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  Citation statistics : Table of Contents
   2016| January-June  | Volume 4 | Issue 1  
    Online since April 19, 2016

 
 
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ORIGINAL ARTICLES
STARS therapy: "Sandeep's technique for assisted regeneration of skin"
Sandeep Shrivastava, Pradeep K Singh, Shounak Taywade
January-June 2016, 4(1):5-7
DOI:10.4103/2319-2585.180688  
Background: The wound management is a huge complex problem consuming billions of dollars. The standard treatment includes advance therapeutics with drugs (such as antibiotics), intense local dressings (such as negative pressure/antimicrobial) and multiple surgical interventions/reconstructions. Such intervention and modalities requires experts and large resources. Still the outcomes are unpredictable and associated with morbidities at donor (otherwise normal) sites. Materials and Methods: The "Sandeep's Technique's for Assisted Regeneration of Skin" (STARS) is therapy for complete healing of wounds with Autologous self activated Platelet Rich Plasma (PRP), imparted as local subcutaneous infiltrate in the wound margin, on every 4 th day, till complete repair takes place and local skin regenerates. The wounds are dressed daily/alternate day with only moist saline. It is a Pilot study of patients treated with STARS Therapy treated at Acharya Vinobha Bhave Rural Hospital, J.N.Medical College, Wardha, INDIA. The different types of wounds were acute wounds with exposed deep tissues such tendons and bones; compound fractures; infected wounds; necrotising post surgical flaps and chronic non healing ulcers including diabetic and pressure ulcers. Result: All the wounds healed aby PRP infiltration not requiring any further drugs, complex dressings and surgical reconstruction. Conclusion: It is safe, effective, efficient, and easily reproducible technique with predictable results for even complex wounds in which surgical reconstructions are not possible. This method of treatment is a huge step forward in preservation of resources and prevention of morbidity.
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CT-based bone density assessment for iliosacral screw trajectories
Andreas Schicho, Florian Gebhard, Peter Hinnerk Richter
January-June 2016, 4(1):8-13
DOI:10.4103/2319-2585.180689  
Introduction: Sacroiliac screw placement is one standard treatment option for stabilization of posterior pelvic ring injuries encountering high intra- and inter-individual variations of bone stock quality as well as a vast variety and prevalence of sacral dysmorphism. An individual, easy-to-use preoperative bone stock quality estimation would be of high value for the surgeon. Materials and Methods: We analyzed 36 standard computed tomography datasets with the uninjured pelvic ring. Using a two-plane cross-referencing technique, we assessed the Hounsfield unit (HU) mean values as well as standard deviation and minimum/maximum values within selected region of interests (ROIs) at five key areas: os ilium left and right, massa lateralis of os sacrum left and right, and central vertebral body on levels S1 and S2. Results: Results showed no difference in mean HU at any ROI when comparing male and female data. For all ROIs set on S1 and S2, there was an age-related decline of HU with a calculated slope significantly different from zero. There was no statistical difference of slopes when comparing S1- and S2-level with respect to any distinct ROI. Comparison of levels S1 and S2 revealed differences at the vertebral body and at the right os ilium. The right and left massa lateralis of os sacrum had lower bone density than the center of the vertebral body, the right, or left os ilium on S1; right and left massa lateralis density did not differ significantly. On level S2, results were comparable with no difference of massa lateralis density. Conclusion: With our easy-to-use preoperative assessment of bone density of five key areas of sacroiliac screw anchoring we were able to find the lowest bone density in both the left and right massa lateralis on levels S1 and S2 with high inter- and intra-individual variations. Significantly lower bone density was found in the center of the vertebral bodies S2 in comparison to S1, which both are crucial for iliosacral screw placement. We thus recommend priority use of level S1 in screw placement and careful consideration of sole massa lateralis short-screw anchoring.
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REVIEW ARTICLE
Current view of bone regeneration using mesenchymal stem cells
Omar A Al-Mohrej, Noura K Al-Ayedh, Abdullah Y Al-Awlah, Nader S Al-Kenani
January-June 2016, 4(1):1-4
DOI:10.4103/2319-2585.180677  
Bone regeneration, reparative and restorative techniques of bone length discrepancies, correction of posttraumatic and congenital defects and deformities can be induced mesenchymal stem cells (MSCs) which is taken from the bone marrow. In this review article, we aimed to have a look at MSCs for bone and tissue regeneration. MEDLINE ® , Embase™, the Science Citation Index, and Google™ Scholar were used to look for relevant articles which published in English since January 2000. Studies on bone regeneration using MSCs in the field of clinical orthopedics were retrieved. The bone graft can create a self-reliant mechanism to induce bone cellular environment that adapts to the whole skeletal nature. There are several factors contributory to deciding which approach to take. These include the type of bone deformities, defects, the biological setting of the patient, the nature of the reparative process desired, and surgical or orthopedic possibility of conducting all these processes. All these factors and several others should be taken into consideration and careful medical consultation. Orthopedics along with osteology made much headway in restoring bone and tissue in uniquely medical approach that is MSCs through the autologous cancellous bone taken from the bone marrow.
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CASE REPORTS
Complete avulsion of the adductor longus in a semi-professional football player: Rapid return to play with nonoperative treatment
Vince W Lands, Daniel M Avery, Steven T Puccio
January-June 2016, 4(1):45-48
DOI:10.4103/2319-2585.180693  
The adductor longus has become recognized as one of the more commonly injured muscles in the medial compartment. Acute complete rupture injuries occurring at the proximal aspect of the muscle are less common. Limited data exist regarding management of the injuries in athletes required for return to play and functioning. The current data favors operative management; however, nonoperative treatment may be a viable option. Nonoperative management of avulsion injuries of the proximal adductor longus tendon may prove equal results to surgical repair in return to play and functioning. A semi-professional football player sustained a left groin injury while participating in the play. Due to continued pain, swelling, and suspicion of injury, a magnetic resonance imaging was performed diagnosing a complete tear of proximal adductor longus tendon. Physical examination, strength, and range of motion were recorded until the patient was able to function normally without strength deficit, the range of motion loss, and the return of speed. The player was treated nonoperatively and was eventually allowed to return to play. The time of return to play was 6 weeks. Strength deficit was not appreciated or loss of motion and player was able to return to baseline function. Nonoperative management of complete avulsion injuries of the proximal adductor longus tendon result in faster return to play than operative management even if significant retraction is present.
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Acute tarsal tunnel syndrome in a pregnant woman following surgical repair of bimalleolar fracture: A case report and review of the literature
Atul Ratra, Jerry Grimes
January-June 2016, 4(1):49-51
DOI:10.4103/2319-2585.172720  
Tarsal tunnel syndrome is generally a subacute condition that gradually develops and worsens with time. Urgent tarsal tunnel release to treat an acute onset of symptomatic neurocompression within the tarsal tunnel following a fracture repair has not been previously reported. We present a case of a pregnant woman who developed an acute tarsal tunnel syndrome following an open reduction internal fixation of an ankle fracture. The urgent release of the tarsal tunnel resulted in resolution of her symptoms.
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ORIGINAL ARTICLES
Carpal tunnel syndrome: Ultrasonographic evaluation of median nerve diameter
Jagannath B Kamath, Babul Reddy, Umapathy Sivam, Anand Venugopal, Nikil Jayasheelan
January-June 2016, 4(1):14-17
DOI:10.4103/2319-2585.180690  
Background: Carpal tunnel syndrome is the most frequently encountered peripheral compression neuropathy. Diagnosis of carpal tunnel syndrome involves physical examination, nerve conduction studies and electromyography. Ultrasonography (USG) examination of median nerve in carpal tunnel has been proposed as a useful alternative in diagnosing carpal tunnel syndrome. Materials and Methods: Patients were selected from those undergoing diagnostic workup for carpal tunnel syndrome in pre-treatment period. USG was performed using 11 MHz linear array transducer. Cross-sectional area at each level, major and minor axes were measured. Results: In our study, the mean median nerve cross sectional area at proximal part of carpal tunnel by direct method was 12.33 mm 2 in patients and 7.33 mm 2 in controls. By indirect method it was 12.01 mm 2 and 6.633 mm 2 in cases and controls respectively. In this study we found significant difference in flattening ratio between cases and controls. The mean flattening ratio in distal part of tunnel (at the level of hook of hamate) was 2.97 and 2.38 in cases and controls respectively. The sensitivity and specificity for cut-off value ≥2.5 was 76% and 63% respectively. Conclusion: We found that best discriminatory criterion for diagnosis of carpal tunnel syndrome are median nerve cross sectional area in the proximal part of carpal tunnel ≥9 mm 2 (Direct method) and ≥8.5 mm 2 (Indirect method). With our experience, we found it easier to evaluate the median nerve in the carpal tunnel in the disto proximal sequence by identifying the flexor pollicislongus (FPL) first with dynamic evaluation. As the percentage of space occupying lesions causing symptoms in unilateral (atypical) carpal tunnel syndrome is 35%, we highly recommend this pre-operative investigation in all carpal tunnel syndrome patients.
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Percutaneous autologous stem cell enriched marrow concentrate injection for treatment of cases of impaired fracture healing with implant in situ: A cost-effective approach in present Indian scenario
Sachin Upadhyay, Hashmukh Shantilal Varma, Vishal Yadav
January-June 2016, 4(1):18-29
DOI:10.4103/2319-2585.172721  
Background: The objective of present study is to investigate the feasibility of proposed methodology in present Indian scenario, to enhance fracture repair in cases of impaired healing with the implant in situ using autologous bone marrow concentrate. During critical analysis, the existing study also aimed to assess the outcome (both objective and subjective) as well as to document complications specific to the proposed therapy if any. Materials and Methods: First the marrow is aspirated from posterior iliac crests. After that Ficoll-Paque technique of density gradient separation for the isolation of mononuclear cell populations enriched with stem cells is employed. Later, the concentrate is injected into critical-sized defects of eight patients with stable fracture delayed/nonunion via fluoroscopic guidance. New bone formation was evaluated by X-rays in two standard planes (anteroposterior (AP)/lateral). Level of statistical significance was set at a P < 0.05. Result: The critical osseous defect reached radiographic observable union by a mean of 12.28 ± 1.38 weeks. A distance of 5 mm or less between the fractures' ends resulted in healing in seven cases (87.5%). The results of the Likert four-point scale showed that majority were very satisfied with the outcome of the procedure (Cronbach's alpha coefficient (follow-up): 0.93 (6 week); 1.0 (1 year)). There were no adverse events reported during the procedure. Conclusion: Our preliminary results indicate that the approach proposed is feasible and effective in the management of stable (implant in situ) fracture with impaired healing. In context of its cost-effectiveness, we recommend to follow proposed methodology in present Indian scenario.
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Midterm results of cementless total hip arthroplasty in young
Abhijit Chandrakant Kawalkar, Chandrashekher Martand Badole, Ajit Phadke
January-June 2016, 4(1):30-35
DOI:10.4103/2319-2585.172719  
Introduction: There are a variety of etiological factors that may result in arthritis of the hip in young adults. There are, therefore, not infrequent occasions when orthopedic surgeons may encounter very young patients with end-stage arthritis of the hip necessitating surgical intervention. In the past hip arthrodesis or resection arthroplasty were used to address end-stage arthritis of the hip in young patients but recently total hip arthroplasty emerged as the viable alternative to above surgical procedures. The high activity level, repetitive loading and excessive demand placed on the hip on one hand and issues of durability of the implant materials on the other lead to high failure rates of total hip arthroplasty in young patients in the past. The aim of this prospective study was to evaluate the clinical and radiographic results of these modern cementless THA in patients with end stage arthritis who were younger than 40 years of age. Materials and Methods: A prospective study was carried out in which 25 patients (28 hips) younger than 40 years with hip arthritis underwent primary cementless total hip arthroplasties participated. The Taperloc femoral component with Porous coated cementless acetabular cup and highly crossed linked polyethylene liner was used in all hips. The Harris hip score was used to determine functional outcome and activity level was evaluated by the classification of Johnston et al. Radiographic analysis consisted of antero-posterior views of the hip and pelvis, a true lateral view of the hip. Observations and Results: All 25 patients were available for both clinical and radiographic evaluation. 93% of patients had excellent to good; and none of the hips had poor clinical outcome. Radiographic assessment revealed consistent evidence of bony ingrowth. No femoral component was loose or required revision. Conclusion: Cementless total hip arthroplasty can be safely and successfully performed in young patients less than 40 years with excellent results in short to midterm follow-up.
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A comparative study between conventional and minimally invasive dynamic hip screw fixation in management of intertrochanteric femoral fractures
Ashish Gohiya, Pulak Sharma, Rahul Verma, Sanjiv Gaur
January-June 2016, 4(1):36-39
DOI:10.4103/2319-2585.180691  
Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.
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Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment
Sohael M Khan, Narendra K Saxena, Shraddha K Singhania, Mahendra Gudhe, Sunil Nikose, Mridul Arora, Pradeep K Singh
January-June 2016, 4(1):40-44
DOI:10.4103/2319-2585.180692  
Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. 
Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.
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