Vertebral hemangiomas are among the most common benign lesions of the spine, with an incidence of 10%–12% in the adult population. Vertebral hemangiomas have been reported in all age groups with most prevalence in the fifth decade of life. A small proportion of the lesions (1%) may cause neurological symptoms ranging from pain to full-fledged paraplegia. Since most of the vertebral hemangiomas are asymptomatic and quiescent, no treatment is required. Treatment is to be considered only if there is back pain or neurological symptoms due to vertebral fracture or spinal cord/root compression. Because these active and symptomatic types of vertebral hemangiomas are a rare occurrence, their treatment modalities remain controversial and hence problematic. Since most of the patients are treated by a combination of modalities, the analysis of the efficacy of each treatment is difficult to assess and hence the apt choice of treatment is still controversial.

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Introduction: Common indications for total knee arthroplasty (TKA) underwent in our hospital were severe grade osteoarthritis of the knee. The etiological factors are idiopathic, post-traumatic injury sequel, postinflammatory sequel, and metabolic conditions like gout and pseudogout. The risk factors include obesity, intraarticular fractures, and meniscal injuries. Materials and Methods: Study participants: A total of 12 cases were analyzed. Three of them were male and 9 were female. Four of them underwent cruciate-retaining and 8 cruciate sacrificing procedures. Discussion: The stability of the knee is a complex issue. The deformity and osteophytes affect the ligaments unequally because of different degrees of tightness or laxity in flexion and extension. We found that the most common difficulty arises in primary TKA was due to the medial tibial bony defect. The defects were secured with a graft fixed to the medial tibial condyle with or without utilizing screws. Physiotherapy was started from the next postoperative day onward. Conclusion: The TKA posed three challenges (1) Instability (2) Difficulty in soft-tissue balancing (3) The longevity of tibial tray. These three challenges were overcome by building the defect using bone graft.

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A 42 year old lady presented with acute onset “recurrent” cauda equina syndrome (CES) as a result of repeated disc prolapse at L4-L5 level on the left side, which was operated 10 years earlier. The patient had a previous successful surgery for cauda equina syndrome at the same level(left sided prolapse) and a symptom free period of 10 years. She presented with acute onset left lower limb radicular pain, inability to walk and void urine. Revision surgery by Posterior decompression and Discectomy L4 - L5 with Instrumented Posterolateral Fusion (PLF) from L3 - L5 were performed. There was intra operative dural tear which was primarily repaired. She regained bowel and bladder control post operatively in 10 days time. She became completely ambulant without any residual deficit. Recurrent cauda equina syndrome due to disc prolapse at the previously prolapsed site after a surgical intervention is not reported in the literature, to the best of our knowledge.

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Charcot neuropathic osteoarthropathy (CNO) is painless, progressive, noninfectious, degenerative arthropathy affecting single or multiple joints and soft tissues of foot and ankle caused by an underlying neurological deficit. The primary indication for surgical correction is a nonbraceble, nonplantigrade foot, instability, and impending or established ulceration. The goal of surgical management is to provide a stable, ulcer-free, plantigrade foot that can accommodate therapeutic footwear for self-ambulation. The choice of implants in midfoot CNO can be a combination of plate and screws well beyond the area of deformity to achieve rigid stability and good alignment following the principle of a super construct. The deformities involving the talus and ankle joint require a Total contact casting (TCC) arthrodesis, preferably with an intramedullary nail. The choices for soft tissue coverage as an additional procedure for ulcer management are guided by anatomic location, size, depth of ulcer, condition of surrounding soft tissue, and underlying deformity.

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Background/Purpose: The pandemic of COVID 19 has swept across the livelihood and economy throughout the world. We created an online survey during the 2^nd week of the first phase of national lockdown and assessed the impact of COVID 19 pandemic on orthopedic surgeons in South India, who are almost forgotten in this fight. Methods: The simple survey which included questions divided into categories – demographic details, awareness of the situation, clinical practice, effects on research, training, and personal aspects. The survey was shared on social media and responses were recorded online using Google forms and analyzed. Results: A total of 132 surgeons from various states of India, mostly from South India answered the survey in 7 days. More than 50% responded that their institution had no specific guidelines nor had adequate personal protective equipment (PPEs). Sixty-percent of the surgeons used only standard precautions and not PPE for emergency surgeries. Sixty-seven percent used telecommunication for regular follow-ups and most preferred WhatsApp messenger over SMS or calls. Over 50% were not confident to handle medical emergencies. 53.6% felt postgraduate training was significantly affected due to the lockdown and 58.8% were most stressed about their personal and family health. Seventy-five percent surgeons used this leisure period to spend time with their family. Conclusion: The pandemic of COVID 19 has significantly affected different domains of work and personal life of orthopedic surgeons in India. The survey helped to identify the deficiency and necessary changes which were implemented further. The situation would lead to long lasting changes in clinical practice and view of surgeons in the field of medicine and personal life in general.

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Flexor tenosynovitis is a common hand infection and if not addressed early with effective treatment can result in permanent disability. A horseshoe abscess is a well-known aggressive variant of flexor tendon sheath infection occurring due to the spread of infection through the interconnections between the deep spaces of the hand. Early diagnosis and prompt and effective treatment are crucial in avoiding late complications. We report a case of horseshoe swelling of the hand following a penetrating injury treated successfully by surgical debridement and closed catheter irrigation.

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Foot is an uncommon location for unicameral bone cyst, and it is widely believed that calcaneal cysts are typically asymptomatic. We report a case of a bilateral calcaneal cyst in a 65-year-old man which produced unilateral symptoms where open curettage and autogenous bone grafting provided a significant symptomatic relief. Our patient had complete symptomatic relief following surgical curettage without any perioperative complications. Calcaneal bone cyst, although rare, forms an important differential diagnosis in patients presenting with heel pain where surgical management can be a viable option in cases refractory to conservative treatment.

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In this study, we have evaluated the prevalence of periarthritis in diabetes above the age group of 50 years in a population residing in Venjaramoodu, Trivandrum. There were a few exclusion criteria. This is a cross-sectional study which includes 100 participants selected from the patients of periarthritis. Data were analyzed using the percentage analysis method. This study showed that 36% of patients of periarthritis attending the orthopedic outpatient department had diabetes mellitus. We come to the conclusion that the prevalence of periarthritis is more in diabetic individuals and that periarthritis is more common in uncontrolled diabetes.

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This article highlights the influence of coronavirus pandemic in patient care from an Orthopedic surgeon's perspective and enumerates the modifications in routine practice while providing quality service to the society. The authors have reviewed the recently available articles regarding the changes in orthopedic practice with respect to the coronavirus disease pandemic. Prioritizing surgical treatment of obligatory fractures and conservative management of non-obligatory fracture will be the cornerstone of management strategy in patient care during these troubled times. Formalizing evidence-based protocols for various subsets of orthopedics not only reduces the event-response time lag but also helps in accurate implementation of services for the best patient outcome.

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Patella tendon avulsion injury following total knee arthroplasty (TKA) is one of the rarest complications to occur. A breach in the extensor mechanism severely affects the knee function. A spectrum of treatment options with unpredictable outcomes is enumerated in the literature. We present a case of patellar tendon avulsion injury following TKA in a 74-year-old diabetic woman managed by percutaneous extraarticular reconstruction using artificial ligament.

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Spontaneous spinal epidural hematoma (SSEH) is a rare and devastating clinical entity. The incidence is considered to be 1 in million/year. SSEH manifests due to accumulation of blood in the epidural space causing compression of the spinal cord and leading to acute neurological deficit. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurological deficit. Magnetic resonance imaging (MRI) serves as the modality of choice in diagnosing spinal epidural hematoma. Decompressive laminectomy and hematoma evacuation is considered as the mainstay of treatment, although conservative treatment can be tried in limited cases. Here, we present the case of a 48-year-old male who presented with progressive neurologic deficit. MRI revealed spinal epidural hematoma at T10-L4 level with cord compression which was promptly evacuated. Functional recovery was achieved after the surgical intervention.

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It is our responsibility to be aware of the current knowledge on COVID-19 such as the pathogenesis, clinical features, and the precautions that we have to follow while handling orthopedic patients. A detailed look into the current protocol and suggestions of orthopedic practices in the COVID-19 outbreak has done here. A review of articles indexed for MEDLINE on PubMed and Scopus using the keywords COVID-19 and orthopedics and as a Boolean search was used. The review included evidence from 44 articles from orthopedic literature. There are risks associated with orthopedic practices in the COVID-19 pandemic, and many standard protocols are available to confront the situation. This article highlights useful recommendations and directions for orthopedic practices in the COVID-19 outbreak.

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Desmoplastic fibroma (DF) of the bone is a very rare benign tumor of the skeletal system with a reported incidence <1.1% of all primary bone tumors. DF of bone is considered to be the skeletal counterpart of extra-abdominal desmoid tumors. The common sites are mandible and tibia. Here, we present a case report of DF of the scapula with a 14-year follow-up. The DF of the scapula is an extremely rare tumor with only six such cases reported in international literature till now.

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Nonossifying fibroma (NOF) is a nonneoplastic lesion of the long bones which are rarely seen after skeletal maturity. The disorder is most often asymptomatic, discovered incidentally on plain radiographs and spontaneous regression over the years is typical. Nevertheless, larger lesions are at an increased risk of pathological fracture and together with atypical radiographic features can cause concern leading to consultations in orthopedic oncology clinics. A correct diagnosis can be established after a careful study of the patient's history and clinical status together with different imaging modalities and histologic characterization of the lesion. Surgical treatment may be required to forestall fractures in symptomatic lesions. Recurrence is rare after surgical intervention. Here, we report an interesting case of a pathological fracture through a symptomatic NOF with a 1-year follow-up, after surgical intervention.

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Melioidosis is a life-threatening infectious disease caused by Burkholderia pseudomallei, seen more commonly in South East Asia and Northern Australia. Though it is an important cause of sepsis, musculoskeletal melioidosis is rare in the Indian subcontinent. We report two cases of cervical prevertebral abscess in a 60-year-old female and a 62-year-old male, caused by B. pseudomallei. No cervical prevertebral abscess due to B. pseudomallei has been reported in the literature to the best of our knowledge.

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Lateral condyle humerus fracture in children is known to have union complications. Delay in diagnosis, pull at the common extensor origin, precarious blood supply and lack of appropriate treatment may result in non-union. Non-union of lateral condyle can lead to progressive cubitus valgus. Progressive cubitus valgus may be associated with pain, instability and stiffness of the elbow and ulnar nerve paresis. Plain radiographs of the elbow are required for the assessment of the joint congruity, size of the lateral condyle fragment, extent of the elbow deformity and physis status. Corrective osteotomy with anterior transposition of the ulnar nerve gives good cosmetic and functional results.

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Denosumab is a relatively new drug and is used in the treatment of giant cell tumor (GCT) of bone. There are hardly any drugs such as denosumab, indication of which changed in a short period of 10 years. The author analyses the cause of this transformation of indication of that drug in the treatment of GCT of bone, based on the scientific ground, review of the literature, and personal experience.

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Superior dislocation of the patella is an extremely rare clinical entity, which is frequently misdiagnosed as acute patellar tendon rupture. Locked knee in extension is the classical presentation, and plain radiographs are most often diagnostic. Closed reduction can be accomplished in majority of cases, and we report superior patellar dislocation in an elderly female following trivial trauma, successfully managed by closed reduction under local anesthesia.

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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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A good outcome in Acute Lateral condyle fractures can be achieved by proper assessment and protocol based treatment. Clinical assessment of fracture stability can be indirectly assessed by associated soft tissue swelling, fracture crepitus elbow joint stability. Radiographs will help in determining the displacement and thereby the fracture stability and classify the fracture. It should essentially include all three views, the Anteroposterior, 15 degrees Internal Oblique and Lateral views, during initial as well as during follow-up. If stability and pattern of fracture cannot be determined on radiographs, especially in very young children, MRI and Ultrasonography will aid in determining the stability of undisplaced fractures by looking at intact cartilage hinge. Stable fractures (Song's Grade 1 and 2) can be managed non-operatively. Weekly followup radiographs out of the cast for the first 2 weeks is essential as majority of undisplaced fractures get displaced within first 2 weeks. Displaced fractures are treated by closed or open reduction. Intra operative arthrogram can aid assessment of fracture fragment and its reduction. Two K-wires, one placed transversely and other obliquely at an approximate angle of 45-60 degrees, will be sufficient to provide good stability. A screw can be placed in older children with a large capitellum or a metaphyseal fragment. A low threshold for open reduction should be considered with an aim to achieve good articular reduction. The commonest concern is lateral prominence causing Pseudovarus deformity. It usually resolves over sometime.

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Spondylodiscitis following sacrocolopopexy is a rare complication. Many cases of spondylodiscitis are preceded by infection elsewhere, most commonly the genitourinary tract. Inadvertent placement of bone anchors into the L5-S1 disc space likely results in an L5-S1 inflammatory process with infection often tracking along the suspension sutures attached to the bone anchors. Commonly onset of spondylodiscitis is in <1 year of index surgery (average 4 months) but is reported as late as 8 years. However, the patient presenting with chronic discharging sinus (6 years) and acute spondylodiscitis following sacrocolpopexy is not reported in the literature to the best of our knowledge. To report a case of lumbosacral (L5-S1) discitis in a patient who had a discharging sinus at the left iliac fossa following a sacral colpopexy procedure 6 years back. A 44-year-old female underwent laparoscopic sacral colpopexy for uterovaginal prolapse approximately 6 years back. Approximately 4 months after the surgery, she had abdominal pain and fever, followed by discharge from the left iliac fossa. She presented to the spine surgery outpatient department with severe back pain and difficulty in walking for the last 2 weeks. Magnetic resonance imaging revealed L5-S1 spondylodiscitis. She was managed collectively by a spine surgeon, gynecologist, and gastro surgeon. The principal aims of surgery are to debride infected disc tissue, which is avascular, and excision of the sinus tract along with the removal of the sling along with its anchor. To minimize L5-S1 spondylodiscitis during sacrocolpopexy, it is recommended to start the presacral dissection at the sacral promontory, which generally lies just below the steep lumbosacral angle.

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