News and Updates

The Robot with a Soft Touch

Adapted from NPR

Cornell University just made a robot hand with a soft touch. it is not just soft, but it can also sense the shape and texture of what it comes into contact with.

Welcome to the growing field of soft robotics.

For more information about soft robotics and their development with human interaction, follow this link.

 

Change is Here

Dear Visitors,

Today is my official first day as a full-time faculty at the West Virginia University Department of Orthopaedics, at the rank of Assistant Professor.

Haunted Arm Cast

My young patient had a happy surprise when she realized her cast was a glow-in-the-dark ‘ghost’ cast.

Harry Potter’s Brackium Emendo- healing broken bones in Witchcraft

Adapted from HarryPotterWikia

Harry Potter fans know very well that witchcraft can be dangerous.

Harry broke his ‘arm’ ( in reality, it was both-bone forearm fracture) during a Quidditch game and was ‘doctored’ by Professor Lockhart. The spell he used, Brackium Emendo, did not work as intended: instead of healing the bones, it made them disappear. Harry was then taken to the Hospital wing and treated with Skele-Gro, an awful tasting potion that grows missing bones.

 

I offer these few points to consider from an Orthopedic point of view:

This is a Sports injury! Should Quidditch players not wear protective ‘armor’?

Can this spell truly heal broken bones instantly?  No cast! No Surgery! No down time! I should go spend sometime at Hogwarts.

Oops. The spell did not work after all. On top, it had the unintended consequence of missing bones: a Complication.

The ‘Doctor’ did not explain the treatment ( the spell itself), its risks ( missing bones), other alternatives ( let it heal with a cast), and did not get consent for treatment. In fact, Potter did not want him to cast the spell! In our world, it is an easy law suit!

The ‘credentials’ of the ‘doctor’ were suspicious to start with. Was he Witchcraft-Certified? even better for the law suit.

Skele-Gro was used to reverse the complication. Where can I get one? Would it work on stubborn fractures ( nonunions) and missing bone fragments? Yet another reason to visit Hogwarts.

 

 

Paper Cuts Hurt so Much

Adapted from BBC

Paper, seemingly completely harmless, can be a weapon in disguise: paper cuts hurt way beyond expectations.

It’s all to do with nerve endings. There are a lot more pain receptors in your fingertips than almost anywhere else in your body, which explains the intense fiery quality of finger paper cuts that are worse that than deeper cuts on the arm or the thigh. They don’t slice that deep into your body, which is perhaps why it’s puzzling that they should hurt so much. But it’s exactly for this reason that paper cuts hurt bad. A deeper wound would result in bleeding. The blood would clot and a scab would develop protecting it from the environment. The shallow wound of a paper cut doesn’t get the same cover, leaving the injured nerve endings exposed and more irritated.

Having said that, nobody has ever proven that this is the case, but it is a reasonable hypothesis. Don’t you agree?

Broken Shoulder- 3 million years ago

Adapted from The Smithonian

Lucy, the famous 3 million years old hominin, has been a mistery for the last few years: how did she die? A group of orthopedic surgeons were asked to review recently obtained 3D CT scans of her skeletal remains and recognized something we are all too familiar with: fracture patterns of the shoulder and other bones that we see with high energy injuries in humans. Those were fractures that happened just before and led to her and not bone breakdown that happens to bone fossils.

Dream Land

​I just attended the feature presentation by author Sam Quinones at the WVSMA Healthcare Summit.

He describes how aggressive promotion of highly a addictive painkiller and the development of cheap underground heroin production, marketing, and delivery industry led to the current opioid epidemic.

The book won several awards including Amazon’s Best Nonfiction Book for 2015.

Athletic Hand Injury

Adapted in part from the Hospital for Special Surgery PlayBook

Sports related injuries can be the result of a single trauma or due to repetitive overuse. Certain sports such as boxing, basketball, and volleyball have greater risk of injury to the  bones, ligaments and muscles of the hand and wrist.

One common injury is a boxer’s fracture, which is a fracture of one of the metacarpal bones: it happens when your punch lands wrong.

Basketball and volleyball players frequently get ‘jammed’ fingers. This happens with a forceful encounter with the ball. There may be visible misalignment of the finger. A jammed finger can be anything from an innocent sprain to a bad fracture-dislocation requiring urgent surgery. 

Looks can be deceiving and these injuries should never be underestimated.It is easy but costly to dismiss a serious injury. If pain and swelling do not go away in reasonable time, you should seek medical attention including proper x-rays.

Appropriately sized, and well applied hand wraps and/or gloves protect the hands from such injuries, and proper training is essential to prevent such injuries. Some of these injuries come with an easy fix while others require surgery and dedicated hand therapy.

While still recovering, you may still work on staying in shape and game ready by running, working on lower body and strengthening your core.Your treating physician, together with your therapist, will set the schedule and time frame towards full use and will let you know when it is safe to start exercising your injured hand.If you do too much too soon and push through pain, you may be delaying your recovery or reversing the outcome of your treatment.

Hand and Upper Extremity Clinical Practice Guidelines

Presenting my findings on “Hand and Upper Extremity Clinical Practice Guidelines” at the Cleveland Clinic 16th Annual New Technology in Upper Extremity: The Cutting Edge, with Advancing Translational Research

Just received from the Evidence-Based Medicine Unit, American Academy of Orthopaedic Surgeons

“Congratulations on being nominated and selected for the Carpal Tunnel Syndrome Appropriate Use Criteria voting panel.”

Wrist x-rays can predict a Child’s age

Adapted from Radiopaedia.org

Can you guess the bone age of this wrist x-ray?

Did you know that your kid’s wrist x-ray roughly matches his/her age?

The small bones of the wrist are called the carpal bones. They start out with no calcium at birth, and do not show on x-ray. They start building up calcium during the first three months of age in a process called Ossification. This occurs in a predictable manner and the bones ‘start appearing’ on x-ray in this order:

  • One bone:                 1-3 months
  • Two bones:               2-4 months
  • Three bones:            2-3 years
  • Four bones:              2-4 years
  • Five-seven bones:   4-6 years
  • Eight bones:             8-12 years

Next time you get an x-ray of your child’s wrist, count the ‘little round’ bones to find out the ‘bone age’.

Time to ossification, similar to height and weight of a growing child, can be highly variable and bone age X-rays are not obtained for  healthy children. A discrepancy between bone age and actual age is not a reason to worry unless there are concerns about the child’s growth.

 

What it’s like to be a Hand Model

From the Big Great Story

Ever wondered who and how some people end up as  hand models?

This short video takes you behind the scenes and shares the experiences of three professional hand models.

 

and the Winner is…

Adapted from ABC news

Anaya Ellick, 7, a first grader from Virginia, had such good handwriting that she won the national handwriting contest last week.

There was just one thing special about Anaya: She was born without hands….

My Better Half: The First Ten Years

http://digital.graphcompubs.com/publication/?i=298770&ver=html5&p=13#{“page”:12,”issue_id”:298770}

On Fingerprints and What They Stand for

adapted from Wikipedia

Fingerprints are the detailed, unique, difficult to alter, impressions left by the friction ridges of fingers. Fingerprints are deposited on smooth surfaces by the natural secretions of sweat of the finger tips. Fingerprints are useful to confirm identity. They may be employed by police or other authorities to identify individuals who are incapacitated, deceased, or unable to identify themselves, such as young children or lost their memories. The ability to recover fingerprints and compare them, led to Fingerprint analysis, which has been in use since the early 20th century and has led to many crimes being solved. Today, many criminals wear gloves to avoid being caught. In 2015, fingerprint analysis was reported to be able to determine find the person’s gender.

Fingerprints have been found on ancient Babylonian artifacts, on the walls of Egyptian tombs, Greek, and Chinese pottery, as well as on bricks and tiles from ancient Babylon and Rome. Fingerprints were used as signatures in ancient Babylon,2000 BCE, and are still used in countries where some people do not know how to write and sign their names. who  in the second millennium BCE.

Fingerprints can also be a subject, or tools, of art. More than 320 students and staff at King Street Intermediate School in Danbury, Connecticut, fingerprinted themselves for fingerprint art installation for The Aldrich Contemporary Art Museum in Ridgefield, Connecticut. Artist Sandy Garnett has a whole fingerprint-themed art project.

One last point: patients with a  very rare medical condition, adermatoglyphia, have no fingerprints. The have completely smooth fingertips, palms, toes and soles, but no other related medical problems.

Submission to Journal of Hand Surgery accepted

> Dear Dr. Sraj,
>
> I am pleased to inform you that your manuscript A Simple Phalangeal External Fixator Using Kirschner Wires and Locking Balls: No need for Cement or Rubber Bands has been accepted for publication in The Journal of Hand Surgery.

….

> We look forward to seeing this manuscript published and to receiving your next one.
>
> Best wishes,
> Section Editor
> The Journal of Hand Surgery
>

I know what distracts me. Do you?

April is Distracted Driving Awareness Month. The American Academy of Orthopaedic Surgeons released its “No Small Distractions” videos  that highlight the importance of safety behind the wheel.

Distractions behind the wheel may not be as small as they seem.

Fixing sharp edges on a cast with a glue gun

wp-1460471115474.jpgMy patient  showed me today a neat trick to cover up the sharp edges of a Fiberglass cast.

She simply used a glue gun. The glue holds very well. In this case, for over a week. The edges are soft and it holds well to fiberglass. No more catching on clothes. She has not tried it close to her skin, and if you do want to try it, be careful not to burn yourself.

An Arrow in the Humerus Uncovers a Colossal Bronze Age Battle

Adapted from Science magazine

In 1996, an amateur archaeologist found a humerus bone north of Berlin. A flint arrowhead was embedded into the one end of the bone, ( funny it is nicknamed the surgical neck) prompting archaeologists to dig more. They found 130 people and five horses so far, and the bones were dated to about 1250 B.C.E., Europe’s Bronze Age. It is estimated that as much as  4000 warriors took part in the fighting- a large number for the bronze age which reflects significant advances in social organization to supports armies of this scale. “It could be the first evidence of a turning point in social organization and warfare in Europe,” one author said.

 

No More Powdered Gloves

Adapted from Medscape

For several years, there has been a push to ban using powder in medical gloves. The US Food and Drug Administration (FDA) recently unveiled a proposal to ban powdered surgeons’ gloves and the absorbable powder lubricating them, as well as powdered gloves for patient examinations. Both synthetic gloves and those manufactured from natural rubber latex are covered.

Professional groups such as the American College of Surgeons, the American Academy of Allergy, Asthma and Immunology, and the American Nurses Association had already taken stands against powdered gloves. Government agencies such as the Centers for Disease Control and Prevention joined the chorus, as did the healthcare systems of Germany and the United Kingdom, as well as several healthcare organizations, such as Cleveland Clinic and Johns Hopkins, have either restricted or forbidden the use of these gloves.

Surgical gloves were first used in 1889, and soon, all sorts of lubricants were used to make them easier to don. Several studies has indicated respiratory complications.

 

 

On Broken Elbows and the Difference between Dictating and Writing

From NPR

Following an injury to her elbow resulting in a broken bone, writer Julia Reed learned about the difference between her speaking voice and her writing voice. “You’d be amazed at what you need two arms and hands for, including, as it happens, my job, ” she said. She sought help from several dictation apps. It won’t be a problem. She the apps as ‘highly temperamental … and …. steadfastly refused to understand almost everything [she] had to say.’ The author also realized that one cannot ‘talk’ a story. When we talk, we do not edit ourselves, and writing (or typing) things down gives us at least a second chance to fix what needs fixed and remove what does not belong there.

Many a time, you do not realize the value of what you have until you can’t have it anymore ( or, in this case, cast it)…

Hospital Day at the Legislature 2016

The 2016 Hospital day at the Legislature was an opportunity to raise awareness to engage with the delegates, senators, and governor with regard to healthcare related matters. Several bills are under review with direct impact on hospitals and physicians. I had the chance to discuss and present input as a hospital advocate and a physician member of the WV State Medical Association.

image

WV Governor, Earl Ray Tomblin

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Congress members Facemire, Romano, and Smith

Hand, X-Rays and, wait… Smuggling!

Adapted from NRP

I have heard many odd stories about medicine, but this one is different…

The Soviet Union state censorship was real strict in the 1950s, and foreign music records were difficult if not impossible to obtain in Russia. Some russians figured out a way to smuggle those records, by cutting grooves into used vinyl X-rays. This was recently discovered, and now there is a book written about it titled X Ray Audio.

.

 

What Happens when Knuckles Crack?

Adapted from: MDLinx and UC Davis

Recent research at UC Davis Health System looked into two questions about knuckle cracking: What causes the “crack” sound, and does it damage the hand? Ultrasound evaluations showed that the knuckle–cracking sound occurs when gas bubbles form in joints very quickly — faster than the blink of an eye. The study also suggests that the “crack” is caused by bubble forming, rather than bubble bursting.

Examinations by hand specialists found no problems in the joints of knuckle crackers, a finding that contradicts a previous study that suggested that knuckle cracking may cause joint swelling and weaken grip.

Author’s note: I personally used to crack my knuckles. My 8-years-old don does that now. I keep telling him not to do it, but- I guess- I do not have a good reason anymore…

Doctors and Santa Claus may be Equally Reliable

Source: Doctors are as Reliable as Santa Claus (or Vice Versa)

A team of researchers decided wanted to find out what people thought of doctors how that compared to … Santa.

The researchers showed a film in which a narrator dressed as either Santa Claus or a doctor and told an identical story.

The results:

1- Santa Claus was perceived to be friendlier.

2- Both were equally reliable….

 

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