A case report: Chronic osteomyelitis of tibia mimicks as hydatid cyst

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 72-75 | Saurabh Kumar Rai, Deepankar Verma, Arunim Swarup, Ish Kumar Dhammi, Sapan Kumar, Anurag Mittal


Authors: Saurabh Kumar Rai, Deepankar Verma, Arunim Swarup, Ish Kumar Dhammi, Sapan Kumar, Anurag Mial

Address of Correspondence

Dr. Deepankar Verma

E-mail: drdeepankarverma@gmail.com


Abstact

Hydatid disease may develop in almost any part of the body and can be identied with a combination of clinical history, imaging ndings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic ndings. Bone hydatid disease is oen asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 53-year-old male who presented with complains pain, swelling, discharge from his right tibia. Radiographs revealed a lytic lesion in diaphysis of tibia mimicking chronic osteomyelitis with further imaging and biopsy was suggestive of hydatid cyst. Patient opted for above knee amputation vs limb salvage.

Keywords: Bone hydatidosis, chronic osteomyelitis


References

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9. Banerjee S, Sabui KK, Mondal J, Nath C, Pal DK: Composite 145 treatment for primary long-bone hydatidosis. Orthopedics 2012, 35:e1827–e1831.

10. Arancibia A, Bürgesser MV, Albertini RA, de Diller AL, Villalba CB: Primary hydatid disease of the tibia. Case report. Rev Fac Cien Med Univ Nac Cordoba 2012, 69:51–55.

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12. Metanat M, Sharifi-mood B, Sandoghi M, Alavi-Naini R: Osseous hydatid disease: case report. Iranian J Parasitol 2008, 3:60–64

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16. Yildiz Y, Bayrakci K, Altay M, Saglik Y. The use of polymethylmethacrylate in the management of hydatid disease of bone. J Bone Joint Surg Br. 2001; 83:1005-1008.

17. Ersin Kuyucua, Mehmet Erdil b, Ali Dulgeroglua, Figen Kocyigitc, Arslan Bora. An unusual cause of knee pain in a young patient; hydatid disease of femur. Int J Surg Case Rep. 2012; 3: 403-406.

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How to Cite this Article:  Rai S K, Verma D, Swarup A, Dhammi I K, Kumar S, Mittal A. A case report: Chronic osteomyelitis of tibia mimicks as hydatid cyst. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):72-75.


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Post-Injection Sciatic Nerve Palsy in a patient with PIVD

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 69-71 | Deepali Srivastava, Vikas Verma, Ashish Kumar.


Authors: Deepankar Verma [1], Anil K Jain [1], Anuragini Gupta [2], Himanshu Bhayana [3]

[1] Department of orthopaedics; UCMS & amp; GTB Hospital;Delhi, India

[2] Department of Otolaryngology & amp; Head & amp; Neck Surgery; Lok Nayak Hospital &amp ; MAMC; Delhi; India

[3] Department of Orthopaedics; Primus super specialty Hospital; Chanakya Puri; Delhi; India.

Address of Correspondence
Dr. Himanshu Bhayana,

Primus Super Specialty Hospital Delhi

E-mail: himanshu.bhayana.mamc@gmail.com


Abstact

Prolapsed intervertebral disc (PIVD) commonly presents as lower back ache associated with features of radiculopathy. We present an unusual case of a patient presenting with foot drop and our diagnostic and therapeutic protocol for the same. Our patient was a 40 year old female who was diagnosed as a case of PIVD L4-L5 and was advised for non operative treatment. During her treatment, the patient received intramuscular analgesic therapy immediately following which the patient reported a foot drop in the le lower limb. While the patient was initially thought to present with an acute neurological worsening of the affected disk requiring urgent decompression. However post injection nerve palsy was kept as one of the differential. e diagnosis of post injection palsy was conrmed by obtaining an NCV study and MRI neurography. She was subsequently managed conservatively via a foot drop splint, oral analgesic therapy and neurotropic agents. On follow up at 6 months she had complete neurological recovery. Post injection palsy can mimic as further prolapse of disc in a case of PIVD. It is imperative to differentiate these two as the management follows different course, the differentiation can be done using MR neurography.
Keywords: MR Neurography; foot drop; PIVD; post injection palsy


References

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9. Mishra P and Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. Int J ClinPract2010; 64: 1573–1579.
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How to Cite this Article: Srivastava D, Verma V, Kumar A. e role of concern and risk perception in anti-osteoporosis behavior. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):69-71.


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Skeletal Fluorosis: An Orthopedic Presentation

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 67-68 | Mayank, Parisha Varshney


Authors: Mayank [1], Parisha Varshney [2]

[1] Department of Orthopaedics, Ganesh Shankar Vidyarthi Memorial Medical College, Lala Lajpat Rai Hospital, Kanpur, Uttar Pradesh, India,

[2] Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

Address of Correspondence
Dr. Mayank,

Room No 50 NRH Hostel, LLR Hospital, Kanpur.

Email: dr.mayank1502@gmail.com


Abstact

Skeletal uorosis is an endemic disease in some regions of Southeast Asia. Diagnosis is made mainly by radiographs seeing osteosclerosis. Other causes of osteosclerosis have to be ruled out. Treatment is done mainly for symptoms.
Keywords: Skeletal Fluorosis, Osteosclerosis.


References

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How to Cite this Article: Mayank, Varshney P. Skeletal Fluorosis: An Orthopedic Presentation. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):67-68.


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Malunited Supracondylar Fractures Of Humerus In Children – A Unique Case

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 64-66 | Praveen Sarogi, Vishnu Vajpai.


Authors: Praveen Sarogi [1], Vishnu Vajpai [1]

[1] Department Of Orthopaedics , Mlb Medical College , Jhansi..

Address of Correspondence
Dr. Vishnu Vajpai,

H/N 543 , Tower No 3,

Mount Kailash Apartments , East Of Kailash , New Delhi110065

E-mail: Vishnu1010vajpai@Gmail.Co


Abstact

Supracondylar fractures of the humerus represent a signicant burden of injuries in children, accounting for 12-–17% of all paediatric fractures and are one of the most commonest fractures requiring surgical intervention, with a high prevalence of associated short- term complications such as nerve injuries and long- term complications such as cubitus varus. We report a peculiar case of a 7-year year-old female presenting with a stiff elbow due to a malunited supracondylar fracture humerus in the form of an anterior humero-ulnar bony bar. e patient was treated by surgical excision of the bar and followed up post-operatively for dramatic improvement in range of movements of the elbow.
Keywords: Supracondylar , Humerus , Malunion.


References

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12. Fitzgibbons PG, Bruce B, Got C, Reinert S, Solga P, Katarincic J, et al. Predictors of failure of nonoperative treatment for Type-2 supracondylar humerus fractures. J Pediatr Orthop 2011;31:372-6.
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14. Onwuanyi ON, Nwobi DG. Evaluation of the stability of pin configuration in K-wire fixation of displaced supracondylar fractures in children. Int Surg 1998;83:271-4.
15. Abbott MD, Buchler L, Loder RT, Caltoum CB. Gartland type III supracondylar humerus fractures: Outcome and complications as related to operative timing and pin configuration. J Child Orthop 2014;8:473-7.
16. Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, et al. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 2012;20:320-7.
17. Or O, Weil Y, Simanovsky N, Panski A, Goldman V, Lamdan R, et al. The outcome of early revision of malaligned pediatric supracondylar humerus fractures. Injury 2015;46:1585-90.


How to Cite this Article: Saraogi P, Vajpai V. Malunited Supracondylar Fractures Of Humerus In Children – A Unique Case. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):64-66.


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Functional outcomes of ACL reconstruction using quadruple hamstring gra

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 58-63 | Sunil Kumar, Harish Kumar, Laxminath Mishra, Harsh Singh, Narendra kumar Choudhary, Rajkumar bharti.


Authors: Sunil Kumar [1], Harish Kumar [1], Laxminath Mishra [1], Harsh Singh [1], Narendra kumar Choudhary [1], Rajkumar bharti [1]

[1] Department of Orthopedics, U P University of medical sciences, Saifai, Etawah India.

Address of Correspondence
Dr. Harish Kumar,

Department of Orthopedics,

U P University of medical sciences, Saifai, Etawah India

E-mail: drharishkumar01@gmail.com


Abstact

Introduction: Modern high speed road traffic accidents and sporting lifestyle has led to an increase in the cases of ligaments injury of the knee. Anterior cruciate ligament (ACL) is the most common ligament to be injured in knee joint injuries. ACL forms pivot in the functional congruence and stability of knee joint. Reconstruction of ACL is required in most of these cases especially in younger age group. As the demand for quality of life is increasing, arthroscopic ACL reconstruction has become the most commonly performed arthroscopic procedure. At our center, we studied the outcomes of 42 patients of ACL reconstruction using quadruple hamstrings autogra. We used Endobuon for femoral end and Bioabsorbable interference screw for tibial end xation.We measured the outcome using lysholm scale for upto 12 months.

Methods: Arthroscopic single bundle ACL reconstruction using quadruple hamstring autogra performed in total 42 knees in 42 patients those having symptomatic ACL decient knee from feb 2016 to july 2017. 33 patients completed the follow up period of 1 year. Patients were evaluated clinically and with lysholm knee scoring at 6, 9 and 12 months after the procedure. patients showed significant improvement in knee laxity and stability. Mean Lysholm knee score was 71.78 (+/- 4.92) preoperatively. ere was significant improvement in score [82.1(+/-4.68) ]at 6 months, 88.81(+/- 4.59) at 9 months, and 93.9 (+/- 4.20) at 12 months of post op. At 12 months of post op 97 % patients showed excellent to good results (>83 score). Only one patient in post op at one year age present with instability , residual knee pain in 8 patients and in one patient develop stiffness of knee.

Conclusions: in this prospective study results of ACL Reconstruction with quadruple hamstrings gra are rewarding and comparable to other methods reconstructions with other gra and fixation devices in one year of follow up.

Keywords: Anterior cruciate ligament, Quadruple hamstring tendon gra, single bundle,


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32. Jeff A Fox, Nedeff DD, Bach BR 鈥?Anterior cruciate ligament reconstruction with patellar autograft tendon. CORR 2002; 402:53-63.
33. Ibrahim SA, Al Kusarry, Noor TAE, Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 2005; 21(4): 412-417.
34. Ejerhed L, Kartus J. Sernet N, Kohler K, Karlsson J. Patellar tendon or semitendinosus tendon autografts for anterior cruciate reconstruction : a prospective randomized study with a two year follow up. Am J sports Med. 2003;31:19-25.
35. Poolman RW, Farrokhyar F, Bhandari M. Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: A cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis. Acta Orthop. 2007;78:350-4
36. Saccomanno MF, Shin JJ, Mascarenhas R, Haro M, Verma NN, Cole BJ, et al. Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral suspensory fixation: a systematic review of randomized controlled trials. Arthroscopy. 2014;30(11):1491-8.


How to Cite this Article: Kumar S, Kumar H, Mishra L, Chaudhari N K, Singh H, Bharti R. Functional outcomes of ACL reconstruction using quadruple hamstring gra. Journal of Bone and Joint Diseases Sep-Dec2018;33(3):58-63.


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Management of Type B Periprosthetic Femoral Fracture in Patients with Narrow Medullary Canal

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 53-57 | Amrit Goyal, Amitosh Mishra.


Authors: Amrit Goyal [1], Amitosh Mishra [2]

[1] Department of Orthopaedics, S.N. Medical College Agra, Agra, Uttar Pradesh, India,

[2] Department of Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India.

Address of Correspondence
Dr. Amitosh Mishra,

Department of Orthopaedics,

King George Medical University, Lucknow, Uttar Pradesh, India.

E-mail: dramitoshmishra@gmail.com


Abstact

Background: Ce number of hip and knee replacements is increasing with beer life expectancy and so is the burden of revision surgery due to periprosthetic fractures. e incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty ranges from 1% to 20%, whereas in post-operative periprosthetic fractures, the incidence ranges between 1% and 4%. Periprosthetic fractures are associated with factors such as osteolysis, osteopenia, and aseptic loosening of the implant and usually require operative treatment. A 61-year-old man presented in emergency with a displaced fracture of neck of femur right, the patient was operated, and hemiarthroplasty was done. 3 months after surgery the patient again had a fall from height. A diagnosis of periprosthetic fracture Vancouver’s classification type B was made from the radiographs. It could not be made out whether the implant was stable or unstable hence could not be classified as B1 or B2, which was later done intraoperatively. e fracture was initially undisplaced which was later found to be displaced in serial radiographs. e recommended treatment according to Duncan and Masri for type B1 fractures is a revision with a long stem. e recommended treatment, bypass with a longer stem, was impractical in this patient due to his narrow medullary canal. Hence, open reduction internal fixation by locking compression plate and cerclage was successfully completed on the patient. e economic constraints of the patient had restricted the use of cable plate.
Keywords: Periprosthetic, femur fracture, internal xation, Encerclage.


References

1. Berry DJ. Epidemiology of periprosthetic fractures after major joint replacement: Hip and knee. Orthop Clin North Am 1999;30:183-90.
2. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995;44:293-304.
3. Fitzgerald RH Jr., Brindley GW, Kavanagh BF. The uncemented total hip arthroplasty: Intraoperative femoral fractures. Clin Orthop Relat Res 1988;235:61-6.
4. Giannini S, Moroni A, Piras F, Guzzardella M, Mosca M. Epidemiologia delle fratture di femore nelle artroprotesi d’anca. G Ital Ortop Traumatol 1997;23:19-28.
5. Lee SR, Bostrom MP. Periprosthetic fractures of the femur after total hip arthroplasty. Instr Course Lect 2006;19:253-60.
6. Kavanagh BF. Femoral fractures associated with total hip arthroplasty. Orthop Clin North Am 1992;23:249-57.
7. Lewallen DJ, Berry DJ. Periprosthetic fracture of the femur after total hip arthroplasty: Treatment and results to date. Instr Course Lect 1998;47:243-9.
8. Brady OH, Garbuz DS, Marsi BA, Duncan CP. Classification of the hip. Orthop Clin North Am 1999;30:215-20.
9. Brady OH, Garbuz DS, Masri BA, Duncan CP. The reliability and validity of the vancouver classification of femoral fractures after hip replacement. J Arthroplasty 2000;15:59-62.
10. Bucholz RW, Heckman JD, Court-Brown C. Rockwood and Green’s Fractures in Adults. 6th ed., Vol. 2. Ch. 21. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 558.
11. Masri BA, Meek RM, Duncan CP. Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 2004;420:80-95.
12. Wilson D, Masri BA, Duncan CP. Periprosthetic fractures: An operative algorithm. Orthopedics 2001;24:869-70.
13. Eingartner C, Volkmann R, Putz M, Weller S. Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures. Int Orthop 1997;21:25-9.
14. Haddad FS, Duncan CP, Berry DJ, Lewallen DG, Gross AE, Chandler HP, et al. Periprosthetic femoral fractures around well-fixed implants: Use of cortical onlay allografts with or without a plate. J Bone Joint Surg Am 2002;84-A:945-50.
15. O’Shea K, Quinlan JF, Kutty S, Mulcahy D. The use of uncemented extensively porous-coated femoral components in the management of vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br 2005;12:1617-21.
16. Ricci WM, Borrelli J Jr. Operative management of periprosthetic femur fractures in the elderly using biological fracture reduction and fixation techniques. Injury 2007;38 Suppl 3:S53-8.
17. Franklin J, Malchau H. Risk factors for periprosthetic femoral fracture. Injury 2007;38:655-60.
18. Giannoudis PV, Kanakaris NK, Tsiridis E. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. Injury 2007;38:669-87.
19. Ricci WM, Bolhofner BR, Loftus T, Cox C, Mitchell S, Borrelli J Jr., et al. Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Joint Surg Am 2005;87:2240-5.
20. Old AB, McGrory BJ, White RR, Babikian GM. Fixation of vancouver B1 peri-prosthetic fractures by broad metal plates without the application of strut allografts. J Bone Joint Surg Br 2006;88-B:1425-9.
21. Brady OH, Kerry R, Masri BA, Garbuz DS, Duncan CP. The Vancouver classification of periprosthetic fractures of the hip: A rational approach to treatment. Technol Orthop 1999;14:107-14.
22. Ko PS, Lam JJ, Tio MK, Lee OB, Ip FK. Distal fixation with wagner revision stem in treating vancouver type B2 periprosthetic femur fractures in geriatric patients. J Arthroplasty 2003;18:446-52.
23. Levenberg R, Iorio R, Gingrich K, Berman AT. Femur fractures associated with total hip arthroplasty. Orthopedics 1990;13:1188-9.
24. Stern RE, Harwin SF, Kulick RG. Management of ipsilateral femoral shaft fractures following hip arthroplasty. Orthop Rev 1991;20:779-84.
25. Wang J, Wang C. Periprosthetic fracture of the femur after hip arthroplasty: The clinical outcome using cortical strut allografts. J Orthop Surg (Hong Kong) 2000;8:27-31.
26. Wilson D, Frei H, Masri BA, Oxland TR, Duncan CP. A biomechanical study comparing cortical onlay allograft struts and plates in the treatment of periprosthetic femoral fractures. Clin Biomech (Bristol, Avon) 2005;20:70-6.
27. Tsiridis E, Narvani AA, Timperley JA, Gie GA. Dynamic compression plates for vancouver type B periprosthetic femoral fractures: A 3-year follow-up of 18 cases. Acta Orthop 2005;76:531-7.
28. Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE. Fixation of periprosthetic femoral shaft factures occurring at the tip of the stem: A biomechanical study of 5 techniques. J Arthroplasty 2000;15:523-8.
29. Berry DJ. Treatment of vancouver B3 periprosthetic femur fractures with a fluted tapered stem. Clin Orthop 2003;417:224-31.


How to Cite this Article: Srivastava D, Verma V, Kumar A. e role of concern and risk perception in anti-osteoporosis behavior. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):53-57.


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Role of Arthroscopic Synovial Biopsy and Synovectomy in Diagnosis and Management of Chronic Synovitis of the Knee

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 50-52 | Rajat Kapoor, C.P.Pal, Yajuvendra Kumar Sharma, Vikas Mishra.


Authors: Rajat Kapoor [1], C.P.Pal [1], Yajuvendra Kumar Sharma [1], Vikas Mishra [1].

[1] Department of Orthopedics, Sarojini Naidu Medical College Agra, Uar Pradesh, India.

Address of Correspondence
Dr. Chandra P Pal,

Department Of Orthopaedics,

Sarojini Naidu Medical College Agra, Uttar Pradesh, India.

Email: drcportho@gmail.com


Abstact

Background: Synovitis of the knee can be very difficult to treat, especially when the diagnosis remains elusive. Synovitis occurs due to the various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy, and did a review of literature.

Methods: This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2015 and January 2017. Inclusion criteria were patients presenting with persistent swelling of the knee, not responding to conservative measures. We excluded patients who had recurrent synovitis and patients who had septic arthritis. All patients underwent arthroscopic synovial biopsy and partial synovectomy. Pre- and post-operative VAS score was calculated.

Results: In n = 5 patients, the histopathological diagnosis was tuberculosis, which improved with antituberculous drug treatment; in n = 1 patient, the diagnosis was juvenile rheumatoid arthritis; patient improved with synovectomy and NSAIDs. In n = 12 patients, the biopsy report came as chronic non-specic synovitis, 8 of these patients did well with arthroscopic synovectomy, while the other 4 had a recurrence. e average VAS score improved from 8.4 pre-surgery to 4.2 post-surgery.

Conclusions: Arthroscopic synovial biopsy and synovectomy give good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.

Keywords: Arthroscopy, Biopsy, Chronic synovitis, Synovectomy.


References

1. Tak PP, Breedveld FC. Current perspectives on synovitis. Arthritis Res Ther 1999;1:11-6.
2. Youssef PP, Kraan M, Breedveld F, Bresnihan B, Cassidy N, Cunnane G, et al. Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples obtained blindly by needle biopsy. Arthritis Rheum 1998;41:663-9.
3. Singhal O, Kaur V, Kalhan S, Singhal MK, Gupta A, Machave Y, et al. Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision. Int J Appl Basic Med Res 2012;2:102-6.
4. Akmeşe R, Yildiz KI, Işik Ç, Tecimel O, Bilgetekin YG, Firat A, et al. Combined arthroscopic synovectomy and radiosynoviorthesis in the treatment of chronic non-specific synovitis of the knee. Arch Orthop Trauma Surg 2013;133:1567-73.
5. Kuzmanova SI, Zaprianov ZN, Solakov PT. Correlations between arthroscopic findings and synovial membrane histology in patients with rheumatoid synovitis of the knee joint. Folia Med (Plovdiv) 2003;45:60-5.
6. Latosiewicz R, Cylwik B, Dołzyński M. Clinical significance of arthroscopic synovial biopsy in the diagnosis of knee synovitis. Chir Narzadow Ruchu Ortop Pol 1998;63:549-53.
7. Ayral X, Bonvarlet JP, Simonnet J, Amor B, Dougados M. Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee. Rev Rhum Engl Ed 1997;64:215-26.


How to Cite this Article: Kapoor R, Pal C P, Sharma Y K, Mishra V. Role of Arthroscopic Synovial Biopsy and Synovectomy in Diagnosis and Management of Chronic Synovitis of the Knee. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3): 50-52.


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A Comparative Analysis of Posteromedial So Tissue Release and Differential Distraction with JESS Fixator in Neglected and Resistant CTEV

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 45-49 | Deepali Srivastava, Vikas Verma, Ashish Kumar.


Authors: Ashwani Sadana [1], Karuna Shankar Dinkar [1], Chandra Prakash Pal [1], Rajat Kapoor [1], Yajuvendra Kumar [1].

[1] Dept. of Orthopaedics, S.N. Medical College, Agra, India.

Address of Correspondence
Dr. Karuna Shankar Dinkar,

Assistant Professor,

S.N. Medical College, Agra, India.

E-mail: drksdinkar27@yahoo.in


Abstact

Club foot is amongst the most common of congenital deformities.CTEV is a complex three dimensional deformity having four components- equinus,varus ,adduction and cavus.e present study was conducted to compare the results of PMSTR and JESS xator in neglected, resistant and relapsed or recurrent club foot .is prospective study comprising of 36 children, was conducted in the department of orthopedics,S.N.Medical College Agra. Preoperative none of the feet in either group had a clinical satisfactory rating but aer surgery a significant improvement was seen. Of the 25 feet subjected to PMSTR procedure it was observed that 16 feet (64%)were in the category of satisfactory rating where all the 9 clinical criteria were in satisfactory range (36 %) had unsatisfactory result. Of the 22 feet subjected to Differential Distraction Method using JESS FIXATOR it was observed that 19 feet (77.3%) were in the category of satisfactory rating, where all the 9 criteria were in satisfactory range, unsatisfactory result were seen in 5 feet (22.7%).

Keywords: cavus,compare,preoperative, JESS,feet


References

1. 1. Hippocrates(400B.C.): The genuine work of Hippocrates translated from Greek by Francis Adams with an introduction by E.C.Kelly. Baltimore: Williams& Wilkins,1939.
2. K.Ikeda, “Conservative treatment of idiopathic clubfoot,” Journal of Pediatric Orthopaedics, vol. 12, no. 2, pp. 217–223, 1992.
3. Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. ClinOrthop 1990; 250:8–26.
4. Joshi, B.B.; Laud, N.S.; Warrier, S.S. Kanaji BG, Joshi AP, Dabake H: Treatment of CTEV by Joshi External Stabilization System (JESS) in : Kulkarni GS, Editor. Textbook of Orthopedics and Trauma, Ist Edition, New Delhi: JaypeeBrothersMedicalPublihers Ltd; 1999.
5. Turco, V.J.: Resistant congenital club foot- One stage posteromedial release with internal fixation; a follow up report of a fifteen years experience. J. Bones Jt. Surg.(1979), 61A, 805-14
6. McKay, D.W.:New concept and approach to club foot treatment:Section II- Correction of club foot. J.Pediat.Orthop (1983),(2),347.
7. Yamamoto, H. And FURUYA,K.(1988): One Stage Posteromedial release of club foot; J. of PaediatricOrthopaedics,(1988), Vol(8), Issue 5, 590. Simons, G.W. Complete subtalar release in clubfeet. J. Bone Jt. Surg1985. 67A:1056-1065.
8. Grill F, Franke J. The Ilizarov distractor for the correction of relapsed or neglected clubfoot. J Bone Joint Surg Br 1987; 69B: 593–597.
9. Suresh S; Ahmed A; SharmaVK Role of Joshi’s external stabilisation system fixator in the management of idiopathic clubfoot. Journal of Orthopaedic Surgery 2003: 11(2): 194–201
10. Sudmann,E., Hald, J.K. and Skandfer, B.: Feature resisting primary treatment of congenital club foot; ActaOrthop. Scand., (1983),54(6),850-857.
11. Cohen-Sobel, E,; Caselli, M.; Giorgini, R. Etal: Long term follow up of club foot surgery; Analysis of 44 patients. J. Foot Ankle Surg., (1993),32(4), 411-423.
12. Ponseti, I.V.: Treatment of congenital clubfoot; J. Bones Jt Surg.(1992) ,74A; 448-454.


How to Cite this Article: Srivastava D, Verma V, Kumar A. e role of concern and risk perception in anti-osteoporosis behavior. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):45-49.


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Management of Angular Deformities around Knee in Children by Dome Osteotomy

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 22-28 | Latif Zafar Jilani Ziaul Hoda Shaan, Muneer Ahmed, Sohail Ahmad, Mohd. Faizan, Mazhar Abbas, Naiyer Asif.


Authors: Latif Zafar Jilani [1], Ziaul Hoda Shaan [1], Muneer Ahmed [1], Sohail Ahmad [1], Mohd. Faizan [1], Mazhar Abbas¹, Naiyer Asif [1].

[1] Department of Orthopaedic Surgery, J. N. Medical College, A.M.U, Aligarh, India- 202002.

Address of Correspondence
Dr. Ziaul Hoda Shaan,

Department of Orthopaedic surgery JNMCH, AMU, Aligarh, UP, India.

Email: shaan.hoda007@gmail.com


Abstact

Background: Coronal plane deformity around knee persisting beyond 8 years of age is a matter of concern for a treating surgeon as well as parents. e corrective dome osteotomy surgery provides beer adjustability of osteotomized fragments, large bone-to-bone contact, and stability. e present study assesses the surgical correction of angular deformities around knee in children by corrective dome osteotomy, evaluates cosmetic, functional, and anatomical outcome based on clinical and radiological follow-up, and assesses the range of motion of knee after surgical management.

Materials and Methods: A prospective clinical study was performed on 16 patients presenting with coronal plane deformity of knee, aged <16 years, and satisfying our inclusion criteria. After thorough clinical and radiological assessment, dome osteotomy was done and stabilized by cross K-wires (2.5 mm). Post-operative measurements of tibiofemoral angle (TFA), intermalleolar and intercondylar distance, scanogram for the calculation of radiological TFA, mechanical axis deviation, mechanical medial proximal tibial angle (m MPTA), and mechanical lateral distal femoral angle (m LDFA) were done and compared with pre-operative values. Patients were followed for any complication, time of osteotomy union, and range of motion of knee after operation.

Results: Out of 16 patients operated, 15 (93.75%) had valgus deformity and only 1 (6.25%) had varus deformity, and 11 were male and 5 were female; the mean time of osteotomy union was 11.88 weeks (range 8–16 weeks) and no patient had non-union. Mean valgus deformity of 28.93° improved to 8° and mean varus deformity of 10° improved to 0° post-operatively. Mean duration of cast was 7.8 weeks (range 6–10 weeks).

Conclusion: Dome osteotomy is a simple, safe, and easy procedure for correcting coronal plane deformities around knee in children before skeletal maturity. It does not cause limb length discrepancy and stable even by minimal internal fixation such as cross K-wire and plaster.

Keywords: Valgus and varus knee deformity, children, corrective dome osteotomy.


References

1. Salenius P, Vankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg [Am] 1975;57:259-61.
2. Frantz CH. Epiphyseal stapling: A comprehensive review. Clin Orthop Relat Res 1971;77:149-57.
3. Fraser RK, Dickens DR, Cole WG. Medial physeal stapling for primary and secondary genu valgum in late childhood and adolescence. J Bone Joint Surg1995;77:733-5.
4. Heath CH, Staheli LT. Normal limits of knee angle in white children-Genu varum and genu valgum. J Pediatr Orthop 1993;13:259-62.
5. Libri R, Sabetta E, Stilli S, Andrisano A. The correction of valgus knee by temporary epiphyseal stapling. J Ortop Trauma 1990;16:221-8.
6. Oudshoorn P, Mulder JD. Kleinekwalen: Genu varumen genu valgumbijkinderen. Ned Tijdschr Gen 1987;131:11-2.
7. Patwardhan S, Shah K, Shyam A. Growth modulation in children for angular deformity correction around knee-use of eight plate. Int J Paediatr Orthop 2015;1:29-33.
8. Wiemann JM, Tryon C, Szalay EA. Physealstapling versus 8-plate hemiepiphysiodesis for guidedcorrection of angular deformity about the knee. J Pediatr Orthop 2009;29:481-5.
9. Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal stapling for angulardeformity correction around the knee joint in children with multiple epiphyseal dysplasia. J Pediatr Orthop 2009;29:52-6.
10. Celestre PC, Bowen RE. Correction of angular deformities in children. Curr Orthop Pract 2009;20:641-7.
11. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994;25:425-65.
12. Stevens PM. Guided growth: 1933 to the present. Strat Trauma Limb Recon 2006;1:29-35.
13. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001;286:188-95.
14. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 12th ed. Philadelphia, PA: Mosby; 2013. p. 472-3.
15. Gautam VK, Kumar R, Mishra P. Focal dome osteotomy for correction of genu valgum. Indian J Orthop 2002;36:6.
16. Kader MS. Correction of genu valgum by reverse dome osteotomy in the supracondylar area of femur. Pan Arab J Orthop Trauma 2002;6:???.
17. Mue DD, Yongu WT, Elachi IC. Childhood lower extremity angular deformities in Nigeria. Int J Med Public Health Sci Res 2014;2:49-60.
18. Gupta V, Kamra G, Singh D, Pandey K, Arora S. Wedgeless ‘V’ shaped distal femoral osteotomy with internal fixation for genu valgum in adolescents and young adults. Acta Orthop Belg 2014;80:234-40.
19. El Ghazaly SA, El-Moatasem EH. Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity. Strat Traum Limb Recon 2015;10:41-7.
20. Lin CJ, Lin SC, Huang W, Ho CS, Chou YL. Physiological knock-knee in preschool children: Prevalence, correlating factors, gait analysis, and clinical significance. J Pediatr Orthop 1999;19:650-4.
21. Matthew SK, Raheel S, Austin TF, Robert SR. Distal femoral osteotomy is internal fixation better than external. Clin Orthop Relat Res 2011;469:2003-11.
22. Davis CA, Maranji K, Frederick N, Dorey F, Moseley CF. Comparison of crossed pins and external fixation for correction of angular deformities about the knee in children. J Pediatr Orthop 1998;18:502-7.
23. Rad PK, Victoria P, Peter B, Terri G, Otsuka NY. Complications of tibial osteotomies in children with comorbidities. J Pediatr Orthop 2002;22:642-4.
24. Makhmalbaf H, Moradi A, Ganji S. Distal femoral osteotomy in genovalgum: Internal fixation with blade plate versus casting. Arch Bone Jt Surg 2014;2:246-9.
25. Dilawaiz N, Quick R, Thomas J, Deborah ME. Focal dome ostetomy for the correction of tibial deformity in children. J Pediatr Orthop B 2005;14:340-6.


How to Cite this Article: Jilani L Z, Shaan Z H, Ahmed M, Ahmad S, Faizan M, Abbas M, Asif N. Management of Angular Deformities around Knee in Children by Dome Osteotomy. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):22-28.


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Correction of Genu Recurvatum Deformity in Polio Patients by Ilizarov Technique – A Single-center 24 Patient Case Study

Vol 33 | Issue 3 | Sep – Dec 2018 | page: 14-17 | R A Agarwal, Rajat Agarwal, Punit.


Authors: R A Agrawal [1], Rajat Agrawal [1], Punit [2].

[1] Department of Orthopaedic Surgeon, Agrawal Orthopaedic Hospital and Research Institute, Uttar Pradesh, India,

[2] Assistant Professor Of Orthopaedics, Maharishi Markandeshwar University of Health Sciences and Medical College, Kumarhai (Solan) Himachal Pradesh.

Address of Correspondence
Dr. R A Agrawal,

Department of Orthopaedics,

Agrawal Orthopaedic Hospital and Research Institute, Gorakhpur – 273 001, Uttar Pradesh, India.

E-mail: agrawalram@hotmail.com


Abstact

Background: The younger generation of orthopedic surgeons having lile experience with polio and its residual deformities should reinvent their skills to deal with challenge of its resurgence. Our knowledge and experience in dealing with genu recurvatum deformity with ilizarov method in polio patients need to be shared.

Materials and Methods: Twenty-four cases of genu recurvatum deformity corrected with distal femoral osteotomy and fixed with ilizarov apparatus in our center from 1994 to 2016 were evaluated.

Results: Nineteen patients had excellent results, two had good results, while three cases had fair outcome.

Conclusion: Ilizarov technique has given excellent and reproducible results with minimal complications in genu recurvatum deformity in polio.

Keywords: Genu recurvatum, femoral osteotomy, ilizarov technique.


References

1. Joseph B, Watts H. Polio revisited: Reviving knowledge and skills to meet the challenge of resurgence. J Child Orthop 2015;9:325-38.
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3. Mesfin G, Schluter W, Gebremariam A, Benti D, Bedada T, Beyene B, et al. Polio outbreak response in Ethiopia. East Afr Med J 2008;85:222-31.
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7. World Health Organization Country Office Tajikistan, WHO Regional Office for Europe, European Centre for Disease Prevention and Control. Outbreak of poliomyelitis in Tajikistan in 2010: Risk for importation and impact on polio surveillance in Europe? Euro Surveill 2010;15:pii: 19558.
8. Mehta SN, Mukherjee AK. Flexion osteotomy of the femur for genu recurvatum after poliomyelitis. Bone Joint J 1991;73:200-2.
9. Men HX, Bian CH, Yang CD, Zhang ZL, Wu CC, Pang BY. Surgical treatment of the flail knee after poliomyelitis. Bone Joint J 1991;73:195-9.
10. Inaba M. Control dysfunction. 3. Bracing the unstable knee and ankle in hemiplegia. Phys Ther 1967;47:838-43.
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12. Gill AB. Operation for correction of paralytic genu recurvatum. J Bone J Surg 1931;13:49-53.
13. Campbell WC, Mitchell JI. Operative treatment of paralytic genu recurvatum. Ann Surg 1932;96:1055-64.
14. Mayer L. An operation for the cure of paralytic genu recurvatum. J Bone Joint Surg Am 1930;12:845-52.
15. Campbell WC. An operation for the correction and prevention of paralytic genu recurvatum. J Am Med Assoc 1918;71:967.
16. Choi IH, Chung CY, Cho TJ, Park SS. Correction of genu recurvatum by the ilizarov method. J Bone Joint Surg Br 1999;81:769-74.
17. Kundu ZS, Sangwan SS, Siwach RC, Guliani G. Correction of bony deformities around knee by hemicallotasis using an innovative apparatus. Indian J Orthop 2005;39:39-44.


How to Cite this Article: Khan R, Jameel J. Efficacy of cerement in large defects created by giant cell tumor. Journal of Bone and Joint Diseases Sep – Dec 2018;33(3):14-17.

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