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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 206-209

Distribution of diseases in orthopedic indoor patients in a rural tertiary care center in central India


1 Department of Orthopedics, JNMC and AVBRH, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
2 Department of Orthopedics, Rajawadi Hospital, Ghatkopar, Mumbai, Maharashtra, India

Date of Submission11-Jun-2019
Date of Decision20-Jul-2019
Date of Acceptance30-Jul-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Nareshkumar Dhaniwala
Department of Orthopedics, JNMC and AVBRH, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha - 442 107, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_103_19

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  Abstract 


Introduction: Orthopedic diseases can be grouped in two broad categories, one consisting of various traumatic fractures and associated injuries and the other consisting of cold orthopedic diseases including infection, congenital and developmental conditions, tumors, degenerative disorders, and nutritional disorders, etc., involving bones, joints, muscles, and other soft tissues. Distribution of these in outpatient department and emergency department vary and has been studied by some authors. The distribution of orthopedic diseases in admitted/inpatients has not been studied much. The present article is an analysis of orthopedic indoor patients to find out the distribution of diseases in admitted orthopedic patients. Materials and Methods: Indoor patients of orthopedic wards admitted under a particular unit during 2 months were analyzed for the age, sex, rural/urban background, hospital stay, diagnosis, and treatment given. This analysis was performed retrospectively from the discharge records. Observations and Results: The total number of cases studied was 62. Males (47) admission was three times more common than females (15). The maximum admitted patients were in the age group of 20–40 years (37.09%), and > than 40–60 years (32.25%) together making about 70% of admissions. About 62.90% of patients were from rural background. Hospital stay less than a week was noted in 38.70% of patients, between 1 and 2 weeks in 22.58% of patients, between 2 and 4 weeks in 29.03% cases and more than 4 weeks in 9.67%. Trauma cases (58.06%) exceeded nontraumatic cases (41.93%). Fifty-five (88.70%) patients were admitted as new cases, whereas seven (11.29%) were admitted as follow-up cases. Treatment with anti-inflammatory drugs, reduction of fracture with closed manipulation, cast or open reduction, and internal fixation were the most common methods of treatment done. Tumor excision, debridement of wound, and decompression of the spine were the common methods to treat orthopedic nontraumatic disorders. Conclusion: Tumor excision, debridement of wound, and decompression of the spine were the common methods to treat orthopedic nontraumatic disorders.

Keywords: Distribution, indoor patients, orthopedic diseases, rural tertiary care center


How to cite this article:
Dhaniwala N, Dhaniwala M. Distribution of diseases in orthopedic indoor patients in a rural tertiary care center in central India. J Datta Meghe Inst Med Sci Univ 2019;14:206-9

How to cite this URL:
Dhaniwala N, Dhaniwala M. Distribution of diseases in orthopedic indoor patients in a rural tertiary care center in central India. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 May 28];14:206-9. Available from: http://www.journaldmims.com/text.asp?2019/14/3/206/283574




  Introduction Top


The orthopedic workload in any hospital primarily consists of orthopedic trauma cases and patients suffering from various orthopedic diseases such as infection, noninfective inflammation, tumors, degenerative, congenital or developmental disorders of bone, joints, muscles, nerves, or vessels.[1] Depending on the facilities of the management of such disorders including trained workforce, the patient is admitted in the hospital. Tertiary care centers, mostly including medical college hospitals and specialty hospitals are supposed to treat all types of orthopedic diseases and trauma cases. However, in reality, all tertiary care hospitals neither have the infrastructure nor trained workforce of the expected level. The geographical location of the hospital also has an important influence on the type and number of cases visiting a hospital. The cost of treatment is yet another influencing factor.[2]

There are very few studies reported on this aspect. Studies on the pattern of trauma cases and outpatient department patients are there, but indoor cases analysis literature is scanty.[3],[4],[5] The present article is an attempt to find out the distribution of illness of the orthopedic inpatient department in a tertiary care hospital in the rural set up in central India.


  Materials and Methods Top


The study is done retrospectively by analyzing the discharge summary of indoor patients admitted during 2 months from August to September 2015 in a particular unit in orthopedics in a medical college hospital. The above period was chosen due to the availability of all the discharge sheets. The sheets were analyzed for age and sex of the patients, rural or urban background, duration of the hospital stay, clinical-radiological diagnosis, and treatment given. No attempt was made for any follow-up or knowing the current status of the patients. The objective was to note the distribution of orthopedic diseases in admitted patients in a rural background tertiary care hospital.


  Results Top


The total number of admissions was 62. Males outnumbered females by three times. There were 47 males admitted, while females admitted were only 15. The male-to-female ratio was 3.13:1. The age-wise distribution showed the maximum patients 23 (37.09%) in the age group of > than 20–40 years, 20 (32.25%) in the age group > than 40–60 years, 11 (17.74%) in the age > than 60 years, and 08 (12.90%) cases in the age range < than 20 years [Table 1]. The age of the patients ranged from 1 to 75 years.
Table 1: Age distribution of the patients

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Thirty-nine patients (62.90%) were from rural background, whereas 23 (37.09%) were from the local urban background. Out of the total 62 cases, 12 cases were from the adjoining states of Telangana and Madhya Pradesh.

Of the total 55 (88.70%), patients were admitted for the first time in orthopedics as new cases, while seven (11.29%) patients were admitted as old treated follow-up cases.

Analyzing the duration of stay in the hospital, 18 (29.03%) patients were admitted for the duration > than 2–4 weeks, 14 (22.58%) for > than 1–02 weeks, 14 (22.58%) for > than 3 days to 01 week, and 10 (16.12%) for < than 03 days [Table 2].
Table 2: Duration of hospital stay

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Thirty-six (58.06%) patients were admitted with a diagnosis related to trauma, while 26 (41.93%) had nontraumatic orthopedic diagnosis. Among traumatic conditions in the upper limb, fracture radius was the most common in 8 cases, followed by fractures in small bones of hand in 4 and humerus in 3 cases. In the lower limb, fracture in the tibia was the most common, in 6 cases, followed by fracture femur in 5 cases. 5 traumatic vertebral fracture cases were seen, 2 in the dorsal spine and 3 in the lumbar spine [Table 3].
Table 3: Details of orthopedic trauma and diseases

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Among the nontraumatic conditions, the spine was noted to be the most common part involved in a total of 13 (50%) cases. Tumorous pathology in 4 cases, chronic disc prolapse in 3 cases, tuberculosis of dorsal D11-12 and lumbar vertebrae at L4-5 each in one patient, lumbar canal stenosis in 2 cases, ankylosing spondylitis in 1 case, and acute disc disease in 1 case were noted. A total of five patients had knee involvement. Four patients had bilateral osteoarthritis knee, while 1 had tuberculosis of the knee. Rheumatoid arthritis was diagnosed in 3 cases, two patients had avascular necrosis of the head femur, two had osteochondroma around the knee, whereas one child had congenital talipes equinovarus [Table 3].

On the analysis of treatment modality, 13 patients were managed by anti-inflammatory drugs and exercises. Ten were treated by closed reduction and cast application, 10 by open reduction and internal fixation, 8 by debridement of wound and regular dressing, and 5 tumor cases by excisional/incisional biopsy. Four spine cases were submitted to posterior decompression and discectomy, three patients were started on anti-tubercular drugs, 3 cases were applied external fixator, and 3 were instilled local steroid injection in the knee. Core decompression of femur head, amputation, and implant removal each were done in two patients. Corrective osteotomy, arthrodesis, and vertebroplasty were done in one patient each, while a case of epithelial cystic teratoma in the spine was referred to cancer hospital for needful [Table 4].
Table 4: Type of treatment given

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  Discussion Top


Distribution of orthopedic diseases in indoor patients has been highlighted in a few studies only.[3],[4],[5],[6] Agarwal[4] has done a prospective hospital-based study of childhood orthopedic problems. A Taiwanese nationwide survey has reported epidemiology of orthopedic fractures and other injuries among inpatients admitted due to traffic accidents.[3] The study noted that 9.17%–11.54% of cases were hospitalized due to traffic-related accidents. Fractures were seen in 29.36% of such cases.[3] Matter-Walstra et al.[6] have analyzed patient flows for orthopedic procedures in Switzerland. Naddumba found 39% admissions in Uganda musculoskeletal trauma services related to trauma and noted the age group of 16 years to 44 years mostly injured.[7] None of these are cross-sectional studies highlighting all orthopedic cases including trauma.

Kumar et al. from West Bengal did a similar study for orthopedic outdoor patients.[1] The study noted male preponderance (62%), common age (18–30 years), trauma cases forming 38.5% of the total, and low backache as the most common complaint seen in 29.5% of patients. These findings match with our observation with respect to the age and sex of patients. Trauma cases reporting mostly in emergency hours formed less percentage than the study. Being an analysis of admitted orthopedic patients, our study shows the type of common problems seen in this part of the country. Traumatic cases 58.06% exceed nontraumatic diseases, highlighting the present-day road traffic accidents occurring in rural vicinity also. Trauma cases are increasing due to fast moving two-wheelers, rash driving, bad road conditions causing fall and collision, good road conditions encouraging high speed without due safety measures, not obeying traffic rules, and poor vehicle maintenance, etc., A study done in England district general hospital noted 242 average monthly admissions, more in the summer season, mainly of elderly osteoporotic females.[5] Shukla et al.[8] noted seasonal variation in orthopedic trauma patients in central India. Their study noted a common age group between 11 and 40 years, males (67.40%), rural background in 72% cases, and more trauma to the upper limb in summer and to the lower limb in winter and rains.

More than one-fourth (29.03%) patients were admitted for > than 2–4 weeks, 22.58% were admitted for 1–2 weeks and > than 3–7 days each. The hospital stay was more as patients came from far off places and wanted to go after stitch removal only. Besides, most of the surgical procedures were carried out under government approved scheme, which delayed the discharge procedure often.

Nontraumatic diseases formed 41.93% of admitted patients. Among this group, vertebral involvement was seen in 50% of patients, again highlighting more occurrence of intervertebral disc disease and tumor involvement. The present-day sedentary lifestyle, lack of exercise, use of mobile and laptop for a prolonged period, and obesity are contributing factors for more incidence of neck and back problems. The pattern of traumatic and nontraumatic cases is on the expected range and treatment modalities offered are standard and keeping in view the trained workforce, infrastructure, and cost effectiveness.

The study has the limitations of being short-term associated with admissions done in orthopedic wards on a specific day of the week. With a larger sample size of admissions spread over the whole week may give a different and realistic distribution pattern.


  Conclusions Top


Trauma forms more than 50% admission load in orthopedics. Spinal diseases, osteoarthritis knee, tumors, and rheumatoid arthritis are the major nontraumatic diseases responsible for admissions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar A, Dalai C, Banerjee S. Distribution of illness of orthopedic outpatient department in a tertiary care teaching hospital in West Bengal: A cross sectional study. Int J Res Med Sci 2018;6:206-9.  Back to cited text no. 1
    
2.
Shiv Prakash SS, Amardeep G, Manjappa CN. Pattern of orthopedic injuries among patients attending the emergency department in a medical college hospital. Int J Orthop Sci 2017;3:93-6.  Back to cited text no. 2
    
3.
Pan RH, Chang NT, Chu D, Hsu KF, Hsu YN, Hsu JC, et al. Epidemiology of orthopedic fractures and other injuries among inpatients admitted due to traffic accidents: A 10-year nationwide survey in Taiwan. ScientificWorld Journal 2014;2014. doi: 10.1155/2014/637872. eCollection 2014.  Back to cited text no. 3
    
4.
Agarwal S. A prospective hospital based study of childhood orthopaedic problems - A case series. J Clin Diagn Res 2014;8:LC01-3.  Back to cited text no. 4
    
5.
Taylor A, Young A. Epidemiology of orthopaedic trauma admissions over one year in a district general hospital in England. Open Orthop J 2015;9:191-3.  Back to cited text no. 5
    
6.
Matter-Walstra K, Widmer M, Busato A. Analysis of patient flows for orthopedic procedures using small area analysis in Switzerland. BMC Health Serv Res 2006;6:119.  Back to cited text no. 6
    
7.
Naddumba EK. Musculoskeletal trauma services in Uganda. Clin Orthop Relat Res 2008;466:2317-22.  Back to cited text no. 7
    
8.
Shukla R, Jain N, Agarwal U, Sheikh T, Jain R. Seasonal variation in orthopedic trauma patients-An experience from central India. J Clin Orthop Trauma 2018;9:S40-3.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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