BACKGROUND: De Quervain’s tenosynovitis is a common painful inflammation of the tendons of the wrist. It affects the tendon of the first dorsal compartment, abductor pollicis longus, and extensor pollicis brevis. Symptoms are generated mainly due to excessive wrist movement causing friction of the synovial sheath. MATERIALS AND METHOD: The study included a total of 90 patients in the outpatient department of orthopedic division of the institute. Various modalities of conservative management like ultrasound therapy, laser therapy, and local steroids injection along with surgical management have been studied. RESULT & CONCLUSION: The study concluded that the conservative treatment is as effective as the surgical management, but the surgical management is the ultimate choice when other conservative modalities fail.

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BACKGROUND AND OBJECTIVES: Supracondylar fractures of the humerus are the most common type of elbow fracture in children. Severely displaced supracondylar fractures of the distal humerus in children are a challenging problem. Many treatment methods have been described for the treatment of displaced supracondylar fracture of the humerus; however, it has not been reached a consensus for the choice of treatment. The purpose of this study is to clinically asses the outcome of surgically managed supracondylar fracture of humerus using K-wire fixation. MATERIALS AND METHODS: Thirty children of supracondylar fracture of humerus treated between June 2018 and February 2020 were included. Out of a total of 30 cases, 24 were treated with closed reduction and internal fixation by K-wire and six were treated with open reduction and internal fixation with K-wire. The average age was 7.1 years. We evaluated the results using Flynn’s criteria. RESULT: According to the results of the study, we obtained 21 excellent, four good, four fair, and one poor results. CONCLUSION: The data in the current study show that surgically managed displaced supracondylar fracture of humerus in children using K-wire fixation gives excellent outcomes both radiologically and functionally and thus can be deemed as a treatment of choice for the same.

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BACKGROUND: Analysis of gait parameters is an essential component of diagnosing musculoskeletal/neuromuscular conditions. A standard approach to gait analysis involves sophisticated commercially available digital technologies, which are expensive and not affordable by under-resourced tertiary care hospitals. We aimed here to test the validity of a low-cost digital tool for gait analysis in a tertiary care hospital setting. MATERIALS AND METHODS: This study used a smartphone with a 12-megapixel camera mounted on a tripod with Kinovea software (version 0.9.5, Free Software Foundation, Inc., Boston, MA, USA, distributed under a GPL v2 license) for gait analysis in our tertiary care hospital. This novel indigenous tool was validated in 502 healthy individuals by comparing standard gait parameters evaluated between younger and healthy cohorts. RESULTS: Overall, the recording and analysis process was simple, quick, and easy to use. The validity of our novel indigenous gait analysis tool was established by observation of reduced stride length, foot clearance, and knee goniometry among elderly subjects compared to the younger cohorts. Our observation of the elderly subjects showing altered gait parameters compared to the younger age group was consistent with previous studies measuring the same parameters using commercially available standard gait analysis tools. CONCLUSION: The novel indigenous approach validated in this study offers a low-cost and effective tool for routine gait analysis in any under-resourced tertiary or primary care hospital setting.

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BACKGROUND: Chronic refractory plantar fasciitis is one of the common causes for long-standing pain in the heel region, which has to be intervened with minimally invasive intralesional injections. The aim of this randomized controlled study was done to compare the functional outcome of patients who have not responded to 6 weeks of conservative treatment for chronic plantar fasciitis (6 months), treated with platelet-rich plasma (PRP) injection and corticosteroid injection. PATIENTS AND METHODS: All patients diagnosed with chronic plantar fasciitis, who did not respond to 6 weeks of conservative trial who came to the orthopedic department of this institute from September 2019 to March 2021, were added in this research. Thirty patients in each group were randomly assigned as per inclusion and exclusion criteria. RESULTS: The mean age receiving PRP (group 1) was 42 and corticosteroid (group 2) was 39.87, respectively. This study comprising of 60 patients had 13 males and 47 females, respectively. Among them, 7 males and 23 females received PRP injection and 6 males and 24 females received corticosteroid injection. At the conclusion of 6 months, the PRP group had a sustained surge in foot and ankle outcome score (FAOS) score (87.23), on the other hand, the corticosteroid group (77.5) had a fall in the FAOS score after three months. At the completion of 6 months, the PRP group had a decrease in visual anolog score (VAS) score (1.93), and the corticosteroid group (3.33) had a raise in the VAS score after 3 months. CONCLUSION: Our research has concluded that PRP injection is efficacious in a long run. At the same time, corticosteroid injection efficacy started to decline after three months.

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Kummell’s disease is avascular necrosis of vertebral body caused by a vertebral compression fracture. It is an osteonecrosis-related disease that can cause severe vertebral collapse, with severe pain, and may progress to kyphosis and neurological deficit. In this case series, we have reported five cases of Kummell’s disease. All the five patients were preoperatively bedridden due to pain in low back while mobilizing. Case 1 complained of low back pain radiating to left lower limb and had neurological deficits in L5 myotome. Other four cases complained of axial type of low back pain. All five patients underwent posterior instrumented stabilization and transpedicular aspiration of fluid along with biopsy; they were diagnosed as Kummell’s disease by exclusion. Postoperatively all five patients improved symptomatically and were able to walk with assistance. We found that posterior instrumented stabilization offered good patient-related outcomes in terms of pain and postoperative rehabilitation on short-term follow-up. Kummell’s disease is overlooked on X-ray when a patient presents at an early stage and hence a thorough knowledge of Kummell’s disease is required for the early treatment of these patients and prevention of complications.

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The incidence of symptomatic osteoarthritis of the hip and degenerative lumbar spinal stenosis is increasing in our aging population. The movements between the spine, pelvis, and hip joints are coordinated to allow for a physiological balance of the upper body and the pelvis during sitting and standing positions. Degenerative changes or spondylolisthesis of the spine result in decreased pelvic mobility and can lead to increased rates of instability and the necessity of total hip arthroplasty. This case report aims to determine the importance of communication between surgeons, in this case, a neurosurgeon and an orthopedic surgeon, which in our experience is very limited in clinical practice. We believe this lack of communication and collaboration is far from ideal for patients; their pathologies are not always put before functional aspects of the hospital or clinic, surgeon’s schedules, etc. This case represents the criterion standard of how a disease such as hip-spine syndrome, in certain cases, must be operated on in two parts of the body during the same surgical session.

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Alkaptonuria is a rare inborn error of metabolism disorder, with an incidence of one in a million births presenting with a triad of dark staining of urine, ochronosis, and Spondyloarthropathy. Till date, 1233 cases have been reported. Ochronotic arthropathy has often been a “serendipity,” with most diagnosis being made intraoperatively when the operating surgeons encountered “black” discs or “bluish-black cartilage. Spine involvement often precedes other musculoskeletal symptoms and begins after 30 years. Symptomatic treatment and arthroplasty form the mainstay of treatment as this disorder has no cure. We report a case of two brothers with a history of lumbar disc prolapse with radiculopathy, for which they underwent a surgery in their early thirties. They were asymptomatic for 6 years following the surgery before developing back stiffness and multiple large joint pains. The brothers were treated as HLA-B27 negative ankylosing spondylitis by multiple clinicians for 3 years before presenting to us with fused vertebrae, advanced arthritis of shoulder and knee, and avascular necrosis of bilateral femoral head. Alkaptonuria is a very rare disease; the symptoms of progressive low back ache/stiffness coupled with arthropathy of axial/weight bearing joints in an individual over 30 years should prompt the clinician to consider a diagnosis of alkaptonuri. Arthroplasty is the only solution to a pain-free functional life; however, it has its own complications. Hence, early diagnosis and lifestyle modifications might help delay the natural course of this debilitating disease until newer therapies emerge.

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