Prof. and HOD Orthopedics
Kasturba Medical College, Manipal
How do you feel being a faculty for this great IAS meeting?
Oh! It is a new experience for me. This is the first time I am here and of course because just being doing a lot of wrist arthroscopy and probably this session was introduced. I do not know when the last time I am here.
So, basically your field of interest is wrist arthroscopy and predominant in the field of arthroscopy.
I am basically a hand surgeon. I do a lot of upper limb surgery and all these years we used to do a lot of congenital brachial plexus so we moved on to the wrist and wrist could be from the last two years now, so we have been doing a lot of wrist and elbow arthroscopies and probably that is why I was been called here.
So what is the present status of wrist arthroscopy and when to do in India and how do you foresee the future of the wrist arthroscopy.
Well as of now, I can say it is probably the initial stage is like probably three or four surgeons doing regular wrist routine arthroscopies and there is a huge amount of indications which are there and when I went to my training two years back, I could see the future because we do get a lot and lot of sports surgeries but then probably very everybody is concentrating on knee and shoulders. Lot of wrist injuries are missed initially and I think there is a huge scope to correct this right at the initial stage. These are the young group of people who come in and I think it is very important.
And you know what I mean is, can you just elaborate a bit about the scope, what the real indications because most of the civil surgeons are comfortable with the knee and shoulder.
The youngsters who are having the knowledge to the field of arthroscopy, they may be having the interest over wrist arthroscopy. If for the matter, the seniors also may start this particular field, so for that I wanted you to throw some light on this scope.
Well the education wise, it is basically more of ligament injuries in the wrist, so the more and more that we know about the anatomy of the wrist and we know more about the ligament anatomy and we start recognizing more of these ligament injuries, x-rays where everybody takes and you see the fractures which is so evident but then the ligament injuries the ones which are missed and also give a long term complications of these so in that way yes, it takes a huge amount of, you know training, but of course we will start picking up lot things, the new things and hopefully I think this is more youngsters take up this I think it becomes a routine tool in your risk assessment. MRI does pick up lot of things but still it is again MRI wrist is still the same symptoms in terms just the quality of MRI reports we get (3:00) dedicated wrist coils from MRI is still not available in most of the big institutions also and in that way the wrist scopy would be adjunct and it would very useful even for the youngsters and it will completely broaden the horizon in terms of diagnosing injuries and also treating them. It not just injures it is also diagnosing a lot of other chronic wrist fields and which we either too thought was for you know it was boring kind of thing but it is not so, so the cartilaginous, the ligamentous injuries are the ones which are being picked up faster.
The routine indications what we all extend arthroscopy for the wrist is about increasing of the immediate nerve and carpal tunnel syndrome and the TFCC injury, these are the two major things.
The TFCC injuries are the major ones but of course you have inter-cartilaginous event that we may have to carefully deal with, so these are the ones which are being picked up fast. We also are extending now to ganglion excisions. We are doing dealing even with scaphoid percutaneous fixations and also assisted fixation of the scaphoid and
The distal radius the intra-articular fractures of the distal radius
And then we are also going further at least I have done it but then I have seen surgeons doing it for even non-scaphoid for the bone graft insertion through the arthroscopic and the distal radioulnar joint ligament reconstruction arthroscopic assisted so every year whether you go for a new conference especially for the wrist you see new indications involved. These got a huge role because the wrist area is one joint like the hand which gets stiff very fast so the I think the arthroscopy plays a big role now in minimizing that stiffness.
Great to know what it does. Any tips for the youngsters who wanted to come to the wrist field.
I would personally it is like my personal experience I would ask them to go for a good category training first and that is the most important things. Second, it is a difficult joint small joint so they need to be very sure of their instruments and the set up is a little difficult to change unlike a tool that it could be probably, there is much more easier to start off with. So they need to invest on that way plus of course the better good candidate trained in would help them to do this.
It is great having you Dr. Anil in the conference.