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   2014| July-August  | Volume 48 | Issue 4  
    Online since July 8, 2014

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Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis
Manish Chug, Nicole Williams, David Benn, Stephen Brindley
July-August 2014, 48(4):394-398
DOI:10.4103/0019-5413.136270  PMID:25143644
Background: Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis. Materials and Methods: We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months. Results: There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup. Conclusion: The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.
  3,667 80 2
Platelet rich plasma versus laser therapy in lateral epicondylitis of elbow
Gyaneshwar Tonk, Anish Kumar, Amit Gupta
July-August 2014, 48(4):390-393
DOI:10.4103/0019-5413.136260  PMID:25143643
Background: Platelet rich plasma (PRP) extract has shown to be a general stimulation for repair and currently used widely in various sports injury. A prospective observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow, and compare the result with low level laser therapy. Materials and Methods: The trial was conducted at a tertiary care center for a period of 2 years. Eighty-one patients with chronic lateral epicondylitis were divided into two groups. PRP group (n = 39) and laser therapy group (n = 42). The primary analysis included Nirschl pain score, local tenderness, pain on wrist extension, grip strength, elbow swelling were clinically assessed at different interval of followup (minimum followup: 52 weeks) and; clinical and functional outcome evaluated at final followup. The statistical analysis were done. Results: The mean Nirschl pain score decreased significantly from baseline in PRP when compared with low level laser therapy ( P ≤ 0.05). Conclusions: Treatment of patients with chronic lateral epicondylitis with PRP extract reduced pain and significantly increased function, exceeding the effect of low level laser therapy on long term followup. Low-level laser therapy is better in the short term period, but on long term followup injection PRP therapy is better than laser therapy in lateral epicondylitis.
  2,961 303 5
Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases
Fubing Liu, Chun Jiang, Yuanwu Cao, Xiaoxing Jiang, Zhenzhou Feng
July-August 2014, 48(4):374-379
DOI:10.4103/0019-5413.136240  PMID:25143640
Background: Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). Materials and Methods: 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P < 0.05 was considered to be statistically significant. Results: Among 50 patients, 22 received one level fusion and 28 two level's, with corresponding operation time and estimated blood loss being approximately 90 min, 150 ml and 120 min, 200 ml, respectively. No severe complications happened perioperatively. The mean VAS (back, leg) scores dropped from (7.6, 7.5) preoperatively to (2.1, 0.6) at 12 months' followup, ODI from 49.1 preoperatively to 5.6 and JOA score raised from 10.6 preoperatively to 28.5, all P < 0.001, suggesting of good clinical outcome. From the three-dimensional reconstructed CT, 62 out of 70 segments displayed solid fusion with fusion rate of 88.6% at 12 months postoperatively. Conclusions: TLIF using uPS fixation plus cTLFS fixation is a safe, feasible and effective technique in the treatment of one or two level lumbar degenerative diseases short termly.
  3,085 145 1
High sensitive C-reactive protein-Effective tool in determining postoperative recovery in lumbar disc disease
Tushar Narayan Rathod, Ajay Chandanwale, Kiran M Ladkat, Shital Chavan, Arvind Chavan, Pradeep B Bhosale
July-August 2014, 48(4):354-359
DOI:10.4103/0019-5413.136216  PMID:25143637
Background: It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP) assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score. Materials and Methods: A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon. Results: The level of HSCRP in the study group was between 0.050- and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points). Conclusion: HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.
  2,675 221 2
Correlation between neurological recovery and magnetic resonance imaging in Pott's paraplegia
Anil Kumar Gupta, Chandan Kumar, Praveen Kumar, Ashok Kumar Verma, Rohit Nath, Chaitanya D Kulkarni
July-August 2014, 48(4):366-373
DOI:10.4103/0019-5413.136228  PMID:25143639
Background: Spinal cord/nerve root compression secondary to a tubercular epidural abscess leads to neurological deficit. Depending on the extent and duration of compression, the end result after treatment may vary from complete recovery to permanent deficit. ASIA has been used extensively to correlate between MRI and neurological status due to traumatic spine injuries. MRI has stood as an invaluable diagnostic tool out of the entire range of current imaging modalities. However, inspite of considerable literature on the applications of MRI in spinal tuberculosis, there have been few studies to assess the relationship between the MRI findings and the neurological deficit as assessed by clinical examination. Aims: The objective of this study was to ascertain whether the findings of magnetic resonance imaging (MRI) correlate well with the actual neurological recovery status using the American Spinal Injury Association impairment scale (ASIA) in patients with spinal compression secondary to tuberculous spondylitis. Materials and Methods: 60 patients (mean age 43.6 years) diagnosed as spinal tuberculosis by MRI/cytology/histopathology were examined and classified into ASIA impairment scale A-E based on the ASIA and again reclassified after 6 months of therapy to assess functional recovery. Similarly, they underwent MR imaging at the start and at the completion of 6 months of therapy to assess the structural recovery. The MRI features of recovery were correlated with the actual neurological recovery as ascertained by the ASIA. Results: Before starting treatment 1 patient (2.08%) was in ASIA A, 2 (4.16%) were in ASIA B, 9 (18.75%) were in ASIA C, 36 (75%) were in ASIA D and 12 (20%) were in ASIA E. There was a significant difference in the epidural abscess thickness, thecal compression and cord compression between ambulatory (ASIA D and ASIA E) and non ambulatory patients (ASIA A, ASIA B and ASIA C). After 6 months of therapy 30 (90%) patients in ASIA D and 5 (55.5%) in ASIA C had complete neurological recovery. Both patients from ASIA B improved to ASIA D. Single patient who was in ASIA A before treatment remained non ambulatory (ASIA C) after treatment. Overall 33 (78.5%) patients showed complete recovery at final followup. Out of all the MRI features, only size of epidural abscess was found to be a poor prognostic factor for recovery of neurological deficit. Conclusions: There are several parameters on MRI which correlate with the severity of neurological impairment according to ASIA score and resolution of those features on treatment is also correlated well with neurological recovery.
  2,316 223 1
Bone formation in rabbit's leg muscle after autologous transplantation of bone marrow-derived mesenchymal stem cells expressing human bone morphogenic protein-2
Licheng Wei, Guang-Hua Lei, Han-Wen Yi, Pu-yi Sheng
July-August 2014, 48(4):347-353
DOI:10.4103/0019-5413.136208  PMID:25143636
Background: To test whether autologous transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) expressing human bone morphogenic protein-2 (hBMP-2) can produce bone in rabbit leg muscles. Materials and Methods: MSCs were isolated from BM of the iliac crest of rabbits and then infected with lentiviral vectors (LVs) bearing hBMP-2 and green fluorescent protein under the control of the cytomegalovirus (immediate early promoter). Differentiation of transduced MSCs to osteoblasts in vitro was evaluated with an alkaline phosphatase activity assay and immuohistochemistry against osteoblast specific markers. MSCs expressing hBMP-2 were placed in an absorbable gelatin sponge, which was then transplanted into the gastrocnemius of rabbits from which MSCs were isolated. Bone formation was examined by X-ray and histological analysis. Results: LVs efficiently mediated hBMP-2 gene expression in rabbit BM-MSCs. Ectopic expression of hBMP in these MSCs induced osteoblastic differentiation in vitro. Bone was formed after the MSCs expressing hBMP-2 were transplanted into rabbit muscles. Conclusion: Ectopic expression of hBMP-2 in rabbit MSCs induces them to differentiate into osteoblasts in vitro and to form a bone in vivo.
  2,262 110 4
Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation
Dhananjaya Sabat, Vineet Dabas, Anil Dhal
July-August 2014, 48(4):426-428
DOI:10.4103/0019-5413.136311  PMID:25143650
Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.
  2,224 112 1
Walking ability in patients with arthrogryposis multiplex congenita
Perajit Eamsobhana, Kamolporn Kaewpornsawan, Ekasame Vanitcharoenkul
July-August 2014, 48(4):421-425
DOI:10.4103/0019-5413.136309  PMID:25143649
Background: Arthrogryposis multiplex congenita (AMC) is a multiple joint condition which affects both lower and upper extremities and thus affects ambulation. Multiple surgeries are needed to correct limb deformity in order to promote walking. The objective of this study is to identify the most critical residual deformity that diminishes the ambulatory status. Materials and Methods: 51 patients were included in this study, 14 patients were nonambulatory. The mean age at first surgery was 4.1 years (range 2-16 years). The mean length of followup was 44.0 months (range 22-168 months). Type of procedures and number of operations, residual deformity and walking ability were recorded. Residual deformity including hip flexion contracture more than 30°, knee flexion contracture more than 30°, scoliosis, hip dysplasia or dislocation, knee extension contracture or recurvatum, active motion of hips and knees and upper limb involvement were evaluated. Statistical analysis was done to evaluate factors that were statistically significant to affect walking ability in AMC patients. Results: At the latest followup, 31 patients were community ambulators, 3 patients were household ambulators, 3 patients were nonfunctional ambulatory, and 14 patients were nonambulatory. There were an average of 4.3 surgeries per patient. Statistical analysis of all factors was done and the results were significant with a P < 0.037 in knee flexion contracture >30 degrees with odds ratio of 4.58. Hip flexion contracture >30° was a trend toward significant with a P value of 0.058 and odds ratio of 4.53. Multivariate analysis showed that knee flexion contracture was significant with 4.58 (95% CI 1.01-20.6). Conclusion: AMC is a rare disease that causes disability, requiring multiple surgeries to correct deformities. Our study showed that residual knee flexion contracture was associated with nonambulatory status of patients with AMC.
  2,192 92 2
Results of pronator quadratus repair in distal radius fractures to prevent tendon ruptures
Mohammad Ali Tahririan, Mohammad Javdan, Mehdi Motififard
July-August 2014, 48(4):399-403
DOI:10.4103/0019-5413.136275  PMID:25143645
Background: Distal radius fractures are one of the the most common adult fractures encountered during the clinical practice of an orthopedic surgeon. [1],[2] Although several methods of treatment are suggested for these fractures, there are still controversies about the best treatment approach in the literature. Volar plating of distal radius fracture is a method of treatment which has become increasingly popular. One of the complications of this technique is flexor tendon rupture. The purpose of this study was to evaluate the protectiveness of complete repair of pronator quadratus muscle against flexor tendon rupture. Materials and Methods: From September 2010 to September 2012, a consecutive series of 157 patients who were younger than 60 years with unstable distal radius fractures were included in the study. A standard volar approach to the distal radius was carried out. The radial and distal ends of pronator quadratus muscle were meticulously elevated from the radius and after volar plate fixation of the fracture, pronator quadratus muscle was restored to its normal insertion. We achieved full coverage of the plate with this muscle and followed the patients postoperatively. Results: A total of 135 patients were studied. The mean age of patients was 34 ± 10 years (range 20-60 years). One 55-year-old diabetic female patient with flexor tendon rupture was identified. The flexor pollicis longus tendon had ruptured 16 months after surgery. Conclusions: Pronator quadratus repair should be done in distal radius fracture to protect flexor tendons.
  2,050 174 3
Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography
Dong Kyu Lee, Eun Mi Chun, Seung Woo Suh, Jae Hyuk Yang, Sung Shine Shim
July-August 2014, 48(4):360-365
DOI:10.4103/0019-5413.136223  PMID:25143638
Background: Change in total lung volume after surgical correction in adolescent idiopathic scoliosis (AIS), measured by computed tomography (CT), has not been studied previously. The primary objective of this study was to measure the change in lung volume between pre and postoperative AIS using low-dose CT and secondary objective was to investigate its relationship to postoperative pulmonary complications. Materials and Methods: 55 AIS patients underwent surgery for correction and fusion using a posterior only approach and pedicle screws. Pre and postoperative lung volumes were measured using a 3-dimensional (3D) whole spine CT (low dose protocol: Tube current, 60 mA; tube voltage 120 kV). Postoperative low dose CT was undertaken at 4 weeks after operation to evaluate the acute changes of postoperative lung volumes and pulmonary complications. The software that was used recognizes the "air density shade" of the lung and the volume of every section of the lung. The software then automatically calculates total lung volume by summation of all section volumes. The relationships between postoperative pulmonary complications and changes in lung volume on low dose CT as well as preoperative forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ) were calculated using logistic regression analysis. Results: There was a decrease of 12% ± 23.2% in total lung volume postoperatively on 3D low dose CT (P < 0.001). Thirteen patients had increased lung volume while 42 had decreased lung volume postoperatively. Pulmonary complications were treated without severe sequale. Lung volume increased by 19.65% ± 19.84% in 13 patients and decreased by 21.85% ± 13.32% in 42 patients (P = 0.647). Lung volume was increased in patients whose preoperative lung volume, FEV 1 and FVC were lower than in patients whose values were higher (r = −0.273, −0.291 and − 0.348; P = 0.044, 0.045 and 0.015, respectively). Postoperative lung volume was also increased when intraoperative fluid administration was larger and operative time was longer (r = 0.354, 0.417 and P = 0.008, 0.002, respectively). There was a statistically significant negative correlation in the change of lung volume in female patients when compared with male patients (r = −0.294, P = 0.03). Conclusion: Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.
  2,128 94 3
Outcome in primary cemented total knee arthroplasty with or without drain A prospective comparative study
Rafal Keska, T Przemyslaw Paradowski, Dariusz Witonski
July-August 2014, 48(4):404-409
DOI:10.4103/0019-5413.136285  PMID:25143646
Background: Suction drain insertion is a common practice in orthopedic surgery, especially after joint arthroplasty to prevent the formation of a hematoma. Theoretically the use of a drain should diminish the volume of hematoma; however the literature has conflicting data. Some authors state that drainage evacuates fluid from a limited area only and can be a cause of infection due to retrograde migration of bacteria. It can also impair the early postoperative rehabilitation. The aim of this study was to evaluate the clinical outcome (especially postoperative pain) and intake of analgesics in patients who had undergone primary cemented total knee arthroplasty (TKA) with or without a postoperative drain. Materials and Methods: A prospective comparative study of 108 consecutive patients (121 knees) was conducted. They were divided into two groups: A study group, with no drainage and a control group with drain inserted at the end of surgery. A total of 121 patients were recruited into two groups. A study group consisted of 59 knees, in which we did not use drainage after TKA and a control group with 62 knees, in which drain was inserted post surgery. Both groups were comparable in terms of preoperative characteristics. The indication for TKA was osteoarthritis (n = 105) and rheumatoid arthritis (n = 16). Results: In patients without drainage we observed lower need for opioids, higher blood loss on the 1 st postoperative day and a lower need for change of dressings. There were no statistically significant differences in terms of total blood loss, hidden blood loss, transfusion rate, range of motion, length of hospital stay or incidence of complications between the two groups. In 1 year observation there were no differences in clinical outcome between the two groups. Conclusions: The present study conclude that there is no rationale for the use of drain after primary TKA. There are benefits in terms of lower opioid intake, lower blood loss on the first postoperative day and lower need for dressing reinforcement during hospitalization.
  1,948 150 4
Bifurcated intraarticular long head of biceps tendon
Vivek Pandey, Simon Nurettin van Laarhoven, Gaurav Arora, Sripathi Rao
July-August 2014, 48(4):432-434
DOI:10.4103/0019-5413.136313  PMID:25143652
Though rare, many anomalous origins of long head of the biceps tendon (LHBT) have been reported in the literature. Anatomic variations commonly explained are a third humeral head, anomalous insertion, congenital absence and adherence to the rotator cuff. We report a rare case who underwent shoulder arthroscopy with impingement symptoms where in LHBT was found to be bifurcated with a part attached to superior labrum and the other part to the posterior capsule of joint. Furthermore, intraarticular portion of LHBT was adherent to the undersurface of the supraspinatus tendon. Awareness of such an anatomical aberration during the shoulder arthroscopy is of great importance as it can potentially avoid unnecessary confusion and surgery.
  1,883 67 1
Functional outcome following a large head total hip arthroplasty A retrospective analysis of mid term results
Sanjay Agarwala, Ganesh Mohrir, Pradeep Moonot
July-August 2014, 48(4):410-414
DOI:10.4103/0019-5413.136295  PMID:25143647
Background: One of the reasons that hip resurfacing and large head metal on metal (MOM) total hip arthroplasty (THA) became popular in Asia was the possible increased range of movement and thereby improved function of the hip joint. Due to concerns of MOM articulation an alternative bearing was sought. Hence, a shift from large head MOM to large head ceramic on ceramic (COC) was made. The aim of this study was to compare the functional outcome including range of motion (ROM) and dislocation rates following large head MOM and large head COC THA. Materials and Methods: Retrospectively, 39 primary THA with large head MOM with a mean age of 56 years (range 36-72 years) and average followup of 54 months (range 38-70 months) were compared with 23 primary THA with large head COC bearing with a mean age of 48 years (range 36-68 years) and an average followup of 18 months (range 12-26 months). Functional outcome was assessed using the Modified Harris Hip Score. Dislocation rate and ROM were compared. Results: Global ROM averaged 248 degrees with MOM group and 252 degrees with the COC group. One patient with metal bearing had dislocation at an average 3 year followup which required revision THA while there were no complications in the COC group. MHHS averaged 89 points in MOM and 94 in COC THR. Conclusion: This study has shown that large head ceramic on ceramic THA is a good alternative to large head metal on metal THA with comparable dislocation rates and range of movements and without complications of metallosis in Asian patients.
  1,734 171 -
Outcome analysis of arthroscopic treatment of partial thickness rotator cuff tears
Oh Soo Kwon, John IV Kelly
July-August 2014, 48(4):385-389
DOI:10.4103/0019-5413.136249  PMID:25143642
Background: Partial thickness rotator cuff tears occupy an important position in the spectrum of rotator cuff disease. The development of a more comprehensive classification has been sought to address both the tear location and extent, which may influence clinical results. The purpose of this study is to classify partial thickness rotator cuff tears according to the arthroscopic findings and to evaluate the clinical outcomes after arthroscopic repair of partial thickness tears. Materials and Methods: One hundred and two patients had arthroscopic treatment of partial thickness rotator cuff tears. The inclusion criterion for the study was a partially torn supraspinatus tendon involving articular or bursal side, verified by direct arthroscopic visualization. Outcome analysis was exclusively applied to patients who underwent transtendon repair, using the shoulder index of American Shoulder and Elbow Society and the University of California Los Angeles (UCLA) rating system. Results: Partial thickness rotator cuff tears were divided into five groups according to arthroscopic findings. There was significant improvement after surgery in all parameters of clinical evaluation in the tears that warranted repair. Arthroscopic repair in situ (transtendon technique) may be the preferred option in unstable partial thickness tear. Conclusion: The proposed classification system may assist decision making in the treatment of partial thickness rotator cuff tears.
  1,750 129 -
Congenital pseudoarthrosis of the clavicle with bifurcation
Narender Kumar Magu, Rohit Singla, Ashish Devgan, Paritosh Gogna
July-August 2014, 48(4):435-437
DOI:10.4103/0019-5413.136314  PMID:25143653
Congenital pseudoarthrosis of clavicle is a rare clinical entity. It usually presents as a swelling in the clavicular region at birth or soon after birth. Fitzwilliam's original description of 60 subtypes of congenital pseudoarthrosis of clavicle have addressed several anatomical variants, e.g. association with cervical rib and abnormally vertical and elevated upper ribs. However, congenital pseudoarthrosis of clavicle associated with bifurcation is an atypical anatomic variant. To the best of our knowledge, this variant has never been mentioned in the literature. In the present report, we have described this subtype of symptomatic congenital pseudoarthrosis of the clavicle with bifurcation and its possible management.
  1,747 86 -
An atypical monomelic presentation of Mazabraud syndrome
Jun Wan, Hong-Bo He, Qian-De Liao, Can Zhang
July-August 2014, 48(4):429-431
DOI:10.4103/0019-5413.136312  PMID:25143651
Mazabraud syndrome is a rare condition characterized by a combination of fibrous dysplasia and intramuscular myxomas. In Mazabraud syndrome, the distribution of fibrous dysplasia is mostly polyomelic and frequently located in the femur, with myxomas adjacent to the fibrous dysplasia lesion of bone (mostly in the quadriceps muscle). However, when presented as atypical clinical features, patients of Mazabraud syndrome is either misdiagnosed or difficult to diagnose. We report an atypical monomelic case of Mazabraud syndrome in the right upper arm and discuss the difficulties in making an accurate diagnosis.
  1,608 94 -
Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip
Jun Wan, Xiang-Sheng Zhang, Lin Ling, Jing Fan, Zhi-Hong Li
July-August 2014, 48(4):415-420
DOI:10.4103/0019-5413.136302  PMID:25143648
Background: Developmental dysplasia of the hip (DDH) is associated with chronic pain and limping which especially has a negative impact on the patients' daily activities, body image, and self-esteem. Although total hip arthroplasty remains the first choice for treatment of DDH in adults, minimally invasive alternative approaches are being increasingly favored both by the surgeon and the patients with severe DDH. This study aimed to evaluate the outcome of these patients treated with a mono-lateral external fixator-based tibial lengthening procedure. Materials and Methods: During the period of month between June 1999 and January 2006, 13 (mean ages 20.8 years) adult patients with unilateral Crowe type-IV DDH were treated by tibial lengthening using a mono-lateral external fixator over an intramedullary nail. Bone healing, infection, gait correction and improvement in body image were assessed during postoperative followup. Patients' overall health status at the end of followup was assessed using the short form-36 (SF-36) health survey. Results: Patients were followed up for an average of 7.3 years. Successful bone healing was observed in all 13 patients and no further surgeries were indicated. A mean external fixation index of 12.4 days/cm was achieved. Bone formation fell in good to excellent categories with a mean consolidation index of 50.1 days/cm. Pin-tract infections were observed in two patients. The degree of limping was reduced from severe or moderate preoperatively to mild postoperatively. Neither equinus deformity nor painful degenerative osteoarthritis and hip dysfunction were observed in any of the patients studied. The SF-36 questionnaire survey showed that all patients were satisfied with their outcomes. Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications.
  1,472 79 -
Midterm results of Oxford shoulder hemiarthroplasty
Amitabh J Dwyer, Ahmed S Eid, Vlasta Dvorak, Andrew FW Chambler
July-August 2014, 48(4):380-384
DOI:10.4103/0019-5413.136244  PMID:25143641
Background: Hemiarthroplasty of the shoulder is known to provide satisfactory long term results provided concentric reduction can be obtained in a high percentage of patients. Careful soft tissue balancing with appropriate adaptation of version of the component appears to allow good results permitting centering of the arthroplasty without replacement of a glenoid component. The study was aimed to evaluate the midterm outcome in patients with Oxford cementless shoulder hemiarthroplasty for end stage arthritis with intact or reparable full thickness rotator cuff tears. Materials and Methods: 29 consecutive patients (30 shoulders) who underwent Oxford cementless shoulder hemiarthroplasty between 2004 and 2006 were analyzed. Mean age was 71 years (range 34-91 years, 95% of the confidence interval [CI] of standard deviation [SD] was 10.32-17.58). Mean duration of preoperative symptoms was 42.8 months (range 9-84 months, 95% CI of SD was 17.83-30.11). Patients' self reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results: The mean initial OSS was 17.9 (range 7-43, 95% CI of the SD was 7.19-12.13). The score improved by an average of 16.9 points at a mean followup of 5.9 years (range 4.3-7.6 years) to reach mean final OSS of 34.8 (range 13-48, 95% CI of the SD was 9.31-15.73). The improvement of OSS was highly significant with a two tailed P < 0.0001 and 95% CI of this difference was 11.47-22.20. Conclusion: This study demonstrates shoulder hemiarthroplasty as reliable procedure for improvement of shoulder function as shown by the patients' self reported outcome score (OSS) in end stage glenohumeral arthritis with intact or reparable rotator cuff at midterm followup. Our results suggest successful outcome of the Oxford shoulder hemiarthroplasty (Corin, UK) away from its originating center and in hospitals where fewer shoulder replacements are performed.
  1,398 100 1
Head size and dislocation rate in primary total hip arthroplasty
Abhay Elhence, Divesh Jalan, Harish Talreja
July-August 2014, 48(4):438-438
DOI:10.4103/0019-5413.136315  PMID:25143654
  1,204 74 -
Prof. Udai Shankar Mishra
Harish Kohli
July-August 2014, 48(4):442-442
  966 44 -
Author's reply
Wasudeo Gadegone, Vijayanand Lokhande, Yogesh Salphale, Alankar Ramteke
July-August 2014, 48(4):440-440
DOI:10.4103/0019-5413.136318  PMID:25143657
  942 55 -
Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur
C Yashavantha Kumar
July-August 2014, 48(4):439-440
DOI:10.4103/0019-5413.136317  PMID:25143656
  883 95 1
Dr. Abdul Qadeer Siddiqui
AN Varma
July-August 2014, 48(4):441-441
  922 51 -
Author's reply
Somesh P Singh, Haresh P Bhalodiya
July-August 2014, 48(4):438-439
DOI:10.4103/0019-5413.136316  PMID:25143655
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