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   Table of Contents - Current issue
January-June 2022
Volume 19 | Issue 1
Page Nos. 1-50

Online since Sunday, June 26, 2022

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Importance of publications p. 1
Suresh S Pillai
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Subvastus approach versus medial parapatellar approach in total knee arthroplasty – A prospective comparative study of functional outcome p. 2
Praveen Dileep, Vinod Padmanabhan, CP Krishnaraj
Introduction: For late stages of arthritis of knee, total knee arthroplasty (TKA) is the most successful joint replacement surgery for the patients to achieve good function. The medial parapatellar (MPP) approach is most often used, whereas the subvastus approach (SV) is a suitable alternative. Patients and Methods: This is a prospective, observational, comparative study. Results: It has been demonstrated that the approach (SV) is advantageous in the early postoperative period compared to the MPP surgical approach (MPP). The SV group was able to perform straight leg raising earlier, had good pain scores, and experienced better range of motion when compared to the MPP group. The Knee Society Knee Score for pain was also better in the SV group in the immediate postoperative period. Conclusion: The SV approach, which is based on avoidance damage to extensor mechanism and peripatellar plexus of vessels, helps in early rehabilitation after TKA.
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Fibrous dysplasia; Is aggressive treatment justifiable? p. 7
Dominic Puthur, K Ajith John, Tony Jose
Purpose: Fibrous dysplasia (FD) is a bone lesion resulting from the displacement of the normal medullary bone, with abnormal fibro-osseous tissue. The aim of the study is to investigate the clinicopathological profile of FD, and the objective is to lay out treatment protocol for this condition. Materials and Methods: 25 patients with 29 lesions including 9 femora (31%), 5 tibia (17%), and 4 humerus (14%), 3 rib, 3 ulna, 3 radius, 3 fibula, and 1 pelvis included for the study. Results: The two children who presented with lesions in the trochanter and later had pathological fracture who subsequently treated by fixation with implants were fine during final follow-up, rest of cases in upper femur graft served the purpose and remained asymptomatic in the final follow-up. Humerus and tibia case treated with fibular grafting during childhood didn't served the purpose as the grafted fibula was replaced by dysplastic bone. In contrast to that fibula is used as a graft gives good result in patients nearing skeletal maturity and also in adult. Lesions that are left alone remained as such except for the increased size during adolescent growth spurt. Conclusion: conservative management (observation alone) is enough in most cases of FD. Peri trochanteric region need surgery and were highly dependent on the patient's age at time of the initial presentation. In patients who were skeletally mature, the result was satisfactory with either fibular graft. In contrast, patients who were skeletally immature, fibular graft gets involved in the disease process and do not serve its purpose.
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Proximal femoral nail versus proximal femoral nail Antirotation 2 in the fixation of intertrochanteric fractures: A prospective and comparative study of clinico-radiological outcomes p. 17
M Harisankar, Rajanish R Menon, P Gangadharan
Intertrochanteric fractures of the femur is one of the most common fractures encountered by an orthopedician during his practice. Hence, it is considered highly relevant to compare the clinico-radiological outcome of intertrochanteric fractures treated with the two different intramedullary implants – proximal femoral nail (PFN) and PFN Antirotation2 (PFNA2) with a critical note on their efficacy. Source of Clinical Data: The clinical material for the present study consists of 78 cases of fresh trochanteric fracture of traumatic etiology meeting the inclusion and exclusion criteria. Study Design: This is a prospective, randomized comparative study. Conclusion: There was no significant difference between the two groups in terms of clinical or functional outcome. However, fluoroscopic exposure and the duration of surgery were significantly lower with PFNA2. Hence, we conclude that PFNA2 is a better option for the treatment of intertrochanteric fractures of hip.
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Cholinergic stimulation of fracture healing: An animal study p. 24
PS John, Ann Maria John, Varghese Thomas, Yogesh Bharat Dalvi, Ruby Varghese
Background: There have been countless attempts not only to address the problems of a failed union but also to accelerate fracture healing. A review of the literature over the last several decades shows that the various strategies for accelerating fracture healing have not been highly successful. Aims and objectives: Recent discoveries on the positive role of cholinergic activity on bone have been successfully used to investigate new promising therapies for various bone diseases and acceleration of fracture healing based on cholinergic stimulation. Citicoline is a precursor of acetylcholine biosynthesis and can increase the level of acetylcholine and thereby increase cholinergic activity. Hence we have done a study to find out the role of citicoline in accelerating fracture healing. Materials and methods: In this animal experiment model, we have studied the healing of leg fracture in a group of ten rats treated with citicoline injection intraperitoneally and in another group without citicoline supplementation. Results: The citicoline group showed early fracture healing with exuberant callus and the tissues studied from the fracture site showed more thymidine incorporation. Conclusions: This animal study has shown that Citicoline can accelerate fracture healing by cholinergic stimulation.
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A rare case of transient anisocoria following microlumbar discectomy: A case report and literature review p. 29
Rizwan Sait, R Krishnakumar
Ocular complications following surgeries in prone positions are rarely reported. With this case report, we present a 39-year-old female who developed transient anisocoria following microlumbar discectomy. Further evaluation showed mild uniocular third nerve palsy, which resolved spontaneously. By understanding the pathophysiology of this complication, we can avoid unnecessary investigations and costs.
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Pigmented villonodular synovitis in a rare site p. 33
Devaraj Nair, Samson Samuel, SK Varkey, PS John
Pigmented villonodular synovitis (PVNS) is a rare locally aggressive benign proliferative growth of the synovium of unknown etiology known to involve the knee (80%), hip (10%), ankle (5%), and exceptionally temporomandibular joint and spine. It poses a diagnostic dilemma when it occurs at the ankle with the clinician tending to overlook it like an ankle sprain or posttraumatic pathology. The optimal treatment is surgery. Malignant change of the lesion, although rare is known for its ability for reactivated growth and a tendency to recur. Postoperative radio synoviorthesis may be required to remove the excess synovium when surgery alone falls short of removing the residual synovial membrane. This article reports the case of a rare localized PVNS of the ankle. Although rare at the ankle, PVNS must neither be mistaken for a malignant lesion nor be neglected as a nonspecific swelling.
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Newer drug for the resistant bug: A case report of spondylodiscitis with Klebsiella pneumoniae producing carbapenemase managed successfully with ceftazidime-avibactam p. 36
Sushma Krishna, Neha Mishra, Nikhil Nediyan Chath, Gowrishankar Swamy, Shrikanth Kanchana Pala
Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae are multidrug resistant organisms that have been increasingly recognized to cause infections with high mortality. The therapeutic options available for treating such infections stand severely compromised. The use of ceftazidime-avibactam in bacteremia and other infections by these organisms has been reported. We report a case of spondylodiscitis caused by KPC-KP diagnosed by pan-bacterial DNA screen and successfully treated with this relatively newer antibiotic. This report highlights the importance of the utility of molecular diagnostic tests in routine practice.
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Glomus tumor: A case series study of 30 cases and review of the literature p. 39
CS Nikhil, Joe Davis, K Muraleedharan, Suresh S Pillai
Glomus tumors are rare usually benign neoplasms arising from the glomus body, accounting for 1%–2% of soft tissue tumors of the hand. They are commonly found in the hand and present as bluish or red-pink discoloration of the nail bed with the classic triad of symptoms and clinical signs. Although classical signs and symptoms have been described, there is a delay in diagnosis of the tumor mainly due to the lack of awareness and low prevalence of the tumor. Magnetic resonance imaging is the investigation of choice in the diagnosis of the glomus tumor and the treatment is complete excision which prevents recurrence.
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Unusual case of surgical site infection with uncommon organism – Burkholderia pseudomallei p. 44
Fawaz Mohammed Manu, Anwar Marthya, Shameez Muhammed Salim, Vinu Elias
Melioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei, previously termed as Pseudomonas pseudomallei. This case report is an unusual case of surgical site infection with uncommon organism-B. pseudomallei. We report a case of melioidosis. A 62-year-old patient complained of swelling, redness, discharge from the surgical site right hip, and on and off generalized temperature from the last 15 days. The patient was toxic. Erythrocyte sedimentation rate was 130, C-reactive protein – 92, and Hb – 9.2, and on further blood investigation, the patient was diagnosed with surgical site infection with an implant in situ and underwent implant removal and surgical debridement of right hip, by intraoperative pus culture shows Staphylococcus aureus growth, and the patient was started on intravenous cefoperazone-sulbactam 1.5 g for 1 week, following which symptoms reappear. Later, Gram-stain shows the growth of B. pseudomallei. He was started on injection ceftazidime 2 g thrice daily (TDS) (Q8 hourly) for 2 weeks followed by oral cotrimoxazole for the next 9 months, the patient is on regular follow-up. Diagnosis of melioidosis is missed in many parts of the world due to lack of awareness of this infection caused by B. pseudomallei. Delay in diagnosis or treatment against melioidosis can worsen the outcome. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.
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Unresectable giant cell tumor of cervical spine p. 48
Suresh S Pillai, Premdeep Dennison, TV Rishin, Jim Thomas Malayil
Giant cell tumors (GCTs) of the spine occurs very rarely above the sacrum. They are even rarer in cervical spine. The complete resection of the tumor is often unachievable in cervical spine due to the close proximity of important neurovascular structures. We describe a case of unresectable (GCT) of cervical spine treated with near-total resection and adjuvant denosumab therapy. A 28-year-old female presented with quadriparesis and imaging showed GCT of the C6 vertebral body, compressing the spinal cord and also abutting the vertebral artery on the left side. Vertebral arteries were dominant on both sides and the feeders to the tumor could not be embolized. This posed a major challenge as removal of the tumor was not feasible. Near-total removal was done and the patient was started on denosumab, which decreases the osteoclast production and thus reduces size and prevents further spread of tumor. GCTs are resilient and can recur locally, even after the complete removal of tumor. Denosumab is a novel monoclonal antibody which can decrease the size of the tumor and also decrease the chance of recurrence after surgery, by preventing osteoclastogenesis. In cases of GCTs which cannot be completely removed, denosumab therapy as an adjunct to surgical removal is a safe and reliable option.
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