bluuebunny/crossref_metadata_2025 huggingface dataset:
Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?
Authors: Karamian Brian A. , DiMaria Stephen , Lambrechts Mark J. , D’Antonio Nicholas D. , Sawires Andrew , Canseco Jose A. , Kaye I. David , Woods Barrett I. , Kurd Mark F. , Rihn Jeffery A. , Lee Joseph K. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: June 2022

Study Design:

Retrospective cohort study.

Objective:

The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS).

Summary of Background Data:

In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear.

Materials and Methods:

Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and −2° (neutral group), and −2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at P < 0.05.

Results:

There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease (P = 0.282), instrumentation failure (P = 0.196), pseudarthrosis (P = 0.623), or revision surgery (P = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = −6.45 [−11.03- −1.83], P = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients (P = 0.024).

Conclusions:

The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index.

Level of Evidence:

III
Does cranial incidence angle have a role in the tendency toward cervical degenerative disc disease?
Authors: Er Uygur , Şimşek Serkan
Published: June 2022

Purpose:

The purpose is to investigate if a correlation existed between the frequency of cervical degenerative disc disease occurrence and cranial incidence (CI) angle.

Materials and Methods:

A retrospective analysis of case series. Sagittal parameters of the case series were compared with the sagittal parameters of the same number of consecutive patients with neck pain only but no cervical degenerative disc disease (CDDD). Moreover, CI angle values were noted to be significantly different among groups on variable-based examination. Furthermore, the cervical lordosis (CL) values of men were observed to be significantly different. Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

Results:

No intergroup differences were noted regarding gender and age distribution (p = 0.565; p = 0,498). A significant intergroup difference was observed regarding CS values and the mean vector of CI angle and CL values for men and women (p = 0.002). CI angle values were noted to be significantly different among groups upon variable-based examination (p < 0.001). The CL values of men were observed to be significantly different, but not the CL values of women (p = 0.850). Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis.

Conclusions:

A reverse correlation between CI angle and CDDD development is demonstrated. This correlation is valid between CL and CDDD development. Therefore, cervical sagittal profile and the CI angle and CL measurements should be performed to follow-up patients with cervical pain.
Translaminar screw of C1 for the reinforcement of subaxial cervical spine reconstruction
Authors: Carelli Luis E. , Girão Alderico , Cabrera Juan P.
Published: June 2022

Translaminar screws in the cervical spine have been mostly employed at C2 level when conventional trajectories are challenging. However, reports in the literature of translaminar screw of C1 are remarkably anecdotal. We aimed to report a case using C1 translaminar in addition to C1 lateral mass screws for the reinforcement of subaxial cervical spine reconstruction. We present a 22-year-old female patient, who developed persistent cervical pain, and computed tomography scan demonstrated lytic lesions of the vertebral bodies and lateral masses from C3 to C6. Magnetic resonance imaging showed spinal cord compression without myelopathy. Surgical biopsy was inconclusive, and an oncological vertebral instability led to surgical stabilization. Laminectomy and bilateral facetectomy of levels involved was achieved, instrumentation from C1 to T3 and reconstruction with posterolateral fibula bilaterally, and without occipital fixation. A third satellite rod was placed using C1-2–7 translaminar screws. Translaminar screw of C1 is a feasible alternative for increasing the strength of the construct.
An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures
Authors: Jain Amit Kumar , Tawari Manish , Rathore Lavlesh , Sahana Debabrata , Mishra Harshit , Kumar Sanjeev , Sahu Rajiv Kumar
Published: June 2022

Objective:

Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique.

Materials and Methods:

This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology.

Results:

The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure.

Conclusions:

Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.
Aspergillus spinal epidural abscess
Authors: Rashid Mohammad Humayun , Hossain Mohammad Nazrul , Ahmed Nazmin , Kazi Raad , Ferini Gianluca , Palmisciano Paolo , Scalia Gianluca , Umana Giuseppe Emmanuele , Hoz Samer S , Chaurasia Bipin
Published: June 2022

Aspergillus spinal epidural abscess (ASEA) is a rare entity that may mimic Pott's paraplegia as it commonly affects immunocompromised patients. We present one institutional case of ASEA with concomitant review of the literature. A 58-year-old female presented with intermittent low back pain for 10 years recently aggravated and with concurrent spastic paraparesis, fever, and weight loss. Emergent magnetic resonance imaging (MRI) showed T11–T12 epidural abscess with discitis and osteomyelitis. After empirical treatment with antibiotics, computed tomography-guided, percutaneous biopsy with drainage was performed, showing granulomatous tubercular-like collection. Antitubercular therapy was initiated, but after 1 month, the patient's condition deteriorated. Repeat MRI showed growth of the spinal epidural abscess with significant cord compression and vertebral osteomyelitis. T11–T12 laminectomy and tissue removal were performed with a posterior midline approach. Tissue histopathology showed necrotic debris colonies of Aspergillus spp. Antifungal therapy was started, and the patient rapidly improved. ASEA may mimic Pott's disease at imaging, leading to immediate start of antitubercular treatment without prior biopsy, leading to severe worsening of patients’ clinical status. Cases of ASEA should be considered at pretreatment planning, opting for biopsy confirmation before treatment initiation so to prevent the occurrence of fatal infection-related complications.
Incidence of recurrent lumbar disc herniation
Authors: Mariscal Gonzalo , Torres Elena , Barrios Carlos
Published: June 2022

Background:

Recurrent disc herniation is a common condition that often results in months of disabling symptoms and additional costs.

Objective:

The objective of this study was to investigate the incidence of recurrent disc herniation in patients treated surgically.

Materials and Methods:

Clinical trials and prospective studies involving patients treated with different techniques, such as open, percutaneous, or microendoscopic discectomy, were included. The incidence of recurrence as well as the level and the time until the recurrent disc herniation was collected.

Results:

Thirteen studies were included. Recurrence of disc herniation ranged from 0% to 14% of patients. Most recurrences occurred at the same level of herniation and on the same side. The time to recurrence of disc herniation ranged from 1 to 5 years.

Conclusion:

This study answers the question of how much, when, and where in lumbar recurrent disc herniation.
Alternative approach to treatment of unusual site giant cell tumor at cervical spine
Authors: Mousavi Seyed Reza , Rezvani Alireza , Eghbal Keyvan , Motlagh Mohammadhadi Amir Shahpari , Dehghanian Amir Reza , Taherpour Sanaz , Farrokhi Majidreza
Published: June 2022

Giant cell tumor (GCT) is an intermediate malignant bone tumor which mostly involves long extremity bones, less commonly involving the spine with sacral predominance. Cervical spine involvement is rare. According to literature, the selective approach for the treatment of GCT is en bloc resection with spinal reconstruction. For unusual sites, such as cervical region, which is a mobile spinal segment and critically proximate to the cervical spinal cord, great vessels, and vital organs, it is almost impossible to perform the selective approach for treatment. Alternative approaches in such situations are under investigations. We present a case of C2 vertebral body GCT, who was treated with polymethylmethacrylate intravertebral injection and was followed by adjuvant therapy with denosumab. A 16-year-old boy without any past medical history presented with progressive suboccipital and axial neck pain since 3 months earlier, which had not responded to conservative treatments. There was no neurologic deficit, and pain was significantly controlled. In the 1-year follow-up, no complication and tumor recurrence was seen. Vertebroplasty with bone cement for lytic spinal GCT lesions, followed by adjuvant therapy with denosumab, not only is a less invasive treatment but also has good results in spinal stability, patient recovery, and 12-month recurrence.
Ozone disc nucleolysis in cervical intervertebral disc herniation
Authors: Ghatge Sharad Balasaheb , Shah Rohit Pannalal , Surya Nirmal , Sankhala Suresh , Unadkat Chetan Jagjivandas , Khan Gulam M. , Modi Dhaval B.
Published: June 2022

Background:

Inherent complications associated with surgery and limited success of percutaneous minimally invasive procedures make researches wanting for an ideal treatment for cervical disc herniation.

Objective:

We prospectively study the role of ozone disc nucleolysis in cervical intervertebral disc herniation.

Patients and Methods:

From January 2008 to December 2020, we prospectively study 246 consecutive patients of cervical disc herniation treated by a single session of intradiscal injection of ozone–oxygen mixture (ozone disc nucleolysis). There were 55% of females and 45% of males. Age ranged from 28 to 68 years with a mean of 47. The outcome was measured on visual analog scale (VAS) scale and neck disability index (NDI) along with Mcnab method.

Results:

The mean baseline VAS score was 7.87 which became 3.09 at 1 month, 1.42 at 3 months, 1.40 at 6 months, and 1.35 at 1 year. The mean NDI was 36.27 at baseline which improved to 9.24 at 1 month, 6.25 at 3 months, 6.20 at 6 months, and 6.22 at 1 year. This was found to be significant with P < 0.05. Modified McNab criterion showed excellent recovery in 138 (56.10%), good recovery in 50 (20.32%), and fair recovery in 22 (8.94%), resulting in a successful rate of 85.36%. Mediocre recovery was seen in the remaining 36 patients amounting to a 14.64% failure rate.

Conclusion:

This study showed that ozone disc nucleolysis significantly reduces the pain related to cervical disc herniation along with a significant reduction in disability.
Unilateral spacer distraction of the subaxial cervical facet joint for the treatment of fixed coronal malalignment of the craniovertebral junction
Authors: Carelli Luis E. , Girão Alderico , Cechin Ígor , Cabrera Juan P.
Published: June 2022

Introduction:

The standard treatment for a fixed coronal malalignment of the craniovertebral junction is an anterior and/or posterior column osteotomy (PCO) plus instrumentation. However, the procedure is very challenging, carrying an inherently high risk of complications even in experienced hands. This case series demonstrates the usefulness of an alternative treatment that adds a unilateral spacer distraction (USD) to the subaxial cervical facet joint to promote coronal realignment and fusion.

Materials and Methods:

A single-center retrospective study of the patients with fixed coronal malalignment of the craniovertebral junction caused by different etiologies treated with USD in the concavity side with PCO in the convexity side of the subaxial cervical spine. Demographic characteristics and radiological parameters were collected with special emphasis on clinical and radiological measurements of coronal alignment of the cervical spine.

Results:

From 2012 to 2019, four patients were treated with USD of the subaxial cervical spine complementing an asymmetrical PCO at the same level. The causes of coronal imbalance were congenital, tuberculosis, posttraumatic, and ankylosing spondylitis. The level of USD was C2–C3 in three patients and C3–C4 in one patient. A substantial coronal realignment was achieved in all four. One patient had an iatrogenic vertebral artery injury during the dissection and facet distraction and developed Wallenberg's syndrome with partial recovery.

Conclusions:

USD of the concave side with unilateral PCO of the convexity side in the subaxial cervical spine is a promising alternative treatment for fixed coronal malalignment of the craniovertebral junction from different causes.
Massive Splenomegaly as the Presenting Feature of Multiple Myeloma in an Elderly Man
Authors: Mishra Vaibhav , Pandey Abhishek , Goyal Deeksha , Chakrabarti Sankha Shubhra
Published: June 2022

A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib–lenalidomide–dexamethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom's macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.
Health-Related Quality of Life of the Geriatric Population Living in Rural Areas of West Tripura District of India
Authors: Debnath Arpita , Bhattacharjya Himadri
Published: June 2022

Background:

Growing life expectancy is challenging the quality of healthcare for elderly. Information regarding health-related quality of life (QOL) may help policymakers to design need-based health programs for this population.

Objectives:

The objective of this study is to estimate health-related QOL of the geriatric population living in rural areas of West Tripura district and to compare it between ethnic and nonethnic populations with respect to important domains.

Methodology:

This community-based cross-sectional study was conducted between February 1, 2019, and March 31, 2020, among 225 geriatric subjects of rural West Tripura district chosen by multistage sampling. The World Health Organization's QOL–BREF scale was used for data collection.

Results:

Among the study population, 46.2% had overall good health-related QOL. About 52.9% had good QOL in environment, and 37.3% had good QOL in social relationship domains. Marginally higher proportion of the subjects from ethnic origin had better QOL than the nonethnic, but it was not significant. A higher proportion of the Muslim subjects had better QOL than the rest, but it was also not significant. Bivariate analysis showed significant associations between QOL with age, sex, literacy, financial condition, socioeconomic status, and type of family. Multivariate analysis identified male sex, younger age, and living with spouse as the significant predictors of good QOL.

Conclusion:

Overall health-related QOL of the geriatric people living in rural areas of West Tripura district is poor, but younger male subjects of ethnic origin and living with spouses may enjoy relatively better QOL.
Lethologica in aging
Authors: Girija P. C. , Shahal N. P. , Narayanan Nayana
Published: June 2022

Introduction:

Lethologica is a phenomenon that is an early sign of aging. Lethologica refers to the inability to retrieve a specific word as a response to a visual, auditory, or tactile presentation.

Need:

Even though it is known that aging has a strong impact on cognitive language functions, it is not yet clear which aspect is most affected. Since naming is an important element of language functions, analysis of this aspect would aid in understanding the nature of deterioration of cognitive-linguistic functions with age.

Aim:

The aim is to analyze the impact of aging on naming abilities in neurotypical individuals.

Methods:

One hundred and fifty neurotypical individuals of 30 individuals from each group between 30 and 80 years of age, i.e., 31–40 years, 41–50 years, 51–60 years, 61–70 years, and 71–80 years participated in the study. A tool was developed in Malayalam language to assess confrontation naming, responsive naming, generative naming, and contextual naming. A score of 1 was given for each correct response.

Results:

As age advances, all the naming abilities deteriorated. The effect was most prominent in the generative naming task as it demands the most cognitive involvement. The neuronal areas governing these cognitive aspects mainly include the prefrontal cortical regions which are highly susceptible to the aging process. Responsive naming and contextual naming were least affected as it gained the advantage of crystallized intelligence. The age-related decline is more prominent after the age of 60 years.

Conclusion:

Naming skills, even though being a language element also have strong foundations within the cognitive domain. Hence, any age-related neurobiological alterations can impact naming functions.
Risk Factors for Falls in Older Adults with Cognitive Impairment
Authors: Saini Mamta , Subramanian Manicka Saravanan , Soni Nidhi , Singh Vishwajeet , Chakrawarty Avinash , Chatterjee Prasun , Dey Aparajit Ballav
Published: June 2022

Background:

Falls are one of the leading causes of disability among older people. The risk factors of falls widely vary among the older populations, including the different stages of cognitive impairment. We aim to identify the risk factors for falls among cognitively impaired older adults.

Materials and Methods:

In a cross-sectional study, older adults attending the memory clinic were screened for falls and their risk factors. A total of 112 subjects who satisfied the inclusion criteria and provided informed consent were subjected to a semi-structured interview and comprehensive geriatric assessment. Cognitive impairment was graded by the Clinical Dementia Rating (CDR). Subjects were divided into fallers and nonfallers. A multivariable logistic regression analysis was done to identify the independent risk factors of falls.

Results:

The prevalence of falls was 39.28% in the study population. Gender (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.21 [0.690–7.117]), body mass index (aOR [95% CI]: 0.89 [0.773–1.028]), socioeconomic status (middle-class aOR [95% CI]: 0.34 [0.077–1.526], lower-class aOR [95% CI]: 2.44 [0.349–17.160]), multimorbidity (aOR [95% CI]: 19.39 [1.043–360.373]), depression (mild aOR [95% CI]: 2.90 [0.896–9.429] and moderate aOR [95% CI]: 4.77 [0.967–23.597]), and impairment in hobbies and home (aOR [95% CI]: 24.78 [6.251–98.294]) part of CDR were the independent predictors of falls.

Conclusion:

Older adults with cognitive impairment are at high risk of falling with definitive risk factors. Regular screening will help to identify older adults at risk of falls and enable fall prevention to reduce morbidity and dependency.
Management of Extra Articular Distal Femoral Fractures with Nail Plate Combination
Authors: Sharma Ashok , Varma Deepak , Vyas Umesh , Bohra Arvind Kumar , Sharma Shiv Bhagwan
Published: June 2022

Background:

Junctional distal femur fractures are considered difficult to unite and often can led to a degree of disability. The incidence of malunion, nonunion, and infection is relatively high in many reported series. In elderly patients, low-energy distal femur fractures can cause devastating injuries, carrying high rates of morbidity and mortality. Operative fixation can be more challenging in comminuted fractures of osteoporotic bones. The management of junctional fractures of the distal femur by using the nail plate combination (NPC) technique can provide stable, well-balanced fixation, allowing for immediate weight-bearing and early mobilization and improve quality of life.

Materials and Methods:

A prospective randomized study including 16 patients with distal femur extraarticular and junctional fractures, was conducted in the department of orthopedic surgery Jhalawar medical college and SRG hospital Jhalawar, from May 2019 to June 2021. There were 9 male and 7 female patients, age range from 43 years to 70 years, with a mean age being 53 years. The average length of follow-up was 18.5 months (12 months to 24 months).

Results:

Patients followed up at 1 month, 3 months, 6 months, annually thereafter. Regular fracture healing was observed in 15 cases. Delayed union seen in 1 case who had infection postoperatively, which was treated with debridement and antibiotics as culture and sensitivity. mild rotational misalignment (~5°) seen in one case and there was no axial misalignment (Varus/valgus angulations) was found in any case. There were no implant failures.

Conclusion:

In our study, functional results trended toward better outcomes in nails plates combinations in terms of knee flexion, early weight-bearing, less union time, and better alignment. NPC system could take the challenges such as poor bone stock, severe comminution both metaphyseal and diaphyseal region.
Predicting Short-Term Outcome of Metal-on-Metal Hip Resurfacing (MOMHR)
Authors: Goyal Amrit , Macaulay William , Geller Jeffrey A , Wang Wenbao , Nyce Jonathon D
Published: June 2022

Introduction:

The aim of this study was to research factors affecting the short-term outcome of metal-on-metal hip resurfacing (MOMHR) and develop a multivariate regression model that may predict outcome.

Materials and Methods:

This was a prospective study of 154 patients who underwent MOMHR and were followed for a minimum of 1 year. Fourteen independent variables (age, gender, diagnosis, co-morbidities, body mass index (BMI), pr-operative Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical component/stiffness (S)/pain (P), short form 12 (SF-12) physical (SP), SF-12 mental (SM), acetabular and femoral component sizes, operative time, and estimated blood loss) were analyzed using correlation and multivariate regression analyses. Multivariate regression model was tested by using an independent cohort for validation.

Results:

Correlation analyses found four variables that significantly influence short term MOMHR outcome. These include comorbidities (C, P = 0.0001), preoperative SF-12 mental (SM, P = 0.0004), BMI (P = 0.0006), and gender (G, P = 0.0454). By multivariate analysis, the subsequent regression model was obtained with an R
2 value of 0.3816: Outcome = G*4.72 [FIGURE DASH] BMI*0.70 [FIGURE DASH] C*0.11 + SM*0.31 + 87.44. The average predicted outcome using this equation did not differ significantly from the observed WOMAC physical function outcome at a minimum of 1 year postoperatively.

Conclusion:

To the best of our knowledge, this study is the first reported multivariate analysis of factors affecting MOMHR and confirms the correlation of some of the previously proposed factors such as gender, BMI, comorbidities, and preoperative function. The multivariate regression equation can be used to predict the short-term outcome of MOMHR.
Combining Proximal Fibular Osteotomy with High Tibial Osteotomy – Is It Better than High Tibial Osteotomy Alone? Comparative Evaluation of Early Outcome
Authors: Baliga Sunil , Tunglut Pausiam , Arya Prashant , Mallick Manabendra Nath Basu
Published: June 2022

Introduction:

Valgisation high tibial osteotomy (HTO) is a widely performed procedure for patients with medial compartment unicompartmental osteoarthrosis knee with varus malalignment of lower limbs. Over the last two decades, medial open-wedge HTO has been more popular than lateral closed-wedge techniques due to multiple advantages. Recently, isolated proximal fibular osteotomy/fibulectomy (PFO) has been advocated as a treatment for medial tibiofemoral osteoarthrosis in young patients. The role of fibulectomy as an adjunct to medial open-wedge HTO has been scarcely reviewed in the literature.

Materials and Methods:

This study is a retrospective comparative evaluation of clinical outcomes between patients undergoing PFO + HTO versus HTO alone. Functional outcome of ten patients in either group was assessed by Oxford Knee Score and Western Ontario and McMaster Universities score.

Results:

Patients undergoing PFO + HTO had a larger degree of angular correction. There were lesser complications related to HTO (no delayed union and nonunion). Furthermore, there was no loss of limb alignment. However, peroneal nerve (transient) palsy was reported in this group. Overall, patients had better pain relief and improved scores in the PFO + HTO group.

Conclusion:

PFO seems to be beneficial (albeit statistically insignificant in our cohort) in medial open-wedge osteotomy by allowing compression and promoting union at osteotomy site, maintaining limb alignment for longer period, and providing bone graft for osteotomy site. We recommend a larger prospective study to study the benefits of PFO + HTO for correction greater than 10°, osteoporosis, iatrogenic fracture of lateral cortex of tibia, and slope correction osteotomies. Care should be exercised while handling the common peroneal nerve during PFO.
Unilateral Upper Extremity Ischemia in a Neonate – A Rare Complication of Prematurity
Authors: Agrawal Alok Chandra , Iyer R Dinesh , Sakale Harshal Suhas , Garg Ankit Kumar
Published: June 2022

Acute limb ischemia in the neonatal period is a rarely reported complication of prematurity and needs a high index of suspicion for early diagnosis and a multidisciplinary approach for its management. Here, we present a case of a preterm baby that developed unilateral upper limb ischemia in the neonatal period and discussed the problems faced in the management of such cases. A 24-day-old male baby was referred to the orthopedics department because of bluish-black discoloration of the right hand and forearm and no active movement in the wrist and hand. The baby was preterm, delivered at 29 weeks of gestation lower-segment cesarean section with a birth weight of 900 g to a healthy mother with no preexisting illness. Although the line of demarcation was just below the elbow joint and conventional wisdom would dictate us to go for a transhumeral amputation, we opted for a below elbow amputation in a bid to save the elbow joint as we could have revised the amputation at a later date if needed. Neonatal acute limb ischemia has been rarely reported and needs a high index of suspicion. Preterm and low birth weight babies are more prone to it. Treatment of such patients depends on the cause of gangrene. Amputation at such young age is psychologically disturbing for the parents. However, it is usually associated with good functional outcomes as the child has not yet learned the use of a limb or developed cortical plasticity in the brain. All attempts should be made to preserve as much joint and physis as possible to have a functional joint with better prosthetic fitting.
Dripping Candle Wax Lesion of the Hand
Authors: Alexander Leon
Published: June 2022

It is essential to consider melorheostosis in the differential diagnosis for patients presenting with soft-tissue swelling, joint contractures, and “dripping candle wax” like hyperostotic lesions on X-rays. Melorheostosis is a sporadic disease with an uncertain etiology. It is often diagnosed incidentally and can affect the bones of the vertebrae, trunk, and upper and lower extremities. It can present with compressive symptoms due to soft-tissue swelling and fibrosis. On the hand, symptoms of median nerve compression or trigger finger may occur. The treatment of this condition is primarily conservative, and surgery is reserved for patients with severe and disabling symptoms.
Functional Outcome of Delayed Surgical Fixation of Capitellar Fractures Treated by Open Reduction and Internal Fixation with Herbert Screw
Authors: Keshkar Sanjay , Barman Riddhideb , Akhtar Mohammad Nasim
Published: June 2022

Introduction:

Capitellar fractures are rare injuries and difficult to manage, especially so if the patient presents late. Treatment is almost always operative. The purpose of this study is to evaluate the functional outcome of capitellar fractures in adults treated by open reduction and internal fixation (ORIF) with cannulated compression headless screws (Herbert screw) with an inadvertent delay of 2 weeks or more.

Materials and Methods:

Twelve patients (4 males and 8 females) of capitellum fracture who were reported after an inadvertent delay of at least 2 weeks, with near-normal elbow range of motion, operated by ORIF with Herbert screw, were studied retrospectively from April 2013 to March 2019. All cases were operated between 2 to 3 weeks of injury. All patients had a follow-up for a mean period of 34 months, and the final functional outcome was assessed using Mayo Elbow Performance Index (MEPI) and by radiology.

Results:

The mean MEPI score was 92.9 points, and as per this evaluation of the functional rating, all but one patient had excellent results. The mean range of elbow flexion/extension was 125 (90–140), while the range of movement in supination/pronation was 170 (130–180).

Conclusion:

ORIF of capitellum fractures with Herbert screw was found to be superior and gives excellent result, even with a delay of around 2 weeks. Preoperative computed tomography is helpful not only to know clear picture of fracture configuration but also to choose right surgical approach and right implant. Apart from stable internal fixation, early mobilization and rehabilitation are the keys for optimum functional outcome.
Bilateral Bunionette in Rheumatoid Arthritis
Authors: Agrawal Alok Chandra , Garg Ankit Kumar , Garg Deepak Kumar , Ranjan Rahul
Published: June 2022

Introduction:

Tailor's bunion or Bunionette deformities were described by Davies et al. as abnormal, painful bony prominence on the lateral aspect of the fifth metatarsal head. This prominence, though present in many individuals, seldom causes symptoms. Most deformities can be managed conservatively, and surgical interventions will be needed only for refractory cases presenting with chronic pain. Various surgical interventions (percutaneous, mini-open, open), including osteotomies at different level, has been described in the literature.

Case:

A thirty-three-year-old female house-maker presented with swelling over the bilateral fifth metatarsal lateral aspect and pain while walking for the last six months. The patient is a known case of Rheumatoid arthritis controlled on medication. The patient underwent Lateral exostectomy resection for bilateral swelling, At one year follow up, the patient had good functional outcome with no recurrence.

Conclusion:

Tailor's bunion deformity, although morphologically common, is rarely symptomatic. Its management involves identifying the cause, thorough clinical and radiographic evaluation of the deformity, and deciding the best surgical procedure to obtain optimal results.
Prevalence of Osteoporosis in Eastern Odisha – A Cross-Sectional Study of Bone Mineral Density
Authors: Pattnaik Madhuchhanda , Mohanty Tanmoy , Jena Sunil Kumar
Published: June 2022

Introduction:

Osteoporosis is a common metabolic disease of the bone characterized by decreased bone mass and micro-architectural deterioration in bone tissues that results in increased susceptibility to fractures. Osteoporosis is a significant public health problem in many parts of the world, also in India. The primary purpose of the article is to find out the prevalence of osteoporosis in Eastern Odisha through the cross-sectional study of bone mineral density (BMD).

Materials and Methods:

Two thousand and one hundred individuals within the age range of 20–82 years were included in the study. It was conducted between February 2016 and August 2017. The instrument to measure BMD was the Achilles Express Bone Ultradensitometer. Their average BMD was calculated according to T score by using the World Health Organization guidelines for the classification into normal, osteopenic, and osteoporotic. The findings were statistically analyzed. The results were compared with the results of other authors. Statistical analysis was performed using the SPSS software version 16 (IBM Corporation, Armonk, New York USA).

Results:

Prevalence of osteoporosis was found to be 22.4% and osteopenia 37.9%. There was a significant difference in the prevalence of osteoporosis between premenopausal and postmenopausal women.

Conclusion:

In India, no centralized data are available to show the prevalence of osteoporosis. This study was an effort to find out the prevalence of osteoporosis in Eastern part of Odisha, India. Ultrasonic heel densitometry is a safe and noninvasive method for the assessment of BMD to diagnose and assess the osteoporotic individuals so that adequate steps can be taken in them to prevent fracture and other complications of osteoporosis.
Hybrid External Fixator for Correction of Genu Valgum in an Adult
Authors: Mohanty Tanmoy , Pattnaik Madhuchhanda , Sethy Gopal Chandra , Jee Rabi Narayan
Published: June 2022

Sometimes genu valgum in an adult poses a challenge to orthopedic surgeons because the deformity is very gross if it developed due to injury or infection in early childhood. If the femoral condyle is found to be hypoplastic, then the corrective osteotomy site is very close to the joint. It may be difficult to manage with a conventional fixator and a hybrid fixator may become a necessity. A limb reconstruction system (LRS) is less cumbersome than ring fixators when fixed to the thigh. A hybrid fixator fabricated using a twin-ring Ilizarov system attached to an LRS was found to be very useful during the management of corrective osteotomy of genu valgum in an adult. A special clamp was designed to fix the Ilizarov portion to the end of the rail system of LRS. Here, the use of such a hybrid fixator to correct the deformity of the right knee in a 27-year-old person has been described in detail.
The Dimensions of Pronator Quadratus and Its Neurovascular Structures – A Cadaveric Study with Its Clinical Implications in Distal Forearm Surgeries
Authors: Ramalingam Sudha , Somanath Deepa
Published: June 2022

Introduction:

The pronator quadratus is one of the deep muscles of the front of the forearm. The neurovascular supply of the muscle is derived from the anterior interosseous nerve and vessels. This muscle is approached in various surgical procedures involving the distal radius. Its nerve can be utilised as a graft in case of peripheral nerve lesions and the anterior interosseous artery perforator flap is used for wrist and hand surgeries. Hence, the anatomy of the muscle and its neurovascular pedicle is needed in orthopedic surgeries.

Materials and Methods:

In this study, 84 upper limbs from 24 male and 18 female cadavers, age ranging from 55 to 78 years, were dissected to study the pronator quadratus muscle and its neurovascular supply in the Department of Anatomy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. Various levels of measurements regarding the length and width of the muscle were considered. The number of branches of its neurovascular structures and their levels of entry into the muscle from various landmarks was measured. The Student t-test was applied to identify the P-value regarding the difference between the subjects.

Results:

No significant differences were observed regarding the measurements of the muscle and its neurovascular structures between male and female cadavers.

Conclusion:

This study can be useful for the surgeries involving the lower part of front of forearm. Since no significant difference was found between the genders regarding the variables, the morphometry of the muscle and its supply can be generalised for both sexes.
A Novel Technique for Posterior Cruciate Ligament Tibial Avulsion Fixation through the Burks and Schaffer Approach
Authors: Vijay Akshat , Bairwa Dinesh Kumar , Goel Rajesh , Gupta Amit
Published: June 2022

Introduction:

Numerous techniques for the treatment of posterior cruciate ligament (PCL) avulsion fractures have been described in literature from closed reduction to definitive fixation, both open and arthroscopically assisted fixation.

Aim:

In this study, we evaluated the clinical and functional outcome after open reduction and internal fixation of tibial avulsion injuries of the PCL using number 5 polyester sutures (Ethicon-Ethibond excel) with Titanium AL (Tit) endobutton (Nebula Surgicals Private Limited, India) through burks and Schaffer posteromedial approach.

Materials and Methods:

It was a prospective study of 22 patients of PCL tibial avulsion fractures; fixed using number 5 polyester sutures with Tit endobutton through burks and Schaffer approach with the patient in the prone position. We included only those patients who had isolated PCL avulsion injuries and came within 12 weeks of injury. The final functional outcome was compared using the Lysholm knee scoring system. Student's t-tests were used for intergroup comparison of Lysholm knee scores before and after surgery.

Results:

The mean follow-up was of 11.9 months, with the loss of two patients in follow-up. Bony union was achieved in all patients within 8–15 weeks (mean-11.6 weeks). The average flexion of 122.8° with full extension achieved in all patients. Slight instability (1+) was noted in four patients. The Lysholm functional score was excellent in 16 patients and good in four patients with an average score of 94.6 ± 4.6.

Conclusion:

Using sutures and endobuttons for PCL tibial avulsion fixation provides secure fixation leading to satisfactory functional and clinical outcomes as well as omits placement of any hardware in joint, thus obviating risk of joint damage and burden of second surgery for removing the implant.
Comparative Analysis of Functional and Radiological Outcome of Proximal Femoral Nail versus Dynamic Hip Screw in Treatment of Intertrochanteric Fractures
Authors: Shukla Rajeev , Pathak Prateek , Choyal Arpit
Published: June 2022

Background:

Intertrochanteric fracture is one of the most common fractures of the hip, especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. This study was done to compare the functional and radiological outcome of PFN with dynamic hip screw (DHS) in treatment of type 31-A2, intertrochanteric fractures.

Materials and Methods:

From June 2019 to June 2021, prospective randomized and comparative study was conducted on the 162 patients of type 31-A2 intertrochanteric fractures of hip who were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris hip score (HHS) and radiological findings were compared at 6, 12, and 24 months postoperatively.

Results:

In our study, out of 162 patients, 77 patients are managed with DHS, while 85 patients are managed with PFN. The average age group of the patients was 61–70 years. In our series, we found that patients with DHS had longer duration of surgery (111 min) and required longer time for mobilization, while patients who underwent PFN had shorter duration of surgery (97 min) and allowed early mobilization. In addition, complications such as DVT, lag screw cutout, shortening, and superficial infection are more in DHS group as compared to PFN group. The patients treated with PFN started early ambulation as they had better HHS in the early postoperative period as well as late postoperative period.

Conclusion:

PFN is better than DHS in type 31-A2 intertrochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight-bearing and mobilization, reduced hospital stay, decreased risk of infection, and decreased complications.
A Retrospective Study to Compare Early Outcomes of Bilateral Total Knee Replacement Done in Single Sitting versus Double Sitting
Authors: Wadhwani Jitendra , Siwach Ramchander , Sihag Ravi , Kamboj Pradeep , Siwach Karan
Published: June 2022

Aim:

We aimed to conduct a study comparing early outcomes of bilateral total knee replacement (BTKR) done in single sitting versus double sitting.

Materials and Methods:

The study included 58 patients who were already operated case of BTKR done in single sitting (sequential BTKR) – Group I (n = 30) and double sitting (staged BTKR) – Group II (n = 27), during time period April 2016 to May 2019. At follow-up, functional outcome in both the groups was assessed by Knee Injury and Osteoarthritis (OA) Outcome Score, Western Ontario and McMaster Universities OA Index score, and Visual Analog Scale scores.

Results:

The mean age in Group I was 64.5 ± 10.52 years and in Group II was 63.92 ± 5.76 years. The mean body mass index (BMI) in Group I was 28.42 ± 1.365 kg/m2, whereas the mean BMI in Group II was 29.19 ± 1.898 kg/m2. The mean length of hospital stay in Group I was 15.23 ± 2.921 days as compared to 23.69 ± 5.259 days in Group II. There was no mortality in both the groups within 90 days after operation in both the groups. There was significantly less requirement of hospital stay in Group I as compared to Group II (P = 0.001, Mann–Whitney U-test).

Conclusion:

We found that the single sitting BTKR is cost-effective and a relatively safe surgery. There was significantly lower length of hospital stay in single sitting BTKR along with no major complication in our study. Thus we advocate BTKR as a single sitting surgery with proper patient selection and preanesthetic workup.
Apelin Association with Hepatic Fibrosis and Esophageal Varices in Patients with Chronic Hepatitis C Virus
Authors: Soliman Lamyaa Abdellatif , Zayed Rania A. , Omran Dalia , Said Fadwa , Darweesh Samar Kamal , Ghaith Doaa Mohamed , Eletreby Rasha , Barakat Mahmoud Salama , Bendary Mahmoud M. , Zaky Doaa Zakaria , Amer Eman , Elmahgoub Iman Rifaat
Published: June 2022

Portal hypertension and esophageal varices complicating hepatitis C virus (HCV)-related chronic liver diseases are some of the most devastating sequelae. Angiogenesis is the hallmark of their pathogenesis. Apelin is one of the recently identified angiogenic and fibrogenic peptides. We studied apelin gene expression, apelin (rs3761581) single-nucleotide polymorphism (SNP), and serum apelin level in patients with chronic HCV, and their association with liver fibrosis and esophageal varices in 112 patients with HCV-related chronic liver disease (40 with liver cirrhosis [LC]/low-grade varices, 33 with LC/high-grade varices, and 39 with fibrotic non-cirrhotic liver/no varices) and 80 healthy control subjects. Real-time polymerase chain reaction was used for apelin gene expression assay and apelin rs3761581 SNP analysis in peripheral blood samples. The serum apelin level was measured by ELISA. Apelin gene expression was undetectable in the studied samples. The SNP analysis revealed a greater frequency of the C (mutant) allele among patients compared with control subjects (P = 0.012; odds ratio, 3.67). The serum apelin level was significantly greater in patients with LC/varices (median, 31.6 ng/L) compared with patients without LC/varices (median, 2.9 ng/L; P < 0.001). A serum apelin level cutoff value of 16.55 ng/L predicted the presence of varices, with an area under the receiver operating characteristic curve value of 0.786. A positive correlation was found between serum apelin level and grade of liver fibrosis (r = 0.346, P < 0.001) and portal hypertension (r = 0.438, P < 0.001). In conclusion, the apelin rs3761581-C allele may be associated with the progression of HCV-related chronic liver disease and varices formation, and can be considered a potential therapeutic target to control fibrosis progression. The serum apelin level provided an accurate prediction of the presence of esophageal varices.