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   2011| November-December  | Volume 45 | Issue 6  
    Online since November 4, 2011

 
 
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ORIGINAL ARTICLES
Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips
Sanganagouda S Patil, Saurabh Rawall, Premik Nagad, Bhavin Shial, Uday Pawar, Abhay M Nene
November-December 2011, 45(6):500-503
DOI:10.4103/0019-5413.87117  PMID:22144741
Background: Interbody fusion surgery has been considered by many to be a treatment of choice for instability in lumbar degenerative disc disease. A posterior lumbar interbody fusion (PLIF) has the advantages of spinal canal decompression, anterior column reconstruction, and reduction of the sagittal slips from a single posterior approach. The PLIF using double cage was a standard practice till many studies reported comparable results and lesser complications with single cage. Iliac crest was considered as an appropriate source of bone graft until comparable spinal fusion rates using local bone graft and cage emerged. Till date, there has been no report of corticocancellous laminectomy bone chips alone being used for spinal fusion. In this paper, we present radiologic results of single level instrumented PLIF, where in only corticocancellous laminectomy bone chips were used as a fusion device. Materials and Methods: It is a retrospective cohort study of 35 consecutive patients, who underwent single level instrumented PLIF surgery, wherein only locally obtained bone chips was used for spinal fusion. The average follow-up was 26 months. The indications for the surgery were as follows: 19 patients had disc herniations, with back pain of instability type, normal disc height on radiology. Ten patients had grade 1 spondylolisthesis, with significant back pain and translational instability on radiography. Three patients were redo spine surgeries, and three patients had healed spondylodiscitis with significant back pain and instability. All patients were regularly followed up and decision of spinal fusion or no fusion was taken at 2 years using modified criteria of Lee. Results: Of total 35 patients, there were 24 males and 11 females, with a mean age of 41 years. There were 16 patients with definitive fusion, 15 patients with probable fusion, 04 patients with possible pseudoarthrosis, and no patient had definitive pseudoarthrosis. The mean time for fusion to occur was 18 months. The average loss of disc height, over 2 year follow up, was only 3 mm in 8 patients. Three patients had a localized kyphosis of more than 3° at the fusion level. The average blood loss was 356 ml and average operating time was 150 min. Conclusion: Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate.
  10,810 210 5
Radiological assessment of cervical lateral mass screw angulations in Asian patients
Mariapan Sureisen, Lim Beng Saw, Chris Yin Wei Chan, Deepak Ajit Singh, Mun Keong Kwan
November-December 2011, 45(6):504-507
DOI:10.4103/0019-5413.87118  PMID:22144742
Background: Various lateral mass screw fixation methods have been described in the literature with various levels of safety in relation to the anterior neurovascular structures. This study was designed to radiologically determine the minimum lateral angulations of the screw to avoid penetration of the vertebral artery canalusing three of the most common techniques: Roy-Camille, An, and Magerl. Materials and Methods: Sixty normal cervical CT scans were reviewed. A minimum lateral angulation of a 3.5 mm lateral mass screw which was required to avoid penetration of the vertebral artery canal at each level of vertebra were measured. Results: The mean lateral angulations of the lateral mass screws (with 95% confidence interval) to avoid vertebral artery canal penetration, in relation to the starting point at the midpoint (Roy-Camille), 1 mm medial (An), and 2 mm medial (Magerl) to the midpoint of lateral mass were 6.8° (range, 6.3-7.4°), 10.3° (range, 9.8-10.8°), and 14.1° (range, 13.6-14.6°) at C3 vertebrae; 6.8° (range, 6.2-7.5°), 10.7° (range, 10.0-11.5°), and 14.1° (range, 13.4-14.8°) at C4 vertebrae; 6.6° (range, 6.0-7.2°), 10.1° (range, 9.3-10.8°), and 13.5° (range, 12.8-14.3°) at C5 vertebrae and 7.6° (range, 6.9-8.3°), 10.9° (range, 10.3-11.6°), and 14.3° (range, 13.7-15.0°) at C6 vertebrae. The recommended lateral angulations for Roy-Camille, Magerl, and An are 10°, 25°,and 30°, respectively. Statistically, there is a higher risk of vertebral foramen violation with the Roy-Camille technique at C3, C4 and C6 levels, P < 0.05. Conclusions: Magerl and An techniques have a wide margin of safety. Caution should be practised with Roy-Camille's technique at C3, C4, and C6 levels to avoid vertebral vessels injury in Asian population.
  9,523 139 1
CASE REPORTS
Complex multilevel lumbar spine fractures with transverse sacral fracture
Kshitij Chaudhary, Prabodhan Potdar, Mihir Bapat
November-December 2011, 45(6):576-580
DOI:10.4103/0019-5413.87143  PMID:22144756
We report an unusual and complex case of spinal trauma in a 17-year-old boy who presented with a transverse sacral fracture associated with multiple-level lumbar fractures, paraparesis, and bladder involvement. A two-stage surgery was performed. The lumbar spine fractures were treated with posterior instrumented correction of displacements, followed by anterior instrumentation and fusion. The sacral fracture was left untreated. At 5-year followup, the patient had complete neurological recovery except for the right L5 root function. The long-segment lumbar fusion and the untreated displaced sacral fracture contributed to spinal imbalance, due to which the patient is now able to stand only in a crouched posture. Determining the optimal treatment for the case is presented due to the relative rarity of transverse sacral fracture and paucity of evidence-based treatment approaches. In patients with associated lumbar spine fractures that require extension of instrumentation to the upper lumbar spine, it is critical to restore sacropelvic alignment to achieve spinal balance. Adequate reduction of sacropelvic anatomy can be achieved with iliac screw fixation.
  7,859 118 -
ORIGINAL ARTICLES
Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty
Parag Garg, Rajeev Ranjan, Utpal Bandyopadhyay, Shiv Chouksey, SR Mitra, Samar K Gupta
November-December 2011, 45(6):535-540
DOI:10.4103/0019-5413.87126  PMID:22144747
Background : Standard treatment of chronic infected total knee arthroplasty (TKA) is a two-stage revision, the first step being placement of an antibiotic-impregnated cement spacer. Here we describe the results of a new technique (modification of the Goldstien's technique) for intraoperative manufacture of a customized articulating spacer at minimal cost and with relatively good conformity and longevity. Materials and Methods : Thirty-six infected knees underwent this procedure from June 2002 to May 2007. The technique consists of using the freshened femur and tibia interface as molds wrapped in a tin foil for manufacturing the two components of the spacer with antibiotic-impregnated methyl methycrylate cement. We used the spacer and the femoral component of the trial set of a TKA system to mold them to perfect articulation. We also reinforced the spacer with a K-wire scaffold to prevent fracture of the cement mantle in the last 21 cases. Results : All 36 knees showed excellent results in terms of infection control, mobility, and stability. There was significant improvement in the WOMAC and Knee Society Scores (20 and 39 points respectively). There were two fractures of the spacers in the initial 15 cases that did not have K-wire scaffolding but none in the last 21 that had reinforcement. Conclusion : This technique provides a more conforming spacer, with good range of motion and stability. The reinforcement helps in preventing the fracture of the cement mantle and is cost effective.
  7,113 250 10
Primary nonunion of intertrochanteric fractures of femur: An analysis of results of valgization and bone grafting
IK Dhammi, AK Jain, AP Singh, Rehan-Ul-Haq , P Mishra, S Jain
November-December 2011, 45(6):514-519
DOI:10.4103/0019-5413.87122  PMID:22144744
Background: Nonunion of intertrochanteric fractures is uncommon because there is excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). There is only one published series that exclusively describes seven primary nonunions of intertrochanteric fractures. The aim of the present study was to analyze the results of internal fixation, valgization with 135΀ dynamic hip screw (DHS), and bone grafting in patients with primary nonunion of intertrochanteric fractures. Materials and Methods: Eighteen patients with primary intertrochanteric nonunion were included in the study; 16 were male and 2 were female. The age range was 30-70 years (mean: 46.9 years). The mean duration since index injury was 8.5 months (range: 4-18 months). As per the AO classification, the fractures were 31A 1.1 (n=1), 1.2 (n=1), 2.2 (n=3), 2.3 (n=9), and 3.3 (n=4). Three patients had hypermobile nonunion and 15 had stiff nonunion. The surgical principle was excision of pseudarthrosis, if present (n=3); freshening of the bone ends; stable fixation with 135΀ DHS, with good proximal purchase; bone grafting; and valgization. Results: Union was achieved in all patients at an average of 5.62 months (range: 4-7 months). The Harris hip score improved from 38 points preoperatively to 86 postoperatively at healing. The average limb shortening improved by 2 cm (range: 1.5 cm-3 cm). There was no infection and pain at the hip at final follow-up in any of the cases. All patients were subjectively satisfied with the outcome. All were capable of full weight bearing on their affected limb. Conclusion: Union in primary nonunion of intertrochanteric fractures in physiologically young patients with a well-preserved femoral head and good bone stock can be achieved with internal fixation, valgization, and grafting procedures.
  5,466 334 4
Minimally invasive plate osteosynthesis for humerus diaphyseal fractures
M Shantharam Shetty, M Ajith Kumar, KT Sujay, Abhishek R Kini, Kiran G Kanthi
November-December 2011, 45(6):520-526
DOI:10.4103/0019-5413.87123  PMID:22144745
Background: Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes) and mean radiation exposure was 160.3 seconds (range: 100-220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.
  5,190 428 9
Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy
Akshay Divecha, Atul Bhaskar
November-December 2011, 45(6):548-552
DOI:10.4103/0019-5413.87129  PMID:22144749
Background: Spontaneous hip lateralization complicates the management of non-ambulatory children with cerebral palsy (CP). It can be diagnosed early using radiographs, but it involves standardization of positioning and exposure to radiation. Hence, the aim of this study was to assess the utility of Combined hip abduction angle (CHAA) in the clinical setting to identify those children with CP who were at greater risk to develop spontaneous progressive hip lateralization. Materials and Methods: One hundred and three children (206 hips) with CP formed our study population. There were 48 boys and 55 girls aged 2-11 years (mean 5.03 years). 61 children were Gross Motor Function Classification System (GMFCS) level 5, while 42 were GMFCS level 4. Clinical measurements of CHAA were statistically correlated with radiographic measurements of Reimer's migration percentage (MP) for bivariate associations using c2 and t tests. Results: CHAA is evaluated against MP which is considered as a reliable measure of hip subluxation. Thus, for CHAA, sensitivity was 74.07% and specificity was 67.35%. False-positive rate was 32.65% and false-negative rate was 25.93%. Conclusions: Our study shows that correlation exists between CHAA and MP, which has been proved to be useful for hip screening in CP children at risk of hip dislocation. CHAA is an easy, rapid, cost-effective clinical test which can be performed by paraclinical health practitioners (physiotherapists) and orthopedic surgeons.
  4,710 110 4
CASE REPORTS
Hydroxyapatite crystal deposition causing rapidly destructive arthropathy of the hip joint
Jae-Hyuk Yang, Kwang-Jun Oh, Dilbans S Pandher
November-December 2011, 45(6):569-572
DOI:10.4103/0019-5413.87139  PMID:22144754
Destructive arthropathy of the hip joint can be attributed to various etiologies like rheumatoid arthritis, aseptic necrosis of the femur head, Charcot's joint, subacute septic arthritis, and tubercular arthritis. A disease that results in much rapid destruction of the hip joint and is not associated with clinical syndrome of above mentioned disease has been reported way back in 1970. However, no evidence-based study has been published to support hydroxyapatite (HA) crystals as a probable cause of rapidly destructive arthropathy of the hip joint. We report a case with microscopic and biochemical confirmation of HA crystal deposition causing destructive arthropathy of the hip joint.
  4,553 69 5
ORIGINAL ARTICLES
Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods
Alia Ayatollahi Moussavi, Alireza Saied, Ali Karbalaeikhani
November-December 2011, 45(6):558-562
DOI:10.4103/0019-5413.87133  PMID:22144751
Background: Tendon transfer for radial nerve paralysis has a 100 years history and any set of tendons that can be considered to be useful has been utilized for the purpose. The pronator tress is used for restoration of wrist dorsiflexion, while the flexor carpi radialis, flexor carpiulnaris, and flexor digitorum superficialis are variably used in each for fingers and thumb movements. The present study was a retrospective analysis, designed to compare three methods of tendon transfer for radial nerve palsy. Materials and Methods: 41 patients with irreversible radial nerve paralysis, who had underwent three different types of tendon transfers (using different tendons for transfer) between March 2005 and September 2009, included in the study. The pronator teres was transferred for wrist extention. Flexor carpi ulnaris (group 1, n=18), flexor carpi radialis (group 2, n=10) and flexor digitorum superficialis (group 3, n=13) was used to achieve finger extention. Palmaris longus was used to achieve thumb extention and abduction. At the final examination, related ranges of motions were recorded and the patients were asked about their overall satisfaction with the operation, their ability, and time of return to their previous jobs, and in addition, disabilities of the arm, shoulder and hand (DASH) Score was measured and recorded for each patient. Results: The difference between the groups with regard to DASH score, ability, and time of return to job, satisfaction with the operation, and range of motions was not statistically significant (P>0.05). All of the patients had experienced functional improvement and overall satisfaction rate was 95%. No complication directly attributable to the operation was noted, except for proximal interphalangeal joint flexion contracture in three patents. Conclusion : The tendon transfer for irreversible radial nerve palsy is very successful and probably the success is not related to type of tendon used for transfer.
  4,200 214 9
Dynamic vs static external fixation of distal radial fractures: A randomized study
Vikas Kulshrestha, Tanmoy Roy, Laurent Audige
November-December 2011, 45(6):527-534
DOI:10.4103/0019-5413.87125  PMID:22144746
Objectives : The present randomized study is conducted to compare the functional and anatomical outcomes of dynamic multiplanar external fixation against that of static external fixation in the management of displaced unstable comminuted fractures of the distal radius. Materials and Methods : Sixty adult patients with displaced unstable comminuted fractures of the distal radius were randomly allocated either to the dynamic (n=30) or static (n=30) fixator groups. Patients in the dynamic fixator group were managed with closed reduction and application of Penning-type articulated fixator (Orthofix, Srl, Italy); the injured wrist was partially dynamized at 3 weeks. Patients in the static group were managed with monoplanar static external fixator of Joshi's external stabilizing system (JESS) type fixator. In both groups, the fixator was maintained for 6-8 weeks. The patients were followed-up over 2 years. The primary outcome measures were the functional outcome as measured using the Gartland and Werley and DASH scores and anatomical outcome as measured using the Lindstrom score. The secondary objective was to correlate anatomical and functional outcomes and to look at overall local complications. Results : Palmar tilt was better restored in the Penning fixator group (P<0.0001). There was reduced loss of ulnar tilt (P=0.05) and radial height (P=0.04) in the Penning fixator group. Gartland and Werley score was better in the Penning fixator group at each time point of the follow-up. The DASH score was similar in the two groups at 2 years (P=0.14). There was poor correlation (0.19) between functional outcome and anatomical restoration at 2 years. Conclusions : In the management of displaced unstable comminuted fracture of the distal radius, use of an articulated multiplanar external fixator, allowing partial dynamization of the injured wrist at 3 weeks, resulted in improved early functional and anatomical outcome as compared to static external fixation. However, there was no significant difference in functional outcome at 2 years.
  3,838 339 2
Bicentric bipolar hip prosthesis: A radiological study of movement at the interprosthetic joint
Anil Kumar Rai, Saurabh Singh, Vinay Kumaraswamy, GN Khare, Vinit Yadav, Rakesh Agarwal
November-December 2011, 45(6):508-513
DOI:10.4103/0019-5413.87120  PMID:22144743
Background: The bipolar hip prostheses after some time functions as a unipolar device. There is a need to change the design of bipolar hip prostheses to make it function as a bipolar device over a prolonged period of time. A bicentric bipolar hip prosthesis was used as an implant for various conditions of the hip. We evaluated the movement of this newly developed prosthesis at the interprosthetic joint radiologically at periodic intervals. Materials and Methods: Fifty two cases were operarted with the Bicentric bipolar prosthesis for indications like fracture neck of femur and various other diseases of the hip and were followed up with serial radiographs at periodic intervals to evaluate, what fraction of the total abduction at the hip was occurring at the interprosthetic joint. Results: In cases of intracapsular fracture neck of femur, the percentage of total abduction occurring at the interprosthetic joint at 3 months follow-up was 33.74% (mean value of all the patients), which fell to 25.66% at 1.5 years. In indications for bipolar hemireplacement other than fracture neck of femur, the percentage of total abduction occurring at the interprosthetic joint at 3 months follow-up was 71.71% (mean value) and at 1.5 years it was 67.52%. Conclusion: This study shows the relative preservation of inner bearing movement in the bipolar hip prosthesis with time probably due its refined design. Further refinements are needed to make the prosthesis work better in patients of intracapsular fracture neck femur.
  3,263 211 -
CASE REPORTS
Gorham's disease of femur
Asif Nazir Baba, Yasmeen J Bhat, Simon D Paljor, Abid Nazir, Nazir A Khan
November-December 2011, 45(6):565-568
DOI:10.4103/0019-5413.87136  PMID:22144753
Gorham's disease is a rare condition of bones characterized by spontaneous massive and progressive osteolysis. Less than 200 cases have been reported so far. Femur is an uncommon site of Gorham disease. We report a young female, presenting as pathological fracture of the femur, wherein rapid osteolysis of femur occurred. The clinical, pathological, and radiological picture suggested a diagnosis of Gorham's disease. The patient was subjected to radiotherapy (40 Gys) and put on bisphosphonates. At a follow-up of 2 years, the disease process had stopped and partial recalcification of the bone had occurred.
  3,180 196 4
ORIGINAL ARTICLES
Salvage of infected total knee arthroplasty with Ilizarov external fixator
Venkata Gurava Reddy, Ramireddy Vinodh Kumar, Aditya Krishna Mootha, Chiranjeevi Thayi, Pareen Kantesaria, Divakar Reddy
November-December 2011, 45(6):541-547
DOI:10.4103/0019-5413.87127  PMID:22144748
Background: Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA) with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA. Materials and Methods: 16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator. Results: Union was achieved in 15 patients (93.75%). The mean duration for union (frame application time) in these patients was 28.33 weeks (range 22 to 36 weeks). Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034). Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls) was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035). Conclusion: Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.
  3,133 156 2
Comparison of one-stage anteroposterior and posterior-alone hemivertebrae resection combined with posterior correction for hemivertebrae deformity
Lei Wang, Yuemin Song, Fuxing Pei, Limin Liu, Hao Liu, Qingquan Kong, Tao Li, Jiancheng Zeng
November-December 2011, 45(6):492-499
DOI:10.4103/0019-5413.87115  PMID:22144739
Background: The surgical technique of hemivertebrae excision varies from anteroposterior procedures to posterior-alone resections according to the experience and preference of surgeons. Both the approaches are reliable and give relatively good results. This study aims to evaluate and compare the clinical and radiological results of these two approaches for hemivertebrae resection. Materials and Methods: Sixty patients were retrospectively enrolled between 2006 and 2009. The subjects included 32 women and 28 men, with a mean age of 12.9 years (range: 5-24 years). Thirty patients who underwent one-stage anteroposterior hemivertebrae resection (the AP group) were followed for 38.5 months, and the other 30 patients who underwent posterior resection (the P group) were followed for 20.6 months. Clinical and radiological assessments were performed preoperatively, 1 week postoperatively, and at the final follow-up. The operation time, blood loss, degree of correction of the main curve/segmental curve/kyphosis, the average hospital stay, and complications were reviewed and compared between the two groups. Results: The mean operation time, blood loss, and hospital stay of the AP group and the P group were 451 min vs 248.5 min, 1290 ml vs 910 ml, and 21.93 days vs 18.97 days, respectively (P<.05). The average correction rate of the main curve/segmental curve/kyphosis of the AP group and the P group was 68.5% vs 66.2%, 71.5% vs 69.6%, and 57.4% vs 56.1%, respectively (P>.05). Overall complication rate was 6.7% in the AP group vs 10% in the P group (P>.05). Conclusion: Posterior hemivertebrael resection is a promising approach for congenital scoliosis in terms of relative safety, degree of correction achieved, reduced operative time and blood loss.
  3,007 127 3
Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index
Cem Copuroglu, Mert Ozcan, Bilal Aykac, Beyti Tuncer, Kenan Saridogan
November-December 2011, 45(6):553-557
DOI:10.4103/0019-5413.87131  PMID:22144750
Background: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. Materials and Methods: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. Results: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. Conclusions: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.
  3,020 110 4
CASE REPORTS
Myositis ossificans around shoulder following military training programme
Mustafa C Kir, Mehmet T Ozdemir
November-December 2011, 45(6):573-575
DOI:10.4103/0019-5413.87142  PMID:22144755
The myositis ossificans around shoulder in military recruits are not reported yet. Three young male soldiers presented with complaints of palpable mass at the anterior aspect of shoulder; tenderness around the superior part of deltopectoral groove close to acromioclavicular joint; and restriction of shoulder motion. They also noticed ecchymosis and pain around the coracoid process and anterior shoulder region during regular firing exercises. Plain X-rays and computerized tomography showed extra-capsular, dense, irregular structure in the space between pectoralis and deltoid muscles which correlated with heterotopic bone. One patient refused surgical intervention because of the completion of his military serving period. Surgical excision was performed for the other two patients. During surgical exploration, both ossified masses were found in deltopectoral region and mostly in fibers of clavicular and acromial parts of deltoid muscle. Pathological reports confirmed the structure of masses as mature trabecular bone. Postoperatively indomethacin treatment and active shoulder exercises were started until the full range of motion was regained. Mini soft bag was used on the rifle contact area of the shoulder. No complications or recurrences were observed during the 24 months of followup period.
  2,762 80 7
EDITORIAL
New technologies for the enhancement of skeletal repair: Challenges and opportunities
Thomas A Einhorn
November-December 2011, 45(6):489-491
DOI:10.4103/0019-5413.87113  PMID:22144738
  2,433 242 2
LETTERS TO EDITOR
Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage
A Raviraja, Ashish Anand
November-December 2011, 45(6):581-581
DOI:10.4103/0019-5413.87138  PMID:22144757
  1,401 80 1
CASE REPORTS
Arterio-venous fistula following a lumbar disc surgery
Thanyani V Mulaudzi, Mbokeleng H Sikhosana
November-December 2011, 45(6):563-564
DOI:10.4103/0019-5413.86418  PMID:22144752
Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tributaries with a patent deep venous system. A digital subtraction angiogram demonstrated a large right common iliac artery (CIA) false aneurysm with an arteriovenous fistula between right common iliac vessels. He had a right CIA covered stent insertion with good results. Varicose veins were later managed with sapheno-femoral junction ligation and a below knee long saphenous vein stripping. At six month follow-up the lower limb swelling had completely recovered and duplex ultrasound did not show any recurrence of varicose veins.
  1,354 69 -
LETTERS TO EDITOR
Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: A comparison of two techniques
Dhananjaya Sabat, Sumit Arora
November-December 2011, 45(6):583-584
DOI:10.4103/0019-5413.87145  PMID:22144759
  1,112 88 1
ERRATUM
Erratum

November-December 2011, 45(6):499-499
PMID:22144740
  987 45 -
LETTERS TO EDITOR
Authors' reply
Mandeep S Dhillon, Kamal Bali, Sharad Prabhakar
November-December 2011, 45(6):582-583
PMID:22144758
  969 48 -
Authors' reply
Vivek Pandey, Kiran KV Acharya, Sharath K Rao, Sripathi P Rao
November-December 2011, 45(6):584-585
PMID:22144760
  957 59 -
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