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2003| October-December | Volume 37 | Issue 4
March 9, 2009
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Anthropometric study of proximal femur geometry and its clinical application
RC Siwach, S Dahiya
October-December 2003, 37(4):247-251
Seventy five pairs (150 bones) of cadaveric femora were studied morphologically and radiologically using standardized techniques to obtain the following anthropometrics measurements: femoral head offset, femoral head diameter, femoral head position, femoral neck diameter, canal width at the level of and 20mm above and below the lesser trochanter, endosteal and extracortical width at the isthmus, isthmus position, femoral neck anteversion and neck shaft angle. The mean and S.D. of these values were calculated. The measurements were used to calculate femoral head volume and cross sectional area of the femoral neck. Percentage of the neck occupied by various implants was calculated. These values were compared with those reported in the literature for Hong Kong Chinese, Caucasian, Chinese and Westerns. Data was found to be quite different from them. The impact of these findings on future implant design in India is discussed. It is proposed that implants designed for Western populations should be used judiciously and future implant designed customized to suit the Indian bones.
Complications of management of developmental dysplasia of the hip
October-December 2003, 37(4):237-240
The most important complications arising from management of DDH include acetabular dysplasia, proximal femoral growth disturbance and redislocation. These complications may either follow non-operative or operative treatment of DDH. This article focuses on complications that can develop during various stages of either forms of treatment. Measures to reduce the risk of these complications are also suggested.
Post operative reinfusion of unwashed, filtered drainage blood in total knee replacement
ON Nagi, Senthil Kumar, RK Sen, YK Batra
October-December 2003, 37(4):252-256
A series of 20 patients undergoing primary total knee arthroplasty were entered into a randomized controlled trial to assess the safety and efficacy of post - operative autologous blood salvage and reinfusion. They were put in two groups of 10 patients each; the first group was managed with closed suction drainage with the use of Romovac system and homologous blood transfusion. The second group was managed with postoperative blood salvage with use of the haemocell post operative collection set and reinfusion of salvaged blood only. The mean volume of autologous blood reinfused was 395 ml per patient (95% of the mean total drainage). Homologous blood transfusion was required in only 2 of patients in the study group compared with 9 of patients in the control group (p< 0.000794.). The mean volume of homologous blood transfused was 0.2 units per patient in the study group compared with 1.1 units in the control (p<0.007001), a saving of 81.8% of banked blood. No complications or episodes of hypotension, confusion, cardiac or pulmonary compromise, febrile reaction, or coagulopathy were observed during or after the reinfusion. No reinfusions were interrupted or discontinued.
Avulsion fracture of the tibial attachment of the posterior cruciate ligament in association with ipsilateral femoral shaft fracture - report
of three cases
S Kumar, R Bahadur, V Kumar, S Duhan, P Aggarwal
October-December 2003, 37(4):271-273
The role of ultrasound in developmental dysplasia of the hip
JC Theis, A Vane
October-December 2003, 37(4):215-222
The use of ultrasound in DDH is primarily before the capital ossific nucleus ossifies. While the use of ultrasound in the diagnosis of DDH still needs further clarification, its usefulness in the monitoring of management of babies with DDH is better defined. The current uses of ultrasound in the diagnosis and management of DDH are reviewed and unresolved issues regarding screening, follow up and treatment are discussed.
Developmental dysplasia of the hip:
Management under six months of age
October-December 2003, 37(4):223-226
Developmental dysplasia of the hip (DDH) includes grades of abnormalities of a growing hip, ranging from dysplasia to subluxation or dislocation of the hip. History, clinical examination and ultrasonography are useful to diagnose instability of hip in the newborn or early in infancy. The natural history of DDH can be altered successfully by early treatment in a Pavlik harness or by closed reduction and spica cast. The goals of treatment are to obtain concentric reduction of hip and avoid avascular necrosis of the femoral head.
The role of hip arthrography in developmental dysplasia of the hip
B Singh, AN Johari
October-December 2003, 37(4):244-246
This study was undertaken to evaluate the role of arthrography in facilitating concentric reduction of the hip in children with developmental dysplasia of the hip. Arthrograms were performed in a total of thirtytwo hips with developmental dysplasia. In twenty-two hips it was performed to evaluate the adequacy of closed reduction. In eight hips it was carried out prior to open reduction in order to identify the obstacles to reduction and in two hips the procedure was undertaken to in an attempt to explain why open reduction had failed. Arthrography was found to be most useful in evaluating the adequacy of closed reduction. It did not significantly facilitate preoperative planning prior to open reduction. Besides not providing additional information, it was also difficult to perform in cases where open reduction had failed.
Effect of chondroprotective drugs on osteoarthritis -
An experimental study
SC Goel, Gaurav Jindal, Amit Rastogi
October-December 2003, 37(4):265-270
Glucosamine and chondroitin, so called chondroprotective drugs have recently acquired substantial popularity as remedies for osteoarthritis. This study was conducted with the aim of determining the effect of Glucosamine and Chondroitin sulfate on experimental model of osteoarthritis in rabbit knees. In 24 rabbits osteoarthritis was created by excision of anterior and posterior cruciate ligaments and medial meniscus. Experimental animals were divided in two groups of 12 each. One group (group A) was given the mentioned drugs. The animals were followed up for various intervals ranging from 1 month to 8 months. At the time of sacrifice, the animals were evaluated for the gross appearance of the cartilage and for the histological picture. Serial radiographs of the knee were taken to look for degenerative changes. All the experimental animals demonstrated definite degenerative changes at the end of follow up on operated (right) side. The two experimental animal groups had no significant difference between the severity of degenerative changes whether it be gross appearance parameters, radiological parameters or histological parameters. They did not alter the natural progression of osteoarthritis in experimental animals. It was concluded that combined meniscus / ligament resection model is most valid and useful experimental model of osteoarthritis among various already available models. However, high quality and independent clinical trials are further needed to determine the actual efficacy and utility of these preparations.
Revision surgery for developmental dysplasia of the hip
AN Johari, FD Wadia
October-December 2003, 37(4):233-236
Formalin preserved allogenic bone graft: Does it work
S Sinha, V Mittal, B Singh, S Agrawal
October-December 2003, 37(4):260-264
The increased need of allogenic bone graft has led to various methods of graft preservation. Freeze dried allograft is most preferred currently. The allograft preservation technique should be simple and cost effective to be widely used. This study comprises 32 cases of formalin preserved allogenic bone transplantation, with an average age of 39.6 years and follow-up ranging from 4 months to 32 months. They were used in comminuted fractures, pathological fractures, nonunions, corrective open wedge osteotomies, benign cystic lesion of bones and revision total hip arthroplasty. In follow-up we looked for infection, graft rejection and radiological union. Union and graft incorporation could be established in thirty-one cases. One case was lost to follow-up. One case developed mild sepsis that was controlled with debridement and antibiotics. There was no case of adverse reaction to formalin or graft rejection. We conclude that the technique of preservation of allogenic bone in formalin is simple. It can be a cost effective alternative to freeze dried allograft.
Late presentation of developmental dysplasia of the hip in children from southwest India -
Will screening help ?
G Rebello, B Joseph
October-December 2003, 37(4):210-214
Of 44 children with DDH that were treated over three years, 19 presented after walking age. This confirms that late presentation of children with developmental dysplasia of the hip is a common occurrence in India. Hospital based incidence of neonatal hip instability is in the order of 2 per thousand live births. The magnitude of the problem is therefore, sufficient enough to warrant the establishment of a screening programme. The principles of screening with specific reference to developmental dysplasia of the hip have been discussed. Strategies to enhance the efficacy of screening for neonatal hip instability have been suggested, so as to reduce the frequency of late presentation.
Role of myoplasty and cancellous bone grafting in chronic osteomyelitis
AS Dube, AK Sharma
October-December 2003, 37(4):257-259
Fifteen cases of chronic osteomyelitis of various long bones, both of hematogenous and non-hematogenous origin were treated with local myoplasty and autogenous cancellous bone grafting, in a same sitting. Improvement was seen in 80% of cases in terms of controlling the infection, obliterating the cavity and restoring the architecture of the affected bone to near normal.
NEWS AND VIEWS
Changes in values of serum calcium, serum phosphates and serum alkaline phosphatase following polytrauma
HS Varma, Neelima Singh
October-December 2003, 37(4):276-277
Developmental dysplasia of the hip -
Management between 6 months and three years of life
October-December 2003, 37(4):227-232
Every effort must be made to achieve concentric reduction of the hip joint in developmental dysplasia of the hip as early as possible. Despite clinical and ultrasound screening programmes, some infants present in the latter part of the first year of life or even later. Depending on the age of presentation, the management of developmental dysplasia is outlined.
Is routine pre-reduction traction necessary for children with developmental dysplasia of the hip?
M Bhatia, B Joseph
October-December 2003, 37(4):241-243
Traction is often used before closed or open reduction of hips with developmental dysplasia, in the belief that it will facilitate reduction and reduce the incidence of avascular necrosis of the femoral head. However, evidence from the literature suggests that traction may neither facilitate reduction, nor influence the frequency of avascular necrosis. The role of pre-reduction traction can only be clarified by undertaking well-designed randomized controlled trials.
Asymptomatic iatrogenic intrapelvic migration of guide wire-
A case report
R Chandra, R Verma, P Monga
October-December 2003, 37(4):274-275
Developmental dysplasia of the hip
October-December 2003, 37(4):209-1
LETTERS TO THE EDITOR
Dr Harish Rao replies:
October-December 2003, 37(4):278-279
A clinical study of bone mineral density using heel ultradensitometer
Ketan C Pandey
October-December 2003, 37(4):278-278
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