Standardized Informed Consent Form for Clinicians Administering Platelet-Rich Plasma.

Introduction When it comes to medico-legal malpractice suits, lawyers and insurers tend to focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for the use of platelet-rich plasma (PRP) injections, which might cause problems. This study aimed to mitigate this concern through the development of a standardized informed consent document for PRP injections, grounded in evidence-based practices. Materials and methods An examination of databases was conducted to explore the medico-legal ramifications associated with PRP injections, as well as the broader topic of informed consent, with a particular focus on the context of PRP injections. Moreover, interviews were carried out with healthcare providers and individuals who had received PRP injections within the preceding year, utilizing a semi-structured methodology. Results We developed an evidence-based informed consent document tailored for PRP injections. To guarantee its legal validity, the document underwent review by a legal specialist. Subsequently, our institutions implemented the finalized form for PRP injection procedures over one year. Conclusion A legally valid and evidence-based informed consent form for PRP injections would ensure patient's rights, and encourage open communication and transparency between them and the doctor. Moreover, if a lawsuit were to arise, it would serve as a critical document in the doctor's defense and withstand scrutiny from lawyers and the judiciary.

Beyond Blame: Is India Ready for No-Fault Liability in Healthcare?

In contemporary healthcare systems, the pursuit of justice intertwines with fault attribution and liability determination. The exploration of no-fault liability as a potential alternative within India's healthcare landscape delves into its feasibility and implications. Drawing from international experiences, regulatory frameworks, and societal readiness, the complexities and potential benefits of adopting a no-fault liability system are elucidated. Perspectives from patients, healthcare providers, and broader societal stakeholders are considered, highlighting both the advantages and challenges associated with such a transition. Addressing disparities in access, legal reforms, and logistical hurdles underscores the groundwork necessary for potential adoption, signaling a potential paradigm shift toward equitable compensation and accountability within India's healthcare system.

The New Consumer Protection Act Controversy: Does It Apply to Doctors in India?

A new Consumer Protection Act (CPA) was introduced in 2019 and has created quite a stir in the medical fraternity. There is widespread uncertainty as to whether this new Act applies to the medical profession. However, on careful review of the original CPA of 1986, the definition of services included within the Act, and understanding the changes introduced in CPA 2019, the legal application of CPA 2019 to medical professionals becomes clear. While the term medical services has been removed from the list of services under the purview of the Act, the phrase "but not limited to" before listing the services leaves the door open for the inclusion of other services.

Customizable Hyperextension Splint for Mallet Finger.

Introduction: Mallet finger is a common deformity occurring due to the traumatic detachment of the extensor tendon at its insertion in the distal phalanx. Despite several different methods of splinting being available, residual extensor lag remains one of the most common complications of conservative treatment. Technique Report: We demonstrate a novel technique to make a hyperextension splint which can be customized as per the individual. The pictorial demonstration depicts every step in the preparation, application, and maintenance of the splint. Conclusion: We believe that the use of such easily accessible materials and visual demonstration of each step, with pointers along the way to verify the correct technique, will empower any medical professional, to satisfactorily treat such injuries at the primary point of contact, without necessitating the services of a hand surgeon.

Arthroscopy in India Through the Medicolegal Lens: A Comprehensive Review.

Introduction: With the increasing number of Arthroscopic surgeries, comes with it, the undesirable problem of litigation associated with it. Arthroscopy does possess certain unique aspects which need to be understood from the legal point of view as well. Materials and Methods: We obtained information on specific medico-legal cases involving arthroscopy from books and websites containing collections of medico-legal judgments in Indian legal courts, consumer dispute redressal forums at the state and national levels, and state medical councils.. Results: We assimilated and analysed all this information, combined it with our experience in the field of medical law, and have provided practical, enforceable ways to decrease the medicolegal risk for arthroscopy surgeons. Conclusion: This review provides a comprehensive overview of pressing issues in relation to the medicolegal aspects of arthroscopic surgery.

Medical Termination of Pregnancy Act of India: Treading the Path between Practical and Ethical Reproductive Justice.

One of the most important facets of reproductive freedom and justice is the right to abortion. For centuries, the debate on legalisation and regulation of abortion has caused ethical dilemmas with proponents for both sides of the argument. India, a developing nation, with a wide spectrum of cultures, traditions, socio-economic statuses and religious beliefs, would be expected to be grappling with this problem. However, India since the 1970s made a clear stance on the matter of abortion. Respecting the right to personal liberty, reproductive freedom of women and upholding the importance of women's health, Medical Termination Pregnancy (MTP) has been legal in India since 1971. We look at the laws governing MTP in India, the practical and ethical considerations, the recent amendments in these laws and the road ahead.

Osteoporosis - An Imminent Ethical and Legal Debacle?

Osteoporosis is a condition characterized by a decrease in bone density. Its prevalence is on the rise and is only going to continue to rise further. Fragility fractures such as neck of femur fracture fractures and intertrochanteric fractures are among the most common fractures encountered by orthopedic surgeons today. Yet, the management of these fragility fractures has unfortunately fallen short of addressing the etiology behind the fracture. Orthopedic surgeons routinely perform arthroplasty or osteosynthesis for stabilization of these fractures, but rarely do they address the coexisting osteoporosis. We explore the factors, leading to this scenario, the practical hurdles faced, the ethical and legal considerations on the matter, and the road ahead. We believe that this is a topic which should be discussed further among orthopedic surgeons to arrive at practical solutions and change in perspectives. The aim of this article was to encourage a debate on the matter, increase awareness about the current situation, and help change the trend in the management of osteoporosis in developing countries like India.

In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery.

Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..

Understanding the Medico-Legal Aspects of Telemedicine in India.

Telemedicine has brought a new dimension to healthcare and has been gaining popularity worldwide. However, the medico-legal aspects of the practice of telemedicine in India remain ambiguous to most doctors and administrators. We have therefore provided a concise overview of the legal aspects of telemedicine, which will enable doctors and administrators to provide better telemedicine services while safeguarding themselves from possible litigation.

Utilization and Perception of Telemedicine among Orthopedic Surgeons.

INTRODUCTION: Telemedicine has been a growing trend. Its use in the field of orthopedic surgery has its own unique facets. To determine the perception and assess the utilization of telemedicine the current study was conducted. MATERIALS AND METHODS: This is a cross-sectional exploratory study conducted from January to April 2022 among 142 orthopedic surgeons across India who had previous experience of using telemedicine and were willing to participate in this study. The data was collected using a validated semi-structured questionnaire consisting of 44 multiple Choice questions, divided into 7 sections: experience in using telemedicine, technical aspects, patient selection, problems faced, benefits, current use, and opinions designed in English language. The data obtained from the responses were tabulated, analyzed and expressed in proportions. RESULTS: We found that nearly 80% of orthopedic surgeons believed that teleconsultation was most appropriate for follow up visits. The two most common issues faced were technical issues relating to poor video/audio/connectivity, and difficulty with regard to viewing of radiographs, MRI films etc. The major advantage was perceived to be easier access for patients, especially bed ridden/old patients. CONCLUSION: Our survey showed a significantly positive response toward telemedicine. Technical issues and lack of clinical examination were cited as the most common hindrances faced. Saving the time of the patient, and easier access to healthcare for old aged individuals, bed ridden patients and individuals in remote areas were the major perceived benefits.

Evidence-based informed consent form for total knee arthroplasty.

INTRODUCTION: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. MATERIALS AND METHODS: We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. RESULTS: Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. CONCLUSION: The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Legally Sound, Evidence-Based Informed Consent Form for Total Hip Arthroplasty.

Introduction: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure for obtaining informed consent for total hip arthroplasty (THA). We aimed to develop a solution for this need for a pre-designed, evidence-based informed consent form for THA cases. Materials and Methods: We extensively reviewed the literature on the medico-legal aspects of THA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in THA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had previously undergone THA in the previous year. Based on all of the above, we developed an informed consent form that was evidence-based. We then had the form reviewed by a legal expert. The final form was utilised for THA cases at our institution for 1 year. Results: Legally sound, evidence-based Informed Consent Form for Total Hip Arthroplasty is given in Form A. Conclusion: The use of legally sound, evidence-based informed consent for total hip arthroplasty cases would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, and promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Combination-type periprosthetic tibial fracture: Felix type (II+IV)A.

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

Scapholunate Advanced Collapse Wrist - Keeping it Simple - A Case Report.

Introduction: Scapholunate advanced collapse is a rare condition of progressive deformity, instability, and arthritis that affects the radiocarpal and mid-carpal joints of the wrist. It occurs as a result of injury to the scapholunate ligament being left untreated. Case Report: We present the imaging of a 50-year-old woman who complained of pain in her right wrist for 2 years. Radiographs of the wrist revealed scapholunate diastasis (Terry Thomas Sign), arthritis of the radio-scaphoid joint, dorsal intercalated segment instability, radial styloid beaking, and proximal migration of capitate. We also demonstrate the measurement of radiological parameters such as scapholunate angle. Conclusion: A complete in-depth radiological analysis can thus demonstrate several signs that can prevent missed diagnosis. Increased awareness regarding these radiological signs can avoid the unnecessary higher imaging modalities being performed.

Neglected Elbow Dislocation leading to Ankylosis of Elbow: A Case Report.

Introduction: Neglected elbow dislocation is defined as a dislocation that is present for 3 weeks or longer. There is no available literature on neglected elbow dislocations, leading to ankylosis of the elbow joint. Case Report: A 17-year-old female sustained a road traffic accident. Anteroposterior and lateral view radiographs of the forearm were done and deemed to be normal at another hospital. Six months after the injury, she presented to us with complaints of absent elbow movements. Examination revealed the elbow to be fixed in 30° of flexion. Radiographs of the elbow revealed an ankylosis of the ulnohumeral articulation in an abnormal position. Conclusion: This case demonstrates that neglected elbow dislocations can lead to ankylosis of the joint. It also shows how radiographs of the forearm are inadequate to assess for elbow dislocations even if the elbow region is covered in the radiograph.

Management of Paediatric Proximal Tibia Osteosarcoma - A Novel Technique of Preservation of Physeal Growth.

Introduction: Osteosarcoma is a malignant tumor, the treatment of which is controversial between amputation and limb salvage surgery. Osteosarcoma occurring in a child is a challenge to manage due to the arrest of limb and the resultant limb length discrepancy. The management options for a child less than eight years of age are very limited. Case report: We present a case of a six year old child who was diagnosed to have osteosarcoma of proximal tibia. She was started on neoadjuvant chemotherapy, after which, she underwent wide resection and reconstruction with free vascularised fibular graft. The joint was fused using a locking compression plate and screws. The locking screws were inserted avoiding the distal femoral physis, enabling growth of the physis in future. Adjuvant chemotherapy was then given. Follow up radiographs showed Harris growth lines indicating growth to be occurring at the distal femoral physis. She was not found to have recurrence on last follow up four years after surgery. Conclusion: We found reconstruction using free fibular graft and arthrodesis using plate and screws, provided satisfactory results. An attempt can be made to preserve the distal femur physis.

Osteoid Osteoma of Talus - A Rare Occurrence Mimicking Ankle Arthritis: A Case Report.

Introduction: Osteoid osteoma is a benign, bone forming tumor which accounts for nearly 10% of all benign bone tumors. The foot is very rarely involved, with only around 2% of osteoid osteomas being reported to occur in bones of the foot. Osteoid osteoma of the talus could present as symptoms mimicking monoarticular arthritis of the ankle. We present a case of osteoid osteoma occurring in the neck of talus, presenting such a diagnostic dilemma. Case Report: A 13-year-old male child had complaints of pain and swelling in his right ankle since 1 year. The pain was predominantly aggravated at night and partially relieved by non-steroidal anti-inflammatory drugs. On examination, we found a diffuse, ill-defined, and soft swelling over the anteromedial aspect of the right ankle, which was anterior and inferior to the medial malleolus. The movements at the ankle joint were restricted and painful. Lateral radiograph of ankle revealed a solitary, osteolytic, and circular lesion involving the neck of the talus. Computed tomography (CT) scan showed a well-defined, lucent, and intramedullary lesion with a sclerotic rim in the neck of talus. The child was diagnosed to have osteoid osteoma of the neck of talus. We performed percutaneous CT-guided radiofrequency ablation (RFA) of the lesion. The child had complete relief of pain after the procedure. The child was followed up for 3 years and had no complaints of pain. Conclusion: Osteoid osteoma very rarely occurs in the talus. It can present as monoarticular arthritis involving the ankle joint and requires a high degree of suspicion to be identified. A CT scan remains the most accurate investigation to confirm the diagnosis. We found percutaneous CT-guided RFA to have yielded good outcome without recurrence.