joyancejames

Tag: #orthopedics

  • What The Thigh Bone Taught Me!

    Femur is latin for thigh and os femoris is thigh bone. In current medical terminology the thigh bone is referred to as femur. It is the largest bone in the human body, as long as 1/4th of the standing height!

    Here I’ll attempt to take you through some unique features of femur and what it teaches us. 

    1. As the largest bone in the body, it is also the strongest. It can take upto 30x the body weight before fracturing. 

    The maximum stress it can tolerate in compression is 205MPa (mega pascals) while a tensile force (in order to stretch/bend) of 135 MPa can be tolerated by the femur. (College of Engineering; University of Wisconsin). 

    2. The thigh bone is not uniform in structure, the ends are spongy bone whereas the middle part is cortical, dense part. The ends of the femur are areas with bone marrow and involved in blood cell formation, more significantly in children. 

    3. Bone is one of the few tissues in human body that heals without scar (fibrosis). A fracture heals with bone tissue and after a few months it remodels to become normal bone again. 

    4. Although the length of femur stops growing in the teenage years but it’s micro-structure is constantly evolving. Bone is involved in metabolism, calcium and phosphorus keep getting deposited and reabsorbed from the bone; the bone mass and density changes according to multiple factors including age.

    Holding a Femur, for size comparision. Specimen courtesy: Anatomist wifey.

    The femur with its intricately marvellous structure and function is an unprecedented engineering marvel! Such strong, life giving (blood forming), self healing and constantly evolving structure can only point towards an intentional and intelligent Creator. 

    Psalms 139:14-15 TPT

    [14] I thank you, God, for making me so mysteriously complex! Everything you do is marvelously breathtaking. It simply amazes me to think about it! How thoroughly you know me, Lord! [15] You even formed every bone in my body when you created me in the secret place;  carefully, skillfully you shaped me  from nothing to something.

    https://bible.com/bible/1849/psa.139.14-15.TPT

    At the foot of the cross as St. John stood and watched, he testified in John chapter 19 that the Roman soldiers when they came to Jesus they didn’t practise the ritual crurifragium (breaking of thigh/leg bone to hasten the death).  In his yesteryears St. John saw a vision of the rider on the white horse, whose title was the Word of God, quite fittingly he describes, 

    “On his robe at his thigh was written this title: King of all kings and Lord of all lords.”

    Revelation 19:16 NLT

    https://bible.com/bible/116/rev.19.16.NLT

    There it is evident for all to see, for all eternity written on His thigh, His title as the ‘King of kings and Lord of lords’. 

    The femur which means, strength, life and resilience for mankind now brings hope to the ailing humanity in the coming of the ‘King of kings & Lord of lords’.

    God bless you!

  • Hypertrophy

    Merriam-Webster Medical Dictionary defines ‘hypertrophy’ as: excessive development of an organ or part
    specifically : increase in bulk (as by thickening of muscle fibers) without multiplication of parts.

    In case of skeletal muscles this (hypertrophy) is what happens in those who undertake strength training. Multiple cycles of repetitions – muscle contractions/ relaxations daily compounded over weeks and months leads to hypertrophied muscle.
    In the initial phase there is a lot of wear and tears (micro trauma) to the muscle causing soreness to un-accustomed muscle group but eventually this persistence leads to bulking up of the particular muscle group.

    Vierck, J et al. “Satellite cell regulation following myotrauma caused by resistance exercise.” Cell biology international vol. 24,5 (2000): 263-72. doi:10.1006/cbir.2000.0499

    Y’hoshua (Joshua) 1:8 CJB
    [8] Yes, keep this book of the Torah on your lips, and meditate on it day and night, so that you will take care to act according to everything written in it. Then your undertakings will prosper, and you will succeed.
    https://bible.com/bible/1275/jos.1.8.CJB

    The Hebrew word for meditate is hagah (הגה) which literally means to mutter/ to utter or speak. This day and night meditation by means of constant utterance and repetition is commonly found in the book of Psalms.
    Psalm 1:2 AMPC
    [2]  But his delight and desire are in the law of the Lord, and on His law (the precepts,
    the instructions, the teachings of God) he habitually meditates (ponders and studies) by day and by night.
    https://bible.com/bible/8/psa.1.2.AMPC

    The human brain is not a muscle to be hypertrophied but the constant repetition day after day brings about a change from the inside out. Saturation with God’s truth kills the weeds of doubts and fear. Verbal repetition strengths the neural pathways in the brain responsible for memory, especially long-term memory.

    Just as repetition cause muscles to hypertrophy and bulk up, become more resistant to injury & stress, repetition of God’s word causes our brains to form strong neural pathways to remind us constantly of His truth.
    I believe this form of meditation is what caused David the little boy to bulk up (not physically but spiritually) to the giant Goliath. He could operate from a place of Faith when all his countrymen cowered in fear.

    May God’s word be the object of our meditations as our minds bathe in the knowledge of His truth.

    God bless!

  • Step & Stride

    Lessons (orthopedic) from the walk

    Step length while walking is the distance between the point of contact of one foot and the point of contact of the opposite foot.
    Stride length is the distance between the successive points of initial contact of same foot.
    Stride involves two steps, hence it’s twice the length of single step.
    Cadence is the number of steps per minute.

    *Aggarwal, Abhinandan & Gupta, Rohit & Agarwal, Ravinder. (2018). Design and Development of Integrated Insole System for Gait Analysis. 1-5. 10.1109/IC3.2018.8530543

    When I walk with my daughter, she has to take couple of steps in order to match my stride length. At a little above 6’1″, my normal stride length will be somewhere between 1.5 – 1.9 meters, depending on my speed, etc, while for my daughter who stands just above my hip, the stride length will be approximately a 1/3rd of that.
    So for every step I take, she’ll take two or more, that increases her cadence (number of steps per minute).

    In our walk with Abba, so many times we take few steps forward but still feel He is not moving. That’s the difference between the human and the divine step/stride.
    Isaiah 55:8-9 NLT
    [8] “My thoughts are nothing like your thoughts,” says the Lord. “And my ways are far beyond anything you could imagine.
    [9] For just as the heavens are higher than the earth, so my ways are higher than your ways and my thoughts higher than your thoughts.
    https://bible.com/bible/116/isa.55.8-9.NLT

    The times when we feel, He’s not moving or working, we must remember that He’s always working, always moving just the divine cadence is different.

    The other aspect to it is that more often than not, I subconsciously take smaller steps while walking with my daughter in order to match her pace. When I reduce my step and stride length, she can walk comfortably & unhurriedly. In our life’s path, when we feel the pace of things is too slow, it would be wise to call to remembrance that Abba has to slow down intentionally so that we can walk comfortably & unhurriedly.

    a daddy-daughter walk

    Matthew 11:28-30 MSG
    [28-30] “Are you tired? Worn out? Burned out on religion? Come to me. Get away with me and you’ll recover your life. I’ll show you how to take a real rest. Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won’t lay anything heavy or ill-fitting on you. Keep company with me and you’ll learn to live freely and lightly.”

    https://bible.com/bible/97/mat.11.28-30.MSG

    Happy walking! God bless!

  • Stapes & Femur

    Although I’m a bone doctor, children’s bone doctor to be precise, I’m not qualified to treat all the 206 bones in the human body. Here I want to highlight the beauty and intricacy of the human body, hence the psalmist wrote, “I’m fearfully and wonderfully made”.

    Femur which is the largest and longest bone in the human body can be up to 48 cms long and can take upto 30 times the body weight. This in itself is an unparalleled engineering marvel. The orthopedic surgeons (such as I) commonly operate on this big bone.

    Stapes, the smallest bone which is stirrup shaped is inside the middle ear cavity (inside the skull). It’s just 2-3 mm in size and the ENT surgeons require either microscope or a magnifying loupe to operate on this small beauty. The stapes serves to relay the sound vibrations from the outside to be transmitted to the brain which in turn deciphers the sounds.

    The dichotomy between the largest and the smallest bones in the body in terms of structure and function is fascinating. While one can bear many times the weight of the body the other can vibrate discreetly to relay the sound signals to the brain.

    The God who made both the femur and the stapes is as much concerned about the minute and mundane as He is about the big things in our lives. Even the tiny and the inconspicuous details in our lives are woven into the grand picture of our lives. From our vantage point we may never fully comprehend the unraveling of divine plan and proposes for our lives. The Creator knows His creation best. It takes decades of learning to unravel even a fraction of what the good Lord made from dust.

    Psalms 139:13-14 NLT
    [13] You made all the delicate, inner parts of my body and knit me together in my mother’s womb. [14] Thank you for making me so wonderfully complex! Your workmanship is marvelous—how well I know it.

    https://bible.com/bible/116/psa.139.13-14.NLT

    God bless you!


    References
    1. openoregon.pressbooks.pub/bodyphysics/chapter/stress-and-strain-on-the-body/#footnote-843-2


    2. Àwengen, D. F.; Nishihara, S.; Kurokawa, H.; Goode, R. L. (April 1995). “Measurements of the stapes superstructure”. The Annals of Otology, Rhinology, and Laryngology. 104 (4 Pt 1): 311–6.

    3.www.researchgate.net/publication/333521311/figure/fig1/AS:764798413332480@1559353559479/The-three-auditory-ossicles-From-left-to-right-the-stapes-malleus-and-incus.jpg

    https://anatomy.app/encyclopedia/femur
    Left – Right: Malleus, incus and stapes (smallest) [Dissected specimen courtesy Dr Shalom Philip MD]

  • Life update: End of an era

    June 2008 I left home to pursue my undergraduate studies in medicine and now I’m back home, it’s end of July 2022. 14 years away from home, MBBS and MS, wife and a baby. God has blessed and multiplied me.

    After completing MS Orthopedics from CMC Ludhiana, I worked in mission hospitals under EHA. I got an opportunity to work in the following hospitals as an Orthopedic surgeon in the last 3 years: 1. Jiwan Jyoti Christian Hospital, Robertsganj, UP
    2. Kachhwa Christian Hospital, Mirzapur, UP
    3. Herbertpur Christian Hospital, Herbertpur, Uttrakhand.
    4. Landour Community Hospital, Mussoorie, Uttrakhand
    5. Duncan Hospital, Raxaul, Bihar.
    I was posted primarily in Robertsganj and worked there the maximum, rest were deputation, ranging from a few days to weeks/months.

    Last surgery in Herbertpur Christian Hospital (30.07.2022)

    I have seen first hand the legacy of the medical missionaries and contributed my little bit to their huge contribution towards nation building. I’ve learnt not only to bridge broken bones and crooked limbs but also gained a deeper understanding of the word of God. Last 20 months I’ve been away from Shalom and Faith, but God has been with us and we’ve seen the goodness of God.

    “You have led me through the fire
    In the darkest night
    You are close like no other
    I’ve known You as a Father
    I’ve known You as a Friend
    And I have lived in the goodness of God”. – Goodness of God by Bethel Music

    But you are not like that, for you are a chosen people. You are royal priests, a holy nation, God’s very own possession. As a result, you can show others the goodness of God, for he called you out of the darkness into his wonderful light.
    1 Peter 2:9 NLT
    ( https://bible.com/bible/116/1pe.2.9.NLT ). So here I am testifying the goodness of God, He is a Father who never leaves us nor abandons us.

    What’s next? We’ll find jobs in Ahmedabad, school for Faith, church community where we’ll thrive and flourish. As someone rightly said, “I don’t know what tomorrow holds but I know the One who holds tomorrow”. So even with the uncertainties surrounding me I am certain of the goodness of God and His favour which lasts a lifetime.

    God bless you.

  • Straightening children since 900 BC

    Solomon Ben David vs Nicholas Andry

    “…one must not neglect the body and let it become deformed, this would be against the intention of the Creator; this is the basic principle of orthopaedics […] this book is aimed exclusively at fathers and mothers and all people bringing up children who must try to prevent and correct any deformed part of the child body” – Nicholas Andry (L’Orthopédie 1741)*

    “Crooked tree” symbol courtesy Nicholas Andry

    The “crooked tree” symbol is attributed to Nicholas Andry. He reasoned that just as a crooked tree is made to grow straight when it’s growth is directed so a crooked bone/deformity can be straightened when it’s growth is directed. What started primarily as a medical speciality to correct childhood deformities has since then progressed to address all musculoskeletal issues from pediatric to geriatric age groups. Since then this crooked tree has become the logo of numerous orthopedic societies and institutions.

    “Direct your children onto the right path, and when they are older, they will not leave it.”
    Proverbs 22:6 NLT – Solomon Ben David

    Here we see an distinctive resemblance in the thought process of both King Solomon and Nicholas Andry. Did Andry take a leaf out of the former’s book and applied it too literally? Both wanted to harness the mallebility of childhood for a better future (sans crookedness).

    The verb translated “direct or train” (חנך – chanak) means, first, “to put something into the mouth,” “to give to be tasted,” as nurses give to infants food which they have masticated in order to prepare it for their nurslings; thence it comes to signify “to give elementary instruction,” “to imbue,” “to train.” The Hebrew literally is, Initiate a child in accordance with his way. In the Hebrew Bible this word chanak appears 5 times and rest of the 4 times it’s translated as “dedicate” in English.

    A very good example of what happens when the parent takes initiative to train and direct is seen in the following 3 verses depicting the life of Samuel:
    1 Samuel 1:28 (Prayer of a mother)
    “Therefore also I have lent him to the LORD; as long as he liveth he shall be lent to the LORD. And he worshipped the LORD there.”

    1 Samuel 2:26 (Straight growth of the child)
    “And the child Samuel grew on, and was in favour both with the LORD, and also with men.”

    1 Samuel 12:2,3 (Lifelong benefits of early initiation)
    “And now, behold, the king walketh before you: and I am old and grayheaded; and, behold, my sons are with you: and I have walked before you from my childhood unto this day.”

    “Adeo in teneris consuescere multum est.” So much depends upon the habit in tender years.
    This hold true both for Orthopedics and for life.

    *Andry N (1741) L‘orthopédie ou l’art de prevenir et de corriger dans les enfants les difformités du corps. A Paris, chez la Veuve Alix et chez Lambert et Durand, 1st ed.