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   Table of Contents - Current issue
January-June 2020
Volume 8 | Issue 1
Page Nos. 1-49

Online since Tuesday, June 30, 2020

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Non-covid, nonemergency spine surgery: Trying times p. 1
Pradeep K Singh
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Impact of COVID-19 in orthopaedic practice: What we must know p. 2
Sharif Ahmed Jonayed
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COVID-19 and elective case triage for orthopedic surgery p. 4
Kedar Phadke, Provash Saha
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Implants and grafts used in fractures for early healing p. 6
Bilal Mohamad Ali Obeid
BACKGROUND: Bones are exposed to different injuries as well as chronic diseases, which can affect the health of them. Different variables affect healing method, as timing, quality, recurrence, and long-term effect. METHODOLOGY: This article is adopting the qualitative method as it is reviewing other researches; it is a scientific survey which is demonstrating the bullet points of each research, such as conclusions, methods, obstacles, and other future studies. RESULTS: The effect was found to be very promising as a quality of osteoblast and timing of healing with precipitating effects among long and short terms. DISCUSSION: The main objective of this study is to introduce the role of implants and grafts in orthopedic. The interventions are made based on the knowledge of the physiology of the bones, their injuries, and the response of the body toward it. Different metals were studied to be used in the implants, and advantages of their use were found. In addition to developing grafts from different tissues such as animal tissue, platelets, and others. CONCLUSION: It can be concluded from the previous studies that future interventions can be made from using different materials to develop grafts and implants which shall aid in the healing process.
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Role of transforaminal epidural steroid injection in chronic disc pain p. 12
Monisha Parasuraman, Jaganath Karunakaran, Anvesh Duvvuru, Natarajan Shanmugam
BACKGROUND: Chronic lower back pain is a chronic pain syndrome in the lower back region lasting for ≥12 weeks with the most common cause being intervertebral disc herniation. Epidural steroid injection is the most widely accepted treatment modality of all the surgical and non surgical methods at various sites such as translaminar, caudal, and transforaminal. It is ideal to start transforaminal epidural steroid injection (TFESI) early as chronic neural compression leads to irreversible changes in neural anatomy, which leads to a less favorable outcome. AIMS AND OBJECTIVES: To study the effectiveness of TFESI in chronic disc pain with radiculopathy in terms of duration of relief. MATERIALS AND METHODS: This is a retrospective study involving 50 patients with chronic disc pain who underwent fluoroscopic guidance TFESI in the year 2018 at Saveetha medical college. These patients are those who were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. Their initial pre injection and current pain scores were assessed using a visual analog scale (VAS score) by recording the medical history and follow-up, respectively. RESULTS: The most common level of involvement was L4/L5 (80%). The mean difference in VAS score was 3.14. The standard deviation of the mean difference in VAS score (σ) is 1.38. The mean duration of relief is 2.5 months. Around 14% (7 patients) did not have any relief in pain after the procedure. Around 76% of the patients were willing to recommend the procedure to others with a similar problem. Two individuals underwent surgery following the procedure, which suggests a failure of the procedure. CONCLUSION: TFESI is a very useful procedure for significant pain reduction in chronic disc pain involving a single level. In addition to corticosteroids, lignocaine is very useful in reducing local inflammation and pain due to its “washout effect.” Hence, TFESI with postoperative strengthening exercises is beneficial for short-term pain relief.
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Bone mineral density measurement in traumatic distal end radius fractures: A case–control study p. 16
Ankur Dilip Kariya, Pramod Ajit Jain, Kisan Ramrao Patond
INTRODUCTION: Osteoporosis is a global problem affecting over 200 million people worldwide. After a first osteoporotic fracture, there is an increased risk of a second fracture. Around 20% of patients experience a second fracture within 1 year of the first fracture. Early diagnosis of osteoporosis and its treatment after a fragility fracture are, therefore, very important interventions that can help in reducing the socioeconomic burden of osteoporosis. In this article, we present a case–control study of bone mineral density (BMD) in 100 cases of distal end radius fractures and matched controls. MATERIALS AND METHODS: One hundred patients with distal end radius fracture and 100 age- and sex-matched controls were selected based on predetermined selection criteria. All selected individuals were investigated for serum calcium, Vitamin D, and alkaline phosphatase. BMD was measured at calcaneum and distal radius. Data analysis was done to determine the strength of association between various parameters and BMD in cases and controls. RESULTS: The prevalence of osteoporosis was higher in age >45 years (35%) as compared to age <45 years (8%). Osteoporosis was higher in females (65%) with Distal end radius fractures (DER) fractures compared to males (33%). There was a significant association between serum Vitamin D, alkaline phosphatase, and BMD. The presence of DER fracture (39%) had a significant association with osteoporosis as compared to controls (17%). CONCLUSION: There is a significant association between increasing age, female sex, Vitamin D deficiency, high alkaline phosphatase, presence of DER fracture, and osteoporosis.
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Does matrilin-3 gene polymorphism and primary knee osteoarthritis have a association in Indian population? p. 22
Vipin Kumar, Ruchit Shah, Afroz Ahmed Khan, Abhisek Pandey, Urvi S Khambhati, Nandan K Mishra
INTRODUCTION: Osteoarthritis (OA) is estimated to be the fourth-leading cause of disability. Results from several studies have shown that OA is inherited and may vary by joint site. Twin family and studies have estimated the heritable component of OA to be between 50% and 65% with larger genetic influences for hand and hip OA than for knee OA. In view of the possible role of matrilin-3 (MATN-3) gene in primary OA, a number of studies during the past few years have evaluated the role of MATN-3 polymorphism in OA in various countries. SUBJECTS AND METHODS: The study was conducted in the Department of Orthopedics and Department of Bio-Technology in ERA's Lucknow Medical College and Hospital, Lucknow. Necessary blood (complete blood count, erythrocyte sedimentation rate, C reactive protein, rheumatoid arthritis factor, serum uric acid) and X-ray of the bilateral knee in investigations anteroposterior and lateral view on standing for confirmation of the diagnosis. Cases will be diagnosed with OA based on the Kellgren-LawrenceKL) Grading System. Five millimeters of venous blood will be drawn and poured in ethylenediaminetetraacetic acid-containing tubes. The DNA samples will be isolated from peripheral blood lymphocytes by the standard phenol extraction method. MATN-3 genotyping done from the blood. RESULTS: Statistically, the difference between the two groups was not significant (P = 0.603). No significant difference in genotype was observed among different KL-grades (P = 0.945). CONCLUSION: The findings of the present study showed that MATN-3 polymorphism does not seem to be associated with primary knee OA in the Indian population.
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Functional and radiological outcomes in 2.7-mm volar locking compression plating in distal radius fractures p. 27
Jose Austine, Prem Kotian, Kiyana Mirza, Rajendra Annappa, Premjit Sujir
BACKGROUND: Bio-mechanical studies have shown volar locking compression plates (LCPs) to have higher rigidity and stability as compared to traditional plates, but lacunae exists with regard to the use of 2.7-mm volar LCP. AIMS: The aim was to prospectively assess the postoperative functional and radiological outcomes in a 2.7-mm fixed-angle volar LCP , to analyze factors influencing the functional and radiological outcomes, and to correlate patient's perception of recovery with the radiological outcome. SETTINGS AND DESIGN: This was a descriptive study with a prospective longitudinal study design conducted at a tertiary care hospital. MATERIALS AND METHODS: Thirty patients who underwent fixation of distal radius fracture with a 2.7-mm fixed-angle buttress-type volar LCP were followed up for functional and radiological outcomes at 6 weeks, 3 months, and 6 months after surgery using standardized scoring systems. STATISTICAL ANALYSIS: Descriptive statistics was used for statistical analysis. RESULTS: Use of 2.7-mm fixed-angle volar LCP was found to have good to excellent functional and radiological outcome in majority of the cases. A significant correlation existed between the functional and radiographic outcome. Patient-rated wrist evaluation had a significant inverse correlation with the radiological outcome. We did not find any significant association of the functional or radiological outcome with age, sex, dominance of the injured hand, and the fracture type. The fracture reduction achieved in the immediate postoperative period was maintained throughout the follow-up duration. CONCLUSION: This study effectively demonstrates the optimal results in terms of postoperative functional and radiological outcomes with the use of 2.7-mm volar locking plate for distal radius fracture fixation.
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Intramuscular hemangioma of the forearm and phlebolith – A review of literature with case report p. 34
Pankaj Kumar Mishra, Vivek Kumar
Intramuscular hemangioma of the forearm (cavernous subtype) with phlebolith is less common in literature and only available as case report. Treatment protocol of intramuscular hemangioma is not established in literature due to sparsely available cases. Here, we discuss the case report with treatment regimen.
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Vascular groove sign in osteoid osteoma of the vertebral body p. 38
Mukesh Kumar, KrishnaKumar R
Osteoid osteoma is a small, benign, painful tumor. Its size is the main distinguishing feature between osteoid osteoma and osteoblastoma and varies between 1.5 and 2 cm. Computed tomography (CT) is usually the best technique for imaging osteoid osteoma because the tomographic nature of the images makes it easy to visualize a lucent nidus, among the surrounding dense bone sclerosis. Vascular supply of osteoid osteoma tumor and nidus are well described. A new CT finding that is vascular groove sign is highly sensitive and specific for osteoid osteoma. It was found that most of this sign was seen in the long bones with very few in the flat bones and only one case of vascular groove sign in the body of the vertebra. A 15-year-old girl presented to us with complaints of lower back pain of 15 months; Pain was a dull-aching type which subsides by nonsteroidal anti-inflammatory drugs and reappears in the middle of the night. She was evaluated and diagnosed to have osteoid osteoma on CT scan with typical vascular groove sign in the vertebral body of L5, which is not mentioned in the literature to the best of our knowledge. Vascular groove sign is highly sensitive and specific for the diagnosis of osteoid osteoma by CT scan; this sign is mentioned mostly in the long bones with only one case in the lamina of the vertebra. We report a case with vascular grove sign in osteoid osteoma of the vertebral body of L5.
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“Black disc” tandem spinal stenosis in ochronotic arthropathy p. 41
Shailesh Hadgaonkar, Pradhyumn Rathi, Ashok Shyam, Parag Sancheti
Alkaptonuria (AKU) is a rare hereditary autosomal recessive disorder characterized by a defect in the gene for enzyme homogentisate 1,2-dioxygenase resulting in the metabolic disorder of phenylalanine and tyrosine. Tandem spinal stenosis refers to spinal canal diameter narrowing in at least 2 distinct regions of the spine, most commonly the lumbar and cervical regions. This entity can be an asymptomatic radiographic finding, or it can present with severe myelopathy and lower-extremity symptoms. On review of literature, in PubMed and Google Scholar, there were no cases of ochronotic tandem spinal stenosis. This is the first case to be reported in the world literature of ochronotic tandem spinal stenosis operated surgically. We report a rare case of a patient suffering from ochronosis with tandem spinal stenosis who was diagnosed during the late course of disease once the myelopathy had set in resulting in increased neck and back pain and associated with walking trouble and clumsiness in hands. A 60-year-old hypertensive farmer suffering from late-stage ochronotic arthropathy with tandem spinal stenosis with cervical spondylotic myelopathy with lumbar disc protrusion with radiculopathy was surgically treated with single-stage simultaneous decompression surgery. His early follow-up showed marked improvement. AKU is a rare metabolic genetic disorder that is caused by the deficiency of homogentisic acid oxidase, affecting multiple organ systems in the body. Detailed history can help diagnose it early and accurately. Ochronotic arthropathy can cause tandem spinal stenosis by ligamentum flavum thickening and disc protrusions, which if overlooked can lead to serious complications. Meticulous preoperative and intraoperative planning with expeditious implementation helps to achieve a successful outcome after a single simultaneous procedure.
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Big data applications in orthopaedics p. 46
Abid Haleem, Mohd Javaid, Ibrahim Haleem Khan, Raju Vaishya
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Penetrating injury by protruding ends of wires or pins of external fixators: An underestimated injury p. 48
Ganesh Singh Dharmshaktu
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