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   2014| July-December  | Volume 2 | Issue 2  
    Online since November 27, 2014

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A new technique for surgical management of old unreduced elbow dislocations: Results and analysis
Parag Garg, Soumya Paik, Sisir Sahoo, Vimal Raj, Aniruddha Pispati, Subhashish Mitra
July-December 2014, 2(2):45-51
Background: Open reduction of neglected dislocations of elbow often leads to less than optimal results. Extensive release during reduction and early mobilization may lead to instability. Post-surgical immobilization to recover the stability leads to loss of range of motion. Arafiles described a technique of creating a cruciate ligament like structure to provide stability while early mobilization is advocated. We have modified this technique in several aspects. We report a retrospective analysis of 26 such cases where we evaluated and compared the standard immobilization technique of K-wires with this new modified technique. Materials and Methods: Twenty-six consecutive cases of dislocated elbow with duration ranging from 4 to 56 months were included in this study. We performed standard open reduction and fixation with K-wire followed by immobilization for 3 weeks for the first 12 cases. In the next 14 cases after standard release and reduction we provided extra stability by adding a cruciate ligament like structure both on the medial and lateral side using autologous semitendinosus graft. Post-operative mobilization was advised the very next day. We evaluated the results of this technique and compared it with the previous one using MEPI scores, complication rate and radiological evaluation.Results: The average follow-up duration for the 26 patients is 4.5 years (2−7 years). All patients achieved full functional ROM in both planes. The mean increase in the MEPI score was significantly more for group II (53.5) than group I (36.6). Movement, activities and stability was better for this group II. Complication rates for both were similar.Conclusion: Providing stability at the time of operation with a mediolateral cruciate ligament provides the option of immediate mobilization post-operatively in open reduction of neglected dislocations of elbow. Thus, this technique provides excellent results disregarding the duration of dislocation with minimal morbidity for the patient.
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Congenital clubfoot
Sanjay Meena, Pankaj Sharma, Shreesh Kumar Gangary, Lalit Kumar Lohia
July-December 2014, 2(2):34-39
Clubfoot is the most common congenital deformity of lower limbs. Its etiology remains an enigma. The aim of the treatment is to obtain a plantigrate, painless and functional foot. Conservative treatment with Ponseti method of clubfoot is well-accepted and has been reported to result in good correction ranging from as low as 50% to as high as 90%. Surgical treatment is indicated only after failure of conservative methods, with limited release also known as " a la carte"release. This review looks at etiology, clinical assessment, scoring and provides an overview of operative and non-operative treatment options.
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Pitfalls in the radiographic diagnosis of the transverse processes fracture of the lumbar vertebrae
Kishor V Hegde, Reddy V Umamaheswara, Amit Agrawal
July-December 2014, 2(2):63-64
  12,027 556 -
Recent advances in shoulder surgery
Vishal Sahni, Ashish Narang
July-December 2014, 2(2):29-33
  6,704 3,585 -
Multisite quantitative ultrasound: It's comparison with dual energy X-ray absorptiometry in the diagnosis of osteoporosis
Shweta Shenoy, Jasmine Kaur Chawla, Jaspal Singh Sandhu
July-December 2014, 2(2):40-44
Background: The aim of the study was to establish the correlation between dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) and to assess the ability of QUS as a screening tool for osteoporosis. Materials and Methods: The study was conducted on 101 healthy women, aged 20-65 years. All the women underwent QUS of radius and tibia using Omnisense bone densitometer and DXA screening for measurement of bone mineral density (BMD) at lumbar spine, total hip, and femoral neck. Results: Significant correlations were observed between speed of sound (SOS) and BMD measurement in all age groups, with the closest association. In the age group of 20-40 years, BMD of femoral neck showed the closed association with SOS radius (0.858, P < 0.01) and SOS tibia (0.860, P < 0.01). Similar trend was observed in the other two age groups as well. All subjects in the premenopausal (41-50 years) and postmenopausal (51-65 years) age group were correctly detected for osteopenia/bone density below the expected range for age and osteoporosis by QUS, as against the diagnosis made by DXA. Post hoc test revealed a significant difference in the BMD of femoral neck, lumbar spine, and SOS radius and tibia in young and postmenopausal females. Conclusion: QUS is a sensitive screening tool to detect changes in the bone mass and risk of osteoporosis.
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A rare case of ectrodactyly in a child in India
Mishil S Parikh, Sunil H Shetty, Ravindra G Khedekar
July-December 2014, 2(2):52-53
Ectrodactyly, termed split-hand/split-foot malformation (SHFM), is a rare genetic condition characterized by defects of the central elements of the autopod (hand/foot). Clinical presentation is with the absence of one or more median rays or digits creating cone-shaped clefts of the hands and/or feet. The present case of severe bilateral SHFM was presented in an 8-year-old girl in India. This case of SHFM involves the complete absence of the central rays of the autopod in which each of the hands and feet is divided into two parts by a cone-shaped cleft tapering proximally, resembling a "lobster claw." SHFM is often associated with other limb anomalies, including monodactyly, syndactyly and aplasia, and/or hypoplasia of the phalanges, metacarpals, and metatarsals. Most cases are sporadic; however, familial forms do exist with predominantly autosomal dominant inheritance. This case is an example of the non-syndromic form of SHFM expressed with isolated involvement of the limbs, while the syndromic form is associated with anomalies such as intellectual disability, ectodermal and craniofacial findings, and hearing loss. Non-syndromic isolated ectrodactyly does not usually require surgical intervention. We recommended against surgical reconstruction due to lack of evidence of functional disability.
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Primary ankle synovial chondromatosis in a young post-partum female
Pallav Mishra, Prashant K Mishra, Divya Pandey, Brajendra N Tripathi
July-December 2014, 2(2):60-62
Primary Synovial Chondromatosis is a rare, benign disorder. A 23-years-old, 4 months post-partum female presented with vague foot pain, found to be having Primary ankle synovial chondromatosis on clinico-radiological examination and was treated by arthroscopic removal of loose bodies with partial synovectomy.
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U shaped sacral fracture with neurological injuries- report of two cases
Aidin Sadeghilar, Mohd Hisam Muhamad Ariffin, Shaharuddin Abdul Rhani, Azmi Baharudin
July-December 2014, 2(2):57-59
U shaped sacral fractures are uncommon and serious injuries that can be accompanied by lumbar plexus neurological dysfunction. We report two unique and frequently missed cases of U shaped sacral fractures with associated neurological deficit (Cauda Equina) which stabilized using Sacropelvic fixation with spinal instrumentation. We also performed laminectomy to decompress the lumbar plexus and preserve neurological function.
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Humerus fracture in the setting of primary pustular adult varicella infection in a young female
Ganesh Singh Dharmshaktu, Anshuman Vijay Roy, Pankaj Singh
July-December 2014, 2(2):54-56
Varicella or chickenpox is an infection caused by Varicella -Zoster virus, which is transmitted mainly by respiratory secretions through aerosol route. It is common in children but less so in adulthood, however, with more severe clinical course in the later. The disease is characterized by characteristic widespread exanthematous skin lesions that are chiefly vesicular but may turn into pustular form in certain cases. Vesicles and pustules not only pose a problem in surgical management of fractures but also increase risk of secondary infections in peri-operative period. We report a case posing management challenges of humerus fracture owing to the presence of concomitant pustular varicella infection.
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