[Indian Medical Journal (1981): 8, 91] Evaluation of Geriforte in Traumatology and Orthopaedics Chakravarty, R.N., M.B.,B.S., M.S., D.Orth. (Luk.) Department of Orthopaedics, Silchar Medical College and Hospital, Dist. Cachar, Assam., India. Geriforte is a comprehensive tonic and a proven systemic and metabolic corrective as well as a reliable physical and mental restorative. It is reported to be more useful to older and ageing persons. With advancing age, there is a reduction in their adaptogenic capacity. After exercise the return to normal blood pressure, heart rate, respiration is slower. Similarly fractures and wounds take a longer time to heal. However, the aged are capable of adjusting to stressful situations; they merely require more time. Geriforte is reported to quicken this slowed down process, helping to improve the general metabolic and anabolic effects. Prolonged bed-rest, especially in elderly patients, may have a deleterious effect on the body. It impairs not only the cardiopulmonary or the urinary system, but bring about marked changes in the musculoskeletal system. An important condition among the aged is osteoporosis, which is characterised by reduction of the skeletal mass (Aegerter and Kirkpatrick). Some orthopaedic geriatric problems, apart from osteoporosis, are compressed fracture of vertebra, fractured neck of femur, degenerative osteoporosis, are compressed fracture of vertebra, fractured neck of femur, degenerative osteoarthritis. These conditions require drugs, which can restore normal health of the individual i.e., a feeling of wellbeing, increase of appetite, good sleep and increased peripheral circulation. In these cases drugs, which can enhance protein metabolism and improve the general condition are helpful. The aim of this study is to evaluate the action of Geriforte (The Himalaya Drug Co.) in elderly orthopaedic patients. MATERIAL AND METHODS A controlled study of 228 patients suffering from senile osteoporosis, degenerative arthritis, prolonged bed-rest following injury, operation or splinting, periarthritic shoulder, non-united fracture and compressed fracture of the vertebrae were selected for the present study from the inpatient and outpatient Orthopaedic Department of Silchar Medical College and Hospital. The patients were evaluated by the following parameters: (a) subjective assessment such as general feeling, appetite, digestion, fatigue, sleep etc. (b) specific assessment such as X-ray of the spine or the part affected, muscle power, muscle tone. (c) Biochemical assessment of serum calcium, serum proteins, S.G.O.T. etc. The age group was from 40 to 82 years. Male patients were more than female patients. After preliminary studies and investigations, Geriforte tablets were prescribed at 2 tablets t.i.d. for the first and second months and then 2 tablets b.i.d. for the third and subsequent months. The patients were evaluated for the aforementioned parameters before and after the completion of the treatment. OBSERVATIONS There were 73 males and 66 females in the Geriforte Group making a total of 139 patients. There were 62 cases of senile osteoporosis, 23 cases of degenerative arthritis, 30 cases of prolonged bed- rest following injury, operative procedure splinting etc., 11 cases of periarthritic shoulder, 8 cases of non-united fractures and five cases of compressed fracture of the vertebrae. One hundred and fifteen on Geriforte were completely followed up and the results were assessed. Twenty four patients could not be followed. 89 patients were not on Geriforte and served as the Control Group. Out of the 89 patients in the Control Groups, 41 were suffering from senile osteoporosis. 10 from degenerative arthritis and 38 were on prolonged bed-rest following operation, splinting etc. Earlier these patients complained of back pain, fatigue, difficulty in walking, and were not amenable to physiotherapy. After Geriforte therapy, there was considerable improvement of gait, relief of pain and some correction of senile kyphosis. Marked improvement was also noted in elderly patients requiring prolonged bed-rest such as in post-operative cases, trochanteric fractures with splint and in degenerative arthritic cases and also cases with osteoporosis. Table 1: Sex and disease-wise distribution Geriforte Group Control Group Disease process Males Females Total Males Females Total Senile osteoporosis 22 40 62 15 26 41 Degenerative arthritis 18 5 23 7 3 10 Prolonged bed-rest following injury, 18 12 30 23 15 38 operative procedure or splinting Periarthritic shoulder 6 5 11 – – – Non-united fractures 6 2 8 – – – Compressed fractures vertebrae 3 2 5 – – – Total 73 66 139 45 44 89 DISCUSSION Geriforte contains indigenous tonic principles such as Chyavanprash concentrate, extracts of Capparis spinosa, Asparagus racemosus, Mandur bhasma, Shilajeet, Makardhwaj etc. which are known to have a stimulating effect on the musculoskeletal system. They have good anabolic property, and no harmful effects. The marked improvement in senile osteoporosis cases in both sexes is probably as a result of protein mobilisation from the other parts of the body to the skeleton. In geriatric patients getting Geriforte the desire and ability for physiotherapy was found to be very remarkable. RESULTS The cases on Geriforte therapy were deemed as improved when there was relief of pain, increase of appetite, general feeling of wellbeing, along with radiological and biochemical improvement. Those cases, which showed no improvement of the condition either clinically or radiologically, were classed as unchanged. There were no short-term or long-term untoward or toxic effects in any of the patients on Geriforte. The results show that out of 115 patients finally followed up, 98 patients (85.2%) in the Geriforte Group improved and had no untoward or toxic effects. In the Control Group out of 89 patients only 8 patients (9%) improved. This demonstrates the remarkable effect of Geriforte in these conditions in aged patients. Patients receiving Geriforte had improved feeling of well-being with increased appetite, increased desire and capacity for doing physiotherapy, which is considered very important in aged patients. There was marked improvement in cases of senile osteoporosis both clinically and radiologically, specially when compared to the Control Group. 1A 1B 1C 1A Fig. 1a – Case No. 26, female aged 40 multipara with Fig. 1c – Shows disappearance of extreme rarefaction pathological fracture upper 1/3 of right femur. There noted earlier. There is evidence of callus formation – a was extreme rarefaction of bones. Also there was sign of fracture healing after 3 months with Geriforte. evidence of deformity of femoral neck (Coxa vera) probably due to untreated osteomalacia. X-ray confirms diagnosis of osteomalacia with pathological fracture, upper third of right femur and coxa vera. Fig. 1b Shows the same case after traction in a Thomas Splint, prior to Geriforte therapy. Results Clinical condition Geriforte Group 115 patients Control Group 89 patients Senile osteoporosis 57 5 2 10 Degenerative arthritis 14 9 – 39 Prolonged bed-rest following 27 3 6 32 operation or splinting Total 98 17 8 81 Percentage 85.2% 14.8% 9% 91% SUMMARY 1. A controlled study on Geriforte was completed in 204 elderly patients with senile osteoporosis, degenerative arthritis and prolonged (or otherwise) post-operative bed-rest. The age range was between 40 and 82 years, males being predominant. 2. One hundred and fifteen patients were kept on Geriforte tablets 2 t.i.d. for 2 months and then 2 b.i.d. continuously for subsequent months 89 other patients served as Controls. 3. The Geriforte Group showed improvement in 85% patients (98 out of 115) while the Control Group showed only 9% improvement (9 out of 89 patients). 4. Geriforte gave proof of excellent results in this controlled study. There were no untoward or toxic reactions on prolonged usage. ACKNOWLEDGEMENT I would like to express my gratitude to Dr. S.D. Baruah, D.C.H., F.R.C.P., Principal, Silchar Medical College and Hospital, for permitting me to use the Hospital records for this work. My thanks are also to M/s. The Himalaya Drug Co. for their help in supplying Geriforte tablets. REFERENCES 1. Aegerter, E. and Kirkpatrick, J.A., 'Orthopaedic Diseases', 4th Edition (1975), W.B. Saunders Co.