bone plate under the muscle of the fracture using minimally invasive surgery guided by computerized X-ray.
External Fixator
External fixator involves inserting pins through the bone that are attached to a steel rod outside the limb. These pins are inserted through the skin into either side of the bone and held in place by an external frame where traction is applied to achieve rigid fixation of the bone. This technique is generally indicated in cases of open fracture because of the high risk of infection and injury to adjacent tissue. Once wound has healed, internal fixation may be reconsidered.
Dr Suthorn says that the choice of treatment always follows a lengthy doctor-patient consultation. Keeping a patients lying on the bed for one to three months in traction not only jeopardizes their job and other daily activities but presents the risk of complications associated with immobility. These can include persistent joint problems and stiffness and muscular atrophy requiring physical therapy. For these reasons, these nearly obsolete techniques are now less popular and practiced only in settings with very limited resources.
The physician's decision to use any treatment needs to take into consideration both the pros and cons of each with the best interests of patient as the first priority - just like doctor is treating themselves or a loved one.
Surgical treatment aims for the rapid restoration of the fractured bone so that the patient can return to all their former activities with minimal risk of complications. In other words, the surgical fixation of a bone fracture is intended to do more than just hold the bone together.
Dr Suthorn is pleased that Bangkok Hospital has the advanced facilities, technology and tools to support the orthopedic surgeons there in both their diagnoses and treatments with precision and safety. An accurate diagnosis involves a clear description of the precise type of fracture, particularly if it extends to a nearby joint. Using X-ray computed tomography, the surgeon's at the center can evaluate the direction of fracture movement and determine where the incision should be. A well-planned treatment strategy coupled with real-time 3D X-ray imaging technology not only reduces the chance of adjacent tissue injury but shortens operating time and improves overall treatment outcome. The innovative minimally invasive surgery currently performed at Bangkok Hospital also allows the doctor to fix the fracture without making an incision at the site, thus reducing infection complications and expediting the healing of the bone.
If a fracture is not treated properly, complications can follow, including the improper fit of joined bone ends, malunion of complicated fractures where the fractured bone heals in a deformed manner resulting in bowlegs or curved arms, vascular injury causing internal or even fatal hemorrhage, nerve damage and paralysis, and serious wound and/or blood infection. The patient also runs the risk of chronic bone inflammation and infection that can require amputation of the bone followed by bone regrafting.
The good news is that there are now treatment techniques for fractures that are safe and performed with the quality of life of the patient as the paramount concern.
In cases of complicated injuries or bones broken into multiple parts (multifragmentary fractures), the team of orthopedic trauma surgeons at the center will utilize a new surgical technique that does not require a traditional open incision but only a small one in a procedure known as minimally invasive fracture surgery. This new safer technique is less likely to cause bleeding and other complications that retard bone healing while it also helps reduce infection in the injured bone and surrounding tissue.
The team of surgeons at Bangkok Orthopedic Center bring a range of specializations to cases like these, including:
• Orthopedic trauma surgery
• Hand and microsurgery
• Spine surgery
• Arthroscopic surgery for sports injuries
• Pediatric fracture treatment
The center utilizes a multidisciplinary approach with every case in which a variety of specialists work together to help particularly vulnerable patients, for example those who have been severely injured and are in critical condition or elderly patients requiring surgery. The team includes specialists in infectious diseases and related fields, as well as skilled anesthesiologists, and works with the rehabilitation staff and physiotherapists in administering postoperative care.
The center specializes in the treatment of a broad range of bone and joint diseases, in operates a comprehensive range of orthopedic clinics and programs including the Osteoporosis Clinic, the Arthroscopy Surgery and Sports Medicine Center and the Knee and Shoulder Arthroscopy Center. All Bangkok Hospital clinics and centers provide treatment of the highest standard and are internationally recognized for their position at the forefront of advanced orthopedic care. Clinicians at the center are encouraged to opt for the least invasive technique best suited to each specific patient to assure faster recovery and less bleeding complications and are continually audited to assure adherence to safety, medical ethics and standards of care based on clinically indicated guidelines. They are also encouraged to provide every patient with the information required to participate in making informed decisions regarding their treatment.
Bangkok Hospital is in the process of establishing the center as an orthopedic research institute to provide training and keep fellow healthcare professionals current on developments in orthopedic surgery, as well as fund research that we hope will continually raise the quality of patient care to continually higher standards.
For further information, please contact Panruetai (Ping Pong) Kongyimlamai in the Public Relations Department of Bangkok Hospital at Tel: 02 755 1639, Mobile: 089 111 5754, or Email panruetai.ko ( @ ) bgh dot co dot th or pr ( @ ) bgh dot co dot th dot
The Bangkok Orthopedic Center has both the specialists and the technology required to effectively treat all manner of bone and joint injuries. 
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