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  Citation statistics : Table of Contents
   2005| July-September  | Volume 39 | Issue 3  
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Femoral neck anteversion: A comprehensive Indian study
AK Jain, Aditya V Maheshwari, MP Singh, S Nath, SK Bhargava
July-September 2005, 39(3):137-144
Background: The femoral neck anteversion has important implications. Since these values are not documented for our population, we undertook this study to define this for Indian population. Methods: FNA was calculated on 300 dry femora by the Kingsley Olmsted method, and prospectively on otherwise normal living adults by CT method (n=72 hips), by biplanar radiography (n=138 hips) and clinically (n=138 hips). Results: The mean FNA by CT was 7.4° (SD 4.6°) and more than 75% of cases were between 3.4° and 11.4°. The mean FNA by X-ray method was 11.5° (SD 5.4°) and more than 71% of cases were between 6.5° and 16.5°. The mean, clinically, was 13.1° (SD 4.6°) and almost 75% of cases were between 9.1° to 17.1°. The mean FNA on dry femora has been calculated as 8.1° (SD 6.6°) and almost 62% of cases were between 3.1° to 13.1°. The mean FNA on right side was statistically significantly 1.7° less than on the left side. Statistically significant difference between the sexes was found only by the dry bone method (F>M = 3°). Conclusions: Considering CT to be most accurate on living subjects, FNA in our study has been found to be 7.4° (SD 4.6°). It is 4 -12° lower than most of the western studies by all these methods. Readings are 4.1° higher by the X-ray method and 5.7° by the clinical method. Correlation and regression equations have also been formed between the various methods and the clinical method correlates better than the X-ray method to the CT method.
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Treatment of closed unstable extra articular proximal phalangeal fractures of hand by closed reduction and dorsal extension block cast
Abheek Kar, Purnima Patni, RL Dayama, DS Meena
July-September 2005, 39(3):158-162
Background: Unstable fractures of proximal phalanges have enormous divergence of opinion regarding the treatment. Treatment options range from fancy over the counter splints to the more exotic forms of internal fixation. Method: A total of 62 cases with 72 fractures with ages from 10­65 yrs of both sexes were treated. After closed reduction under local anaesthesia the dorsal extension block cast was applied with the metacarpophalangeal joints in full flexion and interphalangeal joints in full extension. This method works on the principle of the intact dorsal soft tissue hinge (extensor apparatus) over the fractured proximal phalanx. The intrinsic plus position keeps the intrinsics lax and prevents them from acting as a displacing force pulling the proximal fragment of the fracture into volar angulation. On an average the cast was used for 3 weeks. Results: Fifty eight fractures had united by 3 weeks. The results were judged according to modified Buck-Gramcko's point assessment system for finger fractures, which showed 80.64% excellent, 4.83% good, 8.06% satisfactory and 6.45% poor results. The complications were minimal which included only 3 cases with malunion. Conclusion: Conservative management of unstable proximal phalangeal fractures with dorsal extension block cast has produced excellent results. It maintains mobility of the fingers without compromising the stability of the fracture and prevents future stiffness of hands. It avoids the complications of operative methods and is simple to use.
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Arthroscopic fracture fragment removal from the hip - A case report
Jai Thilak, Jacob Varughese
July-September 2005, 39(3):191-192
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Bone and joint tuberculosis -Guidelines for management
TK Shanmugasundaram
July-September 2005, 39(3):195-198
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Management and follow up of tibial plateau fractures by 'T' clamp external fixator and limited internal fixation
M Thimmegowda, SR Kurpad, Kamini Kurpad, K Srinivasan
July-September 2005, 39(3):163-165
Background: Tibial plateau fractures are difficult to treat especially when soft tissue is compromised by open reduction and internal fixation. Many methods have be1en tried in the past to manage these cases of which external fixation were shown to be effective as they limit the soft tissue and wound complications. Methods: Complex tibial plateau fractures of sixteen patients were treated by closed reduction, fixation of articular fragments by screws and application of unilateral external fixator. The external fixator was kept in place till fracture united clinically and radiologically. The patients were followed up for at least one year to assess the function of the knee joint Results: The average duration of external fixation was 13 weeks. All the fractures healed. Pin track infection (five patients) and instability (six patients) of the knee were encountered with this procedure. The average duration of follow up was 62 weeks. The mean range of motion was 1250 arc. The IOWA knee score averaged 90.3 points. Conclusions: External fixation with limited internal fixation may be effective in the management of complex tibial plateau fractures which requires further support from studies with large sample size. 'T' clamp external fixation with limited Internal fixation is the procedure of choice when alignment, stability, early mobilisation is required in a soft tissue compromised tibial plateau fractures.
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Treatment of long bone fractures in children by flexible titanium elastic nails
Atul Bhaskar
July-September 2005, 39(3):166-168
Background: Elastic intra-medullary nailing is a new technique for treatment of various paediatric fractures. The use of these titanium nails is preferred over conventional stainless steel nails used in the past. Method: Sixty patients with various long bone fractures underwent operative treatment with elastic intra-medullary nails. The mean age was ten years and the mean follow-up period was 28 months. Results: All children achieved union in a mean time of 10 weeks. Few technical complications were seen earlier on in the series. Two cases developed infection which resolved with antibiotics. Insignificant limb length discrepancy was seen in 3 children, but this remains a potential problem which needs close follow-up until skeletal maturity. Conclusion: Elastic intra-medullary nailing of long bone fracture is an excellent technique in the surgical treatment of long bone fracture in children. It is safe, less invasive and associated with fewer complications.
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Paget's disease : An unusual cause of backache in an adult male - A case report
Vivek Trikha, Ravi Mittal, PP Kotwal
July-September 2005, 39(3):193-194
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Bilateral fracture of neck of femur with bilateral dislocations of hip - A case report
GJ Purohit
July-September 2005, 39(3):187-188
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Anterior dislocation of hip with fracture neck femur with migration of head into pelvic cavity - A Case Report
Satadal Nath, VK Chawhan, VK Bansal, Anupam Lal
July-September 2005, 39(3):189-190
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Distally based superficial sural artery flap for soft tissue coverage in the distal 2/3 of leg and foot
B Jagannath Kamath, M Shantharam Shetty, M Ajith Kumar, Praveen Bhardwaj
July-September 2005, 39(3):169-173
Background: Skin coverage for defects in the lower 2/3 of leg, ankle region and posterior heel has always been a difficult challenge for reconstructive surgeon. Methods: We describe our experience with the distally based superficial sural artery flap coverage in 48 patients with moderate sized defects in these difficult areas. Results: One out of 48 flaps (in 48 patients) was lost totally and 3 suffered marginal necrosis which did not require any secondary procedure. These complications could have been avoided by proper selection of cases and refining technical skills. Conclusion: This simple procedure could be an important and versatile tool for any reconstructive surgeon in providing skin coverage in the distal leg and proximal foot. Preservation of major arteries of the lower limb, minimal donor defect, relatively uninjured donor area in compound fracture or poly trauma involving distal leg are some of the advantages of the flap.
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Aneurysmal bone cysts
P Rangachari
July-September 2005, 39(3):174-178
Back ground: Aneurysmal bone cysts have raised intra-cystic pressures which are dynamic and diagnostic in nature. Aneurysmal bone cysts could be diagnosed from other benign cystic lesions of bone by recording their intra-cystic pressures with a spinal manometer. Raised intra-cystic pressures in aneurysmal bone cysts are maintained as long as the periosteum over the cyst is intact even in those with pathological fractures. Even though its pathology is definite its aetio-pathology is not clear Method: Fourteen out of 16 radiologically benign cystic lesions of bone were subjected to intra-cystic pressure recordings with spinal manometer. Other two cysts had displaced unimpacted pathological fractures and so their intra-cystic pressures could not be recorded. All 16 cysts were subjected to histo-pathological examination to confirm their diagnosis and to find out for any pre­existing benign pathology. All the cysts were surgically treated. Results: Fourteen benign cystic lesions of bone were diagnosed as aneurysmal bone cysts preoperatively by recording raised intra-cystic pressures and confirmed by histo-pathology. In addition, histo-pathology revealed pre-existing benign pathology. All cysts were successfully treated surgically. Conclusions: Since, there is appreciable rise in intra-cystic dynamic pressures, the aneurysmal bone cyst is considered to be due to either sudden venous obstruction or arterio-venous shunt. Pre-operative intra-cystic pressure recordings help not only to diagnose aneurysmal bone cysts but also to assess the quantum of blood loss and its replacement during surgery.
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Tubercular osteomyelitis of sternum
Tejas Thakker, MM Prabhakar, DA Patel
July-September 2005, 39(3):179-181
Background: Sternal osteomylitis caused by mycobacterium tuberculosis is rare. Method: During the past 27 years, 10 cases tubercular osteomyelitis of sternum were seen. All patients presented with a painful swelling over the manubrium sternii. The patients were treated by an antitubercular drug regime, aspiration of the cold abscess over the manubrium, and in three patients by curettage of the bony lesion. Results: Follow-up has ranged from 2 years to 27 years. All the tubercular lesions had healed. Conclusion: The diagnosis of manubrial lesions is easy because of their superficial location and the treatment of tuberculosis infection gave excellent results.
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Instrumented gait analysis for planning and assessment of treatment in cerebral palsy
Raji Thomas, T Ganesh, J George, K Venugopal, A Macaden, P Poonnoose, G Tharion, SR Devasahayam, S Bhattacharji
July-September 2005, 39(3):182-186
Background: To improve the walking efficiency of children with cerebral palsy, gait must be documented accurately so that the abnormalities can be assessed and the best treatment option can be selected. Methods: Gait was analysed using Selspot kinematic system with a Kistler force plate and the motion analysis ambulatory EMG system connected to a personal computer. Results: Walking speed and stride length had improved in children. Conclusion: Gait analysis can help to accomplish improvement in walking efficiency of children with cerebral palsy.
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Morphometry of lumbar intervertebral foramen
Rema Devi, N Rajagopalan
July-September 2005, 39(3):145-147
Background: The spinal nerve roots exit through the intervertebral foramina and the proportion between the size of the foramen and the relative space occupied by the root determines the chance of root compression in the intervertebral foramen. Not much data exists regarding the variations in the dimensions of the intervertebral foramen in Indian subjects. Methods: Twenty one sets of lumbar vertebrae dissected out from the cadavers in the Department of Anatomy, was used for the study. The vertical and transverse diameters of the intervertebral foramina were measured. The vertebral foramen index was then calculated by taking the ratio between the vertical diameter and the transverse diameter. Result: It was seen that the vertical diameter was more than the transverse diameter at all levels except at the L5-S1 foramen where it was the other way round. Even though there was a difference in the foramen size between the right and the left sides, it was not statistically significant. There was decrease in the transverse diameter from L 1 (mean 9.89 mm) to L 3 levels (mean 9.78 mm) and thereafter an increase at L 4 (mean 11.15 mm). The vertical diameter showed an increase from L 1 (mean 14.83 mm) to L 2 levels (mean15.52mm) and thereafter a decrease from L 3 (mean 15.29 mm) to L 5 (mean 12.48 mm) which was not statistically significant. The antero-posterior dimension of the superior notch was less than that of the inferior notch at all levels. The vertebral foramen index showed a gradual increase from L 1 (mean 1.47) to L 3 (1.58) and thereafter a decrease at L 5 level (0.94). Conclusion: The foramen dimensions are critical in determining the foraminal constrictions of the lumbar spine. The transverse and vertical dimensions do not have a bearing on each other, as indicated by the vertebral foramen index.
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Interlaminar fenestration in lumbar canal stenosis- a retrospective study
Puneet Gupta, Sansar Sharma, V Chauhan, Rajesh Maheshwari, Anil Juyal, Atul Agarwal
July-September 2005, 39(3):148-150
Background: Degenerative lumbar canal stenosis is a multifaceted problem presenting as backache and neurological claudication. Methods: In fifteen patients of acquired degenerative lumbar canal stenosis multi level interlaminar fenestration with discectomy, if required, was carried out. Retrospective analysis was done to assess the out come by assessing the relief in backache and neurological claudication. Results: The mean age of patients was 50.4 years and average duration of neurological claudication was nine months. Diagnosis of the degenerative lumbar canal stenosis was made by clinical examination and confirmed by radiological and MRI measurement of cross section area of neural canal. Interlaminar fenestration was done at four levels and three levels in six patients each while it was done at two levels in remaining three patients. None of the patients reported immediate or late onset of backache or restriction of spinal movements, indicating spinal in stability. None of the patients had neurological claudication in the postoperative period. Conclusion: Retrospective analysis suggests that multiple interlaminar fenestrations done in moderate spinal stenosis provides adequate neurological decompression besides maintaining spinal stability.
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Reconstructive options in pelvic tumours
N Mayilvahanan, JC Bose
July-September 2005, 39(3):151-157
Background: Pelvic tumours present a complex problem. It is difficult to choose between limb salvage and hemipelvectomy. Method: Forty three patients of tumours of pelvis underwent limb salvage resection with reconstruction in 32 patients. The majority were chondrosarcomas (20 cases) followed by Ewing sarcoma. Stage II B was the most common stage in malignant lesions and all the seven benign lesions were aggressive (B3). Surgical margins achieved were wide in 31 and marginal in 12 cases. Ilium was involved in 51% of cases and periacetabular involvement was seen in 12 patients. The resections done were mostly of types I & II of Enneking's classification of pelvic resection. Arthrodesis was attempted in 24 patients. Customized Saddle prosthesis was used in seven patients and no reconstruction in 12 patients. Adjuvant chemotherapy was given to all high-grade malignant tumours, combined with radiotherapy in 7 patients. Results: With a mean follow up of 48.5 months and one patient lost to follow up, the recurrence rate among the evaluated cases was 16.6%. Oncologically, 30 patients were continuously disease free with 7 local recurrences and 4 deaths due to disseminated disease and 2 patients died of other causes. During the initial years, satisfactory functional results were achieved with prosthetic replacement. Long-term functional result of 36 patients who were alive at the time of latest follow up was satisfactory in 75% who underwent arthrodesis and in those where no reconstruction was used. We also describe a method of new classification of pelvic resections that clarifies certain shortcomings of the previous systems of classification. Conclusion: Selection of a procedure depends largely on the patient factors, the tumour grade, the resultant defect and the tissue factors. Resection with proper margins gives better functional and oncological results
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