bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Complex Nonunion of Long Bones by Distraction Osteogenesis Using Monorail Fixator
Authors: Khan Azad , Ahmed Parwez , Tomar Vishvendra , Gupta Rahul Kumar , Siddiqui Areeb Ali , Adnan Mohd 
Published: June 2024

Abstract

Background:
Treatment of complex nonunion is tough in the context of previous surgeries, recurrent infection, shortening, bone loss, associated bone deformities, and joint stiffness. Various treatments are available, including the Ilizarov ring fixator which is well established, but poor patient compliance and the bulky fixator push us to conduct another method of bone transport and distraction osteogenesis by monorail fixator. We conducted a study on 26 patients to know the outcome of monorail fixator in the treatment of complex nonunion in terms of rate of union, duration of treatment, and frequency of complications.

Materials and Methods:
The study comprised 26 patients, 22 of whom were male and 4 were female. Majority of cases landing up as complex nonunion were as a result of road traffic accidents. Two-thirds of the patients presenting to us had an infection in the form of discharging sinus or quiescent sinus, while one-third of the patients had aseptic nonunion. Majority of the patients had an external fixator or infected implant at the time of presentation. Corticotomy was done in almost all (96.2%) of the patients.

Results:
Out of 26 patients, treatment was completed in 25 patients, and one patient was lost to follow-up. The mean treatment duration was 11.31 months ranging from 5 months to 21 months. The mean follow-up duration was 12.8 months ranging from 7 months to 22 months. Results were assessed according to the ASAMI scoring system. Bone results were excellent in 19 (76%), good in 3 (12%), fair in 2 (8%), and failure in 1 (4%) cases. Functional results were excellent in 20 (80%), good in 2 (8%), and fair in 2 (8%). One case was declared a failure. Pin tract infection was the most common complication. Other complications encountered were pain during distraction, pin loosening, and joint stiffness. There was no significant angular deviation (>15°) in any case. Neurovascular complications, joint subluxation, or fracture of regenerate was not seen in any of the cases. Delayed maturation of the regenerate was dealt with by slowing or stopping the distraction for some days.

Conclusion:
It is concluded that the limb reconstruction system (LRS) (monorail fixator) is less bulky and relatively simple to apply, patient compliance is very good, operating time is considerably less, and no preoperative frame assembly is required. Good patient satisfaction, less pain during bone transport, less fluoroscopy exposure, and easy care management of concomitant soft-tissue injury are added advantages of LRS (monorail fixator).
Erector Spinae Plane Block for Control of Postoperative Pain in Patients Undergoing Thoracolumbar Spinal Fracture Fixation
Authors: Bhattacharya Sushruta , Banerjee Priti , Hazra Sunit , Mukhopadhyay Kiran Kumar 
Published: June 2024

Abstract

Introduction:
Post operative pain control in thoracolumbar spinal fixation following fracture is important for early rehabilitation. Erector Spinae Plane block (ESB) is an effective method.

Study Design:
A prospective comparative longitudinal observational study.

Objective:
The objective is to study the efficacy of erector spinae plane block (ESB) with general anesthesia (GA) in postoperative analgesia in comparison to GA only in thoracolumbar spinal fracture surgery.

Materials and Methods:
A total of 40 patients enrolled for the study were randomly allocated into two groups, 20 patients received GA without ESB and 20 patients with GA and ESB. Numerical rating scale (NRS) pain score was noted in postoperative period at 1, 2, 4, 6, 9, and 24 hours, respectively.

Results:
There was a statistically significant difference in NRS score for 1, 2, 4, 6, and 9 h and the ESB group had better pain control but at 24 h, there was no statistically significant difference was noted.

Conclusion:
Postoperative pain control directly affects the recovery of a patient in any surgical condition. Thoracolumbar spine fracture fixation is a major surgery and postoperative pain control plays a major role during the early recovery period. ESB has been shown a very effective, cost-effective method of pain control in thoracolumbar spine surgery for fractures.
Reverse Sural Artery Flap – A Versatile Option in Distal Lower-limb Reconstruction
Authors: Prakash Om , Ali Sheikh Sarfraz , Khurram Mohammed Fahud , Yaseen Mohd. 
Published: June 2024

Abstract

Background:
The biggest barriers to the reconstruction of soft-tissue defect in the distal part of the lower limb are the paucity of local vascularized soft tissue and the mechanical demands of the region. Advancements in microsurgery techniques and low complication rates have made free tissue transfer the method of choice. However, the option of microsurgery may not be available at all centers. The reverse sural artery flap (RSAF) provides a reliable alternative for covering soft-tissue defects of the distal parts of the lower extremity.

Objective:
The aim of this study was to assess the versatility and efficacy of RSAF for providing coverage for soft-tissue defects over the distal parts of the lower limb.

Materials and Methods:
A retrospective, observational, and descriptive study was performed through a data survey of medical records of patients treated between August 2020 and January 2023.

Results:
A total of 25 patients underwent surgery, 21 males and 4 females. The age range of patients was from 18 to 55 years. Tissue defects following trauma constituted majority of the cases. Four patients had partial flap necrosis. No case of total necrosis of flap was recorded. The average duration of hospital stay was 15.6 days.

Conclusion:
The reverse-flow fasciocutaneous sural flap proved to be a feasible, easily reproducible, and reliable option for reconstruction of distal lower-limb defects.
Original Report: “All inside vs Antero medial portal anterior cruciate ligament reconstruction technique: which is better?”
Authors: Gupta Lalit Mohan , Vivek Vivek , Ghai Amresh , Sood Munish , Singh Shalendra , Dhawan Vikas 
Published: June 2024

Abstract

Objective:
Anterior cruciate ligament (ACL) tears are common injuries and have long-term effects on sportspersons and high-demand professionals like military personnel. The goal of ACL reconstruction surgery is to get back the individual to the preinjury status which may not always be possible. The study aimed to assess outcomes using two techniques of ACL reconstruction.

Materials and Methods:
Fifty patients with an isolated ACL injury and meeting the inclusion were operated on and evaluated at our center using all-inside and anteromedial ACL reconstruction techniques. Twenty-five patients were operated using each technique. The groups were compared in terms of operative issues and postoperative complications, in addition to functional outcome scores and Tegner’s return to injury level.

Results:
The average age of patients was more than 30 years. All were male patients. Sports injuries were the most common mode of injury in both groups constituting more than 60% of all the injuries. The median Tegner, mean Lysholm score, and mean 2000 International Knee Documentation Committee subjective knee score were comparable preoperatively, and the scores improved in both the groups at the final follow-up of 2 years. However, the difference in the score between the two groups was not statistically significant.

Conclusions:
Despite the learning curve, the all-inside ACL reconstruction technique yields outcomes similar to the AM portal technique in terms of functional outcome and return to the preinjury level at mid-term follow-up.
Do Pathologic Fractures in Long Bone Following Bony Malignancy Increase the Risk of Venous Thromboembolism? A Comparative Study
Authors: Rai Sanjay Kumar , Gupta Tej Pratap , Sirohi Bhavya , Rajauria Surbhi , Khandelwal Nitish 
Published: June 2024

Abstract

Background:
Venous thrombosis is a dreaded complication of long bone fractures. The occurrence of deep vein thrombosis (DVT) may be high in specific cases such as bone tumors with pathological fractures. In this regard, more work is required to establish its correlation. Scanty data are available that shows whether pathological fractures increase the risk of DVT by comparing fracture fixation and replacement surgeries as a treatment. The anticoagulation protocols in published literature might not be suitable for this specific group.

Materials and Methods:
In a retrospective study on patients who underwent surgeries for pathological fracture fixation between September 2010 and October 2020. Their data were collected and analyzed. DVT is diagnosed by clinical sign, D-dimer test, and using color Doppler. The study population (n = 68) was compared and paired with a control group (n = 140) with similar baseline characteristics.

Results:
There were 12 patients (17.64%) in the study group and 8 (5.71%) patients in the control group that developed DVT after performing risk ratio and Student’s t-test and calculating odds ratio (P < 0.031). There was a statistically significant correlation found between the development of DVT with the type of implant used, the presence of neoplastic lesions, and the presence of metastases.

Conclusion:
Patients with a pathological long bone fracture who underwent surgical management are at greater risk for DVT or death due to pulmonary embolism under the current recommended thromboprophylaxis protocol. This risk of developing DVT is increased much fold in the presence of metastasis, chemotherapy, radiotherapy, fracture fixation, and arthroplasty.
An Unusual Case of Primary Aneurysmal Bone Cyst of the Patella with a Review of Literature
Authors: Mugdum Girish , Kaul Rajiv , Mishra Anil Kumar 
Published: June 2024

Abstract
Tumors of the patella are uncommon. A 28-year-old male, who presented with intermittent knee pain of 9 months duration, with swelling and tenderness over the patella underwent a clinico-radiological evaluation which revealed fluid-fluid levels, suggestive of an aneurysmal bone cyst (ABC). Conventional treatment of ABCs usually consists of curettage and autologous bone grafting. However, in this case, a total patellectomy resulted in full functional restoration and resumption of activities, thereby ascertaining this method as a successful treatment option for primary ABC of the patella.
Intramedullary Osteosclerosis of the Tibia Diaphysis
Authors: Dharmshaktu Ganesh Singh , Kamat Ajay , Dharmshaktu Ishwar Singh 
Published: June 2024

Abstract
Intramedullary osteosclerosis (IMOS) is an uncommon clinical entity that represents isolated sclerosis within a segment of the medullary cavity of a long bone. Obliteration of the medullary cavity, in the absence of associated features of common causes such as infection, neoplasm, or injury should arise suspicion of this rare differential diagnosis. Localized pain and swelling, but without any periosteal changes, adjacent soft-tissue edema or bony abnormality, may be suggestive of IMOS. Careful radiological assessment and the use of advanced imaging modalities are important to reach to the appropriate diagnosis. We, hereby, describe a case with pain in the left mid-leg region and showing evidence of a segment of sclerosis within the medullary cavity on both the radiograph and magnetic resonance imaging. Open biopsy was done following the creation of a cortical window and was followed by multiple drilling of the adjacent area of the bone. The pain was dramatically relieved postsurgery and the histopathology reports were suggestive of IMOS. There was neither a recurrence of the symptoms nor any complications reported in the follow-up of 15 months.
Vitreous Hemorrhage in Nigerians
Authors: Akanbi Toyin , Okonkwo Ogugua Ndubuisi , Ovienria Wilson , Adenuga Olukorede O. , Nkanga Dennis , Ibanga Affiong A. , Udoh Martha-Mary Ekong , Agweye Chineze Thelma , Oyekunle Idris 
Published: June 2024

Abstract

Aim:
This study aims to determine the prevalence, causes, and systemic associations of vitreous hemorrhage (VH) among Nigerians.

Materials and Methods:
A multicenter cross-sectional study was conducted from January to December 2018. Data were obtained from patients diagnosed with retinal diseases at the general outpatient and retinal clinics of four eye departments in Nigeria. Patient histories were collected. All patients underwent visual acuity and comprehensive ocular examinations. VH was diagnosed clinically. Patients diagnosed with dense VH underwent ultrasonography. Data analysis was performed using IBM SPSS Statistics Version 22. Frequencies, means, and standard deviations were calculated. Significance tests were conducted using Pearson’s chi-square test. A significance level of P < 0.05 was considered statistically significant.

Results:
A total of 8614 patients were examined, among whom 80 eyes of 78 patients were diagnosed with VH. The hospital-based prevalence was 0.9%. The mean age at presentation was 50.44 ± 16.4 years. Males accounted for 62.8%, while females accounted for 37.2%. At presentation, 72.5% of the affected eyes were blind. The cause of VH remained unknown in 37.5% of the cases. The most common causes of VH included proliferative diabetic retinopathy (22.5%), trauma (15.5%), polypoidal choroidal vasculopathy (8.8%), proliferative sickle cell retinopathy (5%), and posterior vitreous detachment (5%). The most prevalent associated systemic disease among patients was hypertension (43.6%).

Conclusion:
The majority of patients presented with blindness. In some cases, the cause of VH could not be identified. This underscores the necessity to improve access to vitrectomy facilities in Nigeria.
To determine the role of transcutaneous retrobulbar amphotericin B in COVID-19-related rhino-orbital-cerebral mucormycosis
Authors: Kaur Rajwinder , Sehgal Akriti , Gupta Priyanka , Budhiraja Grace , Sharma Vandana , Aggarwal Anupriya 
Published: June 2024

PURPOSE:
The purpose of this study was to determine the role of transcutaneous retrobulbar amphotericin B (TRAMB) injection in COVID-19-related rhino-orbital-cerebral mucormycosis (ROCM).

MATERIALS AND METHODS:
This prospective interventional case series included 7 eyes of 7 patients diagnosed with COVID-19 ROCM presenting from May to September 2021 at a tertiary care center in North India. Active or recovered cases of COVID-19 with clinical features suggestive of ROCM and early orbital involvement were included. Following functional endoscopic sinus surgery, patients were given TRAMB 3.5 mg/ml in single ocular quadrant depending upon the muscle involved on contrast-enhanced magnetic resonance imaging (MRI). Patients were followed up for a period of 12 weeks.

RESULTS:
All patients were diabetic and COVID-19 reverse transcription–polymerase chain reaction positive. The mean age of patients was 48.4 years ± 11 years, out of which 5 patients were male and 2 were female. The left eye was involved in 57.14% of cases whereas 42.85% of cases had right eye involvement. Presenting complaints were drooping of the upper lid (57.14%; n = 4), proptosis (28.57%; n = 2), facial pain and swelling (85.71%; n = 6), and nasal block (57.14%; n = 4). Stagewise distribution was 3a in four patients (57.14%), 3b in two patients (28.57%), and 4a in one patient. TRAMB injections (median – 3) were given, and improvement was seen in all patients in terms of ocular movements, ptosis, proptosis, and muscle enhancement on MRI scan. Three patients had an increase in intraocular pressure and inflammation which settled within a week with favorable anatomical and functional outcomes.

CONCLUSION:
Transcutaneous retrobulbar amphotericin B should be considered an adjunctive treatment modality for ROCM patients with limited orbital disease to preserve ocular function.
Role of nonsteroidal anti-inflammatory drugs on change in macular volume postcataract surgery in diabetic eyes: A retrospective comparative study
Authors: Anoop L. , Viswanath B. N. , Shashidhar S. , Bypareddy Ravi , Hithashree R. H. , Surabhi S. 
Published: June 2024

CONTEXT:
Diabetic eyes suffer from variety of complications including macular edema. Cataract surgery is the most commonly done procedure throughout the world and majority would be diabetics. As pseudophakic-cystoid macular edema (CME) is a known complication following cataract surgery, our study concentrated on finding the role of prophylactic topical nonsteroidal anti-inflammatory drugs (NSAIDs) on change in total macular volume (TMV) postcataract surgery in diabetic eyes.

AIMS:
To evaluate the role of NSAIDs on change in TMV postcataract surgery in diabetic eyes.

SETTINGS AND DESIGN:
Retrospective comparative study.

SUBJECTS AND METHODS:
Data were collected from the medical records department of our institute constituting diabetics undergoing cataract surgery from June-2021 to February-2022. Eighty diabetic eyes were divided into two groups: one group were given topical nepafenac drops and another who were not given. Demographic details, diabetic retinopathy stage, preoperative optical coherence tomography (OCT), and postoperative day (POD) 7, day 28, and 3 months OCT were collected. Statistical analysis was done to compare the change in TMV between both the groups.

STATISTICAL ANALYSIS USED:
Student’s t-test and Chi-squared/Fisher’s exact test were employed to find statistically significant differences between the two groups using SPSS-22.0 software.

RESULTS:
In our study, the mean age in the group with nepafenac was 60.93 ± 5.86 years and 31 (77.5%) had moderate nonproliferative diabetic retinopathy (NPDR), and in the group without nepafenac, the mean age was 58.53 ± 7.41 years and 30 (75%) had moderate NPDR. Majority of the individuals in the study group were known diabetic for 2–5 years. Change in TMV at POD 3 months among two groups was not statistically significant; P = 0.758 (P < 0.05-significant).

CONCLUSIONS:
Our study concluded that topical-NSAIDs played no role in postoperative period following cataract surgery with respect to change in TMV in diabetic eyes. Thus, prophylactic usage of topical-NSAIDs can be a burden on patient as it has no role in prevention of pseudophakic-CME in those with the duration of diabetes mellitus <5 years and with mild-to-moderate NPDR.
Efficacy and safety of large-scale use of vancomycin injection in infusion bottle during vitreoretinal procedures
Authors: Boral Subhendu Kumar , Agarwal Deepak , Das Arnab , Chakraborty Debdulal , Mandal Santanu , Sinha Tushar Kanti 
Published: June 2024

PURPOSE:
The purpose of this study was to assess the safety and efficacy of large-scale use of vancomycin injection in an infusion bottle during vitreoretinal procedures.

MATERIALS AND METHODS:
This was a retrospective evaluation of all vitreoretinal procedures done in the last 70 months, where intraoperatively vancomycin injection (0.2 mg/mL) was used in an infusion bottle prophylactically as standard care. Vitreoretinal procedures were categorized as major (duration >30 min), minor (duration <30 min), and silicone oil removal. Postoperatively, a detailed ocular examination was done to rule out hemorrhagic occlusive retinal vasculitis (HORV) or signs of postoperative bacterial endophthalmitis.

RESULTS:
Over the last 70 months, a total of 31,720 vitreoretinal procedures were performed, which included 24,371 major vitreoretinal procedures, 1401 minor vitreoretinal procedures, and 5948 silicone oil removal cases. None of these cases developed HORV or bacterial endophthalmitis.

CONCLUSION:
Vancomycin (0.2 mg/mL) in infusion fluid during vitreoretinal procedures is safe and can be advocated as a prophylactic measure against postvitrectomy bacterial infections.
Study of safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery for hard-grade cataracts
Authors: Joshi Rajesh Subhash , Goel Pranshu , Doble Pallavi 
Published: June 2024

PURPOSE:
The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts.

STUDY DESIGN:
The design of the study was a prospective, observational, and randomized control study.

MATERIALS AND METHODS:
A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon’s satisfaction, and intraoperative complications were examined.

RESULTS:
The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon’s comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation.

CONCLUSION:
Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon’s requirements.
Metabolic disorders and hepatitis: Insights from a Mendelian randomization study
Authors: Liang Ling-Bo , Liu Xiang-Ping , Mao Ting-Rui , Su Qiao-Li 
Published: June 2024

BACKGROUND
Hepatitis is a systemic disease that often results in various comorbidities. Meta-bolic disorders, the most common comorbidities in clinical practice, were selected for this study.
AIM
To investigate the causal relationship between comorbidities and hepatitis trea-tment outcomes.
METHODS
A total of 23583378 single nucleotide polymorphisms from 1248743 cases and related summaries of genome-wide association studies were obtained from online public databases. A two-sample Mendelian randomization (MR) was performed to investigate causality between exposure [type 2 diabetes mellitus (T2D), hyperlipidemia, and hypertension] and outcome (chronic hepatitis B or C in-fections).
RESULTS
The data supported the causal relationship between comorbidities and hepatitis infections, which will affect the severity of hepatitis progression and will also provide a reference for clinical researchers. All three exposures showed a link with progression of both hepatitis B (T2D, P = 0.851; hyperlipidemia, P = 0.596; and hypertension, P = 0.346) and hepatitis C (T2D, P = 0.298; hyperlipidemia, P = 0.141; and hypertension, P = 0.035).
CONCLUSION
The results of MR support a possible causal relationship between different ex-posures (T2D, hyperlipidemia, and hypertension) and chronic hepatitis progression; however, the potential mechanisms still need to be elucidated.