bluuebunny/crossref_metadata_2025_split huggingface dataset:
C1-C2 arthroplasty for craniovertebral junction instability
Authors: Salunke Pravin , Karthigeyan Madhivanan , Kodigudla Manoj Kumar , Kelkar Amey V. , Goel Vijay K. 
Published: June 2022

ABSTRACT

Background:
The atlantoaxial complex contributes to significant neck movements, especially the axial rotation. Its instability is currently treated with various C1-C2 fusion techniques. This however, considerably hampers the neck movements and affects the quality of life; a C1-C2 motion preserving arthroplasty could potentially overcome this drawback.

Objectives:
We evaluate the range of motion (ROM) of lateral C1-C2 artificial joints in cadaveric models.

Materials and Methods:
This is an in vitro cadaveric biomechanical study. After C1-C2 arthroplasty through a posterior approach, the C1-C2 ROM was tested in 4 fresh-frozen human cadaveric specimens, before and after destabilization.

Results:
The mean axial rotation demonstrated after the placement of C1-C2 joint implants was 15.46 degrees on the right and 16.03 degrees on the left side; the prosthesis provided stability, with 46% of the baseline C1-C2 axial rotation on either side. The ROM achieved in the other axes was less compared with that of intact specimens. To initiate rotation, a higher moment of 1.5 Nm was required in the presence of joint implants compared to 0.5 NM in unimplanted specimens.

Conclusions:
In our preliminary ROM evaluation, the C1-C2 arthroplasty appears to be stable and provides about half of the range of atlantoaxial rotation. It has the potential for joint motion preservation in the treatment of atlantoaxial instability resulting from lateral C1-C2 joint pathologies.
Adjunct pelvic fixation in short-to-medium segment degenerative fusion constructs independently predicts readmission and morbidity
Authors: Katz Austen D. , Song Junho , Virk Sohrab , Silber Jeff Scott , Essig David 
Published: June 2022

ABSTRACT

Context:
Despite increasing utilization of fusion to treat degenerative pathology, few studies have evaluated outcomes with pelvic fixation (PF). This is the first large-scale database study to compare multilevel fusion with and without PF for degenerative lumbar disease.

Aim:
The aim of this study was to compare the 30-day outcomes of multilevel lumbar fusion with and without PF.

Settings and Design:
This was a retrospective cohort study.

Subjects and Methods:
Lumbar fusion patients were identified using the National Surgical Quality Improvement Program database. Regression was utilized to analyze readmission, reoperation, morbidity, and specific complications and to evaluate for predictors thereof.

Statistical Analysis Used:
Student's t-test was used for continuous variables and Chi-squared or Fisher's exact test was used for categorical variables. Variables significant in the univariate analyses (P < 0.05) and PF were then evaluated for significance as independent predictors and control variables in a series of multivariate logistic regression analyses of primary outcomes.

Results:
We identified 38,413 patients. PF predicted 30-day readmission and morbidity. PF was associated with greater reoperation in univariate analysis, but not in multivariate analyses. PF predicted deep wound infections, organ-space infections, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, and sepsis. PF was also associated with a longer hospital stay. Age, obesity, steroids, and American Society of Anesthesiologists (ASA) class ≥ 3 predicted readmission. Obesity, steroids, bleeding disorder, preoperative transfusion, ASA class ≥3, and levels fused predicted reoperation. Age, African American race, decreased hematocrit, obesity, hypertension, dyspnea, steroids, bleeding disorder, ASA class ≥3, levels fused, and interbody levels fused predicted morbidity. Male gender and inclusion of anterior lumbar interbody fusion (ALIF) were protective of reoperation. Hispanic ethnicity, ALIF, and computer-assisted surgery (CAS) were protective of morbidity.

Conclusions:
Adjunctive PF was associated with a 1.5-times and 2.7-times increased odds of readmission and morbidity, respectively. ASA class and specific comorbidities predicted poorer outcomes, while ALIF and CAS were protective. These findings can guide surgical solutions given specific patient factors.
Surgical management of os odontoideum
Authors: Berchiche Lakhdar , Khelifa Adel , Asfirane Nadjib , Yakoubi Becherki , Morsli Abdelhalim 
Published: June 2022

ABSTRACT

Background:
Os odontoideum (OO) is a craniovertebral junction malformation of unknown origin. In most times, this lesion is highly unstable demanding surgical management. We present our series of OO surgical management and we discuss clinical, radiological, and management aspects of this pathology via our experience and literature opinions.

Methods:
This is a retrospective study of patients operated on at our department between May 2014 and May 2021 for OO. All patients were explored with plane X-rays and computed tomography (CT). In some cases, magnetic resonance imaging (MRI) was necessary. Posterior C1–C2 or C1-C3 fixation with polyaxial screws and rod fixation was used. In postoperative, the patient is asked to put Philadelphia collar for 3 months. Hospitalization periods vary between 3 and 7 days. After discharge, all our patients are followed up regularly in consultation. Control radiographs of the occipito cervical region were performed. After 3 months postoperatively, the CT scan is performed on all our patients to assess the quality of fusion. Patient's follow-up ranges from 4 months to 6 years.

Results:
Fifteen patients were included in this study; nine males (60%) and six females (40%); with mean age of 32.5 years old. Ten patients (67%) presented motor weakness, three patients (20%) with neck pain, one patient (6.5%) with torticollis, and one patient (6.5%) presented vertigo. No notable cervical trauma was present in six patients (40%) and in nine patients (60%), a remote history of traumatism was noted. All cases of our series presented mobile OO. Normal thickness of the C2 pedicle was noted in nine patients (60%). In two patients (13%), there was hypoplasia of one pedicle and in four patients (27%) both pedicles. MRI showed direct signs of spinal cord aggression: simple compression, myelomalacia, strangulation, or hypotrophy. C1 lateral mass screw fixation was performed in all patients; and according to C2 morphology: nine patients underwent C1-C2 pedicular fixation, in one patient, bilateral crossing C2 laminar screws technique, in three patients, we skipped C2 to perform a C1-C3 articular fixation, and in two patients, C1-C2-C3 fixations were performed. All patients improved clinically. In one patient, we noted an infection resulting in bad wound healing this infection was successfully treated with no complications. In the patient with bilateral crossing C2 laminar screws technique, CT control objectified 4 mm exceeding of one screw; the patient was reoperated and the screw was slightly pulled back. No other complications were noted.

Conclusion:
Congenital origin of OO is always evoked. C1-C2 fixation according to Goel and Harms technique with grafting proved its safety, providing high fixation quality with the acceptable biodynamic outcome. Once treated, the prognostic of OO is in general good, and improvement is observed in most patients with few complications.
C1 lateral mass reduction screws for treating atlantoaxial dislocations
Authors: Singh Deepak Kumar , Pathak Vipul , Singh Neha , Singh Rakesh Kumar , Kaif Mohammad , Yadav Kuldeep 
Published: June 2022

ABSTRACT

Objective:
The C1-C2 fixation technique revolutionized the management of complex craniovertebral junction (CVJ) anomalies. Presently used polyaxial screw and rod systems have inadvertent technical difficulties in rod fitting and reduction of atlantoaxial dislocations (AAD) requiring forceful joint handling. The purpose of this study is to analyze the use of a specially designed “reduction screw” in C1 lateral mass in C1-C2 fixation for treating AAD with or without basilar invagination (BI).

Study Design:
This is a retrospective cohort study in which long lateral mass reduction screws were used for C1-C2 fixation.

Materials and Methods:
Eighteen patients diagnosed with congenital AAD with or without BI treated with C1-C2 fixations using C1 reduction lateral mass were included in the study. The outcome was measured clinically by the modified Japanese Orthopedic Association score and radiologically by conventional craniometric indices.

Results:
Among all cases included in the study, 72% (13/18) are males and 18% (5/18) are females with average age at presentation of 33.5 years. Among 18 cases of AAD, 84% (15/18) of patients have BI, 22% (4/18) have Chiari Type 1 malformation, and one patient has Klipple–Feil syndrome. Symptomatic improvement is noted in all patients following surgery. Adequate reduction of AAD with normalization of radiological indices was also achieved in all 18 (100%) patients.

Conclusion:
C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.
A Scoping Review of Community-Based Geriatric Assessment and Screening Tools Used in South Asia
Authors: Panigraghi Sucharita , Bhoi Trilochan , Pati Sanghamitra , Kshatri Jaya Singh 
Published: June 2022

Background:
Home-based comprehensive assessment and integrated care of the older people could be a key to relieve the pressure on the already overburdened health system. This review summarizes evidence on validated community-based geriatric assessment tools in South Asia.

Methods:
Guided by Arksey and O'Malley's five-stage scoping review framework, a total of 46 studies were included in the scoping review after searching from electronic databases and reference lists using the predefined eligibility criteria. Data were extracted on the main characteristics of included studies, identified instruments, and their psychometric properties of the tools. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses-ScR guidelines.

Results:
Among the 46 included studies, 10 reported on instruments for medical assessment, 12 on tools for psychological conditions, 13 on tools for functional issues, 2 on social well-being, and 9 on tools with multiple domains of health. Most studies included participants from both gender and different social classes. Majority used measurements that were both self-reported or measured by the investigator, whereas only two instruments were designed to be used by clinicians. In the existing geriatric health assessment tools, environmental domain was neglected completely, and not a single tool considered in this review covered all 5 domains which influence regular life of the elderly.

Conclusion:
There are no validated tools available that can be used for comprehensive geriatric assessment in South Asia. There is a need to develop and validate culturally sensitive tools that can be used for assessing all the geriatric health domains.
Study the Co-relation between SpO2 and Radiological and Biochemical Markers with the Severity and Outcome in Geriatric COVID-19 Patients
Authors: Sumathi Selvanathan , Ramalingam Shanthimalar , Ramasamy Jayalakshmi , Banumathy Getrude , Solomon Sony , Veer Praveena 
Published: June 2022

Background:
Pandemics are natural calamities, which humans have been encountering since time im-memorial. The world has witnessed and endured several pandemics like from Justinian Plague to Spanish Flu. The 21st century has already witnessed three major pandemics like Severe Acute Respiratory Syndrome in 2002, Middle East Respiratory syndrome in 2012 and at present COVID-19. The first case of COVID-19 was reported in Wuhan, Hubein Province in Dec 2019. The first case of COVID-19 was reported in Kerala on 30th January 2020. COVID-19 virus is a single stranded RNA Virus and resembles SARS -2 virus and hence the name SARS -COV 2. There has been a report of around 34 million cases with 1 million deaths. Majority of the deaths occur in the elderly population as they have immunosenescence and multiple comorbidities. Hence a study aiming at analysis of correlation between SpO2, radiological and biochemical markers is essential in management of COVID 19 in elderly.

Aims & Objectives:
To study the correlation between SpO2 and radiological features in X ray and CT Chest and biochemical markers with the severity and outcome in geriatric patients.

Study Period:
April 2020 to September 2020, Duration: 6 months. Study Centre: Chengalpattu Medical College, Tamilnadu. Inclusion Criteria: RT PCR positive Covid 19 patients more than 60 years of age. Exclusion Criteria: Covid 19 patients less than 60 years, RT PCR Negative patients.

Materials and Methods:
Retrospective analysis of records of 300 Covid 19 patients, aged more than 60 years hospitalized in Chengalpattu Medical College during April to September 2020 was done and biochemical parameters mentioned below were corelated with features in CXR and CT Chest RTPCR positive spo2 and analysis with severity of disease and outcome was done.

Results and Discussion:
On retrospective analysis of records of elderly Covid 19 patients, it was observed that the elderly could be graded as mild, moderate and severe based on clinical criteria. Radiological parameters co-relating in the same group classified as mild, moderate and severe could be derived and could be used for assessment of patients. Similarly, it was observed that the biochemical parameters of D- Dimer, C reactive protein, Neutrophil Lymphocyte Ratio correlated most significantly in that order with the clinical severity of disease and hence could be used as useful tools for assessment of severity of patients and the ranges corelating with severity could be derived.

Conclusion:
Analyzing SpO2, radiological features, biochemical parameters individually and in combination with clinical severity and outcome in elderly patients helps in deriving biochemical and radiological parameters to predict severity which in turn helps in a holistic approach and right management at the right time preventing or reducing mortality due to Covid 19 in the elderly.
Management of Unstable Fractures of the Distal End Radius Using Bicolumnar Radius Plating
Authors: Sharma Ashok , Ali Nayyar , Vyas Umesh , Bohra Arvind Kumar , Sharma Shiv Bhagwan 
Published: June 2022

Background:
Controversy still exists regarding the current treatment modalities for unstable distal radius fractures. A prospective study was performed to evaluate efficacy of bicolumnar plating (radial buttress and volar plating) technique, which is designed to providing sufficiently secure fixation treatment of distal radius fractures.

Materials and Methods:
The prospective randomized study was done under the department of orthopedics at SRG hospital Jhalawar. We operated 20 patients, with distal end radius fracture of type 23C2 and 23C3 with radial column fracture using bicolumnar plating between May 2019 to MAY 2021. All patients presented for follow-up till union. Patients belonged to age group 20-75 years with the mean age of 45 years. Twelve patients were male and eight were female. The duration of follow-up was 12-18 months.

Results:
Bicolumnar plating led to complete union of unstable distal radius fractures without additional procedures. The assessment of post-operative functional outcome was done using the MODIFIED MAYO WRIST SCORE. At the final follow-up, 15 patients had excellent score, 3 had good score and 2 had fair score.

Conclusions:
Bicolumnar plating is feasible option for the management of displaced distal radius fractures and can result in favorable surgical outcomes.
Evaluation of Functional and Radiological Outcome of Five-Pin Technique in Management of Distal End Radius Fractures
Authors: Solanki Mahendra , Sharma Dev Krishan , Prasad Rakesh , Jain Mitul 
Published: June 2022

Introduction:
Distal end radius fractures are the most common fractures of the upper extremity. The most common mode of injury is a fall on outstretched hand. Closed reduction and percutaneous pinning with “the five-pin technique” improve the reliability of fixation. The current study aimed to assess the clinical and functional outcome of fixation of distal radius fractures using the five-pin technique.

Materials and Methods:
Thirty patients with fracture of distal end radius Frykman type 1 and 2 were subjected to close reduction and K-wire fixation by five-pin technique.

Results:
Functional outcome-using Obrien scoring system for functional outcome, there was 90%–100% score in 11 patients, 80%–89% in 18 patients, and <80 in one patient. Radiological outcome-using Sarmiento modification Lindstrom criteria for radiological outcome, 11 patients had excellent results, and 18 had good results, and one had fair results.

Conclusion:
“The five-pin technique” is a versatile tool which provides optimum functional and radiological outcomes.
Evaluation of Serum Procalcitonin Levels in Patients of Acute Osteomyelitis and Septic Arthritis
Authors: Kumar Narendra , Pandey Vikas Kumar , Sharma Deepak Kumar , Patralekh Mohit Kumar , Lal Hitesh 
Published: June 2022

Aims:
The aim is to study the role of serum procalcitonin (PCT) levels in early diagnosis of acute osteomyelitis (OM) and septic arthritis (SA).

Settings and Design:
This is a prospective study in a tertiary hospital.

Subjects and Methods:
This study was done at a tertiary care hospital. Thirty-nine patients with SA or acute OM who attended the outpatient department or emergency were included in the study. 39 patients were taken as control group out of which one patient lost to follow-up, so 38 patients were left with control group. PCT level was evaluated by using immunoluminetric assay and a cutoff value of 0.5 ng/ml was taken as positive. After collection of data, sensitivity, specificity, positive predictive value, and negative predictive value are calculated for PCT.

Statistical Analysis Used:
Mann–Whitney U-test and Kruskal–Wallis test were used.

Results:
The sensitivity for PCT was 94.87 (95% confidence interval [CI] 82.68–99.37), specificity was 86.84 (95% CI 71.91–95.59), positive predictive value was 88.10%, and negative predictive value was 94.29%, when taking cutoff of 0.5 ng/ml. We have taken 0.5 ng/ml as a cutoff point for PCT; however, as per receiver operator characteristic of this study, the cutoff point was 1.1 ng/ml.

Conclusions:
This study clearly showed that PCT can be helpful in the early diagnosis of OM and SA, along with other indicators such as total leukocyte count, erythrocyte sedimentation rate, and C-reactive protein.
Spinal Tuberculosis and Neurological Deficit
Authors: Patil Rohan R. , Mote Girish Balasaheb , Wankhede Aniket Kanhaiyalal , Wandile Kiran N. , Badole Chandrashekhar M. 
Published: June 2022

Background:
India is a home for 27% of the world's tuberculosis (TB) cases. When compared, extrapulmonary TB (EPTB) cases have a lower incidence than pulmonary TB (PTB), but there is no significant reduction in the incidence of EPTB than PTB. Spinal TB is most common of skeletal TB.

Aims:
We aimed to study and to identify the clinical-radiological features in spinal TB and the incidence of neurological involvement along with factors associated with it.

Settings and Design:
This was a retrospective study in a tertiary care center of Central India.

Subjects and Methods:
A total of 114 cases with spinal TB were included in the study. Data collected retrospectively from January 2008 to December 2018 using a picture archiving and picture archiving and communication system of the hospital. Radiographs, magnetic resonance imaging scan, computed tomography, and ultrasound findings were studied. History and clinical examination findings were thoroughly analyzed.

Statistical Analysis Used:
Data were analyzed using Epi Info Software.

Results:
There were 74 (64.9%) male cases and 40 (35.1%) female cases. Most of the cases belong to rural 85 (74.5%) than urban 29 (24.5%) area. After neurological evaluation, paraparesis/paraplegia was observed in 52 (45.6%) cases and tetraplegia in 2 (1.7%) cases. Sensory deficit was observed in 10 (10.5%) cases. Bowel/bladder involvement was present in 5 (4.4% cases). Most of the cases with neurodeficit had dorsal vertebral involvement 30 (61.1%).

Conclusions:
The pattern of spinal TB is varied and is difficult to get diagnosed. We observed a high proportion of cases with neurodeficit. Most of them were with late-onset TB. This highlights that early diagnosis and complete treatment are very important in the treatment of TB of the spine.
Is Conventional Knee Radiograph Reliable Enough to Assess the Anatomical Knee Alignment and Total Knee Prosthesis Position in Indian Population?
Authors: Balabadra Suryamanikanta , Vecham Ratnakar , Reddy Maryada Venkateshwar , Annapareddy Adarsh , Kumar M. Mahendra , Reddy A. V. Gurava 
Published: June 2022

Background:
The success and survivorship of primary total knee replacement mainly depend on the postoperative alignment and implant position. Long-leg radiograph (LLR) is considered gold standard in assessing knee alignment postoperatively. Studies have reported that bowing of the femoral shaft in the coronal plane is prevalent in Asian population, which is not fully visualized on a conventional knee radiograph (CKR) and may affect the assessment of coronal alignment. However, postoperatively, CKR is easy to perform and has several advantages if it provides similar precision.

Purpose:
The purpose was to evaluate the validity of CKR in assessing the anatomical knee alignment and prosthesis position as compared with the LLR in Indian population.

Materials and Methods:
One hundred knees in 83 patients were subjected to CKR and LLR during postoperative follow-up at 6 weeks. Three parameters were evaluated to assess the coronal alignment and the component positions - femoral component angle (FCA), tibial component angle (TCA), and tibiofemoral angle (TFA).

Results:
There was an excellent correlation between the TCA as measured from the long and CKRs (r = 0.884, P = 0.01). There was a high positive correlation between the FCA (r = 0.703, P = 0.01) and TFA (r = 0.754, P = 0.01) as measured from the long radiographs and the conventional radiographs. Regression analysis defined these relationships to be linear.

Conclusion:
CKR could be an appropriate alternative for the LLR in evaluating the postoperative knee alignment and total knee prosthesis position despite the fact that there is excessive femoral bowing in Indian population.