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   2013| September-October  | Volume 47 | Issue 5  
    Online since September 17, 2013

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Head size and dislocation rate in primary total hip arthroplasty
Somesh P Singh, Haresh P Bhalodiya
September-October 2013, 47(5):443-448
DOI:10.4103/0019-5413.118198  PMID:24133302
Background: Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. Materials and Methods: 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. Results: One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Conclusion: Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA.
  7,239 311 4
Fungal prosthetic joint infection after total knee arthroplasty
Kankanala J Reddy, Jay D Shah, Rohit V Kale, T Jayakrishna Reddy
September-October 2013, 47(5):526-529
DOI:10.4103/0019-5413.118213  PMID:24133317
Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Total duration of fluconazole therapy was 30 weeks. At 2 year followup, she has pain less range of motion of 10΀-90΀ and there is no evidence of recurrence of infection.
  5,108 115 4
The operative treatment of complex pilon fractures: A strategy of soft tissue control
Xianfeng He, Yong Hu, Penghan Ye, Lei Huang, Feng Zhang, Yongping Ruan
September-October 2013, 47(5):487-492
DOI:10.4103/0019-5413.118205  PMID:24133309
Background: Pilon fractures are challenging to manage because of the complexity of the injury pattern and the risk of significant complications. The soft tissue injury and handling of the soft tissue envelope are crucial in pilon fracture outcomes. The purpose of this study was to evaluate the early rate of complications using the strategy of "soft tissue control" for operative treatment of complex pilon fractures. Materials and Methods: 36 complex pilon fractures were treated with the "soft tissue control" strategy. Patients followed the standard staged protocol, anterolateral approach to the distal tibia, the "no-touch" technique and incisional negative pressure wound therapy for pilon fractures. Patients were examined clinically at 2-3 weeks and then 8 weeks for complications associated with the surgical technique. Results: All fractures were AO/OTA (Orthopaedic Trauma Association) type C fractures (61% C3, 22% C2 and 16% C1). Only one patient developed superficial infection and resolved with antibiotics and local wound care. None developed deep infection. Conclusions: The strategy of soft tissue control for treatment of pilon fractures resulted in relatively low incidence of early wound complications in patients with complex pilon fractures.
  4,814 397 5
Outcome of unicompartmental knee arthroplasty in octogenarians with tricompartmental osteoarthritis: A longer followup of previously published report
Sanjiv KS Marya, Rajiv Thukral
September-October 2013, 47(5):459-468
DOI:10.4103/0019-5413.118201  PMID:24133305
Background: Unicompartmental knee arthroplasty (UKA) has specific indications, producing excellent results. It, however, has a limited lifespan and needs eventual conversion to total knee arthroplasty (TKA). It is, therefore, a temporizing procedure in select active young patients with advanced unicompartmental osteoarthritis (UCOA). Being a less morbid procedure it is suggested as an alternative in the very elderly patients with tricompartmental osteoarthritis (TCOA). We performed UKA in a series of 45 octogenarians with TCOA predominant medial compartment osteoarthritis (MCOA) and analyzed the results. Materials and Methods: Forty five octogenarian patients with TCOA predominant MCOA underwent UKA (19 bilateral) from January 2002 to January 2012. All had similar preoperative work-up, surgical approach, procedure, implants and postoperative protocol. Clinicoradiological assessment was done at 3-monthly intervals for the first year, then yearly till the last followup (average 72 months, range 8-128 months). Results were evaluated using the knee society scores (KSS), satisfaction index [using the visual analogue scale (VAS)] and orthogonal radiographs (for loosening, subsidence, lysis or implant wear). Resurgery for any cause was considered failure. Results: Four patients (six knees) died due to medical conditions, two patients (three knees) were lost to followup, and these were excluded from the final analysis. Barring two failures, all the remaining patients were pain-free and performing well at the final followup. Indications for resurgery were: medial femoral condyle fracture needing fixation subsequent conversion to TKA at 2 years (n=1) and progression of arthritis and pain leading to revision TKA at 6 years (n=1). Conclusion: UKA has shown successful outcomes with regards to pain relief and function with 96.4% implant survival and 94.9% good or excellent outcomes. Due to lower demands, early rehabilitation, less morbidity, and relative short life expectancy, UKA can successfully manage TCOA in the octogenarians.
  4,307 129 2
False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures
Kwang-Soon Song, Sin-Gi Kim, Young-Jae Lim, Jong-Hyuk Jeon, Kyunng-Keun Min
September-October 2013, 47(5):482-486
DOI:10.4103/0019-5413.118204  PMID:24133308
Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER) stage IV (Lauge-Hansen) ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59%) patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS) and tibiofibular overlapping (TFO) on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.
  4,251 145 -
Revision hip arthroplasty as a treatment of Vancouver B3 periprosthetic femoral fractures without bone grafting
Jia-Qi Wang, You-Shui Gao, Jiong Mei, Zhi-Tao Rao, Shu-Qing Wang
September-October 2013, 47(5):449-453
DOI:10.4103/0019-5413.118199  PMID:24133303
Background: It is conventionally considered that bone grafting is mandatory for Vancouver B3 periprosthetic femoral fractures (PFF) although few clinical studies have challenged the concept previously. The aim of the current study was to investigate the radiographic and functional results of Vancouver B3 PFF treated by revision total hip or hemiarthroplasty (HA) in combination with appropriate internal fixation without bone grafting. Materials and Methods: 12 patients with Vancouver B3 PFF were treated by revision THA/HA without bone grafting between March 2004 and May 2008. There were nine females and three males, with an average age of 76 years. PFFs were following primary THA/HA in nine patients and following revision THA/HA in three. Postoperative followup was 5.5 years on average (range, 3.5-6.5 years). At the final followup, radiographic results were evaluated with Beals and Tower's criteria and functional outcomes were evaluated using the Merle d'Aubigné scoring system. Results: All fractures healed within an average of 20 weeks (range, 12-28 weeks). There was no significant deformity and shortening of the affected limb and the implant was stable. The average Merle d'Aubignι score was 15.8. Walking ability was regained in 10 patients without additional assistance, while 2 patients had to use crutches. There were 2 patients with numbness of lateral thigh, possibly due to injury to the lateral femoral cutaneous nerve. There were no implant failures, dislocation and refractures. Conclusions: Revision THA/HA in combination with appropriate internal fixation without bone grafting is a good option for treatment of Vancouver B3 periprosthetic femoral fractures in the elderly.
  4,031 132 -
ISHKS joint registry: A preliminary report
Jawahir A Pachore, Shrinand V Vaidya, Chandrasekhar J Thakkar, Haresh Kumar P Bhalodia, Hemant M Wakankar
September-October 2013, 47(5):505-509
DOI:10.4103/0019-5413.118208  PMID:24133312
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are the most widely practiced surgical options for arthritis all over the world and its application is rising in India. Indian Society of Hip and Knee Surgeons (ISHKS) has established a joints registry and has been collecting data for last 6 years. Materials & Methods: All members of ISHKS are encouraged to actively participate in the registry. A simple two page knee and hip form can be downloaded from the website The information collected includes patient demographics, indication for surgery, implant details and in case of revision arthroplasty: the details of implants removed and the cause of failure of primary arthroplasty. These forms are mailed to the central registry office and the data is fed in computerized registry. Data collection started in October 2006. Results: Joint registry is a very important initiative of ISHKS and till date, have data of 34,478 TKAs and 3604 THAs, contributed by 42 surgeons across India. Some important observations have emerged. Data of 34,478 TKAs was assessed: These included 8612 males (25%) and 25,866 females (75%). Average age was 64.4 years (Osteoarthritis range: 45 to 88 years; Rheumatoid arthritis range: 22 to 74 years). Average body mass index was 29.1 (Range: 18.1 to 42.9). The indication for TKA was osteoarthritis in 33,444 (97%) and rheumatoid arthritis in 759 (2.2%). Total of 3604 THA procedures were recorded. These included 2162 (60%) male patients and 1442 (40%) female patients. Average age was 52 years (Range 17 to 85 years) and average BMI was 25.8 (Range: 17.3 to 38.5). The indications for THA was AVN in 49%. Conclusion: The registry will become more meaningful in years to come. Active participation of all arthroplasty surgeons across India is vital for the success of the joints registry.
  3,618 294 7
Outcome of distraction interference arthrodesis of the sacroiliac joint for sacroiliac arthritis
Stefan Endres, Esther Ludwig
September-October 2013, 47(5):437-442
DOI:10.4103/0019-5413.118197  PMID:24133301
Background: After lumbar or lumbosacral fusion for various spine disorders, adjacent segment disease has been reported. Most of the studies have focused on proximal segment disease. The author has reported sacroiliac joint degeneration in these patients. Based on our own experiences with an increasing number of patients with sacroiliac joint (SIJ) arthralgia after multi.level lumbar or lumbosacral fusion procedures, we evaluated a surgical procedure called distraction arthrodesis of the SIJ for patients with refractory severe pain of the SIJ. Materials and Methods: Nineteen (19) consecutive patients were recruited and evaluated prospectively after undergoing distraction arthrodesis of the SIJ. The inclusion criteria for the surgical procedure were degeneration of the SIJ and failed conservative treatment. Magnetic resonance imaging (MRI) scans and CT scans were performed in all cases. The clinical outcome was assessed using the Visual Analog Scale and the Oswestry Disability Index (ODI). CT scans were performed postoperatively and again at the final followup to evaluate assess fusion. The data was analyzed using the SPSS software (version 10.0; SPSS, Chicago, IL) and statistical analysis was performed. The P values were based on the Student t-test. Results: The mean followup was 13.2 months. All patients had an instrumented lumbar or lumbosacral fusion. The overall fusion rate of SIJ was 78.9% (15/19 joints). All patients demonstrated significant improvement in VAS and ODI scores compared to preoperative values. The mean VAS score was 8.5 before surgery and was 6 at final followup, demonstrating 30% improvement. The mean ODI scores were 64.1 before surgery and 56.97 at the final followup, demonstrating 12% improvement. Conclusions: Refractory sacroiliac pain as a result of multi-level fusion surgery can be successfully treated with minimally invasive arthrodesis. It offers a safe and effective treatment for severe SIJ pain. Careful patient selection is important.
  3,275 161 4
Outcomes of total knee arthroplasty following high tibial osteotomy
Himanshu Gupta, Vivek Dahiya, Attique Vasdev, Ashok Rajgopal
September-October 2013, 47(5):469-473
DOI:10.4103/0019-5413.118202  PMID:24133306
Background: Total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is a technically demanding procedure with varying results. The purpose of our study was to analyze the clinicoradiological results of TKA following HTO and to identify the factors that may influence the final outcome. Materials and Methods: 55 patients (58 knees) who had undergone a previous HTO were treated with a TKA from 1991 to 2009. There were 34 female and 21 male patients. The average age was 61.9 years (range 52-82 years) and the average weight was 79.5 kg (range 54-106 kg), with an average body mass index of 29.6 (range 21.8-34.6) at the time of TKA. The knee society scores (KSSs) and knee society functional scores were evaluated for every patient pre and postoperatively and the results evaluated. Results: The mean period of followup was 11.2 years (range 3-18 years) and the patients were followed up every year. The average KSS score at final followup improved from 38.5 (range 0-80 points) preoperatively to 88.5 postoperatively (range 35-95 points) (P < 0.05). The mean femorotibial angle corrected from 6.8 degrees (range 5-12°) varus preoperatively to a valgus of 4.4 (2-8°) degrees postoperatively. The average joint line height improved to an average of 9.6 mm (range 4.4-22 mm) (P < 0.01) at the last followup. The average Insall Salvatti Ratio also improved (average 1.11 preoperative - 1.21 average postoperative) (P < 0.05). The average range of motion improved to 108° (range 85°-125°) from 76° preoperative (range 55°-100°) (P < 0.01). Conclusion: Although TKA postHTO is a demanding surgery however, with newer component designs, results are comparable to primary TKA. Technical difficulties in exposure can sometimes lead to component malpositioning, which can affect the final outcome. Inadequate soft tissue balancing and limb malalignment should always be kept in mind. Regular followup to look for evidences of loosening is advised in such patients].
  3,174 159 1
Results of titanium locking plate and stainless steel cerclage wire combination in femoral fractures
Bilal Farouk El-Zayat, Steffen Ruchholtz, Turgay Efe, Jürgen Paletta, Dimitri Kreslo, Ralph Zettl
September-October 2013, 47(5):454-458
DOI:10.4103/0019-5413.118200  PMID:24133304
Background: Some in vitro studies warn combining different metals in orthopedic surgery. The aim of this study is to determine the impact of combining titanium and stainless steel on bone healing and the clinical course of patients undergoing internal fixation of femoral fractures. Materials and Methods: 69 patients with femoral fractures had polyaxial locking plate osteosynthesis. The locking plate was made of a titanium alloy. Two different cohorts were defined: (a) sole plating and (b) additional stainless steel cerclage wiring. Postoperative radiographs and clinical followup were performed at 6 weeks, 3 months and 12 months. Results: Cohorts A and B had 36 and 33 patients, respectively. Patient demographics and comorbidities were similar in both groups. In two cases in cohort A, surgical revision was necessary. No complication could be attributed to the combination of titanium and stainless steel. Conclusion: The combination of stainless steel cerclage wires and titanium plates does not compromise fracture healing or the postoperative clinical course.
  2,968 155 1
Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits
Ramesh Kumar Sen, Sujit Kumar Tripathy, Shakthivel RR Manoharan, Somya Chakrabarty
September-October 2013, 47(5):510-514
DOI:10.4103/0019-5413.118209  PMID:24133313
Neglected or late presenting femoral neck stress fractures are often associated with varus deformity, with potential risks of nonunion and osteonecrosis. We proposed a surgical technique whereby a wedge osteotomy was performed at the basal part of the neck, on the tensile surface, keeping the inferomedial femoral neck as a hinge. The femoral shaft was abducted to close the osteotomy site and it was fixed with three cannulated cancellous screws. Three military recruits who presented with neglected femoral neck stress fracture with varus deformity were operated on with the proposed modified femoral neck valgus osteotomy. All the fractures united without any complications and the patients resumed their professional activity.
  2,193 144 -
Bone and joint day - India
Anil K Jain, Sudhir Kumar
September-October 2013, 47(5):435-436
DOI:10.4103/0019-5413.118196  PMID:24133300
  2,103 166 1
Osseous involvement in rhinosporidiosis
Atin Kumar Kundu, Satyendra Phuljhele, Mantu Jain, Raman Kumar Srivastava
September-October 2013, 47(5):523-525
DOI:10.4103/0019-5413.118212  PMID:24133316
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually affects the mucocutaneous tissue of the nose. Bone involvement is rare. We report a case of Rhinosporidiosis of the nasopharynx which later involved the right little finger where ray amputation was performed.
  2,098 123 -
Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial
Alexander Di Francesco, Stefano Flamini, Filippo Fiori, Franco Mastri
September-October 2013, 47(5):474-481
DOI:10.4103/0019-5413.118203  PMID:24133307
Background: Total knee arthroplasty (TKA) can result in major postoperative blood loss which can impact on the recovery and rehabilitation of patients. It also requires expensive transfusions. The purpose of the study was to investigate whether a hemostatic matrix, composed of cross-linked gelatin and a thrombin solution, would reduce blood loss in patients following TKA. Materials and Methods: This was a prospective, randomized, controlled study (Trial registration: Hospital S. Salvatore L'Aquila ADJ00843) conducted in 93 patients. Criteria for participation were unilateral TKA for osteoarthritis, and a preoperative hemoglobin level >13 g/dL. The outcomes measured were postoperative hemoglobin and hematocrit levels measured at 24h, 72 h, and 7 days. The mean total postoperative blood loss was calculated from drainage volume, patient blood volume, hematocrit, and red blood cell volume. In addition, the drain output within 24 h following surgery and any transfusion requirements were determined. Results: Hemostatic matrix-treated patients (n0 = 51) showed significant reductions in calculated postoperative blood loss of 32.3% and 28.7% versus control in men and women, respectively ( P < 0.01). Postoperative blood loss after 24 h in drain was significantly less with the hemostatic matrix versus control, as were decreases in hemoglobin levels 7 days post-surgery (each P < 0.01). Three patients in the control group required blood transfusion, whereas no blood transfusions were necessary in the hemostatic matrix group. Conclusion: The use of a hemostatic matrix provides a safe and effective means to reduce blood loss and blood transfusion requirements in TKA.
  1,864 78 5
Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty
Raju Vaishya, Mrinal Sharma, Rajeev Raj Chaudhary
September-October 2013, 47(5):519-522
DOI:10.4103/0019-5413.118211  PMID:24133315
Management of recurrent dislocation of total hip arthroplasty is often a challenging and daunting task. Re-revision of such a total hip prosthesis may not be easy as the removal of a well-fixed, fully coated stem is extremely difficult. We managed to salvage instability in three revision hip cases in which the fully coated stem had subsided by using a bioball universal neck adapter without changing the femoral stem or acetabular cup.
  1,810 75 1
Effects of montelukast sodium on tendon healing: An experimental study
Atilla Polat, Mehmet Kerem Canbora, Dilek Akakin, Faruk Aykanat
September-October 2013, 47(5):500-504
DOI:10.4103/0019-5413.118207  PMID:24133311
Introduction: Montelukast sodium (MS) a selective leukotriene antagonist of the cysteinyl leukotriene receptor, has been used in the treatment of asthma and allergic rhinitis. In this study, we evaluated the effect of MS on the early inflammatory phase (histological) of nonsynovial tendon healing. Materials and Methods: Rats were divided randomly into two groups (n = 6 each). MS (Singulair) was administered to one group at 10 mg/kg/day [250 g/day intraperitoneally (i.p.)]. The control group was administered 250 g/day of 0.9% saline i.p. This nonsynovial tendon was longitudinally divided at the midportion, cut transversely and then sutured. In both groups, the rats were sacrificed by decapitation 10 days later. Results: Decreased inflammatory cell infiltration and more properly oriented collagen fibres were observed in the MS group's histopathological specimens as compared to the control group's (P < 0.05). Additionally, vascularity was decreased in the MS group. Conclusion: MS decreased tendon healing, apparently by inhibiting the early inflammatory phase of nonsynovial tendon healing.
  1,695 110 1
Percutaneous osteoplasty in treatment of bone lymphangiomatosis
Damián Mifsut, Pablo Renovell, Francisco Gomar, Marcos Saravia
September-October 2013, 47(5):515-518
DOI:10.4103/0019-5413.118210  PMID:24133314
Primary bone lymphangiomatosis is a disease of unknown etiology that can cause lytic lesions in long bones, the pelvis, the spinal column and the cranium. We are presenting the case of a woman with localized bone lymphangiomatosis in the left knee. The authors believe this is the first case in which percutaneous osteoplasty was used in long bones for the treatment of bone lesions resulting from this disease showing good clinical results.
  1,682 62 1
Effect of partial and complete posterior cruciate ligament transection on medial meniscus: A biomechanical evaluation in a cadaveric model
Shu-guang Gao, Can Zhang, Rui-bo Zhao, Zhan Liao, Yu-sheng Li, Fang Yu, Chao Zeng, Wei Luo, Kang-hua Li, Guang-hua Lei
September-October 2013, 47(5):493-499
DOI:10.4103/0019-5413.118206  PMID:24133310
Background: The relationship between medial meniscus tear and posterior cruciate ligament (PCL) injury has not been exactly explained. We studied to investigate the biomechanical effect of partial and complete PCL transection on different parts of medial meniscus at different flexion angles under static loading conditions. Materials and Methods: Twelve fresh human cadaveric knee specimens were divided into four groups: PCL intact (PCL-I), anterolateral bundle transection (ALB-T), posteromedial bundle transection (PMB-T) and PCL complete transection (PCL-T) group. Strain on the anterior horn, body part and posterior horn of medial meniscus were measured under different axial compressive tibial loads (200-800 N) at 0°, 30°, 60° and 90° knee flexion in each groups respectively. Results: Compared with the PCL-I group, the PCL-T group had a higher strain on whole medial meniscus at 30°, 60° and 90° flexion in all loading conditions and at 0° flexion with 400, 600 and 800 N loads. In ALB-T group, strain on whole meniscus increased at 30°, 60° and 90° flexion under all loading conditions and at 0° flexion with 800 N only. PMB-T exihibited higher strain at 0° flexion with 400 N, 600 N and 800 N, while at 30° and 60° flexion with 800 N and at 90° flexion under all loading conditions. Conclusions: Partial PCL transection triggers strain concentration on medial meniscus and the effect is more pronounced with higher loading conditions at higher flexion angles.
  1,571 87 1
Intrathoracic displacement of the humeral head in a trauma patient
Selami Cakmak, Kenan Keklikci, Ali Kemal Sivrioglu, Osman Rodop
September-October 2013, 47(5):530-531
DOI:10.4103/0019-5413.118215  PMID:24133318
  1,438 62 1
Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients
Atin Jaiswal, Yashwant S Tanwar, Masood Habib
September-October 2013, 47(5):532-533
DOI:10.4103/0019-5413.118217  PMID:24133320
  1,208 106 1
Outcome of locking compression plates in humeral shaft nonunions
Sandeep R Biraris, Dhiraj V Sonawane, Hitendra G Patil, Pradip S Nemade
September-October 2013, 47(5):534-534
DOI:10.4103/0019-5413.118219  PMID:24133322
  1,173 107 1
Author's reply
Jun-Song Wu, Jing-Yu Du, Xiang-Jin Lin
September-October 2013, 47(5):531-532
  649 42 -
Author's reply
Bhava RJ Satish, Atmakuri V Ranganadham, Karruppasamy Ramalingam, Sujit Kumar Tripathy
September-October 2013, 47(5):533-534
  639 47 -
Author's reply
MN Kumar, V Pratap Ravindranath, MR Ravishankar
September-October 2013, 47(5):534-535
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