SAFETY AT THE PLAYGROUND

Due to its location in a residential area, the hospital sees a fair amount of injuries involving children. The numbers seen in the emergency room usually correspond to the school holidays, where we see an increase in the number of children being brought in due to some kind of injury, usually due to a fall while playing.  I suppose the holidays are the time children are given more freedom to play outdoor, free from the pressures of homework and tuition.

The neighbourhood playground is a natural spot for children to congregate, interact and play; at the same time it helps to build their physical skills, co-ordination and strength. It is also a wonderful place for families to get some fresh air and exercise.  It may look like a safe place, but hidden dangers do lurk. The hospital had a “Smart Parent Safe Kids” campaign earlier this year where I gave a talk on prevention of playground injuries.  Why playground injuries? Well, apart from the home, accidents occur more frequently on the playground than any other places. 
In the US, more than 200,000 playground-related injuries occur annually. Similarly in Malaysia, a recent study has shown that 17% of childhood fractures occur in the parks, second only to the home (35%). Now scrapes and bruises are a normal part of growing up, but injuries that are brought to the hospital are usually of a more severe kind. We see sprains, fractures, dislocations, and rarely, amputated fingertips.

Children can injure themselves at the playground in a variety of ways.  As I have explained above, the majority of the injuries result from a fall from playground equipment. They might slip, lose their grip while climbing, or lose balance while playing on the “monkey bars”. Another way is by improper usage of equipment.

The onus is on parents and caregivers to create a safe environment for children to play. One should firstly choose a safe playground based on the location and surrounding hazards. Watch out for open drains, exposed electrical wires and busy roads among other things.

Close supervision by a responsible adult may be the most important factor in preventing playground injuries.  For young children, adults should be with them the whole time they are playing on play equipment. The word is “Active supervision” – one should not be distracted by other activities such as reading a book, talking on the phone or texting.  Although I do agree that  sometimes  adult supervision might be a problem in urban areas as both parents may be working, delegating this responsibility to the grandparents, housemaids or elder children might not be as effective.  Educating the child on the correct usage of play equipment not only decreases the chance of injuries but also goes a long way in preserving the lifespan of the play equipment.

All these might sound frightening, so should you stop sending your children to the playground? My thoughts are that the benefits of fresh air and exercise far outweigh the danger, and so long as mummy and daddy keep an eye and play an actively supervise, time spent at the playground need not end up a tearful experience.

-The BomohTulang 

Eid-Ul Fitri and Happy Independence Day 2011

The end of August this year coincides with the two largest celebration for Malaysians.

Muslims throughout the country, according to calculation, will observe Eid-ul Fitri on Tuesday the 30th of August, marking the end of Ramadhan, where muslims fasted daily for a month from dawn till dusk. Traditionally the eid holidays (also known as Hari Raya Aidil Fitri) run for two consecutive days but this year, the second day coincides with Malaysia's 54th Independence Day.

So this year is indeed a double celebration for Malaysians in general and especially for the muslims throughout; the Bomoh Tulang would like to take this oppurtunity to wish a Selamat Hari Raya and Happy Independence day to all Malaysians!

Happy Holidays and have a safe journey home!

Selamat Hari Merdeka!

- the BomohTulang -

ACHILLES TENDON CUT due to TOILET BOWL INJURY

The patient slipped in the bathroom and his foot crashed into the toilet bowl. (no he was not squatting on the edge of the toilet seat - see bottom pic)

He sustained a deep laceration over his calf and a clinical examination showed that the achilles tendon was torn.
This was confirmed intra-operatively, where an emergency debridement, exploration and tendon repair was done the same day.

Intra-op findings

Wound blurred out as deemed too gory for public viewing :

Post operatively, a backslab with the ankle in equinus was applied so as to relieve the tension on the operated tendon. This will be replaced later with a special walking boot allowing range of motion exercises to the ankle, with partial weight bearing of the affected limb. Total rehabilitation would take about 4-6 weeks

Apparently a group of doctors reported on this seemingly "rare" case and got it published in the foot and ankle journal.

On another related note, have you been to the toilets in the malls? you would probably come across this sign:

The bottom right symbol is an apt reminder of what not to do if one wishes to avoid getting the injury that our friend above had... perhaps the mall management might want to use the picture above to illustrate the consequences of slipping into a toilet bowl.. hmm...

- the Bomoh Tulang -

reference:

the AAOS Clinical Practice Guideline on the Diagnosis and Treatment of Acute Achilles Tendon Rupture 2009

FALL PREVENTION IN THE ELDERLY - KEMUNING NEWS magazine article

Broken bones are a very real risk in the elderly, partly due to the fact that bones are brittle at that age, and  minor falls could lead to a catastrophic fracture.
The Bomoh Tulang was featured in the July-September 2011 edition of Kemuning News the other day, featuring a write up on do's and dont's on fall prevention in the elderly.

 

Kemuning News is published on a quarterly basis, exclusively for the residents of Kota Kemuning, which is the housing area adjacent to the hospital.
If you are a resident of Kota Kemuning (or just happened to be in the vicinity), do pick up a copy as the publication is freely available at the convenience stores and the Petronas stations.

In case you have missed it, I have appended the article on my website here.

- the Bomoh Tulang -

SCUBA DIVING - Dr Asri's OW dive certification

As you know I'm an avid diver, having had my PADI dive certification in 2005. Since then I have had the opportunity to log numerous dives around the islands off Malaysia's coast.

I managed to "racun" Dr Asri, our Anesthetist in the hospital to take the Open Water Diver Certification, which is basically a "licence" to scuba dive and the first step to experience what the wonderful world beneath the waves has to offer.
Part of the certification is to do a few dives in the open water (as opposed to the confined waters of the pool)

So one fine July weekend, we took a flight to Kuala Terengganu and met up with Divemaster Halimi of Ocean Elements.The speedboat brought us to Pulau Perhentian where we spent the weekend and for Dr Asri to practice his ability to breathe underwater :P

More pics after the jump..

Before the first dive

SYNDACTYLY - joined together

Syndactyly, or "webbed fingers," is caused by the failure of the fingers to separate during embryological development. It is the most common congenital anomaly of the hand, with an occurrence of 1 per 2000 births. Hereditary causes has been suggested, with up to 40% of patients having a positive family history of syndactily.

Syndactyly can also be associated with a variety of other syndromes, some of them rare - for example in the patient below with Apert Syndrome.

Syndactyly in an infant - part of a larger problem - the Apert Syndrome

Syndactyly is most commonly seen in the middle and ring fingers; it can be classified as simple when it involves soft tissues only and complex when it involves the bone or nail of adjacent fingers. It can also be classified as complete or incomplete depending on the degree of soft tissue union between the fingers.

Timing of separation of the digits depends on the fingers affected. If the affected digits grow at unequal lengths (for example the little and ring fingers) then separation should ideally be done within the first few months of life as the tethering of the skin will cause the fingers to deviate and cause contractures.

Ring and mddle finger syndactyly usually does not pose functional problems, as in the case of the older child below. In this case, it is a simple, complete syndactyly of the ring and middle fingers. Since both fingers grow at equal lengths, surgery to separate the fingers can be delayed later in life.

- the BomohTulang -

Smart Parents Safe Kids campaign

Columbia Asia Hospitals, in collaboration with the parenting website parenting2u, organized a series of talks on children safety at CAHBR recently. This event kicks off a nationwide campaign themed "Smart Parents, Safe Kids". 

The aim is to educate parents and caregivers on the importance of children's safety and also highlight the hidden dangers found at home, the parks and in the water.

Given the fact that the ortho surgeons deal a lot with children's fracture, guess who was honoured with the chance to talk on playground safety?..

Earnestly talking

what's this about

Part of the audience

activities for kids

The talks will be held at the Columbia Asia Hospitals nationwide, so check out your nearest hospital for the date of the roadshow.

More on the campaign can be found here

- the BomohTulang -