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   Table of Contents - Current issue
May-August 2021
Volume 4 | Issue 2
Page Nos. 19-57

Online since Thursday, August 26, 2021

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Orthopaedics in covid era p. 19
AS Dube
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An online survey to assess preparedness among orthopedic professionals toward resuming practice amid the COVID-19 pandemic p. 20
Sudeep Kumar, Anup Kumar, K V Charan Teja, Mohammed Roshen Abdul Razek, Alapati Hari Venkata Bramesh, Ravi Kumar
As the world has taken a hit in this COVID-19 pandemic started in 2019 and widely recognized and tackled in 2020, we orthopedic surgeons too have faced many challenges and are trying to cope with the new normal. India being a developing country with various geopolitical and economical differences in this country, it was important for us to understand the preparedness of orthopedic surgeons in this part of the world. We wanted to know and understand what are the protective equipment they are looking for before they take any patient, what is the level and frequency of testing (for COVID-19) that they are doing, and how their practice has been modified in anyways.
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Effect of embolization in the definitive and palliative management of bone and soft tissue tumors of the extremities p. 26
Ravikant Thakur, Vineet Aggarwal, Ekta Dogra, Amit Kumar Salaria, Rajeev Bhardwaj, Shashikant Sharma, Pooja Thakur
Introduction: Surgery may be complex in some bone and soft tissue tumors. Preoperative intra-arterial embolization is a developing method for benign and malignant tumors. The present study was done to assess the outcome on the size of tumor and blood loss by preoperative tumor embolization and pain relief in patients with inoperable tumors. Materials and Methods: Twenty-five patients with biopsy-proven bony tumors of extremities were subjected to embolization. In 12 cases, embolization was done preoperatively to decrease the blood loss. In 13 patients, it was done as a palliative treatment to reduce pain, as patients were inoperable. The embolization was done with the right Judkins catheter. Some cases were done with a microcatheter. The material used for embolization was either polyvinyl alcohol (PVA) particles, microcoils, or gel foam used in various combinations, selectively into the feeding vessel. Results: Mean age of the patients was 44.5 years. Fifteen were male and 10 were female. A total of 60 vessels were embolized, 25 with gel foam, 24 with PVA particles, and 11 with microcoils. In 90% of operated patients, gel foam was used, whereas, in almost 100% of nonoperated patients, PVA particles were used. There was a significant decrease in blood loss in patients with preoperative embolization (865 ± 420 vs. 1633 ± 660 ml). In patients with palliative embolization, the mean pain score before embolization was 6.32–2.58, which was decreased to 3. 2–1.53. Conclusion: Preoperative and palliative transarterial embolization of soft tissue and bony tumors is a safe, effective, and minimally invasive modality for pain relief and de-vascularization of large bony tumors in anatomically difficult locations.
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Epidemiology of cervical spine injury in Northern India: A retrospective study p. 32
Ashish Dagar, Amit Kumar Salaria, Vishal Kumar, Karthick Rangasamy, Sarvdeep Singh Dhatt
Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is largely unknown. Study Design: Retrospective study. Objectives: To find out the epidemiology and demographic factors associated with patients of traumatic cervical spinal injury presented to a level 1 trauma center. Patients and Methods: The study sample includes patients with cervical spine injury admitted to our level one trauma centre from the period of July 2018 to June 2019. Those patients who succumbed to their injuries due to various reasons before imaging or brought dead having suspected cervical spine injury were excluded from the study. Results: During the study period, 83 patients having cervical spine injury were admitted and treated. Out of 83, 75.9% (63) were male and the remaining 24.1% (20) were female. The most common mode of injury was fall from height (66.3%) followed by road traffic accidents (24%). About 64% of the patient population belonged to rural areas. The most affected age group in this study was 20–39 years. The most common associated injury is Extremities fracture (9.6%) followed by head injury (8.4%). C5C6 was the most common level and 69.9% underwent surgery. Pressure sore was presented in 12% of cases. Conclusion: The epidemiology of cervical spine injury in Northern India is different from developed countries. In the present study, the most common cause of cervical spine injury was fall from height followed by motor vehicle accidents. Proper awareness program, educating people, national policymaking, and involvement of NGOs and training primary health care workers will help in reducing the incidence of cervical spine injuries in this region
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How long can secondary resurfacing surgery be delayed with continuous irrigation therapy for gustilo-anderson type iii fracture? A retrospective clinical study p. 36
Masaki Fujioka, Kiyoko Fukui, Miho Noguchi
Background: The resurfacing of Gustilo–Anderson (GA) IIIB and C fractures remains challenging. Immediate debridement and external stabilization of the fracture followed by early internal fixation along with wound closure using flaps are recommended. Although it requires early soft tissue reconstruction, it is not always possible. We considered that continuous wound irrigation might reduce the chance of infection and extend the delay period until the secondary surgery. Patients and Methods: A total of 19 patients with GA IIIB and C fractures who underwent debridement and external fixation were evaluated. Among them, 18 cases were examined, excluding one who received amputation. Ten underwent wound-resurfacing surgery within 10 days after injury, and the other 8 did so after 11 days. We examined the frequency of osteomyelitis development depending on the timing of wound closure and predicted how long secondary wound closure surgery could be delayed on the application of continuous irrigation therapy. Results: Eight patients developed osteomyelitis. The number of days until wound closure in the group that developed osteomyelitis was significantly greater than in those who did not develop osteomyelitis group (P < 0.05). Only one patient (10%) developed osteomyelitis in the early resurfacing group, while 7 (87%) did so in the late resurfacing group. There was a significant difference between the groups (P < 0.01). Conclusion: This study showed that that the continuous irrigation method could extend the delay time until the secondary surgery for GA III fractures. However, it suggested that the waiting should be limited to a maximum of 10 days.
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Graft diameter as a predictor for functional outcome following arthroscopic anterior cruciate ligament reconstruction: A prospective study p. 42
Sudeep Kumar, Anup Kumar, Ravi Kumar
Background: The purpose of the study was to find the effect of autologous hamstring tendon graft size on patient reported outcome (PRO) measures following Arthroscopic Anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A review of prospectively collected cohort data of 90 patients who had undergone primary ACL reconstruction using hamstring tendon autograft was evaluated. Patient's age, sex, graft diameter at the time of surgery, and minimum of 2 years postoperative functional outcome were assessed using PRO measures, i.e. Tegner Lysholm Knee (TLK) Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee score. Mean of the three scores was calculated along with that of graft diameter, and Pearson correlation coefficient was calculated to find the relation between graft diameter and the three-PRO measure scores independently. Two-tailed test was used to compute the statistical significance of parameter inferred from the data sheet. Results: There was a positive linear correlation between the graft diameter and three PRO measures independently; however, two-tailed tests for statistical significance were significant only for TLK Score and KOOS. Conclusion: We conclude that hamstring autograft diameter is one of the important predictor for postoperative functional outcome, and hence, a thicker diameter graft is desirable.
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Pitfalls of ultrasonic bone scalpel: A case-based discussion p. 47
Vishal Kumar, Amit Kumar Salaria, Ashish Daggar, Deepak Neradi, Sarvdeep Singh Dhatt
The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.
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Lateral elbow dislocation with medial epicondyle fracture in a kabaddi player: A case report of rare association p. 50
Diwakar Pratap, Naveen Agarwal, Tariq Akhtar Ansari, Ganesh Singh Dharmshaktu
Lateral elbow dislocation is a rare injury with few reported cases. Most elbow dislocations are posterior and many have associated fractures of either humeral condyles. The medial epicondyle fracture in the setting of lateral elbow dislocation is a rare injury pattern. We report a case of lateral elbow dislocation with medial epicondyle displaced fracture in a 15-year-old male patient following a contact-sports-related injury. The elbow was reduced in the emergency and the medial fracture was fixed later with a pin and screw. There was no ulnar nerve injury associated primarily with the injury and was also not observed after surgery or during follow-up. The functional outcome was good and fracture united uneventfully. The patient had stable elbow with good range of motion and no clinical instability noted in the follow-up of 13 months. There was, however, gradual loosening of the screws noted in the follow-up and implants were removed at 9 months. There was 10° of cubitus valgus noted at last follow-up and the Mayo Elbow Performance Score was 90 depicting excellent outcome. The lateral elbow dislocation requires careful identification and exclusion of any associated nerve injury, soft tissue injury or bony fracture or their incarceration. The standard management and early rehabilitation leads to the optimum outcome.
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Broken instrument may incidentally be found in second surgery: Update and commentary on a previously published article p. 53
Ganesh Singh Dharmshaktu, Shailendra Singh Bhandari
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OSapp: An interesting tool to learn basic biomechanics of fracture and fixation method p. 55
Ganesh Singh Dharmshaktu
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Musculoskeletal mucormycosis and COVID-19 pandemic – caution in the crisis p. 56
Ganesh Singh Dharmshaktu, Tariq Akhtar Ansari, Tanuja Pangtey
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