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  Citation statistics : Table of Contents
   2013| July-December  | Volume 1 | Issue 2  
    Online since January 15, 2014

 
 
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ORIGINAL ARTICLES
Is intraarticular administration of tranexamic acid better than its intravenous administration in reducing blood loss after total knee arthroplasty?
Ameet Pispati, Parag Garg, Nikhil Patil, Abhijeet Savedekar, Nitin Jaiswal, Animesh Kumar
July-December 2013, 1(2):28-32
DOI:10.4103/2319-2585.125039  
Context: It has been well-established now that intravenous (IV) tranexamic acid (TXA) is a potent agent to control postoperative blood loss following total knee arthroplasty (TKA). Recently, intraarticular administration of this agent has also shown good efficacy for the same. Aims: Comparison of postoperative blood loss between IV and topical administration of TXA in TKAs. Materials and Design: Eighty-six TKAs on knees were included in this study. Randomization was done so that 40 TKA received 1 g of IV TXA, while 46 had intraarticular administration of 1 g TXA. Subjets and Methods: We compared the postoperative blood loss by calculating the difference in pre- and postop hemoglobin and need for blood transfusion. Functional assessment was done on basis of Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores and complications like postoperative infection, oozing from the wound site and thromboembolic manifestations. Results: Blood loss was significantly less in the intraarticular administration group as compared to the IV injection group. Total blood loss, blood transfusion group, and drain output was also less but the difference was not significant. The functional assessment (WOMAC) scores were equivocal and so were the complications including thromboembolic manifestations (two cases each of deep vein thrombosis (DVT) and no cases of pulmonary embolism (PE)). Conclusion: Intraarticular administration of TXA to prevent postoperative blood loss in TKA is a safe and effective alternative/adjunct to its IV administration.
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CASE REPORTS
Giant schwannoma arising from cervical nerve root with intra-thoracic extension
Amit Agrawal, Nitish Baisakhiya
July-December 2013, 1(2):37-39
DOI:10.4103/2319-2585.125044  
Schwannomas are well-encapsulated benign neurogenic tumors that arise from the nerve sheaths of peripheral nerves. Schwannomas may occur nearly anywhere in the body, but have a predilection for the head and the neck, with an incidence of 40-50%. Rarely, the cervical nerve root can be the site of a large dumbbell neurogenic tumor in the neck. In the present article, we describe the case of a 40-year-old male with a large schwannoma arising from the cervical nerve root with intrathoracic extension. Surgical excision is the treatment of choice for neurogenic tumors, and it has been described that if the lesion is known to be a schwannoma, it is possible to open the capsule and shell out the tumor from the nerve, possibly avoiding functional deficits. However, as in the present case, it may not be possible to resect the tumor safely from the involved nerve root and it may be necessary to sacrifice the nerve involved in the tumor to achieve complete resection.
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A unusual presentation of syringomyelia as neuropathic arthropathy of elbow joint and review of literature
Samir Dwidmuthe, Gajanan Pisulkar, Narendra Saxena, Karan Mane
July-December 2013, 1(2):40-43
DOI:10.4103/2319-2585.125045  
Neuropathic arthropathy (NA) is one of the less understood and challenging condition to treat in clinical practice. Jean Martin Charcot described neuropathic joint in 1868. He has shown occurrence of NA in cases of syringomyelia and tabes dorsalis. Since then NA has been described in various other conditions. Knee and ankle joints are most commonly affected. Occurrence of neuropathic joint in upper extremity is very rare. Elbow is less commonly affected joint. We describe two cases of NA of elbow joint with unusual presentation. One patient presented with 3 month history of elbow injury with gross destruction of elbow joint. Another patient presented with acute swelling of elbow joint mimicking septic arthritis with ulnar nerve involvement. We reviewed literature to discuss etiopathogenesis, clinical presentation, and treatment available for NA of elbow joint.
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Bilateral recurrent anterior fracture dislocation of shoulder joint due to grand mal epileptic convulsions
Chandrashekara Chowdipalya Maliyappa, Bader Said Khamis Al-Marboi, Mulamootil Abraham George
July-December 2013, 1(2):44-46
DOI:10.4103/2319-2585.125047  
Bilateral shoulder dislocation is very much common with convulsions of different etiology. Often, these dislocations are associated with fractures due to violent muscle contractions. The typical lesion is bilateral posterior dislocation or fracture dislocations. The recurrent shoulder dislocations are common with traumatic etiology. The lack of asymmetry of the shoulders is stressed as a potential pitfall in the clinical evaluation of patients with this condition. We present a rare case of bilateral recurrent anterior fracture dislocation of the shoulder sustained due to repetitive episodes of convulsive seizures. Patient was treated by close reductions and immobilization on each episode. In epilepsy although posterior dislocations are common, the rare possibility of bilateral anterior fracture dislocation should be kept in mind. Often these patients are vulnerable for recurrence, similar to traumatic cases.
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Simultaneous bilateral isolated greater trochanter fracture
Maruti Kambali, Venugopal Narayanappa, Arun Hedduru Shantappa, Naryan Sreenivas Gudi, Siddhartha Saive, Priyamargavi Hanumantharayappa Kambali, Mohammad Imran
July-December 2013, 1(2):47-50
DOI:10.4103/2319-2585.125048  
A 48-year-old woman sustained simultaneous isolated bilateral greater trochanteric fracture, following a road traffic accident. The patient presented to us 1 month after the injury. She presented with complaints of pain in the left hip and inability to walk. Roentgenograms revealed displaced comminuted bilateral greater trochanter fractures. The fracture of the left greater trochanter was reduced and fixed internally using the tension band wiring technique. The greater trochanter fracture on the right side was asymptomatic and was managed conservatively. The patient regained full range of motion and use of her hips after a postoperative follow-up of 6 months. Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports of this particular type of injury are not plentiful and the average textbook coverage afforded to this entity is limited. In our study we discuss the mechanism of injury and the various treatment options available.
  - 6,360 745
EDITORIAL
Bone and joint infection: Tackling as a rural surgeon
Sandeep Shrivastava
July-December 2013, 1(2):25-27
DOI:10.4103/2319-2585.125037  
  - 2,395 1,651
GUEST EDITORIAL
Scope and future of minimal invasive spine surgery
Yue Wai Mun
July-December 2013, 1(2):24-24
DOI:10.4103/2319-2585.125034  
  - 1,981 3,049
ORIGINAL ARTICLES
Evaluation of percutaneous pinning in unstable proximal humeral fractures: A novel technique
Nishikant Kumar, Sumit Anand, Rishi Raj, Anil Mehtani
July-December 2013, 1(2):33-36
DOI:10.4103/2319-2585.125042  
Management of unstable proximal humeral fractures has remained controversial since ages. Open reduction and internal fixation have resulted in devastating complications like stiffness of shoulder joint, avascular necrosis, infection, etc., We are presenting a novel method of percutaneous pinning of unstable proximal humeral fractures. All cases (32) were done closely without soft tissue stripping. All cases were followed-up for a period of 3 years; and results were assessed according to 100 point constant score. A total of 75% cases showed excellent to good results. To minimize the complications like pin site infection, loosening, neurovascular damage we used fixed pin site insertion technique, and threaded pins in osteoporotic patients. So percutaneous pinning is a safe and novel method of management of unstable proximal humeral fractures if certain principles are borne in mind before using it.
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