Author: Darshan Kapoor [1], Sandeep V Vaidya [1,2]
[1] Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Pinnacle Orthocentre Hospital, Thane, Maharashtra, India.
Address of Correspondence
Dr. Sandeep V Vaidya,
Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
E-mail: drsvvaidya@gmail.com
Abstract
Hip spica cast is a useful modality for the lower limb immobilization in children with hip and femur pathologies. Single, one and half, double limb spica cast may be applied depending on the indication. The position of hip immobilization is also dependent on the underlying pathology for which the spica is being applied. The inguinal region and knee are potential weak spots in a spica and these should reinforce during spica application. Potential complications include plaster sores, breakage, avascular necrosis of femoral head (in developmental dysplasia of hip), neurovascular compromise, and superior mesenteric artery syndrome (very rare). Careful attention to technique and vigilant after-care is necessary to prevent these complications.
Keywords: Hip spica cast, Pediatric femur fracture, Closed reduction, DDH
References
Kumar SJ. Hip spica application for the treatment of congenital dislocation of the hip. J Pediatr Orthop 1981;1:97-9.
Wan KL, Shanmugam R, Lee KY, Saw A. Comparing the mechanical strength of hip spica cast between a conventional and a new method of application. J Child Orthop 2016;10:387-94.
Tisherman RT, Hoellwarth JS, Mendelson SA. Systematic. review of spica casting for the treatment of paediatric
diaphyseal femur fractures. J Child Orthop 2018;12:136-44.
Sargent MC. Single-leg spica cast application for treatment of pediatric femoral fracture. JBJS Essent Surg Tech
2017;7:e26.
How to Cite this article: Kapoor D, Vaidya SV. Applying a Hip Spica in a Child. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):27-29.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 09:20:062023-01-03 17:25:54Applying a Hip Spica in a Child
[1] Department of Pediatric Orthopedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, India.
Address of Correspondence
Dr. Sandeep Patwardhan,
Department of Pediatric Orthopedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, India.
References
Rachel DiFazio, Judith Vessey, Incidence of Skin Complications and Associated Charges in Children Treated With Hip Spica Casts for Femur Fractures
Dirk Leu, M. Catherine Sargent, Spica Casting for Pédiatrie Femoral Fractures -A Prospective, Randomized Controlled Study of Single-Leg Versus Double-Leg Spica Casts by The Journal of Bone and Joint Surgery.
Kumar SJ (1981) Hip spica application for the treatment of congenital dislocation of the hip. J Pediatr Orthop.
Wheeless’Textbook of Orthopaedics- Hip spica cast.
Hip spica nursing care guidelines by The Royal Children’s Hospital Melbourne.
How to Cite this article: Patwardhan S, Sodhai V, Gundawar C, Patil V. Wooden board technique for Hip Spica
application in children. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):30-32.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 09:10:162023-01-03 17:24:53Wooden board technique for Hip Spica application in children
[1] Paediatric Orthopaedic Surgery, Sir H. N. Reliance Hospital, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, K. B. Bhabha Municipal General Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Swapnil M Keny,
Paediatric Orthopaedic Surgery, Sir H .N. Reliance Hospital, Mumbai, Maharashtra, India.
E-mail: peadortho@gmail.com
References
1. Donnelly MD, Lane F. Diagnostic Imaging: Pediatrics. 2nd ed. Salt Lake City, Utah: Amirsys Inc; 2011.
2. Donnelly MD, Lane F. Pediatric Imaging: The Fundamentals. 1st ed. Pennsylvania, United States: Saunders; 2009.
3. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. AJR Am J Roentgenol 2003;181:51-5.
4. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976;119:39-47.
5. Portinaro NM, Murray DW, Bhullar TP, Benson MK. Errors in measurement of acetabular index. J Pediatr Orthop 1995;15:780-4.
6. Agus H, Bicimoglu A, Omeroglu H, Tumer Y. How should the acetabular angle of Sharp be measured on a pelvic radiograph? J Pediatr Orthop 2002;22:228-31.
7. Humbert L, Carlioz H, Baudoin A, Skalli W, Mitton D. 3D Evaluation of the acetabular coverage assessed by biplanar X-rays or single anteroposterior X-ray compared with CT-scan. Comput Methods Biomech Biomed Engin 2008;11:257-62.
8. Stein-Wexler R, Wootton-Gorges SL, Ozonoff MB. Pediatric Orthopedic Imaging. Berlin, Germany: Springer; 2014.
9. Hefti F. Pediatric Orthopedics in Practice. Germany: Springer; 2015.
How to Cite this article: Keny SM, Modi N. Tutorial – The ABC of what to see on a hip X-ray of children. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):33-37.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 09:00:522023-01-03 17:28:09Tutorial - The ABC of what to see on a hip X-ray of children
[1] Consultant Anesthesiology, at Lilavati Hospital and Research Centre, Mumbai, India,
[2] Senior Resident Anesthesiology at Lilavati Hospital and Research Centre, Mumbai, India,
[3] MS Ortho, Consultant Spine Surgeon at Spine Centre, Andheri and SL Raheja Hospital, Mahim, Mumbai, India,
[4] MS Ortho, Consultant Spine Surgeon at Lilavati Hospital and Research Centre, Mumbai, India.
Address of Correspondence
Dr. Aaliya Mehmood,
Flat 701, A-8, Al-Quba CHS, Millat Nagar, Andheri West, Mumbai 400053, India.
E-mail: aaliyamehmood@hotmail.com
Abstract
Background: In the last few decades, many studies have been conducted on comparison between general anaesthesia (GA) versus spinal anaesthesia (SA) for lumbar spine surgeries and each have reported discrepancies between the two methods of induction with equivalent pros and cons; ultimately failing to state a final conclusive method. With the ongoing COVID pandemic, and the fear of aerosol generation associated with GA; our focus has shifted on regional anesthesia completely, as it is been proven safer and more hassle-free to conduct during these challenging times.
Materials and Methods: A similar case study was conducted with 178 patients posted for lumbar spine procedures under the same surgeon. Wherein, 86 received GA and 92 SA. Appropriate statistical analysis was applied to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, paraplegia, paraesthesia, post-Dural puncture headache, signs of meningism, urinary retention, and other perioperative complications among the SA patients.
Results: SA was associated with significantly lower operative time, blood loss, total anaesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR. SA was also associated with shorter stay in the PACU, and overall lesser total duration of hospital stay. None of the 92 patients in SA group needed conversion to GA or had an episode of high/complete sympathetic blockade. No incidences of paraparesis or paraplegia, or episodes of persistent post-operative paraesthesia or weakness, Bagai (vasovagal) syncope, PONV, post-op meningism, post-dural puncture headache, spinal hematoma, intraoperative dural Cerebrospinal Fluid leak or post-op fistula, were noted. There were two incidences of failed spinal which were easily managed with a lower dose repeat SA. Overall better post-op analgesia and higher patient and surgeon satisfaction compared to GA was observed.
Conclusion: SA is effective for use in patients undergoing elective lumbar spine surgeries and very efficient alternative technique to GA. SA offers efficient OR functioning with decreasing overall operation theatre time and shown to be the more convenient anesthetic choice in the perioperative setting.
1. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003;15:185–192.
2. De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39–43.
3. Pflug AE, Halter JB. Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiology. 1981;55:120–126
4. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.
5. McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine (Phila Pa 1976). 2004;29:2542–2547.
6. McLain RF, Tetzlaff JE, Bell GR, Uwe-Lewandrowski K, Yoon HJ, Rana M. Microdiscectomy: spinal anesthesia offers optimal results in general patient population. J Surg Orthop Adv. 2007;16:5–11.
7. Available at: https://www.nysora.com/techniques/neuraxial-and-perineuraxial-techniques/spinal-anesthesia/
8. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg. 1988;75(4):299–304.
9. Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. J Res Med Sci. 2011;16:524–529.
10. Brown MJ. Anesthesia for elective spine surgery in adults. 2015. Available from: https://www.uptodate.com/contents/anesthesia-forelective-spine-surgery-in-adults. Accessed July 26, 2017.
11. Modig J, Karlstrom G. Intra- and post-operative blood loss and haemodynamics in total hip replacement when performed under lumbar epidural versus general anaesthesia. Eur J Anaesthesiol. 1987;4(5):345–55.
12. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000;84(4):450–5.
13. Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250–5.
14. Sakura S. Epidural anesthesia and spinal anesthesia in the elderly. Masui. 2007;56(2):130–8. [In Japanese].
15. Kao FC, Tsai TT, Chen LH, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine
J. 2015;24:348–357.
How to Cite this article: Waradkar S, Mehmood A, Raut S, Kundnani V. Moving toward Regional
Anesthesia for Spine Surgery – Need of the Hour. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):38-42.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 08:55:392023-01-03 17:35:51Moving toward Regional Anaesthesia for Spine Surgery - Need of the Hour
Journal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 43-51 | Bhaskaranand Kumar, Ashwath M Acharya, Himanshu R Prasad, S M Venugopal
DOI: :10.13107/jcorth.2022.v07i02.529
Author: Bhaskaranand Kumar [1], Ashwath M Acharya [2], Himanshu R Prasad [3], S M Venugopal [1]
[1] Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Tirupati, Andhra Pradesh, India,
[2] Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India,
[3] Department of Orthopaedic Surgeon, Sunshine Hospital, Hyderabad, Telangana, India.
Address of Correspondence
Dr. Ashwath M Acharya,
Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal – 576 104, Karnataka, India.
E-mail: anmacharya@gmail.com
Abstract
Purpose: :Congenital clasped thumb is a rare deformity and not much has been described in literature about it. The aim of this study was to evaluate clinical profile of congenital clasped thumb, examine peroperative pathoanatomy, and evaluate the results of the treatment of such cases.
Methods: A prospective study on 57 patients [106 hands] was done and their data recorded from the medical case records. A thorough clinical and radiological assessment was performed. Patients were classified using the Tsuyuguchi classification. Splinting program was initially started and patients not responding to it and those older than 10 years underwent contracture release, joint stabilization, and local flap cover with or without tendon transfers. All patients were assessed by Gilbert’s grading after 1 year.
Results: There were 43 males and 14 females. The average age was 33 months [range 0–21 years]. At presentation, 51% [54/106] of hands were classified as severe with syndromic pattern [Type III]. About 61% [35/57] of the patients presented at the age <5 years and 21% after 10 years including three adults. About 41% of these patients [23/57] had a history of consanguinity and 27% [15/57] had a family history of a similar or associated congenital deformity. Splinting program showed excellent results in type I. An a-la-Carté release of soft tissues, joint stabilization with K-wire, and ligament reconstruction with local flap cover gave good to excellent results in 73% of our patients. Nine patients had features of web creep at first web space.
Conclusion: Congenital clasp thumb showed a strong genetic predisposition. There was no difference between type II and type III variants with respect to the pathoanatomy, treatment protocol, operative procedures, and results. Splinting program in mild deformity and surgical correction with reconstruction in more severe cases gave satisfactory results.
Keywords: Congenital adducted thumb, congenital clasped thumb, first web space contracture.
References
Abdel-Ghani H, El-Naggar A, Hegazy A, Hanna A, Tarraf Y, Temtamy S. Characteristics of patients with congenital clasped thumb: A prospective study of 40 patients with the results of treatment. J Child Orthop 2007;1:313-22.
Kozin S. Deformities of the thumb. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS editors. Green’s Operative Hand Surgery. 7th ed. 7th ed. Philadelphia, PA: Elsevier; 2017. p. 1289-337.
Tsuyuguchi Y, Masda K, Kawabata H, Kawai H, Ono K. Congenital clasped thumb: A review of forty-three cases. J Hand Surg Am 1985;10:613-8.
Abdel-Ghani H, Mahmoud M, Shaheen A, Abdel-Wahed M. Treatment of congenital clasped thumb in arthrogryposis. J Hand Surg Eur 2017;42:794-8.
Verhagen JM, Schrander-Stumpel CT, Blezer MM, Weber JW, Schrander JJ, Rubio-Gozalbo ME, et al. Adducted thumbs: A clinical clue to genetic diagnosis. Eur J Med Genet 2013;56:153-8.
McCarroll HR, Manske PR. The windblown hand: Correction of the complex clasped thumb deformity. Hand Clin 1992;8:147-59.
Lin SC, Hung TH, Hsu HY, Lin CG, Chiu HY. A simple splinting method for correction of supple congenital clasped thumbs in infants. J Hand Surg Br 1999;24:612-4.
Zlotolow DA, Tiedeken NC. Reorientation osteotomy for the atypical clasp thumb in children with arthrogryposis. Tech Hand Up Extrem Surg 2014;18:165-9.
Mahmoud M, Abdel-Ghani H, Elfar JC. New flap for widening of the web space and correction of palmar contracture in complex clasped thumb. J Hand Surg Am 2013;38:2251-6.
Wood VE, Biondi J. Treatment of the windblown hand. J Hand Surg Am 1990;15A:431-8.
Caroli A, Zanasi S. First web-space reconstruction by Caroli’s technique in congenital hand. deformities with severe thumb ray adduction. Br J Plast Surg 1989;42:653-9.
Brand PW. The hand. In: Campbell’s Operative Orthopaedics. 4th ed. St Louis: CV Mosby Co.
Buck-Gramcko D. Congenital Malformations of the Hand and Forearm. Vol. 141. London: Churchill Livingstone; 1998.
Ezaki M, Oishi SN. Index rotation flap for palmar thumb release in arthrogryposis. Tech Hand Up Extrem Surg 2010;14:38-40.
How to Cite this article: Kumar B, Acharya AM, Prasad HR, Venugopal SM. Clinical Profile of Congenital Clasped Thumb: A Case Series. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):43-51.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 08:40:202023-01-03 17:41:05Clinical Profile of Congenital Clasped Thumb: A Case Series
Author: Sachin Kale [1], Sunil H Shetty [1], Arvind Vatkar [2], Sushmit Singh [1], Pramod Bhor [3], Raja Ganesh Rayudu [1]
[1] Department of Orthopedics, Dr. D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India,
[2] Spinal Fellow Queens Medical Centre, Nottingham, United Kingdom,
[3] Department of Orthopedics, Terna Medical College Navi Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Raja Ganesh Rayudu,
Dr. D. Y. Patil University-School of Medicine, Navi Mumbai, Maharashtra, India.
E-mail: rajaganesh70@gmail.com
Abstract
Introduction: It is perceived that about 75% of doctors have faced some kind of violence at work, which is similar to the rates from other countries in the continent. A substantial proportion of doctors are in peril as they are victims of violence by their patients or relatives, which often is unreported.
Methodology:A structured study questionnaire was designed and prepared in the form of “Google Forms.”
Results: Student doctors tackling such abuse are known to develop psychological stress at most times; and come about with high functioning depression, fear, and post-traumatic stress disorders at such a preliminary stage of their practice. From this study, we explored that how doctors from being genuinely praised for their altruistic work to having faced social stigma and abuse.
Conclusion: We intent to fortify doctors to tackle this emerging issue for the safety of physicians. Drawing inference from the literature and graphical analysis, a sustainable way to alleviate duress on doctors would be ameliorating public health-care services and thus the quality of life. To fathom this issue and to tackle interludes of violence against doctors, it is of paramount importance that as a society, we concede this as a public health and safety challenge.
Keywords: Doctors, psychological stress, violence
References
Kuhn W. Violence in the emergency department. Managing aggressive patients in a high-stress environment. Postgrad Med 1999;105:143-8,154.
Pitcher G. BMA survey finds one-third of doctors attacked physically or verbally in 2007. Ethics, Health and Safety, HR STRATEGY, Latest News, Occupational Health, Stress, Wellbeing. 2008 Jan 10 .
Nagpal N. Incidents of violence against doctors in India: Can these be prevented? Natl Med J India 2017;30:97-100; 2017.
Available at: www.who.int/violence_injury_prevention/violence/activities/workplace/background/en; 2013.
Crilly, et al.; 2004. Gacki-Smith, et al.; 2009. Gillespie, Gates, and Berry; 2013.
Angland, Dowling, and Casey; 2014. Gillespie, et al.; 2013.
Available at: http://Pubmed.ncib.nlm.nih.gov/16676767/2006.
John M. From Osler to the cone technique. HSR Proc Intensive Care Cardiovasc Anesth. 2013; 5 (1): 57-58.
As sault s upon medi cal men. JAMA. 1892;18:399–400.
Nagpal N. Incidents of violence against doctors in India: Can these be prevented? Natl Med J India 2017;30:97-100; 2017.
available at: https://www.mospi.gov.in/documents/213904/8 48928/annual_report_2020_21_eng.pdf/d448c47a-fa4e-17c5-7a34-e8fe3063b06a?t=1613993557446; 2020.
How to Cite this article: Kale S, Shetty SH, Vatkar A, Singh S, Bhor P, Rayudu RG. Prospective Study of Attitude of MBBS Doctors toward Violence against Doctors. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):52-58.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2022-12-10 08:30:452023-01-03 17:43:22Prospective Study of Attitude of MBBS Doctors toward Violence against Doctors
Applying a Hip Spica in a Child
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 27-29 | Darshan Kapoor, Sandeep V Vaidya
DOI: 10.13107/jcorth.2022.v07i02.521
Author: Darshan Kapoor [1], Sandeep V Vaidya [1,2]
[1] Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Pinnacle Orthocentre Hospital, Thane, Maharashtra, India.
Address of Correspondence
Dr. Sandeep V Vaidya,
Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
E-mail: drsvvaidya@gmail.com
Abstract
Hip spica cast is a useful modality for the lower limb immobilization in children with hip and femur pathologies. Single, one and half, double limb spica cast may be applied depending on the indication. The position of hip immobilization is also dependent on the underlying pathology for which the spica is being applied. The inguinal region and knee are potential weak spots in a spica and these should reinforce during spica application. Potential complications include plaster sores, breakage, avascular necrosis of femoral head (in developmental dysplasia of hip), neurovascular compromise, and superior mesenteric artery syndrome (very rare). Careful attention to technique and vigilant after-care is necessary to prevent these complications.
Keywords: Hip spica cast, Pediatric femur fracture, Closed reduction, DDH
References
diaphyseal femur fractures. J Child Orthop 2018;12:136-44.
2017;7:e26.
(Abstract Full Text HTML) (Download PDF)
Wooden board technique for Hip Spica application in children
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 30-32 | Sandeep Patwardhan, Vivek Sodhai, Chaitrali Gundawar, Vishwajit Patil
DOI: 10.13107/jcorth.2022.v07i02.523
Author: Sandeep Patwardhan [1], Vivek Sodhai [1], Chaitrali Gundawar [1], Vishwajit Patil [1]
[1] Department of Pediatric Orthopedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, India.
Address of Correspondence
Dr. Sandeep Patwardhan,
Department of Pediatric Orthopedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, India.
References
application in children. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):30-32.
(Abstract Full Text HTML) (Download PDF)
Tutorial – The ABC of what to see on a hip X-ray of children
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 33-37 | Swapnil M Keny , Nihar Modi
DOI: 10.13107/jcorth.2022.v07i02.525
Author: Swapnil M Keny [1], Nihar Modi [2]
[1] Paediatric Orthopaedic Surgery, Sir H. N. Reliance Hospital, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, K. B. Bhabha Municipal General Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Swapnil M Keny,
Paediatric Orthopaedic Surgery, Sir H .N. Reliance Hospital, Mumbai, Maharashtra, India.
E-mail: peadortho@gmail.com
References
1. Donnelly MD, Lane F. Diagnostic Imaging: Pediatrics. 2nd ed. Salt Lake City, Utah: Amirsys Inc; 2011.
2. Donnelly MD, Lane F. Pediatric Imaging: The Fundamentals. 1st ed. Pennsylvania, United States: Saunders; 2009.
3. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. AJR Am J Roentgenol 2003;181:51-5.
4. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976;119:39-47.
5. Portinaro NM, Murray DW, Bhullar TP, Benson MK. Errors in measurement of acetabular index. J Pediatr Orthop 1995;15:780-4.
6. Agus H, Bicimoglu A, Omeroglu H, Tumer Y. How should the acetabular angle of Sharp be measured on a pelvic radiograph? J Pediatr Orthop 2002;22:228-31.
7. Humbert L, Carlioz H, Baudoin A, Skalli W, Mitton D. 3D Evaluation of the acetabular coverage assessed by biplanar X-rays or single anteroposterior X-ray compared with CT-scan. Comput Methods Biomech Biomed Engin 2008;11:257-62.
8. Stein-Wexler R, Wootton-Gorges SL, Ozonoff MB. Pediatric Orthopedic Imaging. Berlin, Germany: Springer; 2014.
9. Hefti F. Pediatric Orthopedics in Practice. Germany: Springer; 2015.
(Abstract Full Text HTML) (Download PDF)
Moving toward Regional Anaesthesia for Spine Surgery – Need of the Hour
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 38-42 | Samidha Waradkar , Aaliya Mehmood , Saijyot Raut , Vishal Kundnani
DOI: 10.13107/jcorth.2022.v07i02.527
Author: Samidha Waradkar [1], Aaliya Mehmood [2], Saijyot Raut [3], Vishal Kundnani [4]
[1] Consultant Anesthesiology, at Lilavati Hospital and Research Centre, Mumbai, India,
[2] Senior Resident Anesthesiology at Lilavati Hospital and Research Centre, Mumbai, India,
[3] MS Ortho, Consultant Spine Surgeon at Spine Centre, Andheri and SL Raheja Hospital, Mahim, Mumbai, India,
[4] MS Ortho, Consultant Spine Surgeon at Lilavati Hospital and Research Centre, Mumbai, India.
Address of Correspondence
Dr. Aaliya Mehmood,
Flat 701, A-8, Al-Quba CHS, Millat Nagar, Andheri West, Mumbai 400053, India.
E-mail: aaliyamehmood@hotmail.com
Abstract
Background: In the last few decades, many studies have been conducted on comparison between general anaesthesia (GA) versus spinal anaesthesia (SA) for lumbar spine surgeries and each have reported discrepancies between the two methods of induction with equivalent pros and cons; ultimately failing to state a final conclusive method. With the ongoing COVID pandemic, and the fear of aerosol generation associated with GA; our focus has shifted on regional anesthesia completely, as it is been proven safer and more hassle-free to conduct during these challenging times.
Materials and Methods: A similar case study was conducted with 178 patients posted for lumbar spine procedures under the same surgeon. Wherein, 86 received GA and 92 SA. Appropriate statistical analysis was applied to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, paraplegia, paraesthesia, post-Dural puncture headache, signs of meningism, urinary retention, and other perioperative complications among the SA patients.
Results: SA was associated with significantly lower operative time, blood loss, total anaesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR. SA was also associated with shorter stay in the PACU, and overall lesser total duration of hospital stay. None of the 92 patients in SA group needed conversion to GA or had an episode of high/complete sympathetic blockade. No incidences of paraparesis or paraplegia, or episodes of persistent post-operative paraesthesia or weakness, Bagai (vasovagal) syncope, PONV, post-op meningism, post-dural puncture headache, spinal hematoma, intraoperative dural Cerebrospinal Fluid leak or post-op fistula, were noted. There were two incidences of failed spinal which were easily managed with a lower dose repeat SA. Overall better post-op analgesia and higher patient and surgeon satisfaction compared to GA was observed.
Conclusion: SA is effective for use in patients undergoing elective lumbar spine surgeries and very efficient alternative technique to GA. SA offers efficient OR functioning with decreasing overall operation theatre time and shown to be the more convenient anesthetic choice in the perioperative setting.
Keywords: Spinal Anaesthesia, Regional Anaesthesia, Covid-19, Spine Surgery, Lumbar Discectomy, Fast Track Anaesthesia, Aerosol Generation
References
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Anesthesia for Spine Surgery – Need of the Hour. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):38-42.
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Clinical Profile of Congenital Clasped Thumb: A Case Series
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 43-51 | Bhaskaranand Kumar, Ashwath M Acharya, Himanshu R Prasad, S M Venugopal
DOI: :10.13107/jcorth.2022.v07i02.529
Author: Bhaskaranand Kumar [1], Ashwath M Acharya [2], Himanshu R Prasad [3], S M Venugopal [1]
[1] Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Tirupati, Andhra Pradesh, India,
[2] Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India,
[3] Department of Orthopaedic Surgeon, Sunshine Hospital, Hyderabad, Telangana, India.
Address of Correspondence
Dr. Ashwath M Acharya,
Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal – 576 104, Karnataka, India.
E-mail: anmacharya@gmail.com
Abstract
Purpose: :Congenital clasped thumb is a rare deformity and not much has been described in literature about it. The aim of this study was to evaluate clinical profile of congenital clasped thumb, examine peroperative pathoanatomy, and evaluate the results of the treatment of such cases.
Methods: A prospective study on 57 patients [106 hands] was done and their data recorded from the medical case records. A thorough clinical and radiological assessment was performed. Patients were classified using the Tsuyuguchi classification. Splinting program was initially started and patients not responding to it and those older than 10 years underwent contracture release, joint stabilization, and local flap cover with or without tendon transfers. All patients were assessed by Gilbert’s grading after 1 year.
Results: There were 43 males and 14 females. The average age was 33 months [range 0–21 years]. At presentation, 51% [54/106] of hands were classified as severe with syndromic pattern [Type III]. About 61% [35/57] of the patients presented at the age <5 years and 21% after 10 years including three adults. About 41% of these patients [23/57] had a history of consanguinity and 27% [15/57] had a family history of a similar or associated congenital deformity. Splinting program showed excellent results in type I. An a-la-Carté release of soft tissues, joint stabilization with K-wire, and ligament reconstruction with local flap cover gave good to excellent results in 73% of our patients. Nine patients had features of web creep at first web space.
Conclusion: Congenital clasp thumb showed a strong genetic predisposition. There was no difference between type II and type III variants with respect to the pathoanatomy, treatment protocol, operative procedures, and results. Splinting program in mild deformity and surgical correction with reconstruction in more severe cases gave satisfactory results.
Keywords: Congenital adducted thumb, congenital clasped thumb, first web space contracture.
References
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Prospective Study of Attitude of MBBS Doctors toward Violence against Doctors
/in Vol 7 | Issue 2 | Jul-Dec 2022 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 7 | Issue 2 | Jul-Dec 2022 | page: 52-58 | Sachin Kale, Sunil H Shetty, Arvind Vatkar, Sushmit Singh, Pramod Bhor, Raja Ganesh Rayudu
DOI: 10.13107/jcorth.2022.v07i02.531
Author: Sachin Kale [1], Sunil H Shetty [1], Arvind Vatkar [2], Sushmit Singh [1], Pramod Bhor [3], Raja Ganesh Rayudu [1]
[1] Department of Orthopedics, Dr. D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India,
[2] Spinal Fellow Queens Medical Centre, Nottingham, United Kingdom,
[3] Department of Orthopedics, Terna Medical College Navi Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Raja Ganesh Rayudu,
Dr. D. Y. Patil University-School of Medicine, Navi Mumbai, Maharashtra, India.
E-mail: rajaganesh70@gmail.com
Abstract
Introduction: It is perceived that about 75% of doctors have faced some kind of violence at work, which is similar to the rates from other countries in the continent. A substantial proportion of doctors are in peril as they are victims of violence by their patients or relatives, which often is unreported.
Methodology:A structured study questionnaire was designed and prepared in the form of “Google Forms.”
Results: Student doctors tackling such abuse are known to develop psychological stress at most times; and come about with high functioning depression, fear, and post-traumatic stress disorders at such a preliminary stage of their practice. From this study, we explored that how doctors from being genuinely praised for their altruistic work to having faced social stigma and abuse.
Conclusion: We intent to fortify doctors to tackle this emerging issue for the safety of physicians. Drawing inference from the literature and graphical analysis, a sustainable way to alleviate duress on doctors would be ameliorating public health-care services and thus the quality of life. To fathom this issue and to tackle interludes of violence against doctors, it is of paramount importance that as a society, we concede this as a public health and safety challenge.
Keywords: Doctors, psychological stress, violence
References
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