Suprascapular Neuropathy

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 23-31 | Rahul Singh, Ashish Babhulkar

Author: Rahul Singh [1], Ashish Babhulkar [1]

[1] Department of Shoulder and Sports Injuries, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

Address of Correspondence
Dr. Rahul Singh,
Department of Shoulder and Sports Injuries, Deenanath Mangeshkar Hospital, Pune – 411 004, Maharashtra, India.
E-mail: rahulortho85@gmail.com

Abstract

Suprascapular neuropathy (SSN) is often missed or neglected. Although the occurrence is rare, it is for this reason that one needs to be aware of the correct clinical skill sets and investigations to nail the diagnosis. SSN pathologies are being diagnosed with increasing frequency in high probability groups like athletes, massive rotator cuff tear with fatty infiltration, labral tear and subsequent cyst formation. With better understanding of the pathology, management of SSN has also improved in recent decades. With the advancement in electrodiagnostic modalities, SSN can be more reliably diagnosed now. The article highlights the aetiology and the points of compression, clinical picture to trigger the need for an EMG and the results of Arthroscopic decompression.

Keywords: Suprascapular neuropathy, paralabral cyst, transverse scapular notch, spinoglenoid notch, peripheral neuropathy

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Guest Editorial: Covid and Orthopaedics.

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul – Dec 2021 | page: 1 | Dr. B. Shivashankar, Dr. Terrence Jose Jerome

Author: Dr. B. Shivashankar [1], Dr. Terrence Jose Jerome [1]

[1] Consultant Orthopaedic Surgeon and Traumatologist, Iyer Orthopaedic Centre, 103, Railway Lines, SOLAPUR- 413001, Maharashtra, India

Address of Correspondence
Dr. B Shivashankar,
Consultant Orthopaedic Surgeon and Traumatologist, Iyer Orthopaedic Centre, 103, Railway Lines, SOLAPUR- 413001, Maharashtra, India.
Email: drbshivashankar@gmail.com

Covid and Orthopaedics

It would be too early to say that we have surpassed COVID-19 and immature to say that we have conquered it. What would be apt is we learn from our experience and the sore failures that mellowed this pestilence. Many times, we have lost our dear and near ones.

Sometimes it flooded us with frustration, anger, and sadness over the virus and its powerful impact on our lives. But what surprises us is that the squirreling pandemic unified us to emerge more vibrant and optimistic. Also, we have seen a paradigm shift in outpatient consultations, elective operating procedures, and the beneficial use of telemedicine during such odd times.

Additionally, we focused our educational vibes on webinars and online discussion forums. Slowly we recuperated and excelled in all the stages of the pandemic and managed to live with it. The practice of medicine has taken its ordinary discourse and started its previous practicing style. The World Health Organization has efficiently wiped all the myth busters (HCQ, Ivermectin, bleach, antibiotics, vitamins, etc.) about the covid and illustratively narrated the safety norms (masks, sanitizers) [1].

Orthopedic surgeons’ practices have also resurged from the dreadful pandemic and its gloomy cower. As usual, we have started elective surgeries, found better ways to deliver healthcare, and formulated innovative action measures. This gave birth to more daycare surgeries and minimally invasive procedures, which could be the modern practice too. In the meanwhile, we always performed a standard pre-screening for COVID and efficiently treated all elective surgeries. We allocated more resources, segregated COVID-positive patients from the screening, and treated them at home quarantine/ dedicated facilities. Though fear was a deterrent, we performed all emergency procedures following pre and postoperative preventive measures.   

The webinars have been swapped to physical conferences and we are ready for a face-face meet. Various national and international conferences rejiggered into hybrid mode and encouraged in-person meetings, matching the standard safety norms. However, we are always cautious with time-tested quarantine, social distancing, wearing masks, and washing hands.

We need to focus on the future and have preferences in all aspects. The orthopaedics and allied specialty residents have spent most of their time in covid wards, managing the acute crises in hospitals and teaching institutions. It’s high time for us to redirect them to the orthopaedic units and spend time improving their patient care skills to become efficient independent budding surgeons. Notably, we must make dramatic arrangements for the residents and train them with an innovative curriculum. It’s time to roll up our sleeves, march forward metaphorically, get vaccinated, and persuade our colleagues and fellow citizens to get vaccine shots aiming for herd immunity. If not now, then when?

There has been few silver linings too due to the pandemic. The healthcare spending by government has increased by many folds and everyone is now aware of the importance of basic necessities like medicines, oxygen, ventilators, etc. Many new players who were not in healthcare industries earlier have jumped to manufacture ventilators, PPE Kits and other paraphernalia required in medical industry. Definitely over the years we shall have more indigenisation in the equipment required as well as better equipped hospitals. Over all we shall be more atmanirbhar or self-reliant as far as our health care industry is considered.

Though a return to pre-pandemic normalcy is a mire, for the destined future, our patients and we should continue wearing masks in the hospitals and follow WHO standard safety measures.

Future conferences encourage in-person meetings with mandatory vaccination. Virtual options can be kept for colleagues who are not vaccinated or unable due to various strong reasons. Widespread vaccination is the only specific or reliable method to assuage the fear and stop the raging virus.

As we have transited many waves of the pandemic, we must provide reassurance and promote vaccination and continued social distancing for the greater good of the public. We are still positive and looking ahead with sceptical and unpredictable reality in the coming years. At the same time, we humans are inheritably bound to personal touch and socialization.

We all know that freedom comes with risk, and long-lasting adaptations to the new future are necessary. Eliminating the virus and achieving herd immunity and returning to normalcy is the expected norm, but without risk, is there hope? We are all in together and have emerged more robust than ever in combating this virus.

 

Reference

  1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks (Last accessed on 6th November 2021).
How to Cite this article: Shivashankar B, Jerome TJ. Covid and Orthopaedics. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):1.

 

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En bloc Extraction Technique in Total Hip Arthroplasty for Avascular Necrosis Treated with Non-vascular Fibular Autografts

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 32-34 | Vikram I Shah, Javahir A Pachore, Gautam M Shetty, Amish Kshatriya, Ashish Sheth, Kalpesh Shah

Author: Vikram I Shah [1], Javahir A Pachore [2], Gautam M Shetty [3,4], Amish Kshatriya [1], Ashish Sheth [1], Kalpesh Shah [1]

[1] Department of Orthopaedic Surgery, Shalby Hospitals, Ahmedabad, Gujarat, India

[2] Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India.

[3] Knee and Orthopaedic Clinic, Mumbai, Maharashtra, India.

[4] Head of Research, AIMD Research, India.

Address of Correspondence
Dr. . Javahir A Pachore,
Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India
E-mail: japachore@rediffmail.com

Abstract

Performing a total hip arthroplasty (THA) in the presence of a previous fibular graft can be technically challenging and may be associated with complications. We describe a novel method of “en bloc extraction” of the fibular graft during THA to facilitate complete removal of the graft and adequate femoral preparation. This en bloc extraction technique is safe and effective for complete removal of fibular graft during THA performed in patients with non-vascularized fibula grafting for avascular necrosis.

Keywords: Avascular necrosis, fibular graft, total hip arthroplasty, hip, conversion arthroplasty

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17. Eward WC, Rineer CA, Urbainak R, Richard MJ, Ruch DS. The vascularized fibular graft in precollapse osteonecrosis: Is long term hip preservation possible? Clin orthop Relat Res 2012;470:2819-26.
18. Walter TS, Brawne JA, Ortemdo LA, Wellmam SS, Urbaniak JR, Bolognest MP. Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head. J Surg Orthop Adv 2011;20:158-67.
19. Ryan SP, Woostar B, Jiranek W, Wellman S, Bolognesi M, Seyler T. Outcomes of conversion total hip arthroplasty from free vascularized fibular grafting. J Arthroplasty 2019;34:88-2.
20. Davis ET, Mckee MD, Wadell JP, Hupel T, Schemitsch EH. Total Hip arthroplasty following failure of free vascularized fibular graft. J Bone Joint Surg Am 2006;88:110-5.

How to Cite this article: Shah VI, Pachore JA, Shetty GM, Kshatriya A, Sheth A, Shah K. En bloc Extraction Technique in Total Hip Arthroplasty for Avascular Necrosis Treated with Non-vascular Fibular Autografts. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):32-34.

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Development of Sports Medicine in India and Recent Advances

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 35-41 | Arumugam Sivaraman, Suresh Perumal, Prakash Ayyathurai, Thiagarajan Alwar

Author: Arumugam Sivaraman [1], Suresh Perumal [1], Prakash Ayyathurai [1], Thiagarajan Alwar [1]

[1] Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research
(Deemed University), Chennai, Tamil Nadu, India

Address of Correspondence
Dr. Thiagarajan Alwar,
Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research
(Deemed University), Porur, Chennai – 600 116, Tamil Nadu, India.
E-mail: drkatn@csstrucoach.in

Abstract

Sports are beneficial for us both at individual and social levels. Sports Medicine is an ancient subject. Sports medicine in India is steadily growing. Sports activities have witnessed a remarkable upswing in the recent times, and we require a huge number of sports support staff. There is an urgent need to look at capacity building of institutions in our country. Government of India has launched several measures for sports development including the Khelo India Scheme. Sports Medicine is a multidisciplinary field with a broad objective, focusing on holistic athlete care and not only injuries. Injury prevention, peak performance, high competition levels, and surge in number of sports events has resulted in the development of Sports Medicine. It uses a multi-modal approach including new strategies and technologies. Technology is helping to analyze and create new strategies for boosting performance. Genetic technology can improve performance, health, and safety. Latest advances in sensory garments, helmets, mouth guards, monitors, and wearables have made sports medicine indispensable. Recent advances like High Altitude Simulation Training, Anti-gravity treadmill, exoskeletons, bio-harnesses, smart fabrics, Virtual and Augmented Reality are revolutionizing sports. Centre for Sports Science at Sri Ramachandra Institute of Higher Education and Research (deemed to be university) in Chennai is a center of excellence for Asian Football Confederation and International Cricket Council in India. It serves as a hub for Sports Science Training, Education and Research in India applying the latest scientific advances in sports medicine and sports science. Sports have grown from being just a source of entertainment to a social culture and also as a gratifying career option for many. This trend is expected to evolve further with a bright scope for everyone connected with the sports ecosystem.

Keywords: Sports Medicine, sports science, injury prevention, performance enhancement, sports rehabilitation, wearables, athlete monitoring, GPS tracking system, anti-gravity treadmill, virtual reality, augmented reality, sports genetics

References

1. American College of Sports Medicine-ACSM. Available from: https://www.acsm.org Last accessed on 15.10.2021.
2. Australasian College of Sport and Exercise Physicians-ACSEP. Available from: https://www.acsep.org.au Last accessed on 15.10.2021.
3. International Olympic Committee-medical and Scientific Commission. Available form: https://www.olympics.com/ioc/medical-and-scientific-commission Last accessed on 15.10.2021.
4. FIFA Medical Commission. Available form: https://www.fifa.com/about-fifa/medical Last accessed on 15.10.2021.
5. FICCI. Tanjun Associates Study on Sports as a Full Time Career. New Delhi: FICCI; 2011.
6. Khandare RB. Astudy of physical tutoring and sporting in India. J Sports Phys Educ 2016;3:1-3.
7. Banerjee A. Governmental Initiatives to Promote Sports in India. Available form: https://www.sportskeeda.com/athletics/governmental-initiatives-to-promote-sports-in-india [Last accessed on 2019 Feb 21].
8. Chellathurai P. Sport in modern India: Policies, practices and problems. Int J Hist Sport 2002;19:366-83.
9. Vaishya R, Dhammi IK. Upsurge of sports injuries and their treatment. Indian J Orthop 2017;51:485-6.
10. Dhillon H, Dhillon S, Dhillon MS. Current concepts in sports injury rehabilitation. Indian J Orthop 2017;51:529-36.
11. Centre for Sports Science, SRIHER (DU). Available form: https://www.csstrucoach.in [Last accessed on 15.10.2021].

How to Cite this article: Sivaraman A, Perumal S, Ayyathurai P, Alwar T. Development of Sports Medicine in India and Recent Advances. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):35-41.

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Sagittal and Coronal Plane Fracture of Talar Body, An Unusual Combination with Medial Malleolus Fracture: A Case Report

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 52-55 | Pankaj Kumar Singh, Surendra Kumar Shukla, Satish Chandra Goel, Sachin Yashwant Kale, Rohit Mahesh Sane

Author: Pankaj Kumar Singh [1], Surendra Kumar Shukla [2], Satish Chandra Goel [1], Sachin
Yashwant Kale [3], Rohit Mahesh Sane [3]

[1] Department of Orthopaedics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.

[2] Department of Orthopaedics, K.J. Somaiya Medical College, Sion, Mumbai, Maharashtra, India.

[3] Department of Orthopaedics, D.Y. Patil University School of Medicine, Nerul, Navi-Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Rohit Mahesh Sane,
Department of Orthopaedics, D.Y. Patil University School of Medicine, Nerul, Navi-Mumbai, Maharashtra, India.
E-mail: dr.sanerohit@gmail.com

Abstract

Introduction: Fractures of the talus are relatively uncommon injuries with majority of them involving the neck region. Talar body fracture in sagittal plane in combination with medial malleolus fracture is very rare with few cases being reported in the literature earlier.

Aims and Objectives: To discuss such an unusual combination in an adolescent, which was treated with open reduction and internal fixation with screws for both talus and medial malleolus.

Materials and Methods: A 18-year-old boy with medial malleolus and sagittal plane talus fracture was treated with open reduction and internal fixation.

Conclusion: Talar body fractures in the sagittal plane and its combination with medial malleolus fracture are challenging due to its rarity and associated high degree of complications. Surgery should be planned at appropriate time considering the status of surrounding soft tissues and swelling. Proper anatomic reduction and rigid fixation with good surgical technique followed by cast immobilization and non-weight bearing for longer periods (at least 3 months or till radiological union) is the key to a good clinical outcome.

Keywords: Fracture, Talar body, Sagittal plane, Medial malleolus, Internal fixation

References

1. Fortin PT, Balazsy JE. Talus fractures: Evaluation and treatment. J Am Acad Orthop Surg 2001;9:114.
2. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg 1970;52A:991-1002.
3. Adelaar RS. Fractures of the talus. In: Operative Foot Book. Philadelphia, PA: WB Saunders; 1990. p. 147-56.
4. Mendonca AD, Maury AC, Makwana NK. A simultaneous fracture of the tibia and talar body. Foot Ankle Surg 2004;10:45-7.
5. Shah K, Hakmi A. Unusual ankle injury a case report. Foot 2004;14:169-72.
6. Devalia KL, Ismaiel AH, Joseph G, Jesry MG. Fourteen years follow up of an unclassified talar body fracture with review of literature. Foot Ankle Surg 2006;12:85-8.
7. Saidi H, Ayach A, Fikry T. Unusual fracture of the body of the talus: a case report and literature review. Foot Medicine and Surgery 2008;24:22-4.
8. Isaacs J, Courtenay B, Cooke A, Gupta M. Open reduction and internal fixation forconcomitant talar neck, talar body, and medial malleolar fractures: A case report. J Orthop Surg 2009;17:112-5.
9. Mootha A, Kumar V, Bali K, Dhatt S, Aggarwal S. Combined talar body and medial malleolus fracture: A case report. Webmed Central Orthop 2010;1:WMC00952.
10. Mechchat A, Bensaad S, Mohammed S, Elibrahimi A, Elmrini A. Unusual ankle fracture: A case report and literature review. J Clin Orthop Trauma 2014;5:103-6.
11. Vallier HA, Nork SE, Benirschke SK, Sangeorzan BJ. Surgical treatment of talar body fractures. J Bone Joint Surg Am 2003;85:1716-24.
12. Ogawa K, Usami N. Classification of fractures of the talus: Clear differentiation between neck and body fractures. Foot Ankle Int 1996;17:748-50.
13. Sneppen O, Christensen SB, Krogsoe O, Lorentzen J. Fracture of the body of the talus. Acta Orthop Scand 1977;48:317-24.
14. Boyd HB, Knight RA. Fractures of the astragalus. South Med J 1942;35:160-7.
15. Arkesh M, Gaba S, Das S, Palanisamy JV, Trikha V. A rare combination of sagittal plane fracture of talar body with medial malleolus fracture: Case report and review of literature. J Clin Orthop Trauma 2016;7 Suppl 1:30-4.

How to Cite this article: Singh PK, Shukla SK, Goel SC, Kale SY, Sane RM. Sagittal and Coronal Plane Fracture of Talar Body, An Unusual Combination with Medial Malleolus Fracture: A Case Report.. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):52-55.

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Financial Ignorance among Orthopedic Surgeons: A Survey In COVID-19 Era

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 8-11 | Sachin Kale, Ajit Chalak, Sanjay Dhar, Prasad Chaudhari, Sushmit Singh, Aditya Gunjotikar

Author: Sachin Kale [1], Ajit Chalak [1], Sanjay Dhar [1], Prasad Chaudhari [1], Sushmit Singh [1], Aditya Gunjotikar [1]

[1] Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Nerul, Navi Mumbai, India

Address of Correspondence
Dr. Sushmit Singh,
Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Nerul, Navi Mumbai, India.
E-mail: drsushmits@gmail.com

Abstract

Background: COVID-19 pandemic has severely affected the finances of orthopedic surgeons around the globe due to recurring lockdowns and fewer elective surgeries. It has forced surgeons to reflect on their wealth management status and look for a second source of income as well.
Objectives: The objectives of the study were to determine the effect of the COVID-19 pandemic on the personal finances of orthopedic surgeons and gauge their knowledge regarding the stock market as a second source of income.

Methods: An online survey was conducted among the orthopedic surgeons practicing in Maharashtra, India. The survey included assessment of demographic data, financial knowledge, knowledge of the stock market, and wealth management status.

Results: Most respondents (75.6%) were forced to think about the second source of income after the COVID-19 pandemic. Seventy-nine percent of surgeons felt the need for training for investment in stock markets.
Conclusion: Most of the respondents lack proper knowledge about funds management and retirement planning. This study indicates a strong need for formal education of orthopedic surgeons in the field of personal finance, stock markets, and retirement planning.

Keywords: COVID-19, orthopedic surgeons, personal finance

References

1. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA 2011;306:952-60.
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3. Jennings JD, Quinn C, Ly JA, Rehman S. Orthopaedic surgery resident financial literacy: An assessment of knowledge in debt, investment, and retirement savings. Am Surg 2019;85:353-8.
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5. Ramme AJ, Patel M, Patel KA, Montag WH, Schau AJ, Sabo SI, et al. Personal finance primer for the future orthopaedic surgeon: A starting point. JB JS Open Access 2021;6:e20.00006.
6. Cull WL, Katakam SK, Starmer AJ, Gottschlich EA, Miller AA, Frintner MP. A study of pediatricians’ debt repayment a decade after completing residency. Acad Med 2017;92:1595-600.
7. Connelly P, List C. The effect of understanding issues of personal finance on the well-being of physicians in training. WMJ 2018;117:164-6.

How to Cite this article: Kale S, Chalak A, Dhar S, Chaudhari P, Singh S, Gunjotikar A. Financial Ignorance among Orthopedic Surgeons: A Survey in COVID-19 Era. Journal of Clinical Orthopaedics July-Dec 2021;6(2):8-11.

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A multidisciplinary approach to the management of spinal metastasis: A review article

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 16-22 | Siddharth Badve, Arjun Dhawale, Kshitij Chaudhary, Chetan Anchan

Author: Siddharth Badve [1], Arjun Dhawale [2], Kshitij Chaudhary [3], Chetan Anchan [4]

[1] Orthopaedic Spine Surgeon, Musculoskeletal Institute, Geisinger Health System; MS (Orthopedics), Lewistown, Pennsylvania, United States of America.

[2] Orthopaedic Spine Surgeon, Department of Orthopedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.

[3] Orthopaedic Spine Surgeon, Department of Orthopaedics, P.D. Hinduja National Hospital and Research Centre, Mumbai, Maharashtra, India.

[4] Orthopaedic Onco-surgeon, Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Siddharth Badve,
Orthopaedic Spine Surgeon, Musculoskeletal Institute, Geisinger Health System; MS (Orthopedics), Lewistown, Pennsylvania, United States of America
E-mail: siddharthbadve@hotmail.com

Abstract

Spinal metastasis is a frequent occurrence in patients presenting with advanced malignancy. The burden of this condition is on rise, especially with the availability of aggressive treatment regimens for the primary disease and the improvement in the patient survival. Thoracic spine is the most affected region. The likely source of the primary is from the breast, prostate, lung, thyroid, or kidney. Certain hematological and other malignant conditions can also develop an early spinal involvement that requires timely evaluation and management. The goals for the management of the spinal lesion include preservation of the neurological function, pain control, and maintenance of spinal stability. On the whole, the aim of the treatment continues to palliation in majority of the scenarios. The management strategy is based on the factors that include the patient condition, life expectancy, nature of the tumor pathology, extent of spinal cord compression, severity of neurological deficit, pain control, and the effect on spinal stability. A multidisciplinary approach involving medical oncology, radiation oncology, spine surgery, palliative care and other subspecialtiess forms the cornerstone of the management. Although giant strides have been reported in the advancement of the treatment for spinal metastasis, majority of these avenues are beyond the reach of the patient population from the developing societies. Lack of referral facilities, resource constraints, and geographic disparities are major impediments. The lack of awareness and consensus on the management protocols within the treatment team and the medical community in general poses another challenge in providing an acceptable standard of care. This article offers an insight into the principles that guide the management of spinal metastasis. The application of these principles in the background of the resource constraints that are unique to the South Asian population has also been addressed. This is a synopsis on the multidisciplinary approach to the diagnosis and management of spinal metastasis along with the review of the relevant literature.

Keywords: Vertebral metastasis, spinal stability, pathological fracture, spinal cord compression

References

1. Rose PS, Buchowski JM. Metastatic disease in the thoracic and lumbar spine: Evaluation and management. J Am Acad Orthop Surg 2011;19:37-48.
2. White AP, Kwon BK, Lindskog DM, Friedlaender GE, Grauer JN. Metastatic disease of the spine. J Am Acad Orthop Surg 2006;14:587-98.
3. Kirchhoff SB, Becker C, Duerr HR, Reiser M, Baur-Melnyk A. Detection of osseous metastases of the spine: Comparison of high resolution multi-detector-CT with MRI. Eur J Radiol 2009;69:567-73.
4. Edelstyn GA, Gillespie PJ, Grebbell FS. The radiological demonstration of osseous metastasis: Experimental observations. Clin Radiol 1967;18:158-62.
5. Tatsui H, Onomura T, Morishita S, Oketa M, InoueT. Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine (Phila Pa 1976) 1996;21:2143-8.
6. Rougraff BT, Kneisl JS, Simon MA. Skeletal metastases of unknown origin: A prospective study of a diagnostic strategy. J Bone Joint Surg Am 1993;75:1276-81.
7. Bredella MA, Essary B, Torriani M, Ouellette HA, Palmer WE. Use of FDG-PET in differentiating benign from malignant compression fractures. Skeletal Radiol 2008;37:405-13.
8. Metser U, Lerman H, Blank A, Lievshitz G, Bokstein F, EvenSapir E. Malignant involvement of the spine: Assessment by 18F-FDG PET/CT. J Nucl Med 2004;45:279-84.
9. Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O’malley B, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol 2004;25:1583-8.
10. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: Arandomised trial. Lancet 2005;366:643-8.
11. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol 2008;7:459-66.
12. Sharan AD, Szulc A, Krystal J, Yassari R, Laufer I, Bilsky MH. The integration of radiosurgery for the treatment of patients with metastatic spine diseases. J Am Acad Orthop Surg 2014;22:447-54.
13. Maranzano E, Bellavita R, Rossi R, de Angelis V, Frattegiani A, Bagnoli R, et al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: Results of a Phase III, randomized, multicenter trial. J Clin Oncol 2005;23:3358-65.
14. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 2005;30:2186-91.

15. Tokuhashi Y, Uei H, Oshima M, Ajiro Y. Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 2014;5:262-71.

16.  Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neo-plastic disease: An evidence-based approach and expert consensus from the spine oncology study group. Spine (Phila Pa 1976) 2010;35:E1221-9.

17. Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al. The NOMS framework: Approach to the  treatment of spinal metastatic tumors. Oncologist 2013;18:744-51.

18. Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: A systematic review. Ont Health Technol Assess Ser 2016;16:1-202.

How to Cite this article: Badve S, Dhawale A, Chaudhary K, Anchan C. A multidisciplinary approach to the management of spinal metastasis: A review article. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):16-22.

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A Rare Case Report of Neglected Chronic Dislocation of Distal Interphalangeal Joint Finger

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 49-51 | Rajesh Lalchandani, Mohit Singh, Rakesh Parmar, Rajesh Kumar Yadav

Author: Rajesh Lalchandani [1], Mohit Singh [1], Rakesh Parmar [1], Rajesh Kumar Yadav [1]

[1] Department of Orthopedics, ESI Post Graduate Institute of Medical Science and Research, New Delhi, India.

Address of Correspondence
Dr. Mohit Singh,
Department of Orthopedics, ESI Post Graduate Institute of Medical Science and Research, New Delhi – 110 015, India
E-mail: monu.azad@gmail.com

Abstract

Neglected irreducible dislocation of the distal interphalangeal (DIP) joint due to low energy trauma is a rare traumatic condition and only 6–7 cases have been reported in literature worldwide. Herein, we present a case of chronic dislocation of the DIP joint which got neglected due to lockdown precipitated by COVID-19. It was caused by low energy trauma of slip and fall from stairs.

Keywords: Axillary block, Distal interphalangeal joint, Finger interphalangeal joint, Joint dislocation, Radial mid-lateral incision

References

1. Shiota J, Kawamura D, Iwasaki N. Chronic dislocation of the distal interphalangeal joints. J Trauma Injury 2019;32:47-50.
2. Khuri SM. Irreducible dorsal dislocation of the distal interphalangeal joint of the finger. J Trauma 1984;24:456-7.
3. Murakami Y. Irreducible dislocation of the distal interphalangeal joint. J Hand Surg Br 1985;10:231-2.
4. Phillips JH. Irreducible dislocation of a distal interphalangeal joint: Case report and review of literature. Clin Orthop Relat Res 1981;154:188-90.
5. Pohl AL. Irreducible dislocation of a distal interphalangeal joint. Br J Plast Surg 1976;29:227-9.
6. Banerji S, Bullocks J, Cole P, Hollier L. Irreducible distal interphalangeal joint dislocation: A case report and literature review. Ann Plast Surg 2007;58:683-5.
7. Palmer AK, Linscheid RL. Irreducible dorsal dislocation of the distal interphalangeal joint of the finger. J Hand Surg Am 1977;2:406.
8. Selig S, Schein A. Irreducible buttonhole dislocations of the fingers. J Bone Joint Surg Am 1940;22:436-41.
9. Simpson MB, Greenfield GQ. Irreducible dorsal dislocation of the small finger distal interphalangeal joint: The importance of roentgenograms–case report. J Trauma 1991;31:1450-4.
10. Stripling WD. Displaced intra-articular osteochondral fracture-cause for irreducible dislocation of the distal interphalangeal joint. J Hand Surg Am 1982;7:77-8.
11. Thayer DT. Distal interphalangeal joint injuries. Hand Clin 1988;4:1-4.
12. Yamamoto S, Ochiai N, Matsumoto M. Irreducible dorsal dislocation of the distal interphalangeal joint: Report of two cases. Kanto J Orthop Traumatol 1996;27:79-81.
13. Ghobadi F, Anapolle DM. Irreducible distal interphalangeal joint dislocation of the finger: A new cause. J Hand Surg Am 1994;19:196-8.
14. Montero Lopez N, Paksima N. Perilunate Injuries and dislocations etiology, diagnosis, and management. Bull Hosp Joint Dis 2018;76:337.

How to Cite this article: Lalchandani R, Singh M, Parmar R, Yadav RK. A Rare Case Report of Neglected Chronic Dislocation of Distal Interphalangeal Joint Finger. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):49-51.

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Use of mini-fragment plates in fracture fixation

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 2-7 | Vikas Kulshrestha, Abin Stanley, Santhosh Kumar, Munish Sood

Author: Vikas Kulshrestha [1], Abin Stanley [1], Santosh Kumar [1], Munish Sood [2]

[1] Department of Orthopaedics, Command Hospital Air Force Station, Bengaluru, Karnataka, India

[2] Department of Orthopaedics, INHS Asvini, Mumbai, Maharashtra, India

Address of Correspondence
Lt Col Munish Sood,
Department of Orthopaedics & Traumatology, INHS Asvini, Mumbai – 500 004, Maharashtra, India.
E-mail: soodmunishafmc@gmail.com

Abstract

Background: Over the last two decades improved research in basic sciences has resulted in a better understanding of pathomechanics of skeletal injury. Today we have modern implants and instrumentation which can allow fracture fixation while minimizing soft tissue trauma. The use of mini fragment low profile locking plates is one such technique that is now increasingly being used to implement fragment specific fracture fixation in skeletal injuries.
Methods: At our level III military trauma centre we introduced the use of mini fragment plates in all types of fracture types in 2019 and over the next twelve months we prospectively recorded data of 44 fracture cases of various long and small bones. We have used these plates with different objectives in various intraarticular, metaphyseal or diaphyseal fractures in a manner to augment, supplement or substitute the use of larger implants. We have described the exact method of use in each case.
Results: Out of 44 cases in 42 we achieved fracture union with no loss of reduction and in one case there was a failure of fixation and in one case infected nonunion.
Conclusion: Mini-fragment plates are a very efficient tool available to carry out reduction and fixation of many fracture types and should be kept as a part of instrumentation and implant set for all cases of fracture fixation.

Keywords: Mini-fragment plates, fragment specific, fracture fixation

References

1. Benirschke SK, Henley MB, Ott JW. Proximal one-third tibial fracture solutions. Orthop Trans. 1995;18:1055-6.
2. Archdeacon MT, Wyrick JD. Reduction plating for provisional fracture fixation. J Orthop Trauma. 2006 Mar 1;20(3):206-11.
3. Bogdan Y, Tornetta III P. Fragment-Specific Fixation of Proximal Tibia Fractures: Case Report and Surgical Technique. J Ortho Trauma 2018 e 1-5.
4. Sadek AF, Ahmed MA, Kader MA, et al. Lateral condylar retrograde humeral nail for management of high-energy distal humeralfractures. J Orthop Surg. 2019 Ma y17;27(2):2309499019847922.
5. Knox R, Curran P, Herfat S, et al.. The influence of mini-fragment plates on the mechanical properties of long-bone plate fixation. Ota International. 2019 Sep 1;2(3):e034.
6. Medoff RJ. Immediate internal fixation and motion of comminuted distal radius fractures using a new fragment. specific fixation system. Orthop Trans. 1998;22:165.
7. Bishop JA, Castillo TN. Provisional mini-fragment plate fixation in clavicle shaft fractures. Am J Orthop. 2013 Oct 470-72.
8.Hozack BA, Tosti RJ. Fragment-specific fixation in distal radius fractures. Curr Rev Musculoskelat Med. 2019 Jun;12(2):190-7.
9. Russell Jr GV, Jarrett CA, Jones CB, et al.. Management of distal humerus fractures with minifragment fixation. J Orthop Trauma. 2005 Aug 1;19(7):474-9.
10. Dang KH, Ornell SS, Huynh RA, DeLeon JC, Pesek R, Karia RA. Early clinical and radiographic outcomes of a minifragment, low profile plating system in tibial plafond fractures. Injury. 2019 Oct 1;50(10):1773-80.
11. Gentile J, Taylor BC, Chan R, French B. Clinical comparison of minifragment plates versus conventional semitubular plates for fixation of distal fibula fractures. HSS Journal®. 2015 Jul;11(2):148-53.

How to Cite this article: Kulshrestha V, Stanley A, Kumar S, Sood M. ‘Use of mini-fragment plates in
fracture fixation’. Journal of Clinical Orthopaedics July-Dec 2021;6(2):2-7.

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Osteoblastoma of the lumbar spine in an adolescent: A case report and review of literature

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 45-48 | Bhushan Sagade, Sarang Rokade, Arjun Dhawale, Abhay Nene

Author: Bhushan Sagade [1], Sarang Rokade [1], Arjun Dhawale [1], Abhay Nene [1]

[1] Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India

Address of Correspondence
Dr. Dhawale Arjun A,
Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
E-mail: arjundhawale@hotmail.com

Abstract

Introduction: Osteoblastomas are primary bone tumors representing 1% of all bone tumors and 10% of all spinal osseous neoplasms with a predilection for posterior elements.
Case Report:  A 13-year-old boy with insidious backache for six months presented with progressive radiating paraesthesia and claudication, restricted lumbar motion and positive straight leg test bilaterally with weakness of left ankle dorsiflexion. Radiograph showed an subtle expansile lytic lesion in the L3 posterior elements. CT and MRI revealed a space-occupying lesion of the L3 vertebra lamina, involving the left pedicle causing severe spinal canal stenosis. Excision of the posterior elements of the L3 vertebra including the facet and left pedicle and short segment fixation from L2-L4 using autogenous rib was done.

At two years postoperatively, he was asymptomatic, neurologically normal, showing radiographic evidence of union with no recurrence.
Conclusions: Autogenous structural rib can be used for posterolateral fusion after osteoblastoma excision with potential instability.
Keywords: Osteoblastoma, back pain, rib graft, postero-lateral fusion, en-bloc resection

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How to Cite this article: Sagade BS, Rokade SN, Dhawale AA, Nene AM. Osteoblastoma of the lumbar spine in an adolescent: A case report and review of literature. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):45-48.

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