Ashvin K. Dewan, MD, Orthopedic Surgeon at Houston Methodist Sugar Land Hospital talks about breakthrough technology to help make the process for fixing broken long bones quicker and safer for patients and staff.
Interview conducted by Ivanhoe Broadcast News in May 2019.
Tell me how did this Idea start?
DEWAN: When I started as an orthopedic surgeon I encountered several different challenges relating to the technologies we used. One problem that would frustrate me a lot was taking care of patients with trauma injuries and fractures or broken bones. The further I got in my career I was just like there needs to be a better way to do this. Given my connections and background with Rice University and given the fact that I’ve been a part of a senior engineering design project in my undergrad years, I was like well, why not return to my alma mater, and invite some young innovative minds to help me tackle this problem.
Can you tell me what this problem is?
DEWAN: When a patient comes into the emergency room with a broken long bone– and by long bone I mean like the thigh bone or the shinbone,, these bones are often repaired using a rod that’s inserted inside the bone to realign the broken fragments.
What’s the process?
DEWAN: Implanting this rod, this day and age, we have some pretty minimally invasive techniques that don’t require us to, pardon my description, fully open the whole patient. We can use smaller incisions to insert this rod. The challenging part however is then to secure the rod in the bone we have to use these screws. In order to get these screws both through the bone and through the rod, it’s kind of like threading a needle with the thread. The only difference is you’re trying to thread the needle from like 50 feet away, so in order to accomplish that currently what we do is we use multiple x rays to try to visualize this 3D structure and the orientation of the screw holes in the bone and all the structures. This process can result in several photographs with the X-ray. It can result in a lot of delays on the surgical table. To tackle this challenge, the engineering design team developed a way to quickly find the needle hole within the patient’s leg and provide real time feedback to help us quickly thread that needle and quickly put that screw through the bone through the hole in the rod without having to expose the patient to several x rays.
What is that like as a physician trying to do that?
DEWAN: When you have a patient on the operating room table, often trauma patients number one are sick. They’ve just sustained a major physical harm to their body. So, they’re usually dealing with issues with the amount of blood they have, and anesthesia can be challenging to their heart and lungs. From a surgeon’s perspective I’m trying to do everything I can to get this repaired as quick as possible, as safely as possible and to get them out of the operating room. With that in mind, as I’m taking these multiple X-rays the pressure is mounting because I don’t want to throw an air ball meaning like take my drill bit and miss that hole altogether having to repeat the whole process, and create another incision. Anything I can do to streamline that process is going to not only benefit the patient but benefit the surrounding staff that’s getting exposed to radiation and the main thing at the end of the day is giving a patient hopefully a better outcome by getting them through the procedure much quicker.
With the current process what are some things that could go wrong?
DEWAN: Right now because we’re using 2D images to visualize where this needle hole is pointed within the leg oftentimes we don’t have an accurate representation as to where that needle hole is and consequently we may insert the drill bit and completely miss the hole or maybe it’ll go right above the rod as opposed to through that needle hole. Then we have to withdraw our drill bit find a new orientation of it and then try to again guide it through. And so sometimes we can almost make the end of the bone look like Swiss cheese. We’re making multiple holes trying to find where the appropriate orientation is. That that can weaken the bone that’s already damaged. It can lead to more areas from which the patient could potentially bleed further. And again, it just increases the time that they’re getting exposed to anesthesia. These are some of the problems and the pitfalls with that. Remember all the while, let alone the patient issues, you also have the staff that are getting exposed to more and more radiation. All these are concerns and problems that can benefit from a technology that streamlines that process.
How do you feel knowing that there is a possible solution?
DEWAN: It’s really exciting. And it’s really rewarding to watch an idea grow from a piece of scribble on a napkin, to having engaging discussions with engineering students, coming up with prototypes and seeing it evolve and looking at where these guys started and where we are now. It’s really exciting to think that hey, maybe soon we could actually use this and not only have to just imagine using it on a napkin.
If you could sum it up for a patient, why is this a big deal for them?
DEWAN: This is a big deal for patients because it means less risk of complications, less time in the operating room, less radiation exposure, more accuracy for surgeons, and cost-savings for all from efficiency. I think at the end of the day; it can hopefully ultimately secure a quicker and faster recovery from surgery with a more predictable, less invasive technique.
Is there anything else you want to add?
DEWAN: I may have gotten more out of this than the actual students did. It’s just been really rewarding getting to engage with these young minds and being able to contribute to their education and seeing them work in a multidisciplinary team. I think it’s more of a real-world educational approach. It’s something unique that these Rice students get and it’s really nice to come full circle. To go from being engineering undergrad, going through my training, seeing a real-world problem and bringing it back to my undergrad roots. So, it’s been really rewarding process for me.
This invention could change the time of the x ray process, what would be the difference in time? So, would it be like 45 minutes to five or something like that?
DEWAN: With this new technology it could be maybe anywhere from 60 to 80% reduction in the amount of time it takes just to get that screw in the end of the rod there. So, that’s a substantial improvement in the existing process. And it really can benefit the patient.
Who funded this?
DEWAN: While some resources were provided by me, a lot of the efforts of these undergraduates was supported by Rice University themselves and their patrons that donateto support undergraduate experiences like the OEDK.
And are you directly or indirectly compensated for your involvement?
DEWAN: No. I volunteered to mentor these students.
And will your hospital or organization benefit financially?
DEWAN: If it ultimately becomes successful the goal is to spin off into a company. When we started this project, we all agreed that we should share in the fruits of our labor. The IP is shared by all the students that contributed. I felt this structure was important to help them feel some ownership in what they were producing. Whatever comes out of it is going to be our baby. We’re all going to work on it together. That’s the best recipe for success when everybody has a vested interest in it.
And if this was someone else’s idea would you still want to use it?
DEWAN: I believe so. I mean, obviously, I’m biased. But I think there’s a real challenge that we encounter. This gives us a way to do what we need to do in a more efficient and safer manner. These guys have been doing some market research. They’ve talked to some other surgeons and the reception has been very positive and overwhelming. So, even if you take my biased opinion either way, I think other surgeons also recognize the need and what value it brings to them.
Would you mind demonstrating?
DEWAN: This is a model of a femur bone or your thigh bone. This is the hip joint. This attaches to the knee joint. This type of technology would be used in situations where you have a long bone such as the thigh bone or the shinbone that break from a trauma. Once the bone breaks, the surgeon has to realign the bones and once he realigns the bones, there’s these rods that are commercially available – many different manufacturers. What they do is once you get the bones aligned within the body, we make a small incision up top and then through that incision we insert this rod which helps restore the alignment of the bone. So, this rod now is implanted within the bone. If you recall, there are some screw holes on the end of this rod implanted in the bone here you can see. These screw holes are essentially the “needle hole” part that needs to be threaded. So, you can imagine that that hole is somewhere down here after the break deeper within the bone here and that’s the hole through which we got to insert a screw to secure the end of the rod in the end of the bone. And so now imagine all of this – you can’t see any of this because this is within the thigh muscles underneath the skin. It makes it very challenging because you’ve got to find that rod hole within that leg.
END OF INTERVIEW
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