Mucormycosis is life threatening infection rarely affecting musculoskeletal system and spinal inv... more Mucormycosis is life threatening infection rarely affecting musculoskeletal system and spinal involvement is extremely rare with only two cases reported in English literature. We present this rare case of spondylodiscitis with lumbar vertebral osteomyelitis due to mucormycosis in a patient with chronic kidney disease on haemodialysis diagnosed by CT guided biopsy and highlight its clinico -radiological presentation and management principles. Thus, as the incidence of Mucorales infection increase due to increase in patients with predisposing factors, the unusual sites of affection increase. Treating clinician should have a high vigilance in patients with predisposing factors. Although there is dramatic improvement in the treatment modalities of mucormycosis, still the mortality is high. Early diagnosis is important to prevent dissemination and timely intervention in order to reduce morbidity and mortality. A well equipped multidisciplinary approach for clinico-radiological assessment...
Tendo-achillis tenotomy is required as last step of ponseti method of treatment of Congenital Tal... more Tendo-achillis tenotomy is required as last step of ponseti method of treatment of Congenital Talipes Equino Varus (CTEV). This technical note describes a simple method of doing a percutaneous tenotomy of tendo-achillis using a wide bore needle. This is a simple method and easy to learn and gives predictable results.
Editorial This is a digital world we live in. In last 20 years technology has changed the face of... more Editorial This is a digital world we live in. In last 20 years technology has changed the face of this world specially the way in which the data is shared and interaction is improved. This has accelerated things especially scientific inquiry and distribution of scientific concepts. In field of orthopaedics this has led to better implants and more literature. Increased numbers of journals and articles have led to increased awareness about the results of particular surgery and implant. Also it has improved the propagation of awareness about a new technique / implant and its results. In last century, a new technique would simply remain with a single surgeon or country for a long time [Ilizarov ring fixator for example], but now with advent of the online tools and websites, distribution of knowledge is simply amazing. One of the areas where technology can be successfully used is area of Training in surgical skills. We are currently having video websites like Vu-medi and many more videos on you tube etc, however I believe journals can play a very active part in this area. Surgical training of highest quality can reach each and every corner of the world simply by combining a format which will include text, pictures as well as videos. We all have basic surgical skill sets and to step up our training we would simply need to conceptualise and visualise different methods. This can easily be gained from the above format. Of course the learning curve for such training would be much longer and at times there will be unforeseen complications and difficulties. For this reason such articles should have a continued thread of comment and discussions which can be compiled over a period of time and better a list of frequently asked questions. This can provide answers to queries for a new trainee or even for an experienced surgeon. I believe the techniques should be open peer reviewed and not undergo a blinded peer review. The reviewers should be openly allowed to ask the surgeons questions and doubts that the reader will have. A post publication review of the technique is one of the most important part of this initiative where readers and peers can comment on the published technique. The goal of this entire exercise should be improvement of technique and to impart correct surgical principles to the trainees. Trauma International wants to pioneer in this area of surgical training by publishing and will be inviting
As Evident in earlier Editorials [1,2,3], we at JOCR are striving for a better understanding at C... more As Evident in earlier Editorials [1,2,3], we at JOCR are striving for a better understanding at Clinical Decision Making and better Patient Care. Human A deliberations and Single observations have been highlighted as important concepts in building a comprehensive paradigm for individual patient management [2,3]. A review of the quality and direction of current body of 'Selective' literature, which is highly biased towards Evidence Based Medicine (EBM), is needed. EBM has its own role and important place in literature but it might be suffering from a 'Central Control' phenomenon in terms of few 'Chosen' groups of experts who are dig the Evidence and instruct others on how to interpret and utilize 'Evidence'. Here I will like to introduce a concept from Cybernetics called 'Variety' which represents possible alternatives or possible bits of information. The concept of variety is embodied by Ashby's Law which is stated (and also applicable) in many forms. The most useful form for us is as stated by Steve Hickey and Hillary Roberts: " Ashby's Law stipulates that the minimum amount of information needed to give an accurate answer is exactly the amount needed to specify the problem " [4]. This is interpreted as; if the question has lot of variety the answer too will have same amount of variety. A complicated question will not have a simple answer. Management of a complex fracture in patient with multiple co-morbidites in a resourcefully challenged situation cannot be resolved by 'Cookbook' approach that EBM will like us to believe. Thus if we need an answer to a complex situation, more information will be needed and on a large scale 'Wisdom of Crowds' will be more effective than a controlled guideline. Every one of us holds a part of knowledge about management of these cases and when put together will be much more helpful than the group statistics of large clinical trials. Again as surgeons we need to predict the individual patient outcome and not what will be the outcome in group of such patients. Here if we have had a patient with similar profile, we can model the current patient according to him and apply it to subsequent similar group of patients. However can we get enough information from group statistics to treat Individual patients? This reverse is not found to be true [5] and thus all our Literature which is based on group studies has to be carefully reviewed and interpreted. Again the Best Evidence as defined by a 'central control' will go against the Ashby's law as a group of experts will surely have less variety than an entire profession and their patients. Representation of this individual variety in patient presentation and management is currently lacking in Literature and the main reason is the group statistical process of approximation and 'rounding off ' at all levels of information, practiced in current evidence based literature. We believe that this variety is extremely important in clinical decision making and should be provided a platform for presentation. We should be able to make informed decisions based on wisdom of the crowds and in principle should be able to publish and use all the available information. The concept of 'Wisdom of Crowds' has been introduced and detailed by James Surowiecki in his book 'The Wisdom of Crowds' and finds wide applicability in business world and is also a model for popular online portals like Wikipedia [Crowd Computing] [6]. EBM will definitely be a part of this Information network; not the most important part but just as important as other parts namely human deliberations, collective individual opinions, patient's perspective and socioeconomic aspects. I see no other way in which we will be ever able to build a comprehensive paradigm enabling us to make informed and practical decisions for our patients. Of course there will be a lot of 'Noise' which will be associated with this process but I believe most of us will be very able to detect 'Noise' from 'Value' unlike the same in EBM scenario where we find ourselves so prohibitively unable to sort out the 'Noise' from useful information. Another problem with this paradigm is that EBM is the only front that has been developed and given importance while others are criticized and looked upon negatively. It's high time that we should stop equating Level V
... Radius. Author: Ashok K Shyam, Chetan Pradhan, Rajiv Arora, Gaurav Pardesi, Parag Sancheti, A... more ... Radius. Author: Ashok K Shyam, Chetan Pradhan, Rajiv Arora, Gaurav Pardesi, Parag Sancheti, Atul Patil, Chetan Puram. Abstract: Introduction: Distal radius fractures are among the most common fractures of the upper extremity. ...
The anatomical and morphological differences and high-flexion daily activities in the Asian popul... more The anatomical and morphological differences and high-flexion daily activities in the Asian population have since ever prompted for development of customized knee replacement systems. INDUS knee system has advantages both of high-flex designs and is developed by keeping the anatomical variations of the native population in mind. The purpose of this study is to analyze the 2-year follow-up results using the INDUS prosthesis. Two hundred and ninety-seven knees in 276 patients were prospectively analyzed. There were 65 men (72 knees) and 211 (225 knees) women with a mean age of 64.56 years. Two hundred and forty-five knees had primary osteoarthritis, 48 knees had rheumatoid arthritis, and four knees had post-traumatic arthritis. Clinical parameters, including the Knee Society scores (knee score and function score), range of motion, post-operative anterior knee pain, and complications were recorded. Pre- and post-operative serial radiographs were analyzed for limb alignment, component positioning, and evidence of loosening. The patients were followed-up for an average of 2.59 years (range, 2-3.3 years). The mean knee score and the mean function score were significantly improved from a pre-operative value of 39.4 points and 46.7 points to a post-operative value of 87 points and 86 points, respectively (P value <0.05). Two hundred and thirty four knees had no anterior knee pain while 63 knees had mild to moderate pain, but none of the patients requested any intervention for the same. Of the 276 patients (297 knees), 79 knees had flexion above 140 degrees , 167 had a flexion range of 130-140 degrees , 27 had a flexion range of 100-130 degrees , and 24 knees had a flexion < 100 degrees , with the mean range of movement being 132.9 degrees . Improvements in the range of movement were retained over time and a total of 205 patients (224 knees, 75.7%) could squat or sit cross-legged at the final follow-up. The mean tibiofemoral angle was 8.5 degrees +/-6.9 degrees of varus pre-operatively and 5.4 degrees +/-2.2 degrees of valgus (3-7 degrees of valgus) at the final follow-up, with no loss of alignment noted in any case. One knee underwent revision for late infection while another knee had periprosthetic supracondylar fracture treated with plate fixation. Use of the INDUS knee prosthesis has a favorable short-term outcome, with a mean range of 135 degrees flexion and excellent knee scores.
Abstract Introduction: Compound distal tibia fractures have high incidence of nonunions and have ... more Abstract Introduction: Compound distal tibia fractures have high incidence of nonunions and have varied presentation as far as status of fibula is concerned. If fibula is sufficiently healthy we can use it for bridging the nonunion of tibia. Case Report: We present a case of 20 year old female with compound and segmental tibia fracture. Primary stablisation by external fixation and later cast brace application achieved union at the proximal end of the segmental fragment with non union at the distal end. This was then treated with bridge grafting of fibula and screw fixation of fibula to the tibia. Five years follow shows good clinical and functional outcome without any complications. Conclusion: Its infrequent to find fibula spanning across the tibia nonunion, however when available this can be used as bridge graft to promote healing. Keywords: Fibula Bridge Grafting, Tibia Nonunion, bone grafting.
Medical and other scientific literature follow a peculiar repetitive pattern in their (r)evolutio... more Medical and other scientific literature follow a peculiar repetitive pattern in their (r)evolution. They begin with an a concept (or a case) which forces us to think and deliberate on it. Be it the famous ‘Apple fall’ leading to proposal of gravity or unexpected growth of mould leading to discovery of Penicillin. Such happenings occur and define a turning point, which further ramify into organized studies and data accumulation. As argued by Thomas S Khun in his book “The Structure of Scientific Revolution” the ‘development-by-accumulation’ model of science is interrupted by episodic accelerations which are sparked by individual observations or thought process [1]. Such observations and deliberations (or anomalies) are, what we can define as the ‘Epitome of Case Reports’. Case reports in medicine are conventionally assumed to be something of rare occurrence of disease or medical observations. This definition needs to be expanded to include observations and deliberations that can pote...
Journal of Orthopaedic Case Reports (JOCR) has completed Its First Anniversary and this is the fi... more Journal of Orthopaedic Case Reports (JOCR) has completed Its First Anniversary and this is the fifth issue of the Journal. In last one year we had a memorable journey and in coming one year we have planned incredible routes for JOCR. The idea of JOCR was proposed for the first time in late 2010. The scenario of Research in Orthopaedics was undergoing rapid change. Evidence based Medicine was been highlighted and the principles been spread and widely accepted. EBM movement had its effect on Orthopaedic Journals too, which started publishing less number of Case reports. In this backdrop when JOCR was proposed, it was not an idea which had many supporters. We were trying to create a journal which will publish Case Reports when all other journals are refusing to take them. Where will such a journal stand in EBM landscape? Where are the funds, who will sponsor, what is the need for the journal? And the greatest threat ‘What if we Fail?’ The Indian Orthopaedic Research group was in its in...
Introduction: Mucormycosis is lif e threatening inf ection rarely affecting musculoskeletal syste... more Introduction: Mucormycosis is lif e threatening inf ection rarely affecting musculoskeletal system and spinal involvement is extremely rare with only two cases reported in English literature. Case Report: We present this rare case of spondylodiscitis with lumbar vertebral osteomyelitis due to mucormycosis in a patient with chronic kidney disease on haemodialysis diagnosed by CT guided biopsy and highlight its clinico –radiological presentation and management principles. Conclusion: Thus, as the incidence of Mucorales inf ection increase due to increase in patients with predisposing factors, the unusual sites of affection increase. T reating clinician should have a high vigilance in patients with predisposing factors. Although there is dramatic improvement in the treatment modalities of mucormycosis, still the mortality is high. Early diagnosis is important to prevent dissemination and timely intervention in order to reduce morbidity and mortality . A well equipped multidisciplinary ...
Background: Angular deformities around the knee joint in skeletally immature children are treated... more Background: Angular deformities around the knee joint in skeletally immature children are treated with methods of reversible hemiepiphysiodesis like staples, transphyseal screw and eight plate. Hemiepiphysiodesis using Eight plate has showed good results with advantage being faster correction, less complications and can be used in younger age. Methods: The aim of this retrospective study is show the efficacy of eight plate application and its complication rate. Nineteen patients (37 physes) (unilateral: 3; bilateral: 16) with angular deformity were treated with eightplate application. Seven with pathological physes and twelve with idiopathic physes. Outcome assessment was done clinically with calculation of intermalleolar /intercondylar distance and radiologicaaly with mechanical and anatomical axis. Correction achieved was considered when anatomical/mechanical axis were within normal limits and intermalleolar/intercondylar distance was less than 5 cm. Results: The average age of in...
Purpose Treatment of congenital knee dislocation (CDK) depends
on the severity and flexibility of... more Purpose Treatment of congenital knee dislocation (CDK) depends on the severity and flexibility of the deformity. Various modalities of treatment ranging from serial cast, open quadricepsplasty and minimally invasive quadricepsplasty have been described. We describe percutaneous needle quadriceps tenotomy for treatment of flexible CDK and present our result of retrospective case series. Methods This was a retrospective study of 12 patients (20 knees) with flexible CDK. Eight patients with bilateral and four with unilateral deformities. The mean age of intervention was 14.5 days (range, 4–55 days). None of the patients were syndromic. All procedures were done within eight weeks of age. The outcome was measured using knee evaluation score and complications in view of extensor lag, instability and knee flexion deformity. Ultrasound was performed to check for integrity of quadriceps mechanism. Results The mean pre-operative hyperextension was 50° (range, 30–70°). All patients were able to achieve >90° flexion intra-operatively. The mean knee flexion at walking age was 135° (range, 130–140°). Knee evaluation score showed good results in nine patients and fair result in three patients. There was no extensor lag, knee flexion deformity or infection. One patient of anterior instability had ACL aplasia which was documented on MRI. Ultrasound performed at walking age showed normal functioning of quadriceps mechanism. Conclusions Percutaneous needle tenotomy of quadriceps is a effective, simple and safe procedure for flexible, non syndromic CDK presenting early. It avoids complications associated with the open surgical procedure and causes less extensor scarring. However its effectiveness in stiff/hyperlax variants associated with syndromes is yet to be determined. Keywords Congenital . Knee dislocation . Flexible . Percutaneous . Tenotomy
Mucormycosis is life threatening infection rarely affecting musculoskeletal system and spinal inv... more Mucormycosis is life threatening infection rarely affecting musculoskeletal system and spinal involvement is extremely rare with only two cases reported in English literature. We present this rare case of spondylodiscitis with lumbar vertebral osteomyelitis due to mucormycosis in a patient with chronic kidney disease on haemodialysis diagnosed by CT guided biopsy and highlight its clinico -radiological presentation and management principles. Thus, as the incidence of Mucorales infection increase due to increase in patients with predisposing factors, the unusual sites of affection increase. Treating clinician should have a high vigilance in patients with predisposing factors. Although there is dramatic improvement in the treatment modalities of mucormycosis, still the mortality is high. Early diagnosis is important to prevent dissemination and timely intervention in order to reduce morbidity and mortality. A well equipped multidisciplinary approach for clinico-radiological assessment...
Tendo-achillis tenotomy is required as last step of ponseti method of treatment of Congenital Tal... more Tendo-achillis tenotomy is required as last step of ponseti method of treatment of Congenital Talipes Equino Varus (CTEV). This technical note describes a simple method of doing a percutaneous tenotomy of tendo-achillis using a wide bore needle. This is a simple method and easy to learn and gives predictable results.
Editorial This is a digital world we live in. In last 20 years technology has changed the face of... more Editorial This is a digital world we live in. In last 20 years technology has changed the face of this world specially the way in which the data is shared and interaction is improved. This has accelerated things especially scientific inquiry and distribution of scientific concepts. In field of orthopaedics this has led to better implants and more literature. Increased numbers of journals and articles have led to increased awareness about the results of particular surgery and implant. Also it has improved the propagation of awareness about a new technique / implant and its results. In last century, a new technique would simply remain with a single surgeon or country for a long time [Ilizarov ring fixator for example], but now with advent of the online tools and websites, distribution of knowledge is simply amazing. One of the areas where technology can be successfully used is area of Training in surgical skills. We are currently having video websites like Vu-medi and many more videos on you tube etc, however I believe journals can play a very active part in this area. Surgical training of highest quality can reach each and every corner of the world simply by combining a format which will include text, pictures as well as videos. We all have basic surgical skill sets and to step up our training we would simply need to conceptualise and visualise different methods. This can easily be gained from the above format. Of course the learning curve for such training would be much longer and at times there will be unforeseen complications and difficulties. For this reason such articles should have a continued thread of comment and discussions which can be compiled over a period of time and better a list of frequently asked questions. This can provide answers to queries for a new trainee or even for an experienced surgeon. I believe the techniques should be open peer reviewed and not undergo a blinded peer review. The reviewers should be openly allowed to ask the surgeons questions and doubts that the reader will have. A post publication review of the technique is one of the most important part of this initiative where readers and peers can comment on the published technique. The goal of this entire exercise should be improvement of technique and to impart correct surgical principles to the trainees. Trauma International wants to pioneer in this area of surgical training by publishing and will be inviting
As Evident in earlier Editorials [1,2,3], we at JOCR are striving for a better understanding at C... more As Evident in earlier Editorials [1,2,3], we at JOCR are striving for a better understanding at Clinical Decision Making and better Patient Care. Human A deliberations and Single observations have been highlighted as important concepts in building a comprehensive paradigm for individual patient management [2,3]. A review of the quality and direction of current body of 'Selective' literature, which is highly biased towards Evidence Based Medicine (EBM), is needed. EBM has its own role and important place in literature but it might be suffering from a 'Central Control' phenomenon in terms of few 'Chosen' groups of experts who are dig the Evidence and instruct others on how to interpret and utilize 'Evidence'. Here I will like to introduce a concept from Cybernetics called 'Variety' which represents possible alternatives or possible bits of information. The concept of variety is embodied by Ashby's Law which is stated (and also applicable) in many forms. The most useful form for us is as stated by Steve Hickey and Hillary Roberts: " Ashby's Law stipulates that the minimum amount of information needed to give an accurate answer is exactly the amount needed to specify the problem " [4]. This is interpreted as; if the question has lot of variety the answer too will have same amount of variety. A complicated question will not have a simple answer. Management of a complex fracture in patient with multiple co-morbidites in a resourcefully challenged situation cannot be resolved by 'Cookbook' approach that EBM will like us to believe. Thus if we need an answer to a complex situation, more information will be needed and on a large scale 'Wisdom of Crowds' will be more effective than a controlled guideline. Every one of us holds a part of knowledge about management of these cases and when put together will be much more helpful than the group statistics of large clinical trials. Again as surgeons we need to predict the individual patient outcome and not what will be the outcome in group of such patients. Here if we have had a patient with similar profile, we can model the current patient according to him and apply it to subsequent similar group of patients. However can we get enough information from group statistics to treat Individual patients? This reverse is not found to be true [5] and thus all our Literature which is based on group studies has to be carefully reviewed and interpreted. Again the Best Evidence as defined by a 'central control' will go against the Ashby's law as a group of experts will surely have less variety than an entire profession and their patients. Representation of this individual variety in patient presentation and management is currently lacking in Literature and the main reason is the group statistical process of approximation and 'rounding off ' at all levels of information, practiced in current evidence based literature. We believe that this variety is extremely important in clinical decision making and should be provided a platform for presentation. We should be able to make informed decisions based on wisdom of the crowds and in principle should be able to publish and use all the available information. The concept of 'Wisdom of Crowds' has been introduced and detailed by James Surowiecki in his book 'The Wisdom of Crowds' and finds wide applicability in business world and is also a model for popular online portals like Wikipedia [Crowd Computing] [6]. EBM will definitely be a part of this Information network; not the most important part but just as important as other parts namely human deliberations, collective individual opinions, patient's perspective and socioeconomic aspects. I see no other way in which we will be ever able to build a comprehensive paradigm enabling us to make informed and practical decisions for our patients. Of course there will be a lot of 'Noise' which will be associated with this process but I believe most of us will be very able to detect 'Noise' from 'Value' unlike the same in EBM scenario where we find ourselves so prohibitively unable to sort out the 'Noise' from useful information. Another problem with this paradigm is that EBM is the only front that has been developed and given importance while others are criticized and looked upon negatively. It's high time that we should stop equating Level V
... Radius. Author: Ashok K Shyam, Chetan Pradhan, Rajiv Arora, Gaurav Pardesi, Parag Sancheti, A... more ... Radius. Author: Ashok K Shyam, Chetan Pradhan, Rajiv Arora, Gaurav Pardesi, Parag Sancheti, Atul Patil, Chetan Puram. Abstract: Introduction: Distal radius fractures are among the most common fractures of the upper extremity. ...
The anatomical and morphological differences and high-flexion daily activities in the Asian popul... more The anatomical and morphological differences and high-flexion daily activities in the Asian population have since ever prompted for development of customized knee replacement systems. INDUS knee system has advantages both of high-flex designs and is developed by keeping the anatomical variations of the native population in mind. The purpose of this study is to analyze the 2-year follow-up results using the INDUS prosthesis. Two hundred and ninety-seven knees in 276 patients were prospectively analyzed. There were 65 men (72 knees) and 211 (225 knees) women with a mean age of 64.56 years. Two hundred and forty-five knees had primary osteoarthritis, 48 knees had rheumatoid arthritis, and four knees had post-traumatic arthritis. Clinical parameters, including the Knee Society scores (knee score and function score), range of motion, post-operative anterior knee pain, and complications were recorded. Pre- and post-operative serial radiographs were analyzed for limb alignment, component positioning, and evidence of loosening. The patients were followed-up for an average of 2.59 years (range, 2-3.3 years). The mean knee score and the mean function score were significantly improved from a pre-operative value of 39.4 points and 46.7 points to a post-operative value of 87 points and 86 points, respectively (P value <0.05). Two hundred and thirty four knees had no anterior knee pain while 63 knees had mild to moderate pain, but none of the patients requested any intervention for the same. Of the 276 patients (297 knees), 79 knees had flexion above 140 degrees , 167 had a flexion range of 130-140 degrees , 27 had a flexion range of 100-130 degrees , and 24 knees had a flexion < 100 degrees , with the mean range of movement being 132.9 degrees . Improvements in the range of movement were retained over time and a total of 205 patients (224 knees, 75.7%) could squat or sit cross-legged at the final follow-up. The mean tibiofemoral angle was 8.5 degrees +/-6.9 degrees of varus pre-operatively and 5.4 degrees +/-2.2 degrees of valgus (3-7 degrees of valgus) at the final follow-up, with no loss of alignment noted in any case. One knee underwent revision for late infection while another knee had periprosthetic supracondylar fracture treated with plate fixation. Use of the INDUS knee prosthesis has a favorable short-term outcome, with a mean range of 135 degrees flexion and excellent knee scores.
Abstract Introduction: Compound distal tibia fractures have high incidence of nonunions and have ... more Abstract Introduction: Compound distal tibia fractures have high incidence of nonunions and have varied presentation as far as status of fibula is concerned. If fibula is sufficiently healthy we can use it for bridging the nonunion of tibia. Case Report: We present a case of 20 year old female with compound and segmental tibia fracture. Primary stablisation by external fixation and later cast brace application achieved union at the proximal end of the segmental fragment with non union at the distal end. This was then treated with bridge grafting of fibula and screw fixation of fibula to the tibia. Five years follow shows good clinical and functional outcome without any complications. Conclusion: Its infrequent to find fibula spanning across the tibia nonunion, however when available this can be used as bridge graft to promote healing. Keywords: Fibula Bridge Grafting, Tibia Nonunion, bone grafting.
Medical and other scientific literature follow a peculiar repetitive pattern in their (r)evolutio... more Medical and other scientific literature follow a peculiar repetitive pattern in their (r)evolution. They begin with an a concept (or a case) which forces us to think and deliberate on it. Be it the famous ‘Apple fall’ leading to proposal of gravity or unexpected growth of mould leading to discovery of Penicillin. Such happenings occur and define a turning point, which further ramify into organized studies and data accumulation. As argued by Thomas S Khun in his book “The Structure of Scientific Revolution” the ‘development-by-accumulation’ model of science is interrupted by episodic accelerations which are sparked by individual observations or thought process [1]. Such observations and deliberations (or anomalies) are, what we can define as the ‘Epitome of Case Reports’. Case reports in medicine are conventionally assumed to be something of rare occurrence of disease or medical observations. This definition needs to be expanded to include observations and deliberations that can pote...
Journal of Orthopaedic Case Reports (JOCR) has completed Its First Anniversary and this is the fi... more Journal of Orthopaedic Case Reports (JOCR) has completed Its First Anniversary and this is the fifth issue of the Journal. In last one year we had a memorable journey and in coming one year we have planned incredible routes for JOCR. The idea of JOCR was proposed for the first time in late 2010. The scenario of Research in Orthopaedics was undergoing rapid change. Evidence based Medicine was been highlighted and the principles been spread and widely accepted. EBM movement had its effect on Orthopaedic Journals too, which started publishing less number of Case reports. In this backdrop when JOCR was proposed, it was not an idea which had many supporters. We were trying to create a journal which will publish Case Reports when all other journals are refusing to take them. Where will such a journal stand in EBM landscape? Where are the funds, who will sponsor, what is the need for the journal? And the greatest threat ‘What if we Fail?’ The Indian Orthopaedic Research group was in its in...
Introduction: Mucormycosis is lif e threatening inf ection rarely affecting musculoskeletal syste... more Introduction: Mucormycosis is lif e threatening inf ection rarely affecting musculoskeletal system and spinal involvement is extremely rare with only two cases reported in English literature. Case Report: We present this rare case of spondylodiscitis with lumbar vertebral osteomyelitis due to mucormycosis in a patient with chronic kidney disease on haemodialysis diagnosed by CT guided biopsy and highlight its clinico –radiological presentation and management principles. Conclusion: Thus, as the incidence of Mucorales inf ection increase due to increase in patients with predisposing factors, the unusual sites of affection increase. T reating clinician should have a high vigilance in patients with predisposing factors. Although there is dramatic improvement in the treatment modalities of mucormycosis, still the mortality is high. Early diagnosis is important to prevent dissemination and timely intervention in order to reduce morbidity and mortality . A well equipped multidisciplinary ...
Background: Angular deformities around the knee joint in skeletally immature children are treated... more Background: Angular deformities around the knee joint in skeletally immature children are treated with methods of reversible hemiepiphysiodesis like staples, transphyseal screw and eight plate. Hemiepiphysiodesis using Eight plate has showed good results with advantage being faster correction, less complications and can be used in younger age. Methods: The aim of this retrospective study is show the efficacy of eight plate application and its complication rate. Nineteen patients (37 physes) (unilateral: 3; bilateral: 16) with angular deformity were treated with eightplate application. Seven with pathological physes and twelve with idiopathic physes. Outcome assessment was done clinically with calculation of intermalleolar /intercondylar distance and radiologicaaly with mechanical and anatomical axis. Correction achieved was considered when anatomical/mechanical axis were within normal limits and intermalleolar/intercondylar distance was less than 5 cm. Results: The average age of in...
Purpose Treatment of congenital knee dislocation (CDK) depends
on the severity and flexibility of... more Purpose Treatment of congenital knee dislocation (CDK) depends on the severity and flexibility of the deformity. Various modalities of treatment ranging from serial cast, open quadricepsplasty and minimally invasive quadricepsplasty have been described. We describe percutaneous needle quadriceps tenotomy for treatment of flexible CDK and present our result of retrospective case series. Methods This was a retrospective study of 12 patients (20 knees) with flexible CDK. Eight patients with bilateral and four with unilateral deformities. The mean age of intervention was 14.5 days (range, 4–55 days). None of the patients were syndromic. All procedures were done within eight weeks of age. The outcome was measured using knee evaluation score and complications in view of extensor lag, instability and knee flexion deformity. Ultrasound was performed to check for integrity of quadriceps mechanism. Results The mean pre-operative hyperextension was 50° (range, 30–70°). All patients were able to achieve >90° flexion intra-operatively. The mean knee flexion at walking age was 135° (range, 130–140°). Knee evaluation score showed good results in nine patients and fair result in three patients. There was no extensor lag, knee flexion deformity or infection. One patient of anterior instability had ACL aplasia which was documented on MRI. Ultrasound performed at walking age showed normal functioning of quadriceps mechanism. Conclusions Percutaneous needle tenotomy of quadriceps is a effective, simple and safe procedure for flexible, non syndromic CDK presenting early. It avoids complications associated with the open surgical procedure and causes less extensor scarring. However its effectiveness in stiff/hyperlax variants associated with syndromes is yet to be determined. Keywords Congenital . Knee dislocation . Flexible . Percutaneous . Tenotomy
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Papers by Ashok Shyam
on the severity and flexibility of the deformity. Various
modalities of treatment ranging from serial cast, open
quadricepsplasty and minimally invasive quadricepsplasty
have been described. We describe percutaneous needle quadriceps
tenotomy for treatment of flexible CDK and present our
result of retrospective case series.
Methods This was a retrospective study of 12 patients (20
knees) with flexible CDK. Eight patients with bilateral and
four with unilateral deformities. The mean age of intervention
was 14.5 days (range, 4–55 days). None of the patients were
syndromic. All procedures were done within eight weeks of
age. The outcome was measured using knee evaluation score
and complications in view of extensor lag, instability and knee
flexion deformity. Ultrasound was performed to check for
integrity of quadriceps mechanism.
Results The mean pre-operative hyperextension was 50°
(range, 30–70°). All patients were able to achieve >90° flexion
intra-operatively. The mean knee flexion at walking age
was 135° (range, 130–140°). Knee evaluation score showed
good results in nine patients and fair result in three patients.
There was no extensor lag, knee flexion deformity or infection.
One patient of anterior instability had ACL aplasia which
was documented on MRI. Ultrasound performed at walking
age showed normal functioning of quadriceps mechanism.
Conclusions Percutaneous needle tenotomy of quadriceps is a
effective, simple and safe procedure for flexible, non
syndromic CDK presenting early. It avoids complications
associated with the open surgical procedure and causes less
extensor scarring. However its effectiveness in stiff/hyperlax
variants associated with syndromes is yet to be determined.
Keywords Congenital . Knee dislocation . Flexible .
Percutaneous . Tenotomy
on the severity and flexibility of the deformity. Various
modalities of treatment ranging from serial cast, open
quadricepsplasty and minimally invasive quadricepsplasty
have been described. We describe percutaneous needle quadriceps
tenotomy for treatment of flexible CDK and present our
result of retrospective case series.
Methods This was a retrospective study of 12 patients (20
knees) with flexible CDK. Eight patients with bilateral and
four with unilateral deformities. The mean age of intervention
was 14.5 days (range, 4–55 days). None of the patients were
syndromic. All procedures were done within eight weeks of
age. The outcome was measured using knee evaluation score
and complications in view of extensor lag, instability and knee
flexion deformity. Ultrasound was performed to check for
integrity of quadriceps mechanism.
Results The mean pre-operative hyperextension was 50°
(range, 30–70°). All patients were able to achieve >90° flexion
intra-operatively. The mean knee flexion at walking age
was 135° (range, 130–140°). Knee evaluation score showed
good results in nine patients and fair result in three patients.
There was no extensor lag, knee flexion deformity or infection.
One patient of anterior instability had ACL aplasia which
was documented on MRI. Ultrasound performed at walking
age showed normal functioning of quadriceps mechanism.
Conclusions Percutaneous needle tenotomy of quadriceps is a
effective, simple and safe procedure for flexible, non
syndromic CDK presenting early. It avoids complications
associated with the open surgical procedure and causes less
extensor scarring. However its effectiveness in stiff/hyperlax
variants associated with syndromes is yet to be determined.
Keywords Congenital . Knee dislocation . Flexible .
Percutaneous . Tenotomy