Chaff Machine Injury Of The Elbow–A Case Report

Vol 35 | Issue 3 | September-December 2020 | page: 41-43 |  Atin Jaiswal, Yashwant Singh Tanwar


Authors: Atin Jaiswal [1], Yashwant Singh, Tanwar [2]

¹Department of Orthopedics, Vivekanand polyclinic and institute of medical sciences, Lucknow, U_ar Pradesh, India.
²Department of Orthopedics, Indraprastha Appolo Hospital, New Delhi, India.

Address of Correspondence:
Dr. Atin Jaiswal,
Vivekanand polyclinic and institute of medical sciences, Lucknow, Uttar Pradesh, India.
E-mail: atin.jaiswal@yahoo.com


Abstract:
Agricultural machine injuries are very common worldwide and are a cause of major economic burden and permanent physical disabilities. Such injuries carry a grave prognosis as they usually result in traumatic amputation or compound fractures with deep lacerations which are open contaminated. Infection rate in such injuries are too high and undefined fracture patterns usually pose a problem in adequate management and usually require multiple surgeries. A sequential planned tailor made approach is required for management of such injuries. We present a case of chaff cutter machine injury in a 17 years male patient with compound, comminuted, multiple fractures in right elbow with bone loss managed with thorough debridement and minimal internal fixation and single stage surgery with good results. In this case report we used titanium elastic nails as an alternative to joint spanning external fixation for diaphyseal humerus fracture with its advantages. This manuscript also gives an insight regarding prevention of agricultural machine injuries.
Keywords: Chaff cutter, Compound, Comminuted


References

  1. Leigh JP, McCurdy SA, Schenker MB. Costs of occupational injuries in agriculture. Public Health Rep 2001; 116:235-48.
  2.  Angoules AG, Lindner T, Vrentzos G et al. Prevalence and current concepts of management of farmyard injuries. Injury 2007;38:S27-34
  3.  DavasAksan A, Durusoy R, Bal Eet al. Risk factors for occupational hand injuries: relationship between agency and finger. Am J Ind Med. 2012 May;55(5):465-73.
  4.  Kumar A, Singh JK, Singh C. Prevention of chaff cutter injuries in rural India. Int J InjContrSafPromot. 2013;20(1):59-67.
  5.  Pickett W, Hartling L, Brison RJ, Guernsey JR. Fatal workrelated farm injuries in Canada, 1991–1995. CMAJ. 1999;160(13):1843–1848.
  6.  Hansen RH. Major injuries due to agricultural machinery. Annals of Plastic Surgery. 1986;17(1):59–64.
  7.  Gorsche TS, Wood MB. Mutilating corn-picker injuries of the hand. J Hand Surg Am 1988;13:423-7.
  8.  Melvin PM. Corn picker injuries of the hand. Arch Surg 1972; 104:26-9.
  9.  Reed DB, Browning SR, Westneat SC et al. Personal protective equipment use and safety behaviors among farm adolescents: gender differences and predictors of work practices. Journal of Rural Health. 2006;22(4):314–320.

How to Cite this Article: Jaiswal A, Tanwar Y S | Chaff Machine Injury Of the Elbow–A Case Report | Journal of Source of Support: None Bone and Joint Diseases | September-December 2020; 35(3): 41-43.

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Pseudomonal Clavicular Osteomyelitis Managed by Subtotal Clavicular Excision: A Rare Case Report and Literature Review

Vol 35 | Issue 3 | September-December 2020 | page: 52-54 |  Kumar Keshav, Lalit Kumar Das, Shalesh Kumar, Siddharth Singh


Authors: Kumar Keshav [1], Lalit Kumar Das [1], Shalesh Kumar [2], Siddharth Singh [1]

[1] Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Vrindavan Yojna, Rae Bareli Road, Lucknow, U.P., India.
[2] Neelesh Orthopaedics and Dental Care Centre, Gorakhpur, UP, India.

Address of Correspondence:
Dr. Kumar Keshav,
Assistant Professor, Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Vrindavan Yojna, Rae Bareli Road, Lucknow, U.P., India
E-mail: keshav4700@yahoo.co.in


Abstract:
We are describing the case of a 7 year old male child of chronic clavicular osteomyelitis who presented to us in a very advanced stage with discharging sinus over anterior chest wall. The child was managed by subtotal clavicular excision, retaining the major part of the periosteal sleeve followed by 6 weeks of antibiotics based on culture report. The etiological agent was found to be Pseudomonas aeruginosa. The subsequent follow ups upto 1 year has been uneventful. The functional morbidity was minimal. New bone formation in the periosteal sleeve has also been seen.
Keywords: Clavicular osteomyelitis, Pseudomonas, Clavicular excision, Claviculectomy


References

1. Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med. 1970; 282(4):198–206.
2. Pollack MS. Staphylococcal mediastinitis due to sternoclavicular pyarthrosis: CT appearance. J Comput Assist Tomogr. 1990; 14(6):924–927.
3. Burns P, Sheahan P, Doody J, Kinsella J. Clavicular osteomyelitis: a rare complication of head and neck cancer surgery. Head Neck. 2008 Aug;30(8):1124-7.
4. Morrey BF, Bianco AJJr. Hematogenous osteomyelitis of the clavicle in children. Clinical Orthopaedics and Related Research. 1977;(125):24–28.
5. Srivastava KK, Garg LD, Kochhar VL. Osteomyelitis of the clavicle. Acta Orthop Scand. 1974;45(5):662-7.
6. Oheim R, Schulz AP, Schoop R, Grimme CH, Gille J, Gerlach U-J. Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients. International Orthopaedics. 2012;36(4):775-781.
7. Dugg P, Shivhare P, Mittal S, Singh H, Tiwari P, Sharma A. Clavicular osteomyelitis: a rare presentation of extra pulmonary tuberculosis. Journal of Surgical Case Reports. 2013;2013(5):rjt030.
8. Damodaran A, Rohit A, Abraham G, Nair S, Yuvaraj A. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy. F1000Research. 2014;3:268.
9. Lombard LL. Observation sur une nécrose de la clavicule et surune périostose du femur. Arch Gen Med. 1826;10:248-55.
10. Rubright J., Kelleher P., Beardsley C., Paller D., Shackford S., Beynnon B. Long- term clinical outcomes, motion, strength and function after total claviculectomy. J. shoulder Elb. Surg. Feb 2014;23(2):236–244.


How to Cite this Article: Keshav K, Das LK, Kumar S, Singh S | Pseudomonal Clavicular Osteomyelitis Managed by Subtotal Clavicular Excision: A Rare Case Report and Literature Review| Journal of Bone and Joint Diseases | September-December 2020; 35(3): 52-54.

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Long Term Follow Up And Management Of Adamantinoma Of Tibia: A Rare Case Report

Vol 35 | Issue 3 | September-December 2020 | page: 49-51 |  Rahul Patel, Devanshu Mohaniya, Birju Manjhi, Shivam Sinha, Amit Rastogi


Authors: Rahul Patel [1], Devanshu Mohaniya [1], Birju Manjhi [1], Shivam Sinha [1], Amit Rastogi [1]

¹Department of orthopedics, IMS and Trauma center, BHU, Varanasi, India.

Address of Correspondence:
Dr. Rahul Patel,
Department of orthopedics, IMS and Trauma center ,BHU, Varanasi, India.
E-mail: rahulpatel161092@gmail.com


Abstract:
Introduction: Adamantinoma is a rare low grade malignant tumor of unknown origin, commonly seen in the mandible and the long bones like tibia. It is histologically biphasic, contains both epidermal and mesenchymal cells. Management depends upon staging and local destruction ranging from amputation to limb reconstruction.
Case report: We report a case of 20 years old male patient presented with pain and slowly progressive swelling in left leg that evolved over last 3 years without significant clinical manifestations. Radiological and Histological evaluation was done and diagnosed with adamantinoma. It was managed with excision of tumor and limb reconstruction with corticotomy and stabilisation with Ilizarov external fixator. Secondarily tibia vara was managed by LRSs. We report no recurrence.
Conclusion: Adamantinoma is locally aggressive bone tumor with distant metastasis, can occur after many years of initial presentation. Once the diagnosis is made, there must be a wide excision of tumor to be done to reduce tumor load en-masse and limb salvage surgery along with plastic surgical intervention and thus, remaining vigilant for late complications of limb reconstruction.
Keywords: Management of adamantinoma of tibia


References

1) Fechner R, Mills S. Tumors of the bones and joints. In: Atlas ofTumor Pathology. 3rd ed. Washington DC: Lippincott- Raven;1993
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3) Unni KK. Dahlin’s Bone Tumors: general aspects and data on11,087 cases. 5th ed. Philadelphia: Lippincott- Raven;1996.
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7) Filippou DK, Papadopoulos V, Kiparidou E, Demertzis NT
(2003) Adamantinoma of tibia: a case of late local recurrence along with lung metastases. J Postgrad Med 49(1):75–77
8) Gonçalves R, Saad Junior R, Dorgan Neto V, Botter M (2008)
A rare case of pneumothorax: metastatic adamantinoma. J Bras Pneumol 34:425–429.
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12) Kask G, Pakarinen TK, Parkkinen J, Kuokkanen H, Nieminen J, Laitinen MK. Tibia Adamantinoma Resection and Reconstruction with a Custom-Made Total Tibia Endoprosthesis: A Case Report with 8-Year Follow-Up. Case Rep Orthop. 2018;2018:3656913. Published 2018 Jun 6. doi:10.1155/2018/3656913
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How to Cite this Article: Patel R, Mohaniya D, Manjhi B, Sinha S, Rastogi A | Long Term Follow Up And Management Of Adamantinoma Of Tibia: A Rare Case Report | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 49-51.

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Reversible Physeal Arrest In An Adolescent Intraarticular Distal Femur Fracture With Unusual Configuration: A Case Report

Vol 35 | Issue 3 | September-December 2020 | page: 44-48 |  Atin Jaiswal, Yashwant Singh Tanwar


Authors: Atin Jaiswal [1], Yashwant Singh Tanwar [2]

[1] Department of Orthopedics, Vivekanand polyclinic and institute of medical sciences, Lucknow, Uttar Pradesh, India.
[2] Department of Orthopedics, Indraprastha Appolo Hospital, New Delhi, India.

Address of Correspondence:
Dr. Atin Jaiswal,
Vivekanand polyclinic and institute of medical sciences, Lucknow, Uttar Pradesh, India.
E-mail: atin.jaiswal@yahoo.com


Abstract:
Distal femur physeal fracture in adolescent age group are unpredictable in view of their prognosis and complications. We present a case of distal end femur fracture due to its unusual configuration and management in a 13 years male patient. This patient was treated by open reduction and internal fixation with distal femoral locking plate with screws spanning the physes. We also want to report this case as it showed features of impending physeal arrest which was reversible after removal of transphyseal screws which were promoting epiphysiodesis. End result was anatomical healing of fracture with no limb length discrepancy and deformity and fully preserved joint motion. This report shows that effective management of physeal injuries and timely intervention can lead to successful outcome even in a limited resource setup. However we should be prepared to anticipate and manage adverse outcome and complications while handling such injuries.
Keywords: Physeal, Distal femur, Fracture


References

1. Arkader A, Warner WC, Jr., Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. Journal of Pediatric Orthopaedics. 2007;27(6):703–708. [PubMed]
2. (BasenarCJ, Mehlman CT, Dipasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta–analysis. J Orthop Trauma.2009;23(9):663- 667)
3. Campbell operative orthopaedics12th ed
4. Thomson JD1, Stricker SJ, Williams MM. Fractures of the distal femoral epiphyseal plate.JPediatrOrthop. 1995 Jul- Aug;15(4):474-8.
5. Anderson M, Messner MB, Green WT. Distribution of lengths of the normal femur and tibia in children from one to eighteen years of age. The Journal of Bone and Joint Surgery. American. 1964;46:1197–1202.[PubMed]
6. Torg JS, Pavlov H, Morris VB. Salter-Harris type-III fracture of the medial femoral condyle occurring in the adolescent athlete. The Journal of Bone and Joint Surgery. American. 1981;63(4):586–591. [PubMed]
7. Riseborough EJ, Barrett IR, Shapiro F. Growth disturbances following distal femoral physeal fracture-separations. J Bone Joint Surg Am. 1983; 65(7):885-893.].
8. Mäkelä EA1, Vainionpää S, Vihtonen K, Mero M, Laiho J, Törmälä P, Rokkanen P. Healing of physeal fracture after
fixation with biodegradable self-reinforced polyglycolic acid pins. An experimental study on growing rabbits..Clin Mater. 1990;5(1):1-12
9. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963;45:587-622
10. Lombardo SJ, Harvey JP Jr. Fractures of the distal femoral epiphyses. Factors influencing prognosis: a review of thirtyfour cases. J Bone Joint Surg Am. 1977; Sep;59(6): 742-51.
11. Khoshhal KI, Kiefer GN. Physeal bridge resection. J Am Acad Orthop Surg. 2005; Jan-Feb;13(1): 47-58].


How to Cite this Article: Jaiswal A, Tanwar Y S | Reversible Physeal Arrest In An Adolescent Intraarticular Distal Femur Fracture With Unusual Configuration: A Case Report | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 444-48.

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Traumatic Transverse Patella Fracture In A Bipartite Patella – An Unusual Case Report

Vol 35 | Issue 3 | September-December 2020 | page: 38-40 |  Atin jaiswal, Yashwant singh Tanwar, Gautam Chatterji


Authors: Atin jaiswal [1], Yashwant singh Tanwar [2], Gautam Chatterji [3]

[1] Depatment of orthopaedics, Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow, UttarPradesh, India.
[2] Depatment of orthopaedics, Indraprastha Appolo Hospital, New Delhi, India.
[3] Depatment of orthopaedics, AIIMS Bhopal, India.

Address of Correspondence:
Dr. Atin Jaiswal,
Senior consultant Orthopaedics, Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow, UttarPradesh, India.
E-mail: atin.jaiswal@yahoo.com


Abstract:
Bipartite patella results due to the failure of fusion of secondary ossification centres. Most bipartite patella are asymptomatic and usually an incidental finding. Various treatment modalities for symptomatic bipartite patella and fracture of bipartite portion of patella are described in literature but traumatic transverse fracture in a bipartite patella and its management is not reported in our knowledge. We present a case of traumatic transverse fracture in a bipartite patella in a 50 year old male. Fixation of the fresh traumatic fracture while leaving bipartite Portion undisturbed resulted in a good functional outcome. Fresh fracture of patella in a previously asymptomatic bipartite patella should be fixed without addressing bipartite portion and surgeon should try to restore pre injury status of patient. Normal opposite knee radiograph does not always rule out the presence of bipartite patella in the limb.
Keywords: Patella, Bipartite, Fracture


References

1. Atesok K., Doral M.N., Lowe J., Finsterbush A. Symptomatic bipartite patella: treatment alternatives. J. Am. Acad. Orthop. Surg. 2008;16(8):455–461.
2. Oohashi, Y., Koshino, T. & Oohashi, Y. Clinical features and classification of bipartite or tripartite patella. Knee Surg
Sports Traumatol Arthrosc 18, 1465–1469 (2010).
3. Dündar U., Solak O., Cakir T. An Usual Painful Bipartite Patella. Eur. J. Gen. Med. 2009;6:52–54.
4. Weaver J.K. Bipartite patellae as a cause of disability in the athlete. Am. J. Sports Med. 1977;5(4):137–143.
5. Green W.T., Jr Painful bipartite patellae. A report of three cases. Clin. Orthop. Relat. Res.1975;(110):197–200.
6. Halpern A.A, Hewitt O. Painful medial bipartite patellae: a case report. Clin. Orthop. Relat. Res.1978;(134):180–181.
7. Saupe H. Primäre Krochenmark serelung der kniescheibe. Deutsche Z Chir. 1943; 258:386-392(In German).
8. Bourne MH, Bianco AJ Jr. Bipartite patella in the adolescent: Result of surgical excision. J Pediatr Orthop. 1990; 10:69-73.
9. Kavanagh EC, Zoga A, Omar I et al. MRI findings in bipartite patella. Skeletal Radiol.2007; 36:209–2148.
10. Mori Y, Okumo H, Iketani H, Kuroki Y. Efficacy of lateral retinacular release for painful bipartite patella. Am J Sports Med. 1995;23:13–18.


How to Cite this Article: Jaiswal A, Tanwar YS, Chatterji G | Traumatic Transverve Patella Fracturre In A Bipartite Patella – An Unusual Case Report | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 38-40.

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Co-relation Between Cervicothoracic Angle and Neck Pain in Adults

Vol 35 | Issue 3 | September-December 2020 | page: 7-9 | Amit Dwivedi, Vikram Dagar, Shivani Tiwari Dwivedi, Sonam, Fenil Shah


Authors: Amit Dwivedi [1], Vikram Dagar [1], Shivani Tiwari Dwivedi [1], Sonam [1], Fenil Shah [1]

[1] Department of Orthopedics, Santosh Medical College & Hospital, Ghaziabad, Uttar Pradesh, India

Address of Correspondence
Dr. Vikram Dagar,
Postgraduate Student, Santosh Medical College & Hospital, Ghaziabad, Uttar Pradesh, India
E-mail: dr.vikramdagar@gmail.com


Abstract

Introduction: Neck pain is the fourth most common cause of disability after lower back pain, depression, and joint pain. Cervical sagittal balance is as crucial as pelvic sagittal alignment and is related to the concept of T1 alignment.
Methods and materials: An observational cross sectional study was conducted on 235 Patients diagnosed as neck pain and treated at our institute between August 2017 to July 2019 with age between 20-80 years with neck pain complaints and on medication were included in this study. Pain and functional improvements were assessed using visual analogue scale (VAS) and neck disability index (NDI). Standing lateral view and standing swimmers lateral view of cervical spine radiographs were taken and studied for evaluating cervicothoracic parameters T1 slope and SVA (Saggital Vertical Axis) C2-7, following neck pain and compared with normal ranges. Variations of these criteria have been reported along with the scores of the questionnaire. Statistical analysis was carried out using the edition 21.0 of the Statistical Package for Social Sciences (SPSS).
Results: After analysis, it was found that the average T1 slope was 27.82 + 14.33, the average male T1 slope was 26.74 + 14.21 and the average female T1 slope was 28.56 + 14.42. According to Sang et al average T1 slope is 25.7.5 + 6.4 which was taken as a reference for comparison with the asymptomatic population, our study had an increased value but was not significant.
Conclusions: The pain in the neck increases with age. It is more prevalent in females. Study shows an increase in neck pain with increasing age due to degenerative changes in the T1 slope, SVA C2-C7. There is no significant correlation with cervical and neck pain or disability but a good relationship between the two. There was no substantial difference in cervical curve between symptomatic and asymptomatic patients.
Keywords: Neck Pain; Cervical Pain; Cervicothoracic Junction; T1 Slope.


References

1. Murray JL et al. US Burden of Disease Collaborators. The state of US health, 1990- 2010: burden of diseases, injuries, and risk factors. JAMA 2013;310: 591-608.
2. Yang H, Haldeman S, Nakata A, Choi B, Delp L, Baker D. Work-related risk factors for neck pain in the US working population. Spine (Phila Pa 1976) 2015;40:184-92.
3. Gore D, Sepic S, Gardner G. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986;11:521-4.
4. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J 2007;16:669-78.
5. Brattberg G, Thorslund M, Wikman A. The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain 1989;37:215–22.
6. Endo K et al (2016) “Relationship among cervical, thoracic, and lumbopelvic sagittal alignment in healthy adults”: Journal of Orthopaedic Surgery 2016;24(1):92-6
7. Guo et al. (2018) “Cervical lordosis in asymptomatic individuals: a meta- analysis”: Journal of Orthopaedic Surgery and Research (2018) 13:147
8. Gore DL et al. (1986) “Roentgenographic findings of cervical spine in asymptomatic patients”: spine ;volume 11, number 6 :1986.
9. Yang et al (2011) “Relation between alignments of upper and subaxial cervical spine: a radiological study”: Arch Orthop Trauma Surg (2011) 131:857–862.
10. Nojiri K et al (2003) “Relationship between alignment of upper and lower cervical spine in asymptomatic individuals”: J Neurosurg (Spine 1) 99:80–83, 2003
11. Sang Hun Lee, Eon Seok Son, Eun Min Seo, Kyung Soo Suk, Ki Tack Kim. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J 2013;5(4):705-12.
12. Guo et al. “Cervical lordosis in asymptomatic individuals: a meta- analysis”: J Ortho Surg Res 2018;13:147.
.


How to Cite this Article:  Dwivedi A, Dagar V, Dwivedi ST, Sonam, Shah F | Co-relation Between Cervicothoracic Angle and Neck Pain in Adults | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 7-9.

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Starvation in The Midst of Plenty: Are we Orthopaedic Surgeons Smart Enough?

Vol 35 | Issue 3 | September-December 2020 | page: 1- 2 | Kumar Keshav


Authors: Kumar Keshav [1]

¹Department of Orthopaedics, SGPGI, Apex Trauma Centre, Luknow, UP, India.

Address of Correspondence:
Dr. Kumar Keshav,
Assistant Professor, SGPGI, Apex Trauma Centre, Luknow, UP, India.
E-mail: keshav4700@yahoo.co.in


Starvation in The Midst of Plenty: Are we Orthopaedic Surgeons Smart Enough?

“Water water everywhere, nor any drop to drink”, lines from the classic poem ‘The rime of the ancient mariner’ by Samuel Taylor Coleridge can be compared to the present scenario of orthopaedic surgeons in large parts of the world. Many amongst us are currently having ample amount of time at our disposal, but do not know how to utilize it.
Before the onset of COVID 19 pandemic, we were, generally speaking, quite a busy lot looking at the broken bones or an arthritic joint or a torn ligament or a prolapsed disc – and fixing them up. We had forgotten that other domains of medicine too exist (pun intended), a trait due to which we have often been hilariously labelled as Arjuna, who saw nothing but the eye of the bird. The pandemic and the measures taken thereafter to channelize the resources towards COVID care has brought severe disruption of orthopaedic and trauma services [1]. We are doing our best to tide over the pandemic. Some amongst us, who are at managerial positions of the hospitals/institutes, are looking after the logistics of COVID care while others are taking clinical care of the COVID-19 patients when their turn comes as per rotation policy. If we talk of orthopaedic services, it has resumed partially at some places. Even after resumption of orthopaedic clinical services in many hospitals, it is still far from what it was pre-pandemic [2]. Consequently, most amongst us are having a feeling that we have become less productive. The management of patients have become a bit tedious starting from changing the hospital set-up, creating different teams, getting COVID RT-PCR before any surgery, use of special protective equipments and despite all these, we are not getting the satisfaction that we were used to. Satisfaction is, no doubt, the greatest pleasure. So, the big question is how to feel most satisfied in the present scenario. There are three aspects which gives us orthopaedicians ‘Ikigai’ (reason for being)- clinical work, academics (teaching and training) and research [3]. But, the majority of us, especially in India are focused on the clinical orthopaedic work only- again something akin to Arjuna and the parrot’s eye. It’s high time to ask ourselves the question- “Have we moved too close to the tree that we have lost sight of the forest?”

If we zoom out a bit, we can see that the orthopaedic surgery, as a speciality stands on the three pillars, as mentioned above. But, this whole structure rests on the survival of the humankind (human beings considered collectively) itself (Figure 1). So, at this time, our first responsibility is to protect the base of our building which is being threatened by the COVID-19. We should not shun away from our responsibilities and hence get involved in the management of COVID-19 patients to the extent of our training and competence. We need to change the hospital infrastructure based on the guidelines given by major orthopaedic associations to improve the clinical services- the pillar, hitherto we were most focused at [4]. And despite that, if we have plenty of time at our disposal, rather than wasting it in contemplating about the future, we should utilize it to strengthen the other two pillars of academics and research. No doubt, we are trying our best to act smartly. The daily webinars related to orthopaedics and COVID-19 from various platforms can indeed be a great substitute of the conventional classrooms and meeting halls that we are used to. The publications have seen a tremendous rise in these times [5]. It’s high time to update ourselves in orthopaedic knowledge, gain insights into some related fields like biostatistics, technology, computing, etc and develop new skills from the confines of home. We can involve ourselves in research, which has often been neglected and that which is not allowing us to gain orthopaedic excellence and leadership. Contrary to what most of the Indian orthopaedicians think, not all the research has to be original clinical research. Secondary research like systematic review and meta-analysis, or primary research from the pool of data that we already have can be best done to quench our thirst of Orthopaedic Ikigai. Of course, there is water (time) everywhere and it can be used to quench our thirst, provided we know how to desalinate and purify it (do our part with responsibility to contain the pandemic and focus on academics and research).


References

1. Rolling updates on coronavirus disease (COVID-19). Updated 01 June 2020. Accessed on 06 June 2020. Available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
2. Keshav K, Kumar A, Sharma P, Baghel A, Mishra P, Huda N. How Much has COVID-19 Pandemic Affected Indian Orthopaedic Practice? Results of an Online Survey. [published online ahead of print, 2020 Aug 4]. Indian J Orthop. 2020;1‐10. https://doi.org/10.1007/s43465-020-00218-z
3. Alliance of International Organizations of Orthopaedics and traumatology. COVID-19 Best Practices Joint Statement. Accessed on April 27, 2020. Available at: https://www.apoaonline.com/pdf/aiot-jointstatement.pdf
4. Chhabra HS, Bagaraia V, Keny S, et al. COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons [published online ahead of print, 2020 May 18]. Indian J Orthop. 2020;1‐15.
5. D’Ambrosi R. Orthopedics and COVID-19: Scientific Publications Rush [published online ahead of print, 2020 May 25]. Indian J Orthop. 2020;1-7. doi:10.1007/s43465-020-00141-3.


How to Cite this Article: Keshav K | Starvation in The Midst of Plenty: Are we Orthopaedic Surgeons Smart Enough? | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 1-2.

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Achilles Tendinopathy: Functional Results In Patients Treated With Eccentric Exercises, Air Heel Brace And A Combination Of Both

Vol 35 | Issue 3 | September-December 2020 | page: 21-27 | Vikram Sharma, Vivek Chandak


Authors: Vikram Sharma [1], Vivek Chandak [2]

[1] Professor in Orthopaedics, KD medical college and hospitals, Mathura, UP, India.
[2] Senior Resident in Orthopaedics, KD medical college and hospitals, Mathura, UP, India.

Address of Correspondence
Dr. Vivek Chandak,
Senior Resident in Orthopaedics, KD medical college and hospitals, Mathura.
E-mail: drvivekchandak@gmail.com


Abstract

Background: To compare eccentric training, AirHeel Brace and the combination of eccentric training with the AirHeel Brace for the management of tendinopathy of the main body of the Achilles tendon.
Methods: 108 patients were randomly assigned to 1 of 3 treatment groups: (A) Eccentric training, (B) AirHeel brace, and (C) Combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 24 weeks after the beginning of the treatment protocol with visual analog scale (VAS) for pain and Revised Foot functional Index (FFI-R) for functional improvement.
Results: The VAS score for pain, FFI-R improved significantly in all 3 groups at all 3 follow-up examinations. Group C had significantly better results than the other two groups.
Conclusion: The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is synergistic effect when both treatment strategies are combined.
Keywords: Achilles tendon, Achilles tendinopathy, AirHeel brace, Eccentric training, Tibia.


References

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6. Petersen,W;Welp,R;Rosenbaum,D:chronicachillestendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the airheel brace, and a combination of both. The Am J Sports Med, 2007 Oct;35(10):1659-67
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How to Cite this Article:  Sharma V, Chandak V | Achilles Tendinopathy: Functional Results In Patients Treated With Eccentric Exercises, Air Heel Brace And A Combination Of Both | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 21-27.

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Minimally Invasive Technique For Delayed union Or Nonunion #Tibia: The Use Of Percutaneous Autologous Bone Marrow Injection

Vol 35 | Issue 3 | September-December 2020 | page: 3-6 | Aman Saini, Sumit Kumar, Himanshu Bansal, Sanjeev Sareen


Authors: Aman Saini [1], Sumit Kumar [1], Himanshu Bansal [1], Sanjeev Sareen [1]

[1] Department of orthopaedics, Govt. Medical college and Hospital, Patiala, Punjab, India.

Address of Correspondence
Dr. Sumit Kumar.
Department of orthopaedics, Govt. Medical college and Hospital, Patiala, Punjab, India.
E-mail: sumitsjh@gmail.com


Abstract

Context: Fracture heals by a specialized process in which bone regenerates by restoring the integrity of skeletal tissue. In non-union fracture healing cascade has ceased and it’ll not progress without an intervention. Autologous bone marrow grafts are regarded as gold standard for treating non-unions. Recently there has been a trend a towards lesser invasive techniques in which bone marrow can be aspirated from iliac bone by aspiration needle and is administered percutaneously at non union site.
Material and Methods: 30 cases of post-traumatic delayed union and non-union of fracture tibia with internal fixation having abnormal mobility without infection were included in the study. Baseline RUST scoring was calculated for each fracture and bone marrow aspirate injections were given at fracture site by percutaneous route.
Result: On the premise of final RUST and clinical analysis, union in 23(76.67%) fractures was achieved by autologous bone marrow injections by percutaneous route whereas 7(23.33%) cases did not responded even after three attempts of procedure. The complications of the procedure are negligible and it is safe. The mean time of radiological union in our study was fourteen weeks with a range of 11-22 weeks.
Conclusion: On the basis of our results and observations within the study we are able to conclude that autologous bone marrow injection is an efficient method compared to traditional open bone grafting with less invasive technique and be performed as out-patient procedure undern local anesthesia. It is cheap and safe with negligible complication rate at donor or recipient graft site.
Keywords: Non-Union, Fractures, Autologous, bone marrow, Tibia.


References

1. Thompson Z, Miclau T, Hu D, Helms JA. A model for intramembranous ossification during fracture healing. Journal of Orthopaedic Research 2002 Sep;20(5):1091-8.
2. Beck BR, Matheson GO, Bergman G, Norling T, Fredericson M, Hoffman AR, et al. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. The American journal of sports medicine. 2008 Mar;36(3):545-53.
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4. Brashear HR. Diagnosis and prevention of non-union. JBJS. 1965 Jan 1;47(1):174-8.
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6. Frölke JP, Nulend JK, Semeins CM, Bakker FC, Patka P, Haarman HJ Viable osteoblastic potential of cortical reamings from intramedullary nailing. Journal of orthopaedic research. 2004 Nov;22(6):1271-5.
7. Guttarlapalli PG, ChallaS .Outcome of percutaneous bone marrow injection in delayed union and nonunion of long bone fracture. International Journal of Orthopedics;.2017: 16-19.
8. Gross JB, Diligent J, Bensoussan D, Galois L, Stoltz JF, Mainard D. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Bio- medical materials and engineering. 2015 Jan 1;25(s1):187-97.
9. Upadhyay S, Varma HS, Yadav V. Percutaneous autologous stem cell enriched marrow concentrate injection for treatment of cases of impaired fracture healing with implant in situ: A cost-effective approach in present Indian scenario. J Orthop Allied.2015;2016:18-29.
10. Sarmiento A. On the behaviour of closed tibial fractures:clinical/radiological correlations. Journal of orthopaedic trauma. 2000 Mar 1;14(3):199-205.
11. Phemister DB. Treatment of united fractures by onlay bone grafts without screw or tie fixation and without breaking down of the fibrous union. J bone koint Surg 1947; 29:946-60.
12. Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AH. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone & joint research. 2016 Apr;5(4):116-21.
13. Whelan DB, Bhandari M, Stephen D, et al. Development of the radiographic union score of tibial fractures for the accessment of tibial fractures healing after intramedullary fixation. J trauma 2010;68:629-32
14. Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injection for delayed or non-union of bones.21 J Orthop Surg.2013;21(1):60-4.
15. Padha V, Mahajan N, Kalsotra N, Salaria A, Sharma S.Role Of Percutaneous Bone Marrow Injection In Delayed Union And Non Union 2009;18:1-8
16. Bhutia KU, Bary AA, Singh AK, Singh AM, Raghuvanshi R, Hmar C. Role of percutaneous autologous bone marrow injection in treatment of delayed union and nonunion of long bones. Journal Of Dental And Medical Sciences. 2015;14:07-13.
17. Sahu R L.Percutaneous autogenous bone marrow injection for delayed union or non-union of long bone fractures after internal fixation.rev bras orthop .2018;53(6):668–673
18. Bhargava R, Sankhla S S, Gupta A, Changani RL,Gagal KC. Percutaneous autologous bone marrow injection in the treatment of delayed or non-union.Indian J Orthop. 2007 Jan-Mar; 41(1): 67–71.
19. Elsattar TA, Alseedy AI, Khalil AA. Bone marrow injection in treatment of long bone nonunion. Menoufia Med J 2014;27:632-5.


How to Cite this Article:  Saini A, Kumar S, Bansal H, Sareen S | Minimally Invasive Technique For Delayed union Or Nonunion #Tibia: The Use Of Percutaneous Autologous Bone Marrow Injection | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 3-6.

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Management And Outcome Of Unstable Intertrochanteric Fracture By Proximal Femoral Nail Versus Proximal Femoral Nail Antirotation In Elderly Patients: A Prospective Comparative Study

Vol 35 | Issue 3 | September-December 2020 | page: 15-20 | Nishant Gandhi, Najmul Huda, Man Mohan Sharma, Sandeep Bishnoi


Authors: Nishant Gandhi [1], Najmul Huda [1], Man Mohan Sharma [1], Sandeep Bishnoi [1]

[1] Department of Orthopaedics, TMMC & RC, Moradabad, UttarPradesh, India.

Address of Correspondence
Dr. Sandeep Bishnoi,
Assistant Professor, TMMC & RC, Moradabad, UttarPradesh, India.
E-mail: sandeepbishnoi.bishnoi@gmail.com


Abstract

Background: Various treatment modalities for unstable intertrochanteric fractures include osteosynthesis with dynamic hip screws or cephalomedullary nail and arthoplasty in selected cases. However, choice of implant for unstable intertrochanteric fracture is still debatable. Cephalomedullary nails are currently the means of fixation; Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-rotation (PFNA) have their own advantages and disadvantages. The purpose of the present study was to compare the outcome of unstable intertrochanteric fracture by Proximal Femoral Nail versus Proximal Femoral Nail Anti-rotation in elderly patients. Recent literature search gives numerous publications on this topic, but there are very less literatures available in our country which includes combined functional and radiological parameters. The present study may contribute to the existing literature.
Methods: Sixty patients with unstable intertrochanteric fracture classified according to A.O. classification system (AO- 31.A2 & 31.A3) were included and randomized in two groups. Follow up was done for a period of nine months and complications were noted. Functional outcomes were assessed by using Harris Hip Score.
Results: Sixty patients were included in the study out of which, 30 patients were treated with Proximal Femoral Nail (Group A) and 30 with Proximal Femoral Nail Anti-rotation (Group B). The mean age of patients in group A and B was 71.47±4.16 and 70.17±8.96 years respectively. The demographic variables in each group were comparable. There was no significant difference in the mean Harris Hip Score (HHS) among both the groups. All the fractures united. Implant related complications like screw backout was equal in both the groups.
Conclusion: The study showed that there was no significant difference in the functional and radiological outcomes between the two groups. However considering the fact that the geriatric patients may have associated medical co morbidities, the use of proximal femoral nail anti-rotation may be a more viable option as it significantly reduces the duration of surgery and gives less radiation exposure as compared to proximal femoral nail.
Keywords: Intertrochanteric fracture, Elderly patients, Proximal femoral nail, Proximal femoral nail anti-rotation.


References

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7. Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive classification of fractures of long bones. Berlin/Heidelberg: Springer-verlag; 1990.Special section, Femur; p.116-121.
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11. Sharma A, Mahajan A, John B. A comparison of the clinico radiologicaloutcomes with proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in fixation of unstable intertrochanteric fractures. J Clin Diagn Res. 2017 Jul; 11(7):05-09.
12. Mohan NS, Shivaprakash SU. PFNA v/s PFN in the management ofunstable intertrochanteric fractures. J Evol Med Dent Sci. 2015 Mar 23; 4(24):4086-92.
13. Bajpai J, Maheshwari R, Bajpai A, Saini S. Treatment options forunstable trochanteric fractures: Screw or helical proximal femoral nail. Chin J Traumatol. 2015 Dec 1;18(6):342-6.
14. Zeng C, Wang YR, Wei J, Gao SG, Zhang FJ, Sun ZQ, Lei GH. Treatment of trochanteric fractures with proximal femoral nailantirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012 Jun;40(3):839-51.
15. Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, Date K, Shmizu K. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system. Bull NYU Hosp Jt Dis. 2008 Oct 1; 66(4):276-9.


How to Cite this Article:  Gandhi N, Huda N, Sharma MM, Bishnoi S | Management And Outcome Of Unstable Intertrochanteric Fracture By Proximal Femoral Nail Versus Proximal Femoral Nail Antirotation In Elderly Patients: A Prospective Comparative Study | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 15-20.

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