Orthopaedics

Sacral alar iliac fixation: An update Pradeep K Singh, Sohael Mohammed Khan Journal of Orthopaedics and Allied Sciences 2019 7(1):1-1

General considerations about atlantoaxial dislocation management Edgar Casajuana Journal of Orthopaedics and Allied Sciences 2019 7(1):2-3

Factors contributing to superior gluteal nerve injury during cephalomedullary nailing of femoral fractures Ahmed A Khalifa, Ahmed M Ahmed, Mohammed Khaled, Elsayed A Said Journal of Orthopaedics and Allied Sciences 2019 7(1):4-7 Operative treatment of femoral fractures using intramedullary nailing is considered as the gold standard technique; despite safety and minimal invasiveness, it is prone to some complications, of these is the persistent abductor lurch even after complete fracture healing. In this review, we are discussing the possible factors which may endanger the superior gluteal nerve during cephalomedullary nailing of the femur.

Rating visualization in shoulder arthroscopy: A comparison of the visual analog scale versus a novel shoulder arthroscopy grading scale Vince W Lands, Daniel M Avery, Ajith Malige, Jill Stoltzfus, Brett W Gibson, Gregory F Carolan Journal of Orthopaedics and Allied Sciences 2019 7(1):8-11 PURPOSE: To assess the interobserver reliability and intraobserver variability of the visual analog scale (VAS) for visualization in shoulder arthroscopy and compare it to a less variable, more objective novel grading scale, the shoulder arthroscopy grading scale (SAGS). METHODS: Twenty separate 30-s length video clips were created from a library of shoulder arthroscopies. Video clips were randomized and distributed to six sports medicine fellowship-trained surgeons at two time points with a 1-month interval. Each rated visualization according to an adapted VAS and a novel grading scale, the SAGS. RESULTS: The VAS and SAGS both showed an excellent degree of consistency with interobserver reliability among raters with intraclass correlation coefficients (ICCs) of 0.96 and 0.97, respectively. Five of six raters demonstrated strong intraobserver variability with the VAS and SAGS with ICC ranging from 0.87 to 0.97 and 0.61 to 0.93, respectively. CONCLUSION: Given the strong-to-excellent degree of consistency in using the VAS and the SAGS, either can be reliably used as a measurement of visualization in shoulder arthroscopy.

Computed tomography scan morphometric study of adolescent vertebral laminae: From three-dimensional reconstruction to laminar hook Elie Haddad, Cyrielle Soulaine, Bruno Dohin Journal of Orthopaedics and Allied Sciences 2019 7(1):12-16 INTRODUCTION: The authors report a descriptive analysis of spine computed tomography (CT) scan to describe the anatomy of the laminae of T2 and T3 vertebrae. The aim of the study was to establish reference data in the adolescent population. These data could be useful to improve the effectiveness of laminar hooks. Hook-claw anchorage has been considered as one of the best choices in terms of safety and durability in the spine surgery. MATERIALS AND METHODS: We systematically reviewed CT scans of 14–16-year-old healthy individuals who underwent CT scans in other indications than scoliosis during a 2-year period. Patients with spine, chest, or bone disease were excluded. The Risser sign was ≥ 2. CT scan data were converted into a three-dimensional reconstruction. RESULTS: Seven hundred and fifty measures were collected from 30 CT scans matching with the inclusion/exclusion criteria. The mean age was 15-years old. Gender was mixed. Mean T2 lamina's upper half height was 8.9 mm (8.2–9.6) corresponding to a thickness of 7.1 mm (6.6–7.7). Mean T3 lamina's lower half height was 9.0 mm (6.9–10.4) corresponding to a thickness of 7.3 mm (6.8 à 7.9). DISCUSSION: No previous study reported these data in adolescents. Laminae in adolescents appeared to be slightly oversized in this study relative to the previous reports in adults. It seems that the intracanal part length of the hook and depth of the gorge should be adapted in order to improve fitting of the implant with laminae. CONCLUSION: This study brings new data in the knowledge of anatomical characteristics of the vertebras that should help to improve safety and stability of implants as laminar hook and hook claw.

A clinico-epidemiological study on trauma cases attending a tertiary care hospital in North India Ajay Bharti, Kriti Mohan, Raj Kumar Singh, Indu Narain Vajpai, Tanu Midha, Ashutosh Diwedi Journal of Orthopaedics and Allied Sciences 2019 7(1):17-21 OBJECTIVES: Injuries are the leading cause of death in the first four decades of life and the third leading cause of death among all patients. Road traffic accidents (RTAs) is the most common cause of injury in India with varied reports of mortality ranging from 7% to 45%. There are several scoring systems to evaluate the severity of injury and predict mortality. However, the reliability of injury score as a mortality predictor is challenging. The purpose of this study was to assess the cause of trauma with its epidemiological correlates and to categorize patients of trauma using the New Injury Severity Score (NISS) and Injury Severity Score (ISS) with their comparison in terms of mortality prediction in the present scenario of trauma in India. MATERIALS AND METHODS: Between October 2015 and March 2017, 5122 injured patients meeting the inclusion criteria were enrolled in this prospective longitudinal study. Data of the patients were recorded as per the working pro forma; detailed description of injury, treatment given, ISS and NISS, and ultimate outcome (mortality occurring within 30 days) was documented at the time of arrival/admission and stay at the hospital. Patients were divided into the score groups of 0–8, 9–15, 16–25, 26–49, and ≥50. The patients who were discharged or referred to a higher center were also followed up to 30 days of admission and any mortality occurring was recorded. RESULTS: Totally 5122 patients were enrolled in the study, and injuries, NISS/ISS, and outcome as mortality were documented. The overall mortality was 525 (10.25%). RTA constituted 61.56% and mortality was two times higher than that in female. Patients arriving after 24 h had the highest mortality (16.22%) and time lag had a significant effect on outcome. Sensitivity and specificity of NISS/ISS in predicting mortality was 85.5%, 63% and 61.7%, 68.3%, respectively, and the sensitivity of NISS in predicting mortality is higher than ISS whereas the specificity of NISS is similar to ISS. CONCLUSION: The major cause of trauma in India is RTA and time lag has a significant effect on the prognosis of the patient, and NISS is a better scale and should be incorporated in management protocols and TRISS methodology.

Study of functional outcome of displaced intra-articular fractures of the calcaneum treated with open reduction, bone grafting, and plate fixation Nikhil Dilip Palange, GS Prasannakumar, Nadir Shah, Eknath Pawar Journal of Orthopaedics and Allied Sciences 2019 7(1):22-27 BACKGROUND: Calcaneal fractures are one of the most difficult and challenging fractures to treat by the orthopedic surgeon. Most of these fractures (i.e., almost 75%) are intra-articular. Furthermore, majority of these fractures are highly comminuted. Hence, open reduction and internal fixation (ORIF) with anatomical plate gives the best possible opportunity to bring about near-anatomical joint surface reduction and prevention of subsequent arthritis. This article studies the functional outcome after ORIF of such fractures. METHODS: Thirty patients, having intra-articular displaced calcaneum fractures, were admitted and included in the study after obtaining valid consent and permission from the ethical committee. All the patients were investigated with X-ray and computed tomography scan and classified according to the Sanders classification system. The functional outcome after surgery was measured using the American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: All patients had joint depression-type fractures with a similar history of trauma due to fall from height. Out of the 30 patients, 26 were male and 4 were female. After surgery, 20 patients out of 30 had good results with a mean AOFAS score of 82.6, 7 patients had fair results with a mean AOFAS score of 70.4, while the remaining 3 patients had poor results with a mean score of 50. Postoperatively, wound complications were seen in 2 patients which settled after debridement and medications. No other complication was encountered. CONCLUSION: Open reduction and rigid internal fixation of calcaneum fractures allows anatomical reduction of fracture, restoration of joint surface, and prevention of subtalar joint arthritis and helps in early mobilization after surgery.

Osteofibrous dysplasia mimicking exostosis Priyank Sahoo, Afroz Ahmed Khan Journal of Orthopaedics and Allied Sciences 2019 7(1):28-30 Osteofibrous dysplasia is an uncommon benign fibro-osseous lesion of childhood, more often seen in maxilla and mandible. Among a long bone, it is usually encountered in the tibia as a painless swelling or anterior bowing. Osteofibrous dysplasia mimicking exostoses has never been reported in the literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of the tibia clinically mimicking exostoses.

Tuberculosis presenting as a scaphoid fracture: A rare case report Ganesh Singh Dharmshaktu, Tanuja Pangtey Journal of Orthopaedics and Allied Sciences 2019 7(1):31-33 Tuberculosis of the wrist is an uncommon clinical entity and mostly presents as insidious pain and swelling. Presentation of singular carpal bone involvement is rare as the presenting feature. A case of scaphoid fracture was evaluated in a 20-year-old male patient, and underlying tuberculosis was diagnosed on magnetic resonance imaging and culture of joint fluid. Antitubercular therapy under appropriate supervision resulted in clinical improvement and optimal regain of function. No reactivation of the disease was noted in a follow-up of 2 years. This case highlights a rare presentation of tuberculosis presenting with a fracture of scaphoid.

Extrapulmonary Mycobacterium tuberculosis-induced carpal tunnel syndrome presented with rice body Mikaeil Tafkiki Alamdari, Ali Tabrizi, Ahmadreza Afshar Journal of Orthopaedics and Allied Sciences 2019 7(1):34-36 Skeletal involvements are less likely in Mycobacterium tuberculosis (TB), and it is even rarer in the hand. Flexor tenosynovitis from M. tuberculosis concomitant with median nerve involvement has been rarely reported, and it usually presents with symptoms of carpal tunnel syndrome (CTS). In this report, we introduced a patient with symptoms of CTS with rice body in the volar wrist synovium membrane and extrapulmonary tuberculosis (TB). Rice bodies were presented in synovium and histological study indicated the inflammatory granulomatous with necrosis caseous. Surgical debridement with excision of the involved synovium and irrigation was performed. Twelve-month treatment with anti-TB medication regimen was successful.

Alexandros Sfakianakis
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