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No new patients, but numerous old patients struggle

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No new patients, but numerous old patients struggle

Monday, 22 October 2018 | Dr BKS Sanjay

Health is not only an asset but a resource too. The physical, mental and social development depends upon good health. If every person is developed, then the country too will definitely be developed. Any goal of majority of the people can be achieved only if the people are physically fit. If hands and feet are not functioning well, then it becomes difficult to achieve various goals in is life.

Polio and cerebral palsy (CP) are the common causes of paralysis and disability in children all over the world but particularly in developing and poor countries like India. World CP day is observed on October 6 and world polio day is observed on October 24 every year all over the world. The awareness campaign are being organised all over the world during this month and India is not an exception. This article, too, is part of an awareness campaign to reduce the disability in polio and CP afflicted children. Rs

The author strongly believes that health is not only an asset but a resource too and any kind of disability not only reduces the efficiency of a disabled person, but indirectly affects the society and the nation as a whole. Being an orthopaedic surgeon and seeing the personal, social and financial suffering of victims of post polio residual paralysis and cerebral palsy in last 40 years of his career, this author has taken a resolve to increase awareness among the affected and general public about the impact of polio and CP on personal and social front in India. One regularly gives his services through free camps and public awareness lectures for these disabled patients and has done 1526 operations on such children and made their life better through his surgical knowledge and skills.

Polio is a highly infectious disease caused by polio virus. The polio virus spreads through faecal oral route that means polio virus contaminates food and water consumed by affected child. Therefore, hygiene is vital to prevent the infection.

Since the introduction of extensive use of polio vaccine, the incidents of the polio have been drastically reduced all over the world and ultimately, most of the countries have become polio free except few countries namely Pakistan, Afghanistan and Nigeria. Last polio infection was seen in India on January 13, 2011. WHO has declared India polio free country on March 27, 2014.

Polio is a crippling disease which mainly affects the children of up to five years of age. It affects the anterior horn cells of spinal cord and rarely the brain cells. It, usually, affects the lower limbs. It is a flaccid type of paralysis and is non progressive. Maximum recovery of paralysis occurs within two years of infection, if not, it gives residual paralysis. This residual paralysis results into deformity and contracture of the joints which makes the gait abnormal. These days, we are not dealing with any new case of polio infection but with the old affected polio patients.

Polio virus affects the paralysis of certain group of muscles which cause the imbalance of the muscle power that usually gives the angular fixed deformity around the joint due to growth potential of the epiphysis in the children. Joint is deformed usually in multiple plain which makes normal walking either difficult or even impossible. The deformities are progressive initially but usually they become static at a later stage.

The principle of surgery in polio is correction of deformity, balancing of the muscle power, stabilisation of joints and lengthening of the bone. This can be achieved with physiotherapy by strengthening of the weak muscles, manipulation of contracted joint, correction of deformity by repeated use of passive force, use of splint, orthosis or calliper etc.

Most of the mild deformities can be corrected with the above mentioned means. If they cannot be corrected and deformities are gross then patient require surgical intervention. In polio multiple muscle and multiple joints are involved hence it requires multiple surgeries at multiple sites depending upon the power of muscle and severity of deformity of the joint.

Tendon transfer is indicated when dynamic muscle imbalance results in a deformity that interferes with ambulation or function of the upper extremities. The basic principle of tendon transfer is to balance the power of muscle around the joint by transferring the powerful muscle to the weak muscle. When a relaxed or flail joint cannot be stabilised by the tendon transfer then it should be stabilised by fusing the range of motion of the joint. It is rarely required nowadays, if it is done then it is usually on the foot joint.

The aim of treatment, in simple words, is that the deformity should be prevented, if existing-it should be corrected and corrected position should be maintained forever.

If deformity cannot be corrected by the tendon surgery then bone surgery has to be done to correct the deformity and corrected position to be maintained by the internal fixation like plate or external fixation by fixator or by plaster for the period till the bone is healed which usually take approximately three months time. Patients should use the brace or splint for another nine months to a year.

The shortening of the limb is the rule in the polio rather than exception. If the shorting is of half an inch to an inch then the heel of the shoe can be raised. Ilizarov external fixator has been a boon in the polio and CP surgeries particularly to correct the deformities of the joint and to lengthen the limb simultaneously.

If shorting is more than one inch then bone should be lengthened. About two to three inches lengthening of bone can be easily done. The bone can be lengthened up to 8-10 inches by the experienced and skilled surgeon with Ilizarov external fixator though it takes up to a year for complete healing and recovery.

The polio surgery is very rewarding. The simple surgery can change the gait of the polio patient and ultimately the life of the patient. They can be self reliant rather than being dependent on others after successful surgery.

(The author is an orthopaedic and spine surgeon, and the founding president of State Chapter of Indian Orthopaedic Association)

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