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    Bone Deformity

    LRS - Rotational Deformity Femur (with Shortening)

    In the example that follows, the patient had a short limb gait with intoeing (walks with foot turned inwards) on the left side. Examination revealed an intorsion (internal rotation deformity) of about 90º and shortening of about 6cms in the femur. The deformity had developed as a result of osteomyelitis in early childhood.
    Since it was a large internal rotation deformity, it was decided to correct the deformity in a staged manner and correct the shortening with gradual distraction. Hence, LRS (Limb Reconstruction System) fixator was applied, acute correction of about 45º internal rotation deformity was done and gradual distraction was started after 10 days.

    The distraction process was largely uneventful, whereas the consolidation process took some time. At the time of fixator removal, the regenerate fractured when the rail was removed and patient made to walk. As a result the fixator was reassembled. The regenerated healed well ultimately in another 8 weeks.

    The x-ray picture here shows the antero-posterior projection of pelvis with both the hips and sacro-iliac joints. The left hip appeared as is seen in lateral view - the lesser trochanter is not visible and the greater trochanter is overlapping the neck of femur.

    These are the x-ray pictures of the knee joint.

    The picture on left is a lateral view of knee joint. While the tibia is seen in true profile the distal femur appears oblique.

    The picture on the right is the antero-posterior view of the knee joint. The tibia is seen as frontal, the distal femur appears oblique.

    The full length x-ray showing the difference in lengths between the two limbs. The shortening was measured clinically using blocks and palpation of both ASIS (anterior superior iliac spines) and then tallied with the difference on the full length x-ray.

    These pictures were taken in the operating room for better understanding of the rotational deformity. The picture on the left was taken with the foot forward. The picture on the right shows the c-arm picture of the hip joint in the same position. The hip was in extreme internal rotation (normally this would have been in the mid-position, with both the lesser and greater trochanters visible).

    This picture on left shows that the knee has been bent to 90º and the hip has been externally rotated to the maximum extent possible.

    The c-arm picture on the right was taken with the limb in the position as described above. The appearance of the hip joint is as would be in the frontal (antero-posterior) projection. The lesser trochanter is visible maximally and the greater trochanter is also seen without any overlap.

    This is how it was done.

    The schanz screws were put perpendicular to the axis of bone, but at an angle of about 45º to each other. The proximal group was inserted postero-laterally and the distal group laterally.

    Percutaneous osteotomy was then performed between the two groups of schanz screws. The schanz screws were then brought in the same plane correcting 45º of rotational deformity.

    Distraction was started after 10 days at the rate of 1mm per day, to correct the shortening of 6cms.

    The x-ray picture on the left was taken after the surgery. It shows the osteotomy in the compressed state.

    The x-ray picture in the middle was taken after distraction of around 14 days. The gap created at the osteotomy site gradually fills up with new bone called regenerate.

    The x-ray picture on the right was done after completion of distraction of 6cms, which took a little more than 60 days. The distraction gap is showing some fluffy kind of shadow, this is the regenerate which has not mineralized completely yet and hence doesn't show up well on the x-ray.

    These x-rays show the progress of consolidation. The regenerate solidifies into stronger bony tissue during this process.

    The criteria for removal of the fixator is formation of at least three cortices (out of four-anterior, posterior, medial & lateral). The fixator is removed after gradual disassembly. First the CD unit is removed and clamps are loosened. Patient is then asked to walk for about 10-15 minutes. If there is no pain or trouble then the next step is to remove the rail and clamps, the schanz screws remain in position. Again the patient is asked to walk for 10-15 minutes. Once this step is done comfortably, the schanz screws are removed usually in the out patient department itself.

    In this particular case, when the patient was made to walk during the second stage of fixator removal i.e. after the rail and clamps were removed, there was pain after a few steps. The LRS assembly was reapplied connecting the clamps with rail and fresh x-rays taken.

    The radio-lucent line seen here (red arrow) in the middle of the regenerate depicts the fracture in the regenerate. This is a known complication and is seen rarely. The further treatment is to continue with the fixator till union, which generally takes 8-10 weeks. During this time the patient continues to bear full weight.

    The final x-ray picture 6 weeks after fixator removal. The regenerate has healed and remodeled well. The pin sites have also healed well. The regenerate would get recanalized in another 2 months time.

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      Dr. Mangal Parihar

      MS Orthopaedics, MBBS
      Speciality Orthopedist, Joint Replacement Surgeon
      Consulting Room 202
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      Dr. Anand Parihar

      MD - Radiodiagnosis, DMRD, MBBS
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      MD - Pathology
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      DNB Orthopedics
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      Dr. Chetan Anchan

      MS-Orthopedics, Trained in Orthopedic Oncology from Tata Memorial Hospital
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      MS - Orthopaedics, MBBS
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      MS - Orthopaedics, DNB - Orthopedics
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      MS -Orthopedics, MRCS (UK)
      Speciality Orthopaedics
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      Dr. Hitesh Kubadia

      DNB - Orthopedics
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      Dr. Abhishek Kini

      DNB Orthopedics/Orthopedic Surgery, MBBS
      Speciality Foot & Ankle Surgeon
      Consulting Room 202
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      Dr. Parag Lad

      Diploma Orthopedics, FCPS - Orthopedics
      Speciality Hand Surgeon
      Consulting Room 003
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      Dr. Kunal Makhija

      MS - Orthopedics
      Speciality Joint Replacement
      Consulting Room 005
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      Dr. Sheetal Mohite

      MS - Orthopedics, Fellowship in spine
      Speciality Spine
      Consulting Room 205
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      Dr. Pradip Nemade

      MS - Orthopedics, DNB - Orthopedics
      Speciality Arthroscopy & Trauma
      Consulting Room Ground floor, Room no.3
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      Dr. Chasanal Rathod

      MS - Orthopedics, Fellowship in Pediatric Orthopedics
      Speciality Pediatric Orthopedics
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      MS - Orthopedics, Fellowship in Shoulder Surgery
      Speciality Orthopedics
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      Dr. Milind Sawant

      MS - Orthopedics, FRCS Trauma & Orth
      Speciality Joint Replacement
      Consulting Room 203
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      2pm - 3pm

      Dr. Amandeep Singh Gujral

      DNB - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 204
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      Dr. Raghuprasad Verma

      MS - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 201
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      MD - General Medicine and Endocrinology
      Speciality General Medicine
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      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
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      Dr. Kusumlata

      BPT - Bachelor of Physiotherapy, MPT
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      Consulting Room 004
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      Dr. Kanchan Suvasia

      BPT - Bachelor of Physiotherapy
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      Consulting Room 004
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      4pm - 7pm

      Dr. Sauramibika Tiwari

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
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      9am - 2pm

      Dr. Suman Bijlani

      MBBS, MD - Obstetrics & Gynaecology, DGO, FCPS - Mid. & Gynae
      Speciality Gynecologist
      Consulting Room 203
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      Dr. Preeti Jobalia

      DGO - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 003
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      Dr. Shilpa Shah

      DNB - Obstetrics & Gynecology
      Speciality Gynecologist
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      Dr. Vidula Daundkar

      MS - Obstetrics & Gynecology
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      Dr. Ashutosh Kharche

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Vascular Surgeon
      Consulting Room 203
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      Dr. Amit Sahu

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Interventional Radiology
      Consulting Room 205
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      Dr. Satish Chougale

      MD - Anesthesiology
      Speciality Anesthesiology
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      Dr. Sayali

      Diploma in Anesthesiology
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      Dr. Sheetal

      Speciality Anesthesiology
      Consulting Room 005
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      Dr. Suratkal

      MBBS, DNB Nephrology
      Speciality Nephrologist
      Consulting Room 201
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      Dr. Ashish Agrahari

      MD Pathology
      Speciality Pathologist
      Consulting Room 203
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      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive
      Consulting Room 204
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      MBBS, MCh - Plastic Surgery, MS - General Surgery
      Speciality Plastic & Reconstructive Surgery
      Consulting Room 004
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      Dr. Tushar Jadhav

      DNB - Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 005
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      Dr. Devashri Patil

      MS - ENT, Fellowship in Head and Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 001
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      Dr. Ankit Shah

      MDS & Fellowship in Head & Neck Surgical Oncology
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      Consulting Room 201
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      Dr. Dimple Chudgar

      DNB (Obstetrics & Gynecology), Fellowship in Reproductive Medicine and Endoscopic Surgery
      Speciality Obstetrics & Gynecology
      Consulting Room 204
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      Dr. Sanjay Singh

      DNB (Orthopedics), Fellowship in Shoulder & Elbow
      Speciality Shoulder & Elbow Surgery
      Consulting Room 203
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      Our Doctors

      Dr. Mangal Parihar

      MS Orthopaedics, MBBS
      Speciality Orthopedist, Joint Replacement Surgeon
      Consulting Room 202
      Consultation
      Timing
      Monday, Wednesday and Friday
      3 pm - 8 pm

      Dr. Anand Parihar

      MD - Radiodiagnosis, DMRD, MBBS
      Speciality Radiologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Maya Parihar Malhotra

      MD - Pathology
      Speciality Pathologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Divya Ahuja

      DNB Orthopedics
      Speciality Orthopaedics
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Thursday,Saturday
      4pm - 7pm ,1pm - 4pm

      Dr. Chetan Anchan

      MS-Orthopedics, Trained in Orthopedic Oncology from Tata Memorial Hospital
      Speciality Orthopaedics
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Sunil Arora

      MS - Orthopaedics, MBBS
      Speciality Orthopaedics
      Consulting Room 205
      Consultation
      Timing
      Monday to Saturday
      11am - 1 pm

      Dr. Prasad Chaudhari

      MS - Orthopaedics, DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Kaustubh Durve

      MS -Orthopedics, MRCS (UK)
      Speciality Orthopaedics
      Consulting Room 004
      Consultation
      Timing
      On Appointment

      Dr. Hitesh Kubadia

      DNB - Orthopedics
      Speciality Orthopaedics
      Consulting Room 002
      Consultation
      Timing
      On Appointment

      Dr. Abhishek Kini

      DNB - Orthopedics, Dip. Sports Medicine from IOC
      Speciality Foot & Ankle Surgeon
      Consulting Room 202
      Consultation
      Timing
      Wednesday
      7pm - 8pm

      Dr. Parag Lad

      Diploma Orthopedics, FCPS - Orthopedics
      Speciality Hand Surgeon
      Consulting Room 003
      Consultation
      Timing
      Wednesday
      3.30pm to 5pm

      Dr. Kunal Makhija

      MS - Orthopedics
      Speciality Joint Replacement
      Consulting Room 005
      Consultation
      Timing
      Tuesday, Thursday and Saturday
      3pm - 4pm

      Dr. Sheetal Mohite

      MS - Orthopedics, Fellowship in spine
      Speciality Spine
      Consulting Room 205
      Consultation
      Timing
      Wednesday, Saturday
      5:30pm - 7pm, 10am - 11am

      Dr. Pradip Nemade

      MS - Orthopedics, DNB - Orthopedics
      Speciality Arthroscopy & Trauma
      Consulting Room Ground floor, Room no.3
      Consultation
      Timing
      Monday, Wednesday and Friday
      6pm - 7 pm

      Dr. Chasanal Rathod

      MS - Orthopedics, Fellowship in Pediatric Orthopedics
      Speciality Pediatric Orthopedics
      Consulting Room Ground floor, room no. 1
      Consultation
      Timing
      Mondays
      3pm - 5pm

      Dr. Dipit Sahu

      MS - Orthopedics, Fellowship in Shoulder Surgery
      Speciality Orthopedics
      Consulting Room 005
      Consultation
      Timing
      On Appointment

      Dr. Milind Sawant

      MS - Orthopedics, FRCS Trauma & Orth
      Speciality Joint Replacement
      Consulting Room 203
      Consultation
      Timing
      Saturday
      2pm - 3pm

      Dr. Amandeep Singh Gujral

      DNB - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 204
      Consultation
      Timing
      Tuesday and Thursday
      7pm - 8pm

      Dr. Raghuprasad Verma

      MS - Orthopedics, Fellowship in Spine Surgery
      Speciality Spine
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Swaroop Hegde

      MD - General Medicine and Endocrinology
      Speciality General Medicine
      Consulting Room 204
      Consultation
      Timing
      On Appointment

      Dr. Antima Jain

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
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      Monday to Saturday
      8am to 1pm

      Dr. Kusumlata

      BPT - Bachelor of Physiotherapy, MPT
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
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      Monday to Saturday
      5pm - 9pm

      Dr. Kanchan Suvasia

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
      Timing
      Monday to Saturday
      4pm - 7pm

      Dr. Sauramibika Tiwari

      BPT - Bachelor of Physiotherapy
      Speciality Physiotherapist
      Consulting Room 004
      Consultation
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      Monday to Saturday
      9am - 2pm

      Dr. Suman Bijlani

      MBBS, MD - Obstetrics & Gynaecology, DGO, FCPS - Mid. & Gynae
      Speciality Gynecologist
      Consulting Room 203
      Consultation
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      Dr. Preeti Jobalia

      DGO - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 003
      Consultation
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      On Appointment

      Dr. Shilpa Shah

      DNB - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 001
      Consultation
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      On Appointment

      Dr. Vidula Daundkar

      MS - Obstetrics & Gynecology
      Speciality Gynecologist
      Consulting Room 201
      Consultation
      Timing
      On Appointment

      Dr. Ashutosh Kharche

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Vascular Surgeon
      Consulting Room 203
      Consultation
      Timing
      Tuesday and Friday
      8pm - 9pm

      Dr. Amit Sahu

      MD - Radiodiagnosis, Fellowship in Vasclular & Interventional Radiology
      Speciality Interventional Radiology
      Consulting Room 205
      Consultation
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      On Appointment

      Dr. Satish Chougale

      MD - Anesthesiology
      Speciality Anesthesiology
      Consulting Room 002
      Consultation
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      Dr. Sayali

      Diploma in Anesthesiology
      Speciality Anesthesiology
      Consulting Room 003
      Consultation
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      Dr. Sheetal

      Speciality Anesthesiology
      Consulting Room 005
      Consultation
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      Dr. Suratkal

      MBBS, DNB Nephrology
      Speciality Nephrologist
      Consulting Room 201
      Consultation
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      Monday, Wednesday and Friday
      11am - 1pm

      Dr. Ashish Agrahari

      MD Pathology
      Speciality Pathologist
      Consulting Room 203
      Consultation
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      Dr. Akshay Deshpande

      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive
      Consulting Room 204
      Consultation
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      Dr. Amit Patil

      MCH - Plastic & Reconstructive Surgery
      Speciality Plastic & Reconstructive Surgery
      Consulting Room 004
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      Dr. Tushar Jadhav

      DNB - Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 005
      Consultation
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      Dr. Devashri Patil

      MS - ENT, Fellowship in Head and Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 001
      Consultation
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      Dr. Ankit Shah

      MDS & Fellowship in Head & Neck Surgical Oncology
      Speciality Surgical Oncology
      Consulting Room 201
      Consultation
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      On Appointment

      Dr. Dimple Chudgar

      DNB (Obstetrics & Gynecology), Fellowship in Reproductive Medicine and Endoscopic Surgery
      Speciality Obstetrics & Gynecology
      Consulting Room 204
      Consultation
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      Dr. Sanjay Singh

      DNB (Orthopedics), Fellowship in Shoulder & Elbow
      Speciality Shoulder & Elbow Surgery
      Consulting Room 203
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      Our Vision & Mission

      Our Vision दृष्टिकोन:
      To improve the quality of life; free of deformities for our patients, at an affordable price while always treating them like a family.
      आमच्या रुग्णांच्या जीवनाचा दर्जा सुधारण्यासाठी त्यांस परवडणाऱ्या किंमतीत आरोग्य सेवा देणे. तसेच त्यांच्या सोबत नेहमी कुटुंबाप्रमाणे वागणे.

      Our Mission मोहीम:
      To provide the best, empathetic medical care to our patients. To help our patients make an informed choice in their treatment. To pass on the knowledge we have received to our collegues and to the next generation.
      आमच्या रुग्णांना सर्वोत्तम, सहानुभूतीपूर्ण वैद्यकीय सेवा प्रदान करणे. आमच्या रुग्णांना त्यांच्या उपचारांमध्ये माहितीपूर्ण निवड करण्यास मदत करणे. आम्हाला मिळालेले ज्ञान आमच्या सहकाऱ्यांना आणि पुढच्या पिढीपर्यंत पोहोचवणे.