SICOT e-Newsletter

Children comprise more than 25% of the world’s population. With trauma being the leading cause of both morbidity and mortality in children, it’s no surprise that specialized paediatric healthcare and appropriate injury prevention continues to be on the forefront of the global medical agenda.

Firstly, our treatment approach towards paediatric musculoskeletal trauma has drastically changed within the last few years. For example, evidence supports better outcomes and financial benefits to patients and their families with:

1. Pinning of supracondylar type III fractures.
2. Flexible nails for paediatric femoral fractures.
3. Spinal instrumentation with pedicle screws and early mobilization for unstable spinal fractures.
4. Multidisciplinary approach - “Trauma Team”, “Golden Hour”, Paediatric trauma registries.
   

Secondly, commitment to injury prevention is also paramount. It was Sir William Osler, one of the four founding professors of Johns Hopkins Hospital, who in the early 1900’s eloquently said: “Prevention is the pinnacle of the physician’s art, but late treatment is what we do most often”; true even today. Historically we have gone a long way in terms of injury prevention measures: poison control, building safety (limiting hot water temperature, outlet voltage, non-accessible windows on higher floors), toy safety, road traffic safety, and child passenger safety to list a few.

Can individuals influence global trauma care? The following three examples show how SICOT members have made a difference. The first example is from the member country of India. In April 2014, the Supreme Court of India delivered a landmark judgment in response to the Public Interest Litigation plea filed by Dr Rajasekaran Shanmuganathan (President of the Indian Orthopaedic Association at the time and current SICOT Treasurer) charging the Indian Government with negligence for failure to commit themselves in combating road accidents and thereby being the cause of deprivation of the citizens to the constitutional right “to live and to live honorably and without disability”: the Court appointed an “Empowered Committee” that has been given powers to monitor the plans and actions of the Chief Secretaries of the State Government and has been charged with the responsibility of coordinating the necessary activities, monitoring the implementation of rules and making the States accountable for any inaction or lapse. It is very inspiring that an orthopaedic association was able to find a legal solution to a social problem.

Another example is Mr Michael Laurence from the United Kingdom, President of the World Orthopaedic Concern UK (WOC). Mr Laurence, working with the SICOT leadership is making great strides in bringing together the “teaching sides” with the “learning sides” while at the same time underlying the benefits and importance of this training to be done “in-situ” hoping that the local communities would benefit, rather than the “Western Centres of Excellence”. On that subject, during the XXVII Triennial Meeting of SICOT (Rio de Janeiro, Brazil, 19-22 November 2014) we look forward to an important session (“Bridging the Gap”- organized by Mr Laurence) on the discrepancy between the widely differing grades of fracture managing equipment in low- and middle-income countries (LMIC).

A third example from the author’s home Institution (The Children's Hospital of Philadelphia (CHOP)) is Dr David Spiegel's efforts on global trauma. He serves as a consultant for the World Health Organization (WHO) and WHO’s Global Initiative for Emergency and Essential Surgical Care (GIEESC) since its inception in 2005; this organization serves to bring together a multidisciplinary group of stakeholders interested in improving the delivery of surgical services, especially for the more remote and marginalized segments of the population in LMICs.

Can SICOT influence global trauma care? These three examples of humanitarians/physicians in this ever-changing environment highlight the crucial role and responsibility of international medical societies like SICOT. The fundamental principles of advancement of the science and art of orthopaedics, improvement of patient care, and fostering of teaching, research and education should be the base of our future direction. SICOT has already made great strides through training scholarships and fellowships, education centres and diploma examinations that are offered within its member nations. However, with SICOT having members both in the so-called “developed” as well as the “developing” world, it is the moral duty and scientific obligation of each and every one of us to strengthen our relationships with other groups that serve the same goals as SICOT (Health Volunteers Overseas (HVO), World Orthopaedic Concern, etc.), support our outreach program, and volunteer in building our regional approach in order to match the “teaching sides” of our society with the needs of the “learning sides”.

References:

1. Dormans JP. Orthopaedic surgery in the developing world: an introduction. Instr Course Lect. 2000;49:567-573.
2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. Dec 15 2012;380(9859):2197-2223.
3. Durbin DR. Child passenger safety. Pediatrics. Apr 2011;127(4):788-793.
4. Bickler SW, Spiegel D. Improving surgical care in low- and middle-income countries: a pivotal role for the World Health Organization. World J Surg. Mar 2010;34(3):386-390.
5. Chatterjee P. India's Supreme Court tells government to improve road safety record. BMJ. 2014;348:g3254.
6. Dormans JP. Orthopaedic surgery in the developing world - can orthopaedic residents help? J Bone Joint Surg Am. Jun 2002;84-A(6):1086-1094.