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Distal radius fractures with unstable distal radioulnar joint treated by volar plate: A comparative study of immobilization versus early mobilization
Subraya Bhat Kuloor, Abdul Jameel Shareef
July-December 2019, 7(2):46-50
BACKGROUND: Instability of distal radioulnar joint (DRUJ) following distal radius fracture is a treatment enigma with few options and uncertain outcome. Different studies have been conducted in this regard which came out with contradicting results. The aim of this study was to analyze whether immobilization of unstable DRUJ with above-elbow cast for 6 weeks has any advantages versus immobilization for 3 weeks similarly after anatomical fixation with volar plates. MATERIALS AND METHOD: We conducted a prospective study on patients with unstable distal radius fractures treated by open reduction with volar buttress plate from 2013 to 2016. Patients were grouped into Groups 1 and 2 depending on the postoperative immobilization protocol (each group with 21 patients). Group 1 patients were immobilized with above-elbow cast for 3 weeks and Group 2 patients for 6 weeks. Results were compared using wrist range of movements, patient-oriented Patient-Rated Wrist Evaluation (PRWE) and physician-based Sarmiento modified Gartland–Werley (GW) demerit scoring. All patients were evaluated for the persistence of DRUJ instability. RESULTS: Demographic data were comparable between the groups. AO type C fracture (67%) was common in both groups. The range of movements was comparable in both groups (P > 0.11). There was no statistically significant difference found in GW and PRWE scoring (P > 0.05). There were two patients with unstable DRUJ with decreased radial height and positive ulnar variance who needed further treatment. CONCLUSION: Prolonged immobilization (6 weeks) contributed no extra benefit when DRUJ is well reduced with anatomical fracture fixation. The instability recovered with healing of ligamentous injuries and fractures after stabilization of unstable bony fragments with surgical fixation of distal radius fracture.
  1,445 173 -
Arthroscopic treatment of isolated type 2 SLAP lesions in athletes: A systematic review
Atul Mahajan, Dougulas Wong
July-December 2019, 7(2):40-45
Superior Labrum From Anterior to Posterior (SLAP) lesions refer to a tear of the superior portion of the glenoid labrum that begins posteriorly and extends anteriorly to the mid-glenoid notch. Patients who sustain traumatic injuries to the shoulder girdle and also who undergo repetitive, overhead motions are at risk for SLAP lesions. Among the various types of SLAP lesions, type 2 lesion is the most common lesion encountered and is defined by 'superior labral fraying with stripping of the superior part of the labrum and attached biceps tendon from the underlying glenoid cartilage”. In superior labrum anterior and posterior (SLAP) tears, a common concern for patients is being able to return to their previous levels of activity after surgery, whereas clinicians are concerned with providing a consistent prognosis of successful return to participation after surgery. Thus, return to play (RTP) and patient satisfaction can be used as a vital measure of treatment success which has been evaluated by significantly fewer studies, especially in isolated type 2 SLAP repairs. The published outcomes of surgical treatment are inconsistent, with variable and suboptimal patient satisfaction rates and RTP. Thus, we wanted to address and reevaluate the current treatment, rehabilitation protocols, and outcome following arthroscopic repairs in order to expand the knowledge and give further insight into providing better management plan in these patients. This study used a systematic review of papers reporting arthroscopic treatment of isolated type 2 SLAP lesions with the main objective in trying to assess the effectiveness of arthroscopic repair, to determine patient satisfaction and RTP at previous level of activity, and to analyze the rehabilitation protocols being followed among all athletes who underwent repair of type 2 SLAP tears using various types of fixation.
  1,123 129 -
Virtual reality applications in orthopaedics
Abid Haleem, Mohd Javaid, Raju Vaishya, Ibrahim Haleem Khan
July-December 2019, 7(2):83-84
  1,116 94 1
Role of transforaminal epidural steroid injection in chronic disc pain
Monisha Parasuraman, Jaganath Karunakaran, Anvesh Duvvuru, Natarajan Shanmugam
January-June 2020, 8(1):12-15
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.
  957 133 -
Obesity and osteoarthritis of the knee joint: Is leptin the missing link?
Obinna Henry Obiegbu, ID Nnakenyi, CU Ndukwu
July-December 2019, 7(2):57-61
BACKGROUND: Osteoarthritis (OA) involves a progressive degeneration of the articular cartilage, remodeling of the subchondral bone, and synovitis. It typically affects diarthrodial (synovial) joints including the knee joints. Obesity, which represents a body mass index (BMI) of ≥30, has been linked to OA of the knee joint. A biomechanical theory which infers that repetitive application of axial loading at the knee joint is the mechanism through which obesity causes OA has long been put forward. However, metabolic factors (adipokines) may yet be a link between OA and obesity. AIM AND OBJECTIVES: This study was performed to establish if there is a correlation between serum leptin and radiological severity of OA of the knee joint in obese individuals. MATERIALS AND METHODS: This was a prospective study carried out after ethical clearance was obtained from the hospital's ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were selected by random sampling into either the obese or nonobese group based on their BMI. The patients were radiographically evaluated, and data were collected using a well-designed and structured pro forma. 5 ml of blood was collected from each patient for the analysis of serum leptin level. RESULTS: A total of 100 patients were included into this study. Fifty of these patients were obese (BMI ≥30), whereas the other fifty were nonobese (BMI <30). The peak age of the occurrence of knee OA was 61–70 years. The mean serum leptin level in obese patients was 20.11 ng/ml, as opposed to that in nonobese patients of 4.88 ng/ml. The radiological severity was analyzed, and there was a positive correlation between serum leptin level and radiological severity in OA of the knee joint. A higher percentage of females in this study were obese (71%) as opposed to males (29%), and females had statistically significantly higher leptin levels when compared to males. CONCLUSION AND RECOMMENDATION: From the results of this study, it is concluded that there is a correlation between serum leptin levels and radiological severity of OA of the knee joint in obese patients.
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Refinement of the journal of orthopedics and allied sciences
Pradeep K Singh, Shraddha Singhania, Sohael Mohammed Khan
July-December 2019, 7(2):39-39
  916 132 -
Study on risk factors affecting nonunion of fractures
Giridharan Shanmugam, M Sivasubramanian, V Kabilan, S V Pavan Kumar, K Caroline Priya, Seenivasan Poikailawar
July-December 2019, 7(2):62-67
INTRODUCTION: Nonunion is one of the most common complications of fracture healing. The incidence of nonunion is believed to vary from 5% to 10%. AIM: The aim of the research is to study the risk factors affecting nonunion of fractures and analyze the treatment taken, and it is bearing on nonunion. MATERIALS AND METHODS: The study is a cross-sectional observational study with purposive sampling done in the orthopedic department. A total of 71 patients were selected, and a questionnaire was filled in with data obtained from the patient and medical records. Radiological evidence was also used to confirm the nonunion. RESULTS: The sample included 48 men and 23 women. Of the females, 21 had attained menopause (91%). About 58% of the patients had taken treatment from Traditional Bone Setters (TBS), and 49% of the patients first went to a TBS before coming to the allopathic physician for fracture treatment. About 45% of the patients had a very short duration of immobilization of their fractures. A history of previous malignancy, bone cyst, or other illnesses lead to a longer time for recovery and return to work (P = 0.0339). Patients who had infected fractures had a significantly more number of surgeries than those without infection (P = 0.015). Nonsteroidal anti-inflammatory drugs use during treatment of fracture was also associated with nonunion (P = 0.0077), especially in allopathic medicine. CONCLUSION: Nonunion continues to be a significant problem for all orthopedic surgeons despite their best ability to prevent them. A complete examination of the patient with relevant investigations and selection of the most suitable and appropriate treatment for each individual should be carried out; since each person is unique, and every fracture is not alike.
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Use of biodegradable materials as local antimicrobial carriers in orthopedic infections
Antariksh Waghmare, Narendra K Saxena, Suvarn Gupta, Sohael Khan
July-December 2019, 7(2):51-56
INTRODUCTION: Orthopedic infections have been a major complication; despite numerous advances in prophylactic measures, infections still remain a major complication in orthopedic and trauma surgery. The progressive infection of the bone and the surrounding tissue results in bone infarcts with abscess and sequestrum formation. Adequate treatment can be an implant removal and a radical debridement with a long-term course of systemic antibiotic, but these prolonged therapies can result in side effects or toxicity. The primary reason for using local antibiotic delivery vehicles is its ability to achieve high local concentrations without associated systemic toxicity. MATERIALS AND METHODS: This is a prospective study conducted over 2 years. Thirty-five patients were studies in which 33 patients were managed with calcium sulfate + antibiotic, 1 was managed prophylactically with beads, and one was managed with Abgel + antibiotic as a biodegradable carrier. The aim was to evaluate the efficacy of biodegradable materials as antimicrobial carriers in localized orthopedic infection. OBSERVATIONS: A prospective study consists of 35 cases of orthopedic infections with major number of patients belonged to the age group of 20–40 years, with a mean 37.66 ± 19.9 years. One patient was included with soft tissue infection and rest all the patients had bone infections. It was observed that there is statistically significant improvement in ASEPSIS score at 0 week to ASEPSIS score at the end of 9 weeks. CONCLUSION: In the present study, the patients showed evidence of excellent control of infection and osseous repair, and further, none of the patients required follow-up. In our series, we have used calcium sulfate as a biodegradable antimicrobial carrier with appropriate antibiotics and achieved good-to-excellent results in local orthopedic infections.
  908 115 -
Functional and radiological outcomes in 2.7-mm volar locking compression plating in distal radius fractures
Jose Austine, Prem Kotian, Kiyana Mirza, Rajendra Annappa, Premjit Sujir
January-June 2020, 8(1):27-33
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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Multifocal intraarticular lipoma arborescens of the hip and knee: A case report and review of literature
Atul Mahajan, Seung Han Beom
July-December 2019, 7(2):72-75
Lipoma arborescens (LA) is a rare clinical condition presenting mostly as an intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of sub synovial fat. We report a case of a multifocal LA localized in the knees and the hips in a 20-year-old man symptoms being present for the last 3 years and initially mimicking an inflammatory arthropathy. On physical examination a discreet joint swelling of the left knee with effusion, and limited movements in the left hip were observed. Laboratory tests presented normal acute phase reactants of inflammation as well as the rheumatoid factor, CK, and negative results for antinuclear and anti-CCP (ELISA) antibodies. Magnetic resonance imaging of the knees and hips showed articular effusion and synovitis, and a pattern of LA. The histopathologic study confirmed the diagnosis. Arthroscopic synovectomy for the knee and open synovectomy for the hip brought some improvement to joint mobility and pain.Although rare, this condition must be differentiated from inflammatory arthropathy, particularly in the absence of response to clinical treatment, and absence of positive biochemical markers, since the therapeutic strategy is radically different.
  918 68 -
Acute compartment syndrome of the foot: An unusual case caused by Graston technique
Vince W Lands, Ajith Malige, William L Delong
July-December 2019, 7(2):68-71
The purpose of this case report is to describe an unusual cause of compartment syndrome of the foot that developed subsequent to the use of Graston technique in a patient who had recently underwent revision total hip arthroplasty (THA). A 60-year-old female presented for orthopedic follow-up care in the office, 10 days postoperatively following an explant of her right hip Prostalac® spacer (DePuy) for previous infection and conversion to right THA (DePuy CORAIL® Hip System) complaining of severe right foot pain, swelling with pressure in foot, paresthesia, and inability to bear weight. The patient had undergone Graston technique for bilateral foot swelling by her home physical therapist. The patient was clinically diagnosed with acute compartment syndrome (ACS) of her right foot and underwent intervention. The treatment consisted of acute fasciotomy of her right foot with vacuum-assisted closure application. Delayed closure was initiated once soft-tissue decompression occurred. Due to acute fasciotomy, ambulation was inhibited and physical therapy delayed. The postoperative course was uneventful following the release of tense compartments, weight bearing was resumed once incisions healed, and the patient was pain free while deep-venous thrombus prophylaxis was continued. No further issues occurred postoperatively, and the patient showed overall clinical improvement. Residual soft swelling can be expected following hip surgery, especially at the caudal end of limbs. Immobilization enhances this engorgement. However, due to the aggressive Graston technique performed by the therapist, the patient developed ACS of the foot. Graston technique has been documented to increase blood flow to treated areas. Early and aggressive intervention should be initiated if ACS is clinically or objectively found, as late detection may have disastrous results.
  898 85 -
Implants and grafts used in fractures for early healing
Bilal Mohamad Ali Obeid
January-June 2020, 8(1):6-11
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.
  864 106 -
Noncontiguous two levels traumatic dislocation of the cervical spine managed with a posterior only approach
Amit Agrawal, V A Kiran Kumar, N A Sai Kiran, M Venkatesh, V Anil Kumar
July-December 2019, 7(2):80-82
Literature defines multiple noncontiguous vertebral injuries, as “injuries to the vertebral column involving ≥1 site, and these injuries are separated by an apparently normal area of the spine.” In the present article, we report an unusual case of two nonadjacent levels traumatic dislocation, involving the cervical spine managed through the posterior-only approach.
  884 83 -
Non-covid, nonemergency spine surgery: Trying times
Pradeep K Singh
January-June 2020, 8(1):1-1
  815 114 -
Impact of COVID-19 in orthopaedic practice: What we must know
Sharif Ahmed Jonayed
January-June 2020, 8(1):2-3
  798 131 -
A rare case report of osteomyelitis of myositis ossificans traumatica mass in leg
I Ibad Sha, Ajin Edwin, Syam Roy
July-December 2019, 7(2):76-79
Myositis ossificans traumatica is a non-neoplastic proliferation of bone and cartilage tissue at the site of a previous injury. Osteomylitis of Myositis Ossificans Traumatica mass is even rarer and literature review show that this is only the second case reported till now. A 61 years old male presented to our outpatient department with main complaints of discharging sinus left leg for 7 months. Clinical provisional diagnosis of chronic osteomyelitis of left leg was made. Standard radiograph shows a large mass around the middle and lower third of left leg with osteomyelitic changes in the lower third. Magnetic Resonance Imaging confirm the diagnosis as Infectious Myositis mass. The patient got operated with complete excision of myositis mass and infected tissue. Post operative follow up shows complete healing with no recurrence. Osteomyelitis of myositis ossificans can be a possible differential diagnosis of chronic discharging sinus in cases were there is associated myositis mass adjacent to the lesion. Prompt diagnosis along with excision removal of mass and infected tissue should be the treatment to avoid recurrence.
  816 85 -
Spinal problems – Spine surgeon or neurosurgeon: Is it an issue?
Pradeep K Singh, Sohael M Khan, Shraddha Singhania
July-December 2020, 8(2):51-51
  803 94 -
Vascular groove sign in osteoid osteoma of the vertebral body
Mukesh Kumar, KrishnaKumar R
January-June 2020, 8(1):38-40
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.
  778 62 -
COVID-19 and elective case triage for orthopedic surgery
Kedar Phadke, Provash Saha
January-June 2020, 8(1):4-5
  724 112 -
Does matrilin-3 gene polymorphism and primary knee osteoarthritis have a association in Indian population?
Vipin Kumar, Ruchit Shah, Afroz Ahmed Khan, Abhisek Pandey, Urvi S Khambhati, Nandan K Mishra
January-June 2020, 8(1):22-26
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.
  745 87 -
Debridement and stabilization with transpedicular screws in thoraco-lumbar spinal tuberculosis
Lenin Ligu, Moji Jini
July-December 2020, 8(2):52-56
BACKGROUND: The treatment for spinal tuberculosis (TB) remains a difficult and challenging decision-making process, given the lack of evidence and guidelines on the optimal treatment and management strategies. Conservative treatment options for spinal TB include methods such as immobilization using body casts or plaster beds, as well as a healthy diet. MATERIALS AND METHODS: The records of 26 patients who underwent posterior stabilization with pedicle screws and decompression with laminectomy for thoraco-lumbar TB with associated neurological deficit between January 2015 and December 2019 from hospitals were reviewed. The patients were followed up for a minimum of 24 months. In this study, we did not include patients with HIV co-infection. Results: In the present study, total 26 patients with thoraco-lumbar (T12-L1) TB. The study group consisted of 11 male and 15 female patients. The preoperative and postoperative mean kyphotic Cobb's angle were 23.1± 2.9° in males and 26.4 ± 2.4° in females and 8.9± 1.3° in males and 8.1± 1.4° females in the present study, respectively. At 1-year follow-up, the mean kyphotic angle was 11.2± 2.2° with a mean loss of kyphotic correction by 4.9± 1.1° in male. In our study, the C-reactive protein level decreased when compared preoperatively and postoperatively, 14.26 ± 1.8 in preoperatively, and 8.26 ± 1.2 postoperatively. Similarly, ESR value also decreased from 38.2 ± 2.3 mm to 21.6 ± 2.8. In addition, visual analog scale also decreased from 7.42 ± 1.1 to 2.9 ± 0.9. Conclusions: The procedure of one stage posterior debridement, decompression, and transpedicular screw fixation is effective and safe for treating thoracic and lumbar spinal TB.
  742 79 -
Dr Ketan Khurjekar (1975–2019)
Gururaj Sangondimath
July-December 2019, 7(2):85-86
  747 71 -
Intramuscular hemangioma of the forearm and phlebolith – A review of literature with case report
Pankaj Kumar Mishra, Vivek Kumar
January-June 2020, 8(1):34-37
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.
  737 69 -
Bone mineral density measurement in traumatic distal end radius fractures: A case–control study
Ankur Dilip Kariya, Pramod Ajit Jain, Kisan Ramrao Patond
January-June 2020, 8(1):16-21
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.
  726 80 -
“Black disc” tandem spinal stenosis in ochronotic arthropathy
Shailesh Hadgaonkar, Pradhyumn Rathi, Ashok Shyam, Parag Sancheti
January-June 2020, 8(1):41-45
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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