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   Table of Contents - Current issue
January-June 2021
Volume 9 | Issue 1
Page Nos. 1-50

Online since Saturday, October 30, 2021

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Thoracic disc: Current scenario p. 1
Pradeep K Singh, Sohael M Khan, Shraddha K Singhania
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Webinars in orthopaedics and spine surgery – A review on current status and future considerations-will it be a new normal? p. 2
Shailesh Hadgaonkar, Pramod Dashrath Bhilare, Parag Sancheti, Ashok Shyam
Technological advancements are rapidly changing the face of medical science in terms of knowledge sharing. It therefore becomes essential for medical professionals to remain up to date with recent trends and innovations in the field. Especially in India, this is even truer as the country is striving to foster the development of innovative tools and strategies to improve health outcomes in the country. It is therefore complementary to its other training initiatives to ensure medical professionals have access to avenues to disseminate their research, discuss their work, and network with peers. Continued medical education (CME) in the form of seminars and conferences is a good opportunity for sharing and discussing new insights and networking with peers and can be considered as scientific meetings. CMEs have been the backbone for spreading the knowledge and means to get updated regarding the innovations and treatment strategies. With the growing situation of COVID-19 pandemic that has glorified the need for “Social Distancing,” the idea of conduct of these in-person activities is farfetched. Also with the economy hitting the new low, the prohibitive traveling costs and increased logistics, it is not always feasible to organize and attend numerous regular seminars. In an increasingly interconnected world brought about by technological advancements in communications, other alternatives can be used to supplement the in-person experience. Webinar can serve as an important link for conducting CME in the era of “Social distancing.” Here, we review the webinars in orthopedics and spine surgery – its standard operating procedure and its future directions.
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Approach to dealing with orthopedic trauma patients at semi-urban centers during COVID-19 pandemic: An insight from a developing country p. 6
Saubhik Das, Vivek Trikha, Arvind Kumar, Abhinav Mishra
Coronavirus disease 2019 (COVID-19) has wreaked havoc on global health care. Although tertiary care hospitals and major trauma centers in developing countries are well equipped to render trauma care safely, this is not the case in district or nonmetropolitan small centers. Herein, we intend to outline the problems currently being faced by these small peripheral centers and their carefully crafted strategy in managing trauma victims. We also proposed some recommendations that are hoped to boost the endeavor to work in a sound and effective milieu.
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Clinico-microbiological profile of urinary tract infections in hospitalized spinal cord injury patients p. 11
Gaurav Mittal, Mohammed Schezan Iqbal, Mohit Kumar Aggarwal, Ram Chaddha
BACKGROUND: Hospitalized spinal cord injury (SCI) patients are predisposed to develop nosocomial infections owing to a variety of risk factors, and treatment of such infections is usually suboptimal. AIMS: We aimed to evaluate the prevalence of urinary tract infection (UTI) in hospitalized SCI patients along with their clinical profile, prevailing uropathogens, and their antibiotic sensitivity patterns. SETTING AND DESIGN: This is a cross-sectional, analytical study carried out at a tertiary military center specialized in management of SCI. MATERIALS AND METHODS: Fifty-two admitted patients of SCI were selected, whose clinical profiles including times since injury and since present admission, level of spinal injury, American Spinal Injury Association scale, urinary or fecal incontinence, and mode of bladder emptying were assessed, and sterile midstream urine samples were subjected to cytological and microbiological examination inclusive of antibiotic sensitivity testing using VITEK 2 (bioMerieux®, France) automated system. STATISTICAL ANALYSIS USED: Comparisons were made for each variable using Chi-square test. RESULTS: The prevalence of UTIs in our cohort was 67.31% (35/52 patients). Statistically significant differences were found in development of UTI in the presence of a neurogenic bladder, fecal incontinence, usage of clean intermittent catheterization as mode of bladder emptying, pyuria, and increased length of hospital stay (P < 0.05). The most common uropathogen isolated was Klebsiella pneumoniae. Antibiotics to which the isolated uropathogens were most sensitive were colistin (97.1%), tigecycline (82.9%), and ertapenem (74.3%). CONCLUSION: UTI in SCI patients is often mismanaged owing to unnecessary or faulty empirical antibiotic institution. We have tried to provide a systematic antibiotic protocol for management of this oft encountered entity.
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A comparative retrospective analysis of indoor patients between 50 to 85 years of age suffering from osteoarthritis to determine the effectiveness of epidural and intravenous tramadol in pain relief and functional recovery after total knee replacement surgery p. 17
Rajendra Butala, Kedar Anil Parelkar, Akshat Pandey
BACKGROUND: Total knee replacement surgery is among the most common major orthopedic surgery performed in cases of osteoarthritis on the knee joint. Total knee arthroplasty is considered to cause moderate-to-severe postoperative pain. No clear consensus in the available literature suggests a clear advantage between epidural tramadol and intravenous tramadol postoperatively due to the complications associated with an epidural catheter. AIM: This study aimed to determine the effectiveness of epidural tramadol and intravenous tramadol in pain relief and functional recovery in postoperative total knee replacement patients. MATERIALS AND METHODS: All cases operated for total knee replacement and postoperatively managed by epidural tramadol and intravenous tramadol were studied. This group included 20 patients of total knee replacement managed by epidural tramadol compared to 20 patients of total knee replacement managed by intravenous tramadol. RESULTS: Patients in the group managed postoperatively with intravenous tramadol for postoperative pain management showed a better functional outcome and pain relief as compared to patients managed with epidural tramadol. It was noted that in patients managed with intravenous tramadol, the knee range of motion and static and dynamic quadriceps exercises were started earlier and the patients were more compliant, which intern helped to achieve a better functional outcome posttotal knee replacement surgery. CONCLUSION: We would like to suggest in our limited 40 patient study group, the pain managed in patients by intravenous tramadol showed a better functional outcome as compared to the pain managed in the patients by epidural tramadol. Within our study group of 40 patients, it was noted that patient compliance and comfort was better in cases where tramadol was administered through an intravenous line as compared to an epidural catheter with no statistically significant difference in postoperative pain as well as functional outcome and recovery.
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A computed tomography-guided analysis of pedicle morphology of the lower thoracic and lumbar spine in the Indian population: An observational study p. 25
Vipin Singh, Santosh Kumar Mishra, Anshuli Trivedi, Suneet Tandon, Maneesh Singh Rajpoot
BACKGROUND: The knowledge of morphometric characteristics of the pedicle is crucial for successful transpedicular screw fixation. Since differences are reported across various ethnic populations; hence, this study was conducted to analyze the morphometry of pedicle from D6-S1 vertebrae among the population of central India. MATERIALS AND METHODS: The prospective cross-sectional observational, study was conducted on 102 patients between January 2018 and March 2019 at a tertiary center in central India with spinal pathology. After the initial workup of each patient, computed tomography scan images of the dorso-lumbosacral spine were obtained. Morphometric characteristics from D6-S1 vertebrae studied in three parameters including transverse pedicle isthmus width (TPIW), pedicle length (PL), and transverse pedicle angle (TPA). RESULTS: In this study, the highest TPIW was observed at S1 and narrowest at T6. In the lumbar region, the widest pedicle was at L5 while in the thoracic region widest TPIW was at T12. The highest PL was observed at S1 with the minimum at T7 level. In the lumbar region, the longest mean PL was found at L2 and shortest at L5. In the thoracic region longest PL was observed at the T12 level. The mean of TPA at thoracic level was <10° except at T7 level at which its value was slightly higher. At the lumbar region, value of TPA increased gradually. There was no statistically significant association of gender with morphometric measures. CONCLUSION: The study includes morphometric analysis of thoracolumbar vertebrae including S1. Hence, giving a rational approach for transpedicular screw fixation taking into consideration of racial variations.
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Comparison of surgical and nonsurgical treatment of lumbar disc herniation with motor deficit: A prospective study p. 31
SK Arfaaz, Sundar Narayan Mohanty, Aditya Prasad Panda, Saurav Narayan Nanda, Amit Kumar, Sudipta Biswas
INTRODUCTION: Several studies had compared the differences between surgical and nonsurgical modalities of treatment for patients with herniated discs. Some studies announced several modalities for treating motor weakness caused by lumbar disc herniation but few randomized control trials had compared the efficacy of one treatment over the other treatment except cross-over treatment. This study excludes patients underwent cross over treatment. This study aims to assess outcomes of patients of lumbar disc herniation with motor deficit who underwent surgical treatment with a patient group who underwent nonsurgical treatment. Subjects and Methods: We included 75 cases of lumbar disc herniation with the motor deficit in our tertiary healthcare center. Thirty-six patients were treated with a microdiscectomy, and 39 patients were treated conservatively prospectively from June 2018 to June 2019. The minimum follow-up period was 1 year, i.e., at 1, 3, 6, and 12 months, respectively. Visual analog scale compares outcomes for pain evaluation, motor function by Medical Research Council scale and Oswestry Low Back Pain Questionnaire for overall health quality of life. RESULTS: Patients who undertook surgical treatment shown rapid recovery of the motor deficit, as well as rapid alleviation of symptoms in the first 6 months, postoperatively compared to the nonsurgical group. The difference was statistically significant between both groups in the initial period but the difference, was no longer significant during the final follow-up examination at 1 year. CONCLUSION: Early surgical treatment of properly selected patients of severe motor weakness and severe pain from disc herniation could provide a chance for rapid alleviation.
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Preoperative Knee Self-Efficacy Scale as a predictor of outcome following anterior cruciate ligament reconstruction: A short-term study p. 39
Sudeep Kumar, Anup Kumar, Ravi Kumar
BACKGROUND: The purpose of this study was to validate the possibility for preoperative self-efficacy of knee function measured by the Knee Self-Efficacy Scale (K-SES) to foresee patient outcome in terms of patient-reported outcome (PRO) scores at 2 years after an anterior cruciate ligament (ACL) reconstruction (ACLR). MATERIALS AND METHODS: This was a prospective study of cohort of 90 patients who underwent primary ACLR using hamstring tendon graft by a single team of surgeons over a period of 2 years at a government teaching tertiary care hospital. Demographic data (age and sex) and self-efficacy of knee function using K-SES were measured before surgery. Functional outcome were assessed using Tegner Lysholm Knee (TLK) Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) score at every scheduled follow-up after surgery. The mean of K-SES, TLK, IKDC, and KOOS scores was calculated. Pearson correlation coefficient was calculated to find out the relation between K-SES and the three knee subjective scores independently. Two-tailed test was used to compute the statistical significance of parameter deduced from data set. RESULTS: There was a strong positive correlation between K-SES and the three subjective scores independently. Two-tailed tests were statistically significant for all the three correlations. CONCLUSION: Evaluation of knee function using K-SES preoperatively is of predictive value for good functional outcome at 2 years after ACLR.
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Clinicopathological study of intradural extramedullary spinal tumors in central Indian rural hospital: 6-year experience p. 43
Prasheelkumar Premnarayan Gupta, Anil Vishnu Akulwar, Deepak Premnarayan Gupta, Richa P Goyal
BACKGROUND: Single institutional study of intradural extramedullary (IDEM) based on clinical presentation, location, and histopathological diagnosis. AIM: The aim of this study is to evaluate a single institution-based epidemiology of IDEM spinal tumors in Rural Hospital of Central India. MATERIALS AND METHODS: This study is retrospective observational study from July 2013 to July 2019 in the Department of Neurosurgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram. A total of 27 patients fulfilled the criteria and were included in the study. The case records of the patients were identified and studied for clinical manifestation, neurological examination, and radiological and histopathological diagnosis. RESULTS: Out of total 35 spinal tumors, 27 patients were IDEM tumors (77.14%) with male-to-female ratio of 1:1.07. While spinal nerve sheath tumors were slightly more common in males, meningioma had significant female preponderance. The most common location of spinal tumor was dorsal spine and the most common histopathological type was schwannoma. CONCLUSION: At present, no published study about epidemiology of IDEM tumors in central India is present. This study may provide the clinicopathological profile of various IDEM spinal tumors for our region.
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The role of 3-D printed models in planning and resection of heterotopic ossification around the elbow: A case series p. 46
Venkateshwar Reddy Maryada, Praharsha Mulpur, Vinay Mathew Joseph, Annapareddy Venkata Guravareddy
BACKGROUND: Heterotopic ossification (HO) is a concern after elbow trauma and is associated with significant limitation of movement. Although complete restoration of elbow movement is seldom possible even by surgical resection, it improves functional range of movement and quality of life. Surgical excision of HO requires meticulous preoperative planning to minimize complications such as inadequate resection, and neurovascular complications. Life size models printed with three-dimensional (3D) printing technology help in understanding the complex HO mass and its relation to neurovascular structures, thereby helping in better preoperative planning. AIM: The aim is to study the usefulness of 3D-printed patient-specific models in resection of heterotrophic ossification around elbow MATERIALS AND METHODS: The 3D models are printed using computed tomography scans by FDM technology. Surgical approaches were planned based on the dimensions and extent of the HO mass in the 3D model. Resection was performed as planned and the sterilized 3D model was also used during surgery as anatomical reference. All patients had a minimum follow-up of 1 year. They were evaluated for improvement in elbow range of motion and complications. RESULTS: Six patients underwent surgical excision of HO of the elbow, with preoperative planning using 3D-printed models. A functional range of movement was achieved in all patients. There were neurovascular complications in this case series. CONCLUSION: 3D-printed models are accurate and provide a replica of the patient-specific abnormal heterotopic ossification. 3D models provide excellent anatomical reference in planning excision by providing good orientation of the mass, dimensions, extent, and relation to neurovascular structures.
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