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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.
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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.
2. Finney B, Mattu G. National family medicine resident survey. Part 1: Learning environment, debt, and practice location. Can Fam Physician 2001;47:117, 120, 126-8.
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.
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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

References

1. Healey JH, Ghelman B. Osteoid osteoma and osteoblastoma. Current concepts and recent advances. Clin Orthop Relat Res. 1986 Mar;(204):76-85.
2. Kan P, Schmidt MH. Osteoid osteoma and osteoblastoma of the spine. Neurosurg Clin N Am. 2008 Jan;19(1):65-70.
3. Chi JH, Bydon A, Hsieh P, Witham T, Wolinsky JP, Gokaslan ZL. Epidemiology and demographics for primary vertebral tumors. Neurosurg Clin N Am. 2008 Jan;19(1):1-4.
4. Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E. Osteoblastomas of the spine: a comprehensive
review. Neurosurg Focus. 2016 Aug;41(2):E4.
5. Elder BD, Goodwin CR, Kosztowski TA, Lo SF, Bydon A, Wolinsky JP, Jallo GI, Gokaslan ZL, Witham TF, Sciubba DM.
Surgical Management of Osteoblastoma of the Spine: Case Series and Review of the Literature. Turk Neurosurg. 2016;26(4):601-7.
6. Harrop JS, Schmidt MH, Boriani S, Shaffrey CI. Aggressive “benign” primary spine neoplasms: osteoblastoma aneurysmal bone cyst, and giant cell tumor. Spine (Phila Pa 1976). 2009 Oct 15;34(22 Suppl):S39-47.
7. Boriani S, Amendola L, Bandiera S, Simoes CE, Alberghini M, Di Fiore M, Gasbarrini A. Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases. Eur Spine J. 2012 Oct;21(10):2003-10.
8. Ruggieri P, Huch K, Mavrogenis AF, Merlino B, Angelini A. Osteoblastoma of the sacrum: report of 18 cases and analysis of the literature. Spine (Phila Pa 1976). 2014 Jan 15;39(2):E97-E103.
9. Kadhim M, Binitie O, O’Toole P, Grigoriou E, De Mattos CB, Dormans JP. Surgical resection of osteoid osteoma and
osteoblastoma of the spine. J Pediatr Orthop B. 2017 Jul;26(4):362-369.
10. Reynolds JJ, Rothenfluh DA, Athanasou N, Wilson S, Kieser DC. Neoadjuvant denosumab for the treatment of a sacral osteoblastoma. Eur Spine J. 2018 Jul;27(Suppl 3):446-452.

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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Home based unsupervised rehabilitation protocol following rotator cuff repair has good outcomes: A prospective study

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  July-Dec 2021 | page:12-15 | Rohan A Habbu

Author: Rohan A Habbu

[1] Department of Upper Limb Surgery, Prime Health Clinic Ground floor, Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India

Address of Correspondence
Dr. Rohan A Habbu,
Department of Upper Limb Surgery, Prime Health Clinic Ground floor,
Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India
E-mail: dr_habbu@yahoo.com

Abstract

Background: Rehabilitation after rotator cuff repair achieves good results but it involves time and costs. A simple home based program will reduce costs, time to travel and chance of exposure in a pandemic scenario. The objective of the study was to assess outcomes of home based rehabilitation protocol following rotator cuff repair.
Methods: This was a prospective study of 42 patients who underwent rotator cuff repair followed by an unsupervised home based rehabilitation protocol. The tears were identified using clinical examination and Magnetic Resonance Imaging. The cuff repair was done with mini open incision technique. The patients were taught an exercise protocol, which they did by themselves at home. There was no daily supervision by the treating surgeon or a physiotherapist. The study measured pain scores, return to work, range of motion and failures at one year.
Results: Mean duration of followup was 14 months. Visual Analogue Score for pain improved from preoperative mean 7.5 to followup mean 1.3. Disability of the Arm, Hand and Shoulder score, measured in 26 patients improved from preoperative mean 33.2 to followup mean 4.5. Range of motion improved in 39 patients. Cuff strength was normal in 39 patients. 37 patients returned to full work by three months. There were three failures with one patient developing significant stiffness and two patients showing a retear. The retear was seen in patients with large retracted tears and the repair was done under tension.
Conclusion: Home based exercise protocol for postoperative rehabilitation in rotator cuff repairs can achieve good results in carefully selected patients. The study does not recommend this for large tears with difficult repairs. Since the patients are doing the postoperative rehabilitation at home, this reduces the costs, time lost in travel and exposure to external factors.
Keywords: Rotator cuff, mini open repair, unsupervised rehabilitation, motion

References

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How to Cite this article: Habbu RA. Home based unsupervised rehabilitation protocol following rotator
cuff repair has good outcomes: A prospective study. Journal of Clinical Orthopaedics July-Dec 2021;6(2):12-15.

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Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report

/in , /by

Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 42-44 | Febyan, I Gusti Ngurah Paramartha Wijaya Putra, Made Deker, Agus Eka Wiradiputra

Author: Febyan [1], I Gusti Ngurah Paramartha Wijaya Putra [1], Made Deker [1], Agus Eka Wiradiputra [1]

[1] Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia

Address of Correspondence
Dr. Febyan,
Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia
E-mail: febyanmd@gmail.com

Abstract

Gout is an inflammatory disease commonly characterized by tophus deposits containing uric acid crystals in the intraarticular joints. An acute locked joint due to gouty tophus formation is a rare finding. This case describes a 36-year-old man with sudden pain and locking in the knee joint. Physical examination, plain radiography, and serum uric acid examination showed unremarkable results. Further investigation with diagnostic arthroscopy confirmed tophaceous gout as the sole cause of an acutely locked knee. The patient exhibited satisfactory clinical results following surgical intervention under arthroscopy and the administration of urate-lowering agents. This case highlights the probability of tophus deposition as the cause of an acute locked knee, despite unremarkable initial presentation. The awareness regarding this case should be raised, especially on emphasizing arthroscopy as a cost-effective diagnostic and therapeutic modality in patient management.

Keywords: Arthroscopy, gouty tophi, knee joint, rare case

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15. Pan F, Li Q, Tang X, Xue J, Li J. Method and effectiveness of arthroscopic debridement for treating gouty arthritis of the knee. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi (Chinese Journal of Reparative and Reconstructive Surgery)
2011;25(8):937-40 (in Chinese).
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How to Cite this article: Febyan, Putra IGNPW, Deker M, Wiradiputra AE. Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):42-44.

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Guidelines on Infection after ACL Reconstruction

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Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 53-59 | I. Geethan, Raju Easwaran

Author: I. Geethan [1], Raju Easwaran [2]

[1] Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur

[2] Director, Shree Meenakshi Orthopaedics & Sports Medicine Clinic

 

Address of Correspondence
Dr. I. Geethan,
Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur
E-mail: igeethan@gmail.com

Abstract

Infection after ACL reconstruction (ACLR) is a rare but disastrous event that increases the cost of treatment and affects the short and long term outcome. Clinicians must be aware of the best preventive practices and be knowledgeable regarding the early diagnosis and prompt management to minimise the complications following ACLR. Recent literature has identified the risk factors for infection after ACLR and has proposed recommendations for its management. This article reviews the recent literature and proposes a plan for prevention of infection and its treatment. Specifically, the use of Bone Patellar Tendon Bone graft in patients at a higher risk of infection and Vancomycin wrapping of graft are the two interventions that can reduce the risk of infection. A surgeon must have a low threshold for suspecting infection and early graft preserving arthroscopic lavage must be performed on suspicion of infection. Culture directed antibiotics must be given for 6 weeks following infection. Graft and hardware must be removed in patients requiring repeat debridement. Revision ACLR is offered only for those patients who report instability.
Keywords: Infection, ACL reconstruction, Prevention, Management

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How to Cite this article: Geethan I, Easwaran R. Guidelines on Infection after ACL Reconstruction. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1): 53-59.

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Role of anterolateral reconstruction in ACL surgery. Why, When and How?

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Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 45-52 | Philippe Landreau

Author: Philippe Landreau [1]

[1] DxBone, Bone and Joint Excellence Center Dubai, United Arab Emirates

Address of Correspondence
Dr. Philippe Landreau,
DxBone, Bone and Joint Excellence Center Dubai, United Arab Emirates
E-mail: landreau@mac.com

Abstract

Ruptures of the anterior cruciate ligament (ACL) cause both abnormal anterior translation and anterolateral rotation of the tibia under the femur. Isolated intra-articular ACL reconstruction has evolved significantly over the past years, but in many cases it is insufficient to correct rotational laxity. There are several justifications for anterolateral plasty in the context of ACL surgery: The persistence of anterolateral laxity after some isolated ACL intra-articular reconstructions, the evidence of traumatic lesions of these anterolateral structures after ACL tear and the recent anatomical and biomechanical research on the anterolateral complex of the knee. One more justification is that some recent studies comparing the outcomes after isolated ACL reconstruction and those after ACL reconstruction combined with anterolateral reconstruction are in favor of the simultaneous procedures. The addition of an extra-articular procedure to the intra-articular reconstruction of the ACL can improve the outcomes particularly in these situations: Young age (<25 ans), sports with pivot contact particularly if high level, pivot-shift Grades 2–3, recurvatum of the knee and generalized hyperlaxity, posterior tibial slope superior to 12°, meniscus deficiency, and ACL revision. Different surgical techniques have been proposed and described. They can be classified in two groups: The techniques using an ilio-tibial band graft to perform a lateral tenodesis and the procedures aiming to reconstruct the anterolateral ligament. Both techniques intend to control the anterolateral displacement of the tibial plateau.
Keywords: Anterolateral ligament, anterior cruciate ligament, anterolateral reconstruction, lateral tenodesis, condylar strap

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How to Cite this article: SLandreau P. Role of anterolateral reconstruction in ACL surgery, why, when and how?. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):45-52.

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