bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistant and Refractory Distal Tibia Non-Union Using an Intramedullary Free Fibular Graft and Ilizarov Fixation – An Illustrative Case Report
Authors:   Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India., Aravind S , Harshavardhan Giriraj ,   Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India., Suryakumar Sundar ,   Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Published: November 2024

Introduction: Resistant and refractory non-union of distal tibia extra-articular fractures is very common even following internal fixation due to poor blood supply to the distal tibia metaphyseal region. The management can be challenging. Case Report: A 50-year-old diabetic male had sustained closed distal tibia extra-articular fracture at the junction of diaphysis and metaphysis. Intramedullary interlocking nailing was done elsewhere. The fracture did not unite. Nail removal, bone grafting, and plate fixation were done elsewhere. The fracture did not unite and implant failure occurred. The nonunion was successfully managed by plate removal, intramedullary free fibula bone grafting, and Ilizarov fixation. Union required 6 months but patient finally was able to return to his work with good function and without any signs of infection. Conclusion: This case illustrates the successful incorporation of a stabilized intramedullary fibula graft which enabled union of a resistant distal tibia fracture nonunion. Keywords: Resistant tibia non-union, avascular fibular strut graft, distal tibia non union, ilizarov fixation
Clostridium Septicum: Cause of Gas Gangrene in the Upper Extremity Leading to Proximal Trans-Humeral Amputation, A Review of Clostridium septicum
Authors:   Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania,, LaGreca Mark , Chen Denise ,   Department of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania,, Frick Patrick ,   Department of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania,, Morway Genoveffa ,   Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania,, Egger Austin ,   Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania,, Mayberry Julia ,   Department of Orthopaedic Surgery, Philadelphia Hand Surgeon PLLC, Lankenau Medical Center, Wynnewood, Pennsylvania.
Published: November 2024

Introduction: Gas gangrene is a rare, often lethal infection of soft tissue that is commonly associated with the Clostridial species due to penetrating injuries. Case reports of spontaneous atraumatic gas gangrene due to the Clostridium septicum species are exceedingly rare. Atraumatic C. septicum is notably related to bowel pathologies, immunodeficiencies, and individuals with vascular insufficiency. The rapid progression of Clostridium myonecrosis contributes to its high mortality rates. Case Report: The authors report a case of a 71-year-old right-hand-dominant female who developed fulminant atraumatic left forearm pain and swelling. The patient was indicated for emergent irrigation and debridement (I&D) of the left upper extremity. She was later found to have C. septicum bacteremia and required multiple I&Ds including the left side of the neck and chest wall. Repeat post-operative examinations revealed no motor function or sensation distal to the elbow and she was subsequently indicated for a proximal trans-humeral amputation. Conclusion: Although she had a prolonged hospital stay, she progressed well and was eventually discharged to a rehabilitation facility. This case report highlights the importance of early recognition of Clostridial myonecrosis as well as the need for emergent surgical intervention for the patient’s survival. Keywords: Trans-humeral amputation, gas gangrene, Clostridium septicum infection.
Femur Fracture in Klippel Trenaunay Syndrome: A Case Report
Authors:   Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India, Parakh Naman K. , Saraf Amit ,   Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India, Habib Hamza ,   Department of Emergency and Trauma Care, All India Institute of Medical Sciences. Gorakhpur, Uttar Pradesh, India, Kumar S. Krishna ,   Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
Published: November 2024

Introduction: Klippel-Trenaunay Syndrome (KTS) is a medical condition that involves the abnormal enlargement of bones and soft tissues, along with the presence of arterio-venous malformations and cutaneous vascular nevus. This is an uncommon condition that is present from birth and affects the blood vessels. There are relatively few documented cases of how to treat fractures in the lower limbs of individuals with this condition. Case report: A 37-year-old Indian male patient presented to our emergency room with a history of trivial trauma resulting from slipping and falling on the floor. From a clinical perspective, there was a bone deformity observed on the right thigh, accompanied by large dilated veins on the affected limb. The radiographs revealed osteoporotic bone with a fracture in the middle third of the right femur, as well as several small calcified masses dispersed throughout the affected lower leg. A Computed Tomography angiography was performed, revealing the presence of developmental venous malformations along with dilated deep and superficial venous channels. The diagnosis of KTS was ultimately confirmed by integrating clinical and radiological observations. The patient had surgical management with closed intramedullary nailing. Subsequent examinations showed strong indications of bone union without any significant complications. Conclusion: The surgical treatment of orthopaedic injuries in patients with KTS has been demonstrated to be linked to higher amounts of blood loss during the operation. In such circumstances, it is essential to do a comprehensive clinic-radiological assessment and careful preoperative planning to effectively treat or prevent surgical problems in these patients. Keywords: Fracture, Femur, Klippel-Trenaunay Syndrome
An Unusual Giant Osteochondroma of Distal Tibia: A Case Report with Literature Review
Authors:   Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,, Jilani Latif Zafar , Ishtiyaq Mohd. ,   Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,, Khurana Shivank ,   Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,, Bhowmik Arindam Kumar ,   Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,, Sharma Nikhil Kumar ,   Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,, Gupta Medha Mani ,   Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
Published: November 2024

Introduction: Benign bone tumors like osteochondroma are common during skeletal maturity occurring usually at the ends of long bones, such as the distal femur, proximal humerus, and proximal tibia. The tumor can occur in sessile or pedunculated forms. Mass lesions occurring around the ankle can lead to chronic pain, pathological fractures, progressive erosion, and scalloping of adjacent bone. This report highlights a case of a progressively enlarging bony swelling around the distal tibia with uncommon radiological and histological presentation managed with en bloc excision. Case Report: A 30-year-old male with 3 years of progressive bony enlargement without any history of significant trauma presented to our tertiary care hospital. The radiological and histological investigations were performed and many varied differentials were proposed. The lesion was provisionally diagnosed to be a case of an uncommon form of osteochondroma and en bloc excision was done. The patient followed up for a period of 6 months and the patient had uneventful recovery with no recurrence. Conclusion: Osteochondromas in the distal tibia are infrequent occurrences among common skeletal tumors. Timely surgical intervention is recommended for symptomatic lesions or those causing compression or mass effects. Keywords: Osteochondroma, distal tibia, benign, tumor, fibular deformation, bizarre parosteal osteochondramatous proliferation.
Unusual Sites of Brodie’s Abscess and the use of Calcium Sulfate Beads: A Case Series
Authors:   Department of Orthopaedic Surgery, AIIMS Kalyani, Kalyani, West Bengal, India,, Sahoo Samrat S , Biswas Mridul ,   Department of Orthopaedic Surgery, AIIMS Kalyani, Kalyani, West Bengal, India,, Kumar Amit ,   Department of Orthopaedic Surgery, AIIMS Kalyani, Kalyani, West Bengal, India,, Sahoo Bismaya ,   Department of Orthopaedic Surgery, AIIMS Kalyani, Kalyani, West Bengal, India,, Mandal Srirupa ,   Department of Anaesthesiology, AIIMS Kalyani, Kalyani, West Bengal, India., Saha Supriyo ,   Department of Orthopaedic Surgery, AIIMS Kalyani, Kalyani, West Bengal, India,
Published: November 2024

Introduction: Brodie’s abscess is one type of subacute osteomyelitis without any sequestrum or any systemic illness. Thorough debridement and removal of sclerotic rim are the mainstay of the treatment. Antibiotic-impregnated calcium sulfate (AICS) beads act as osteoconductive and at the same time, it maintains high antibiotic concentration locally. Case Report: Three cases are presented with unusual sites of Brodie’s abscess without any history of injury, puncture wound, swelling, or fever. All the patients were presented with dull-aching localized deep bony pain. With X-ray and magnetic resonance imaging (MRI) typical findings, it was diagnosed as Brodie’s abscess. All patients went through surgical procedure and AICS beads insertion inside the bony cavity. All the patients were cured of the disease without any discharge or recurrence of pain with well consolidation of the bony void. Conclusion: In chronic localized bony dull-aching pain with normal blood parameters without any systemic illness, investigations such as X-ray and MRI should be done. Meticulous surgical debridement and AICS beads insertion without bone graft may be considered as definitive treatment of Brodie’s abscess. Keywords: Brodie’s abscess, chronic osteomyelitis, antibiotic-impregnated calcium sulfate, calcium sulfate.
An Unusual Case of Early-onset Ankylosing Spondylitis with Predominant Cervical Spine Involvement
Authors:   Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India,, Kumar S Venkatesh , Kapuriya Jalpesh Sureshbhai ,   Department of Anesthesia and Critical Care, Max Hospital Shalimar Bagh, New Delhi, India,, Solankey Rupali Dnyandeo ,   Department of Orthopaedics, ESI-PGIMSR, Basaidarapur, New Delhi, India,, Sathyendra K G ,   Department of Orthopaedics, ESI-PGIMSR, Basaidarapur, New Delhi, India,, Venkatesh Rohini ,   Department of Neurosurgery, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur - 621 113. Tamilnadu, India, Pandian Arun ,   Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India,
Published: November 2024

Introduction: Ankylosing spondylitis (AS) is a chronic, inflammatory disease of the axial spine characterized by the involvement of the spine and sacroiliac (SI) joints. Increasing spinal stiffness and persistent back pain are the most typical symptoms of this systemic illness. The most often affected areas in AS are the lumbosacral spine and the sacroiliac joints. Case Report: We report this uncommon case of a 30-year-old male patient recently diagnosed with AS having an exclusive cervical spine involvement corroborated by X-rays and magnetic resonance imaging. Conclusion: The results of the lumbosacral spine, fingers, chest, and sacroiliac joint examinations were normal. The examination of the sacroiliac joint, lumbosacral spine, chest, and digits was normal. The pain and neck stiffness were partially relieved by pharmacotherapy (NSAIDS) and physiotherapy. This is a rare presentation of AS, the reported literature on such case reports are very rare. Keywords: Recently diagnosed ankylosing spondylitis, young male patient: exclusive cervical spine involvement.
Open Reduction and Internal Fixation with Bone Morphogenetic Protein-2 for Correction of Nonunion Humeral Shaft Fracture with Pseudoarthrosis in the Geriatric Population: A Case Report
Authors:   Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd Spokane, WA 99202, USA,, Tapio Ryan M. , Zhu Kai ,   Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd Spokane, WA 99202, USA,, Frolov David ,   Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd Spokane, WA 99202, USA,, Dolgov Vadim ,   Washington State University, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd Spokane, WA 99202, USA,, Schmitz Miguel ,   Alpine Orthopaedic and Spine, 212 E Central Ave # 365, Spokane, WA 99208, USA.
Published: November 2024

Introduction: Bone morphogenic protein-2 (BMP-2) is a potent growth factor cytokine, with indications for interbody spinal fusion surgery and open tibial shaft repairs due to its osteoinductive properties. Off-label usage of BMP-2 has been documented; however, there are limited studies regarding the efficacy of using BMP-2 in non-union humeral shaft fractures. Case Report: We present a case of a comminuted left humeral shaft fracture with pseudoarthrosis in a 64-year-old woman. Due to the patient’s significant comorbidities, initial fracture management focused on non-surgical intervention with the use of a humeral cuff to correct the fracture. However, the patient’s report of persistent and significant pain and serial radiographs indicating poor healing with a non-union fracture prompted surgical intervention. The patient underwent an open reduction and internal fixation (ORIF) with the application of one pledget of BMP-2 at the fracture site to promote osteogenesis. To the best of our knowledge, there is limited information about the efficacy of using BMP-2 for humeral fractures. Conclusion: Six months following the surgery, radiographs have shown appropriate fracture healing of the left humerus without loosening of hardware and other significant complications. The usage of BMP-2 in this patient has shown to be effective in promoting the healing of her nonunion humeral shaft fracture. Although BMP-2 has typically been FDA indicated for use in lumbar interbody spinal fusion surgery and open tibial shaft repairs, this case demonstrates that BMP-2 can also promote healing of non-union humeral shaft fractures in a safe and effective manner. Keywords: Bone morphogenetic protein-2, humeral fracture non-union, pseudarthrosis, fracture, bone healing.
Pregnancy and Lactation Associated Osteoporosis in a 24-Year-Old Presenting with Multiple Fragility Fractures in the Dorsolumbar Spine: A Case Report and Review of Literature
Authors:   Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India., Gandhi Tejas , Bhilare Pramod ,   Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India., Sancheti Parag ,   Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Published: November 2024

Introduction: Osteoporosis is rare in the young having an incidence of 4.1 per 100,000 person-years and can occur secondary to endocrine diseases, inflammatory disorders, malnutrition or malabsorption syndromes, and medications. Pregnancy and lactation-associated osteoporosis (PLO) should be thought of as one of the causes but is often missed as the diagnosis requires a high degree of suspicion along with X-rays and densitometry which are avoided as far as possible during the peripregnancy period. If missed, it can lead to osteoporotic fractures and disability. Case Report: We report a case of a 24-year-old primigravida presenting with low back pain 4 months after pregnancy having multiple vertebral compression fractures. On initial workup, a diagnosis of osteoporosis was made and causes of secondary osteoporosis were ruled out after radiological and laboratory investigations. A diagnosis of PLO was made after exclusion of other possible causes. The patient was treated with cessation of lactation and medical management in the form of Calcitonin, Teriparatide, Vitamin D, and calcium supplementation. The patient was symptom-free after 12 months. Conclusion: Through this case report, we hope to emphasize that PLO should be considered as a possible etiology in young females with multiple atraumatic fragility fractures presenting in the peri-pregnancy period. Keywords: Pregnancy, lactation, osteoporosis, spinal fractures, antiosteoporotic agents, teriparatide.
Mucoid Degeneration of Posterior Cruciate Ligament – A Case Study
Authors:   Department of Orthopaedics, Apex Superspeciality Hospital, Varanasi, Uttar Pradesh, India., Jha Amit Kumar , Chaubey Ankit ,   Department of Orthopaedics, Apex Superspeciality Hospital, Varanasi, Uttar Pradesh, India., Patel Swaroop ,   Department of Orthopaedics, Apex Superspeciality Hospital, Varanasi, Uttar Pradesh, India., Singh Santosh Kumar ,   Department of Orthopaedics, Apex Superspeciality Hospital, Varanasi, Uttar Pradesh, India., Singh Amit ,   Department of Orthopaedics, Apex Superspeciality Hospital, Varanasi, Uttar Pradesh, India.
Published: November 2024

Introduction: Mucoid degeneration of the cruciate ligament is a well-known entity, but symptomatic lesions are rare. It is even rarer to find symptomatic posterior cruciate ligament mucoid degeneration than the anterior cruciate ligament. Case Report: A 63-year-old male presented to our hospital complaining of posterior knee pain was induced when the knee approached full flexion without episodes of trauma, despite conservative treatment over the preceding 8 months, his symptoms persisted. Physical examination of the right knee revealed on terminal flexion and cross-leg sitting pain get exaggerated. Right knee ROM 0–110° and a further terminal flexion was limited and painful. On ligament examination, posterior sagging and Lachman test were negative, and no clinical finding indicative of ligament insufficiency was noted. Magnetic resonance imaging showed a diffusely thickened posterior cruciate ligament with increased signal intensity on the T2-weighted sequence. A intact PCL fibers were observed with continuous margins from origin to insertion. Based on the patient’s history and the magnetic resonance imaging findings, we suspected mucoid degeneration of the posterior cruciate ligament as the cause of the patient’s symptoms. Since conservative treatment had failed to relieve the symptoms, arthroscopic treatment was indicated. Arthroscopic examination revealed yellowish crumbly tissues along the thickened posterior cruciate ligament. Tension and bulk of the posterior cruciate ligament were well preserved. Curettage of degenerative tissue and decompression of the posterior cruciate ligament resulted in symptom relief without instability of the knee joint. We did a notchplasty of the medial wall and roof to accommodate the posterior cruciate ligament and avoid impingement. Conclusions: Arthroscopic decompression of the posterior cruciate ligament may relieve knee pain and facilitate early return with good functional results. Keywords: Mucoid degeneration of PCL, posterior knee pain, arthroscopic decompression of PCL
Cuff Arthropathy, Scapular Spine Fracture Non-union, and Instability: Open Reduction, Internal Fixation & Simultaneous Reversed Shoulder Arthroplasty – A Case Report
Authors:   Department of Orthopaedics, Shoulder and Elbow Unit, Hôpital de Morges, EHC, 1110 Morges, Switzerland,, Bauer Stefan , Walch Arnaud ,   CHU de Lyon - Groupement Hospitalier Edouard Herriot, 69003 Lyon, France,, Kremer David ,   Department of medicine and Biology – University of Lausanne, Switzerland.
Published: November 2024

Introduction: This article presents a simultaneous operative technique, which allowed to successfully treat a Cuff Tear Arthropathy (CTA), instability and Levy-type III scapular spine fracture non-union with 90°-double plating, humerus-to-scapula grafting and simultaneous reverse shoulder arthroplasty. Case Report: We present a 64year-old woman with previously known cuff arthropathy (2012/53yo). She fell in 2017 (58 years old with minor shoulder disability) before dislocating the shoulder in 2020 (60 years old) with evidence of a medial Levy-type III scapular spine fracture non-union and severe apprehension, unable to anterior elevate her arm more than 90°. She underwent ORIF of a flexed scapular spine with locked 90°-double plating and bone grafting as well as simultaneous lateralized reverse shoulder arthroplasty (RSA) with an excellent outcome at 3.5 years of follow-up (Constant score of 84 points and a subjective shoulder value of 99%). Conclusion: The radiographic sequence suggests an abduction fracture mechanism due to an axial force. RSA with simultaneous locked 90°-double plating with grafting from the humeral head achieved correction and union with an outstanding result despite tensioning the deltoid with a lateralized RSA. To deal with excessive forces, five important practical recommendations are essential: (1) assess the bone stock with a CT-scan, (2) span the scapular spine and acromion with a long superior plate and its screws, (3) use at least two locking screws on either side of the fracture on each plate, (4) avoid stress risers from erroneous drilling, and (5) protection with an abduction sling for 6–8 weeks. Keywords: Scapular Spine fracture, fracture Non-union, open reduction and internal fixation, 90°-double plating, reverse shoulder arthroplasty.
Intertrochanteric Fracture Fixation Using a Traction Table in a Patient with Ipsilateral Above-knee Amputation – A Case Report and Review of Reduction Techniques
Authors:   Department of Trauma and Orthopaedics, Salford Royal Hospital, Salford, Greater Manchester M6 8HD., Patwardhan Shaunak Sandeep , Kempannaor Vijaya Hosahalli ,   Department of Trauma and Orthopaedics, Salford Royal Hospital, Salford, Greater Manchester M6 8HD., Najjar Majed Al ,   Department of Trauma and Orthopaedics, Salford Royal Hospital, Salford, Greater Manchester M6 8HD.
Published: November 2024

Introduction: Although commonly encountered in clinical practice and considered among the “bread and butter” cases in trauma and orthopedics, intertrochanteric fractures of the femur in certain scenarios pose a challenge to the orthopedic surgeon. Good reduction and stable fixation are a key for good outcome, and certain anatomical limitations such as amputations make that difficult to achieve. Ipsilateral above-knee amputation is a scenario where positioning of the patient on an orthopedic fracture table and reduction of the fracture becomes challenging. Case Report: An active 59-year-old female with good functional baseline and ipsilateral above-knee amputation presented with an intertrochanteric fracture of the right proximal femur. The fracture was treated operatively and fixed with a dynamic hip screw (DHS). This case report highlights the technique of positioning of the patient and reduction of the fracture on a traction table using skeletal traction though the amputation stump with a Denham pin connected to the traction device. Conclusion: This technique provides a reliable and stable means of reducing the fracture using skeletal traction through the bone itself and will be helpful to any orthopedic surgeon faced with a similar situation. This report also sheds light on current literature regarding different ways of overcoming the challenge of positioning and reducing intertrochanteric/intracapsular neck femur fractures using the orthopedic traction table in patients with ipsilateral limb amputations. Keywords: Intertrochanteric fracture, above-knee amputation, reduction techniques, traction table
Hydropneumothorax in an Isolated Midshaft Clavicle Fracture
Authors:   Department of Orthopaedic Surgery, Changi General Hospital, Singapore., Mohamad Hasjmy , Zhi Chen Kim Koh ,   Department of Orthopaedic Surgery, Changi General Hospital, Singapore., Socklingam Raj ,   Department of Orthopaedic Surgery, Changi General Hospital, Singapore., Sheng Foong Wei ,   Department of Orthopaedic Surgery, Changi General Hospital, Singapore., King Charles Kon Kam ,   Department of Orthopaedic Surgery, Changi General Hospital, Singapore.
Published: November 2024

Background: Clavicle fractures are the fourth most common fracture. These fractures are either managed conservatively or surgically. Pneumothorax is a rare complication of clavicle fractures and potentially can be missed if this rare complication is not known. Case Report: A 76-year-old female presents with a 2-day history of pain and bruising over the right clavicular prominence following a fall from a standing height. Subsequent radiographs show the development of pneumothorax, despite having no respiratory symptoms. Discussion: Pneumothorax as a complication of isolated clavicle fractures is rare, with no case reports of hydropneumothorax in the literature. We hypothesize that the posterior displacement of the clavicle fragment penetrated the lung pleura resulting in the pneumothorax. We propose routine chest radiographs for patients presenting with clavicle fractures to rule out pneumothorax for the three reasons below. (1) Clinical features of pneumothorax might not be present upon patient’s initial presentation, especially if they are relatively healthy individuals(2) Adequate pre-operative management if the patient is for surgical intervention (3) Assessment of surgical complications if the patient is for surgical intervention as iatrogenic pneumothorax is a potential complication of surgical fixation. Conclusion: Thorough clinical examination and radiological evaluation should be performed with the diagnosis of pneumothorax in mind when a patient presents with a clavicle fracture to ensure early diagnosis and treatment of this life-threatening complication. Keywords: Clavicle fracture, pneumothorax, hydropneumothorax.
Surgical Planning and 3D-Printed Mesh Implant for Effective Bone Gap Management: A Case Report
Authors:   Department of Orthopedics, LTMMC and GH, Mumbai, Maharashtra, India,, Kachare Avinash , Goregaonkar A B ,   Department of Orthopedics, LTMMC and GH, Mumbai, Maharashtra, India,, Purohit Shaligram ,   Department of Orthopedics, LTMMC and GH, Mumbai, Maharashtra, India,, Munde Kishor ,   Department of Orthopedics, Medicover Hospital, Chhatrapati Sambhajinagar, Maharashtra, India,, Renthlei Lalhmingmawi ,   Department of Pathology, LTMMC and GH, Mumbai, Maharashtra, India,, Gaur Bhanupratap ,   BETIC, Mechanical Engineering Department, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India.
Published: November 2024

Introduction: Critical-size bone defects in distal tibial open wounds pose a formidable challenge, requiring interventions that can address osseous reconstruction with less number of surgeries. Current treatment modalities may fall short in achieving optimal outcomes, with respect to early weight bearing due to the inability of the graft to sustain weight, graft-related infections, non-union in large defects, donor site morbidity, and non-availability of bone grafts due to earlier harvest. This case report explores the potential application of a 3D-printed mesh implant to this complex clinical scenario. Case Report: A 38-year-old male, post-road traffic accident, presented with an inability to walk due to fractures of the medial malleolus and distal tibia-fibula with a grade 3b open wound. Initial treatment was done with an external fixator and fibula plating, with the fixator removed after 5 months. The fracture showed atrophic non-union and a 2.5 cm limb shortening at the end of 5 months. Preferring thick flap incisions, the patient operated with a 3D-printed titanium mesh implant with a plate construct. Post-surgery, we followed a non-weight-bearing regime for 1.5 months, progressing to full weight-bearing by 3 months. At 1.5 years, CT scans confirmed good bone integration and ambulation restoration. Conclusion: The use of 3D-printed mesh implants may be a viable option for managing critical-size bone defects in distal tibial open wounds. Porotic nature of mesh implant facilitates bone ingrowth in large gaps. Keywords: 3D-printing, mesh implant, non-union.
Arthroscopic Management of Posterior Ankle Impingement Syndrome – A Case Series
Authors:   epartment of Orthopedics, Shri B M Patil Medical College Hospital and Research Centre, Bijapur, Karnataka, India,, Kembhavi Raghavendra , Chitten Jojin Jose ,   Department of Orthopedics, Al Azhar Medical College and Superspeciality Hospital, Thodupuzha, Kerala, India., Yashwantbahai Ronak Khatri ,   epartment of Orthopedics, Shri B M Patil Medical College Hospital and Research Centre, Bijapur, Karnataka, India,
Published: November 2024

Introduction: Posterior ankle impingement is a common cause of chronic ankle pain. Although nonoperative treatment is initially preferred, there are surgical options if the symptoms are persistent. Minimally invasive arthroscopic procedures reduce surgical trauma and enable an early return to routine activities. Case series: We conducted a study including 6 patients who underwent arthroscopic decompression for posterior ankle impingement. Five of them were female patients and one was a male patient. The pathology varied; one had os trigonum (OT), two had stieda processes (SP), and three had OT with posterior osteophyte complex as part of ankle arthritis. In this paper, we discuss the required clinical approach, preoperative investigations, surgical indications, functional outcomes, and complications of arthroscopic treatment. The patients were followed up for a minimum of 6 months and evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS) , and range of movement (ROM) pre and post-operatively. All the patients reported a significant reduction of pain and an improved ROMs and functional scores at the operated ankles compared to the opposite side. However, one of the patients developed post-operative tingling and numbness at the plantar aspect of the forefoot. Another one developed tingling at the lateral plantar aspect of the foot. One of the patients with SP, had an incomplete excision of the lesion. Conclusion: Ankle arthroscopy is an effective and minimally invasive surgery that has a significant role in managing chronic ankle pain due to posterior impingement that does not respond to conservative management and provides good functional outcomes with minimal complications. Keywords: Ankle arthroscopy, OS trigonum, stieda process, posterior ankle impingement.
Hematoma Block as an Alternate Mode of Anesthesia for Management of Extra-Articular Distal End Radius Fracture with Percutaneous K-Wire Fixation in Emergency Department
Authors:   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India., Toshniwal Raman , Iqbal Md Zafar ,   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India., Ambulgekar Rajesh ,   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India., Ghag Niranjan Sunil ,   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India., Bendale Dhiraj ,   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India., Chaware Sanket ,   Department of Orthopedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India.
Published: November 2024

Introduction: Fractures of the distal end of the radius have a higher prevalence, particularly in older individuals, and typically necessitate a painful procedure of reduction by manipulation. Various regional blocks, including hematoma blocks, are used to manage this pain. Hematoma block is simple, effective, and safe, providing adequate analgesia without increasing post-procedural infection risks. Materials and Methods: This prospective study was conducted to observe and analyze the outcomes of 18 patients, aged from 18 to 65 years, who had displaced fractures in the distal end of the radius. These fractures were treated using percutaneous pinning under a hematoma block. The study measured the time from trauma to surgery, time for hematoma block administration, surgery duration, Visual Analog Scale (VAS) scores for pain preoperatively, intraoperatively, and postoperatively, reduction quality, and functional outcome using Mayo Wrist score and complications if any. Results: The time from trauma to surgery was 31.44 ± 9.25 h. Hematoma block administration took 3.45 ± 1.34 min, and surgery duration was 29.16 ± 5.33 min. Pre-operative VAS was 6.39 ± 1.09, intraoperative VAS was 0.94 ± 0.54, and post-operative (3 h) VAS was 2.06 ± 0.80. The average pain-free duration postoperatively was 9.36 ± 3.21 h. Quality of reduction was excellent in 44.44% of cases and good in 38.89% of cases. Patients were discharged on average 4.19 ± 0.82 h after surgery. The functional outcome as noted by the Modified Mayo wrist score was excellent in 55.55% and poor in only 5.55% of cases. Discussion: The hematoma block demonstrated effective post-operative pain control, comparable to the brachial plexus block. It provided significant perioperative pain relief, reduced hospital stay, and allowed for outpatient or daycare surgery. Conclusion: Hematoma block is a viable alternative for managing extra-articular distal end radius fractures in the emergency department, offering effective pain relief with minimal risk of complications. Further studies are needed to compare its efficacy with other anesthesia modalities. Keywords: Distal end radius fracture, hematoma block, percutaneous pinning, Visual Analog Scale score.
Comparison of Percutaneous Versus Open Hamstring Lengthening in Patients of Spastic Diplegic Cerebral Palsy – A Randomized Controlled Trial
Authors:   Department of Paediatric Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India,, Afaque Syed Faisal , Singh Ajai ,   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India,, Agrawal Udit ,   Department of Paediatric Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India,, Chand Suresh ,   Department of Paediatric Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India,, Verma Vikas ,   Department of Paediatric Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India,, Gupta Anil Kumar ,   Department of Physical Medical and Rehabilitation, King George Medical University, Lucknow, Uttar Pradesh, India.
Published: November 2024

Background: Cerebral palsy (CP) often manifests with crouch gait due to hamstring spasticity, necessitating surgical intervention like hamstring lengthening surgery. Percutaneous techniques are emerging as an alternative to traditional open approaches in orthopedic surgeries. Objectives: This randomized controlled trial aimed to compare the outcomes of percutaneous hamstring lengthening (pHSL) versus open hamstring lengthening (oHSL) in pediatric patients with spastic diplegic CP, focusing on improvements in gait and knee function. Materials and Methods: One hundred children diagnosed with spastic diplegic CP were randomized into pHSL (n = 50) and oHSL (n = 50) groups. Surgical procedures were performed using single-event multilevel surgery techniques. Pre-operative and post-operative assessments included range of motion, popliteal angle, gross motor function classification system (GMFCS) score, and gait analysis (functional independence measure [FIM], observational gait scale [OGS], physician gait scale). Statistical analyses were conducted using Statistical Packages for the Social Sciences v25. Results: Both pHSL and oHSL groups showed significant improvements in popliteal angle and GMFCS scores postoperatively (P < 0.001 within each group). However, there were no significant differences between the groups in terms of these outcomes (P > 0.05). FIM, OGS, and physician gait scale also showed comparable improvements between groups (P > 0.05). Conclusion: pHSL is as effective as oHSL in improving gait and knee function in pediatric patients with spastic diplegic CP. The percutaneous approach offers a safe and efficient alternative to traditional open surgery, potentially minimizing muscle damage and promoting quicker recovery. Keywords: Cerebral palsy, hamstring lengthening surgery, percutaneous surgery, gait analysis, pediatric orthopedics.
The Influence of Coccygeal Dynamic Patterns in Ganglion Impar Block for the Treatment of Chronic Refractory Coccydynia
Authors:   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India., Ramesh Dusyant Ram , Murugan Yuvaraja ,   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India., Ganesh A ,   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India., Thavasianantha Krishnavel ,   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India., Sheik Mohideen ,   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India., V Y Ashwin ,   Department of Orthopaedics, Chettinad Hospital and Research Education, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
Published: November 2024

Introduction: Patients with persistent coccygodynia who do not respond to conventional therapies may undergo ganglion impar block (GIB). We looked at how GIB therapy for individuals with persistent coccygodynia affected their coccygeal dynamic patterns. Materials and Methods: Patients with persistent coccydynia with GIB once using a trans-Sacro-coccygeal technique with fluoroscopy supervision were taken up for the study. Out of 14 patients, they were categorized as Group I- mobile coccyx (8 patients) and Group 2- immobile coccyx (6 patients) using static and dynamic coccyx radiographs, based on coccygeal mobility. A visual analog score (VAS) was used to measure pain levels both before and after the intervention (at 1 hour and 2, 4 weeks). A VAS score drop of 50% or more was considered to be a meaningful reduction in pain. Discussion: On every subsequent visit, the VAS scores were considerably lower in both groups, the pre- and post-intervention VAS scores significantly differed between the two groups. In follow-up, there was no significant difference in the scores between the two groups. Conclusion: Normal and immobile coccyges detected by standard and dynamic radiographs of patients with chronic coccydynia appear to be two different coccygeal dynamic patterns that do not affect the treatment outcome in Ganglion Impar Block Keywords: Coccyx, back pain, tailbone, ganglion impar block, coccygeal mobility.
Undocumented Futures: Afrofeminist Conviviality in Chika Unigwe's On Black Sisters' Street
Authors: Allahyari Keyvan
Published: November 2024

Abstract: This article thinks with Chika Unigwe's On Black Sisters' Street (2009) to conceptualise "Afrofeminist conviviality" as a form of resistance that enables repair on two levels. Afrofeminist conviviality offers the possibility of preventing the trafficked sex worker's social death. It also gestures, however provisionally, towards the possibility of flourishing for the subaltern subject outside the liberal, moralist binaries of free will and coercion. On Black Sisters' Street interweaves stories by four undocumented West African women trafficked from Lagos, Nigeria to Antwerp, Belgium. Afrofeminist conviviality can capture something of both the historical weight of resistance and the open-ended trajectory for the undocumented African sex worker towards less violent futures. It thus communicates a sense of becoming that is caring, affirmative, and recuperative, while also being incomplete, irregular, and irreverent. On Black Sisters' Street allows for accounting the reparative possibilities for trafficked sex workers against the sheer cruelty of the global sex market. At the same time, On Black Sisters' Street remains resolute in its hope for the thriving of the trafficked women in their undocumented futures, however unauthorised, informal, and outlawed those may be.
Misreading the Air: Narrative Ambivalence and the Burden of Representation in Dinaw Mengestu's How to Read the Air
Authors: Rotzokou Elena
Published: November 2024

Abstract: This article argues that Ethiopian-American writer Dinaw Mengestu's novel How to Read the Air (2010) generates a narrative and cultural conundrum. It contests mainstream, trauma-riddled depictions of immigrant life while simultaneously conforming to the reductive cultural tropes it criticizes. I approach the notion of the stereotypical "singular" immigrant story, wherein the individual's struggles stand for those of the diasporic community, by drawing on Kobena Mercer's and Stuart Hall's notion of "the burden of representation" as well as Cathy Park Hong's "literature of minor feelings." Situated within an ongoing critical conversation about Mengestu's relationship to diasporic identity and popular migrant stories, this article foregrounds How to Read the Air 's narrative dissonance and departs from the current scholarly discourse, which tends to either interpret Jonas' individual experience as reflective of collective diasporic experience or overemphasize the novel's revisionist self-consciousness. Through close textual analysis, I show that How to Read the Air both masterfully employs irony and falls victim to it. The novel might not ultimately rise above tropes, but its ambivalence blends opposed positions, sentiments, and tones, and in doing so creates a pluralist revisionist narrative that assimilates stereotypes creatively.
On the Confusion Matrix
Authors: Dobson James E.
Published: November 2024

ABSTRACT: Confusion matrices are graphical objects used in machine learning to demonstrate the efficacy of models. They frequently take the form of brightly colored figures adorning scientific reports and technical documents. Guiding readers of these texts through an interpretation of models with their special affordances, such as diagonal lines that draw the eye from one corner to the other, confusion matrices function as graphical arguments. That they instruct interpreters of machine learning how to read the presented methods and models is no surprise, as early forms of these matrices were instrumental to mid-twentieth-century psychological research on teaching children how to read. This essay reconceives of confusion matrices as not only data visualizations but also media objects through the tracing and reconstruction of their material and cultural history.
A Literary Landscape of Istanbul: Possibilities of Interdisciplinary Criticism
Authors: Bell Jameson Kısmet
Published: November 2024

ABSTRACT: This article presents a literary landscape of short expressive ensembles (SEEs) that appeared in Istanbul’s public locations between 2020 and 2023. By documenting the space and time of public literary genres, I follow in the footsteps of twentieth-century literary critics who explored literature in nontraditional locations. I supplement the work of Walter Benjamin, Roland Barthes, Marshall McLuhan, and more recently Katherine Hayles with “linguistic landscaping” methods from sociolinguistics to emphasize three important points about literary genres that are distributed in space and time. First, mapping literary fragments in public locations allows for them to remain in their diverse polysemic habitats rather than conform to book-length collections, the traditional medium of literary studies. Second, linguistic landscaping offers a more robust taxonomy for documenting where, when, and in what material and media writings appear, providing data for further study of diverse topics. Finally, by exploring urban areas for literary genres, we see neighborhoods provide multilingual instances of literature that do not conform to national and monolingual collecting practices. By mapping examples of short genres, this project reveals that urban spaces have their own literary landscapes that are in dialogue with, contribute to, and interrupt our historical and contemporary urban imaginaries.
From Fortress Europe to Border-Filter: Vulnerability, Biopolitics, and the Management of Migration in Greece and the European Union after 2015
Authors: Alexandridis Antonios , Sinatti Giulia , Dalakoglou Dimitris
Published: November 2024

Abstract: Following increased migration flows in 2015, the European Commission (EC) and the Greek government implemented new strategies and legislation to regulate mobility in the EU area. The impact of one of these strategies is especially important. The EC "European Agenda on Migration" was implemented by Greek Asylum Law 4375/2016 and followed up with subsequent legislation. The legislation introduced "vulnerability assessment" as a tool for granting or withholding refugee status based on biopolitical criteria. The border can be seen as a filter that admits, on biopolitical grounds, those supposedly deserving of entry while it excludes those deemed undeserving. The border-filter differs from the perception of Fortress Europe that is popular in activist and other political discourses in much of Europe. The idea of Fortress Europe implies a total absence of migrant mobility and does not correspond to our empirical research findings.
Women on the Move: Prostitution on Syros and Corfu in the Nineteenth Century
Authors: Shoup Rebecca
Published: November 2024

Abstract: Governments across Europe began to implement systems of state-regulated female prostitution during the nineteenth century. Starting in the 1830s, authorities in British-protected Corfu and Greek Syros marshaled the bureaucracy of the modern state to protect public health—both biologically and morally—from the so-called public woman. Women working as prostitutes on both islands were registered with local authorities, inspected regularly, and hospitalized at the discretion of police and health inspectors. Despite moral and legal prescriptions, prostitution in the Greek world was a highly permeable trade. These women, who came from a variety of socioeconomic backgrounds, not only moved into and out of prostitution but also traversed the changing political boundaries of the eastern Mediterranean, living and working among its various port cities. Indeed they were a central component of a transforming yet still integrated region, demonstrating the persistence of a connected Mediterranean world from the early modern into the modern period.
Loss, Lament, and Survival in the Poetry of C. P. Cavafy
Authors: Scott Christopher
Published: November 2024

Abstract: The question of loss and its relation to aesthetic form emerges in poems by C. P. Cavafy that deal specifically with the unacknowledged losses suffered by lives on the sexual margins, for whom the challenge of survival takes shape under punitive social forces. Finding in Greek literary tradition the aesthetic potential to manage what is unmanageable about loss under the historical conditions of modernity, Cavafy has recourse to the poetry of lament to reimagine the work of living with enduring loss. Cavafy's revisions to the poetry of lament facilitate the process of grieving for same-sex desiring subjects, especially when one does not know precisely what or how much has been lost. A number of these poems articulate new forms of pleasure that become possible in the aftermath of loss, thus proposing sensual pleasure as a mode of survival.