Suprascapular Neuropathy

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.


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


    1. Thompson WA, Kopell HP. Peripheral entrapment neuropathies of the upper extremity. N Engl J Med 1959;260:1261-5.
    2. Witvrouw E, Cools A, Lysens R, Cambier D, Vanderstraeten G, Victor J, et al. Suprascapular neuropathy in volleyball players. Br J Sports Med 2000;34:174-80.
    3. Ringel SP, Treihaft M, Carry M, Fisher R, Jacobs P. Suprascapular neuropathy in pitchers. Am J Sports Med 1990;18:80-6.
    4. Arriaza R, Ballesteros J, Lopez-Vidriero E. Suprascapular neuropathy as a cause of swimmer’s shoulder results after arthroscopic treatment in 4 patients. Am J Sports Med 2013;41:887-93.
    5. Cummins CA, Bowen M, Anderson K, Messer T. Suprascapular nerve entrapment at the spinoglenoid notch in a professional baseball pitcher. Am J Sports Med 1999;27:810-2.
    6. Romeo AA, Rotenberg DD, Bach BR Jr. Suprascapular neuropathy. J Am Acad Orthop Surg 1999;7:358-67.
    7. Cummins CA, Messer TM, Schafer MF. Infraspinatus muscle atrophy in professional baseball players. Am J Sports Med 2004;32:116-20.
    8. Young SW, Dakic J, Stroia K, Nguyen ML, Harris AH, Safran MR. High incidence of infraspinatus muscle atrophy in elite professional female tennis players. Am J Sports Med 2015;43:1989-93.
    9. Lajtai G, Wieser K, Ofner M, Raimann G, Aitzetmüller G, Jost B. Electromyography and nerve conduction velocity for the evaluation of the infraspinatus muscle and the suprascapular nerve in professional beach volleyball players. Am J Sports Med 2012;40:2303-8.
    10. Shah AA, Butler RB, Sung SY, Wells JH, Higgins LD, Warner JJ. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg 2011;20:975-82.
    11. Costouros JG, Porramatikul M, Lie DT, Warner JP. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy 2007;23:1152-61.
    12. Shi LL, Boykin RE, Lin A, Warner JP. Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration. J Shoulder Elbow Surg 2014;23:339-46.
    13. Collin P, Treseder T, Ladermann A, Benkalfate T, Mourtada R, Courage O, et al. Neuropathy of the suprascapular nerve and massive rotator cuff tears: A prospective electromyographic study. J Shoulder Elbow Surg 2014;23:28-34.
    14. Mallon WJ, Wilson RJ, Basamania CJ. The association of suprascapular neuropathy with massive rotator cuff tears: A preliminary report. J Shoulder Elbow Surg 2006;15:395-8.
    15. Kong BY, Kim SH, Kim DH, Joung HY, Jang YH, Oh JH. Suprascapular neuropathy in massive rotator cuff tears with severe fatty degeneration in the infraspinatus muscle. Bone Joint J 2016;98-B:1505-9.
    16. Silvan Beeler, Eugene TH, Gerber C. A comparative analysis of fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears and suprascapular neuropathy. J Shoulder Elbow Surg 2013;22:1537-46.
    17. Gosk J, Rutowski R, Wiacek R, Reichert P. Experience with surgery for entrap ment syndrome of the suprascapular nerve. Ortop Traumatol Rehabil 2007;9:128-33.
    18. Aiello I, Serra G, Traina GC, Tugnoli V. Entrapment of the suprascapular nerve at the spinoglenoid notch. Ann Neurol 1982;12:314-6.
    19. Nardin RA, Rutkove SB, Raynor EM. Diagnostic accuracy of electrodiagnostic testing in the evaluation of weakness. Muscle Nerve 2002;26:201-5.
    20. Shin C, Lee SE, Yu KH, Chae HK, Lee KS. Spinal root origins and innervations of the suprascapular nerve. Surg Radiol Anat 2010;32:235-8.
    21. Bigliani LU, Dalsey RM, McCann PD, April EW. An anatomical study of the suprascapular nerve. Arthroscopy 1990;6:301-5.
    22. Greiner A, Golser K, Wambacher M, Kralinger F, Sperner G. The course of the suprascapular nerve in the supraspinatus fossa and its vulnerability in muscle advancement. J Shoulder Elbow Surg 2003;12:256-9.
    23. Rengachary SS, Burr D, Lucas S, Hassanein KM, Mohn MP, Matzke H. Supra scapular entrapment neuropathy: A clinical, anatomical, and comparative study. Part 2: Anatomical study. Neurosurgery 1979;5:447-51.
    24. Inoue K, Suenaga N, Oizumi N, Sakamoto Y, Sakurai G, Miyoshi N, et al. Suprascapular notch variations: A 3DCT study. J Orthop Sci 2014;19:920-4.
    25. Yamakado K. The suprascapular notch narrows with aging: A preliminary solution of the old conjecture based on a 3D-CT evaluation. Surg Radiol Anat 2016;38:693-7.
    26. Long R, Wang N, Liu W, Liu Z, Cheng S, Zhang X, et al. An anatomical study of the superior transverse scapular ligament of Jining population. Surg Radiol Anat 2019;41:1345-9.
    27. Polguj M, Jędrzejewski K, Podgórski M, Majos A, Topol M. A proposal for classification of the superior transverse scapular ligament: Variable morphology and its potential influence on suprascapular nerve entrapment. J Shoulder Elbow Surg 2013;22:1265-73.
    28. Cummins CA, Anderson K, Bowen M, Nuber G, Roth SI. Anatomy and histological characteristics of the spinoglenoid ligament. J Bone Joint Surg Am 1998;80:1622-5.
    29. Demirhan M, Imhoff AB, Debski RE, Patel PR, Fu FH, Woo SL. The spinoglenoid ligament and its relationship to the suprascapular nerve. J Shoulder Elbow Surg 1998;7:238-43.
    30. Plancher KD, Peterson RK, Johnston JC, Luke TA. The spinoglenoid ligament. Anatomy, morphology, and histological findings. J Bone Joint Surg Am 2005;87:361-5.
    31. Plancher KD, Luke TA, Peterson RK, Yacoubian SV. Posterior shoulder pain: A dynamic study of the spinoglenoid ligament and treatment with arthroscopic release of the scapular tunnel. Arthroscopy 2007;23:991-8.
    32. Brown DE, James DC, Roy S. Pain relief by suprascapular nerve block in glenohumeral arthritis. Scand J Rheumatol 1988;17:411-5.
    33. Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Supra scapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? Anesth Analg 1997;84:1306-12.
    34. Kim JY, Rhee YG. The prevalence and morphometric analysis of ossified superior transverse scapular ligaments in patients with rotator cuff tears. J Shoulder Elbow Surg 2018;27:1044-50.
    35. Yi JW, Cho NS, Rhee YG. Intraosseous ganglion of the glenoid causing supra scapular nerve entrapment syndrome: A case report. J Shoulder Elbow Surg 2009;18:e25-7.
    36. Lee BC, Yegappan M, Thiagarajan P. Suprascapular nerve neuropathy secondary to spinoglenoid notch ganglion cyst: Case reports and review of literature. Ann Acad Med Singap 2007;36:1032-5.
    37. Hosseini H, Agneskirchner JD, Tröger M, Lobenhoffer P. Arthroscopic release of the superior transverse ligament and SLAP refixation in a case of suprascapular nerve entrapment. Arthroscopy 2007;23:1134.e1-4.
    38. Albritton MJ, Graham RD, Richards RS 2nd, Basamania CJ. An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elbow Surg 2003;12:497-500.
    39. Ochiai N, Hashimoto E, Sasaki Y, Akimoto K, Sugaya H, Takahashi N, et al. Prevalence of concomitant neuropathy in large to massive rotator cuff tear using needle electromyography. J Shoulder Elbow Surg 2017;26:E111.
    40. Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K. Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears. Am J Sports Med 2012;40:606-10.
    41. Hoellrich RG, Gasser SI, Morrison DS, Kurzweil PR. Electromyographic evaluation after primary repair of massive rotator cuff tears. J Shoulder Elbow Surg 2005;14:269-72.
    42. Warner JP, Krushell RJ, Masquelet A, Gerber C. Anatomy and relationships of the suprascapular nerve: Anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg Am 1992;74:36-45.
    43. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. Int Orthop 2002;26:339-43.
    44. Scalf RE, Wenger DE, Frick MA, Mandrekar JN, Adkins MC. MRI findings of 26 patients with parsonage-turner syndrome. AJR Am J Roentgenol 2007;189:W39-44.
    45. Gaskin CM, Helms CA. Parsonage-turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology 2006;240:501-7.
    46. Zoltan JD. Injury to the suprascapular nerve associated with anterior dislocation of the shoulder: Case report and review of the literature. J Trauma 1979;19:203-6.
    47. Solheim LF, Roaas A. Compression of the suprascapular nerve after fracture of the scapular notch. Acta Orthop Scand 1978;49:338-40.
    48. Travlos J, Goldberg I, Boome RS. Brachial plexus lesions associated with dis located shoulders. J Bone Joint Surg Br 1990;72:68-71.
    49. Visser CP, Coene LN, Brand R, Tavy DL. The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery. A prospective clinical and EMG study. J Bone Joint Surg Br 1999;81:679-85.
    50. Huang KC, Tu YK, Huang TJ, Hsu RW. Suprascapular neuropathy complicating a neer Type I distal clavicular fracture: A case report. J Orthop Trauma 2005;19:343-5.
    51. Visser CP, Tavy DL, Coene LN, Brand R. Electromyographic findings in shoulder dislocations and fractures of the proximal humerus: Comparison with clinical neurological examination. Clin Neurol Neurosurg 1999;101:86-91.
    52. Kowalczuk M, Lin A. Isolated suprascapular mononeuropathy following nondisplaced scapular fracture. J Shoulder Elbow Surg 2018;27:e50-3.
    53. Houtz C, McCulloch PC. Suprascapular vascular anomalies as a cause of suprascapular nerve compression. Orthopedics 2013;36:42-5.
    54. Carroll KW, Helms CA, Otte MT, Moellken SM, Fritz R. Enlarged spinoglenoid notch veins causing suprascapular nerve compression. Skeletal Radiol 2003;32:72-7.
    55. Meir NV, Fourneau I, Debeer P. Varicose veins at the spinoglenoidal notch: An unusual cause of suprascapular nerve compression. J Shoulder Elbow Surg 2011;20:e21-4.
    56. Maquieira GJ, Gerber C, Schneeberger AG. Suprascapular nerve palsy after the latarjet procedure. J Shoulder Elbow Surg 2007;16:e13-5.
    57. Ladermann A, Denard PJ, Burkhart SS. Injury of the suprascapular nerve during latarjet procedure: An anatomic study. Arthroscopy 2012;28:316-21.
    58. Kim SH, GonKoh Y, Sung CH, Moon HK, Park YS. Iatrogenic suprascapular nerve injury after repair of type II SLAP lesion. Arthroscopy 2010;26:1005-8.
    59. Sando MJ, Grieshober JA, Kim H, Dreese JC, Henn RF 3rd. Evaluation of risk to the suprascapular nerve during arthroscopic SLAP repair: Is a posterior portal safer? Arthroscopy 2018;34:389-95.
    60. Ferretti A, de Carli A, Fontana M. Injury of the suprascapular nerve at the spinoglenoid notch. The natural history of infraspinatus atrophy in volleyball players. AmJ Sports Med 1998;26:759-63.
    61. Goss TP, Aronow MS, Coumas JM. The use of MRI to diagnose suprascapular nerve entrapment caused by a ganglion. Orthopedics 1994;17:359-62.
    62. Inokuchi W, Ogawa K, Horiuchi Y. Magnetic resonance imaging of suprascapular nerve palsy. J Shoulder Elbow Surg 1998;7:223-7.
    63. Youm T, Matthews PV, El Attrache NS. Treatment of patients with spinoglenoid cysts associated with superior labral tears without cyst aspiration, debridement, or excision. Arthroscopy 2006;22:548-52.
    64. Piatt BE, Hawkins RJ, Fritz RC, Ho CP, Wolf E, Schickendantz M. Clinical evaluation and treatment of spinoglenoid notch ganglion cysts. J Shoulder Elbow Surg 2002;11:600-4.
    65. Ahlawat S, Wadhwa V, Belzberg AJ, Batra K, Chhabra A. Spectrum of suprascapular nerve lesions: Normal and abnormal neuromuscular imaging appearances on 3-T MR neurography. AJR Am J Roentgenol 2015;204:589-601.
    66. Filler AG, Maravilla KR, Tsuruda JS. MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 2004;22:643-82.
    67. Chhabra A, Andreisek G, Soldatos T, Wang KC, Flammang AJ, Belzberg AJ, et al. MR neurography: Past, present, and future. AJR Am J Roentgenol 2011;197:583-91.
    68. Kim DH, Kim J, Sung DH. Hourglass-like constriction neuropathy of the suprascapular nerve detected by high-resolution magnetic resonance neurography: Report of three patients. Skeletal Radiol 2019;48:1451-6.
    69. Boykin RE, Friedman DJ, Higgins LD, Warner JJ. Suprascapular neuropathy. J Bone Joint Surg Am 2010;92:2348-64.
    70. Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg 2003;12:333-6.
    71. Leclere LE, Shi LL, Lin A, Yannopoulos P, Higgins LD, Warner JP. Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy. Arthroscopy 2014;30:639-44.
    72. Wall LB, Teefey SA, Middleton WD, Dahiya N, May KS, Kim HM, et al. Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles. J Bone Joint Surg Am 2012;94:e83
    73. Martin SD, Warren RF, Martin TL, Kennedy K, O’Brien SJ, Wickiewicz TL. Suprascapular neuropathy. Results of non-operative treatment. J Bone Joint Surg Am 1997;79:1159-65.
    74. Black KP, Lombardo JA. Suprascapular nerve injuries with isolated paralysis of the infraspinatus. Am J Sports Med 1990;18:225-8.
    75. Walsworth MK, Mills JT 3rd, Michener LA. Diagnosing suprascapular neuropathy in patients with shoulder dysfunction: A report of 5 cases. Phys Ther 2004;84:359-72.
    76. Drez D Jr. Suprascapular neuropathy in the differential diagnosis of rotator cuff injuries. Am J Sports Med 1976;4:43-5.
    77. Callahan JD, Scully TB, Shapiro SA, Worth RM. Suprascapular nerve entrapment. A series of 27 cases. J Neurosurg 1991;74:893-6.
    78. Post M. Diagnosis and treatment of suprascapular nerve entrapment. Clin Orthop Relat Res 1999;368:92-100.
    79. Antoniou J, Tae SK, Williams GR, Bird S, Ramsey ML, Iannotti JP. Suprascapular neuropathy. Variability in the diagnosis, treatment, and outcome. Clin Orthop Relat Res 2001;386:131-8.
    80. Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: Technique and preliminary results. Arthroscopy 2007;23:34-42.
    81. Oizumi N, Suenaga N, Funakoshi T, Yamaguchi H, Minami A. Recovery of sensory disturbance after arthroscopic decompression of the suprascapular nerve. J Shoulder Elbow Surg 2012;21:759-64.
    82. Tsikouris GD, Bolia IK, Vlaserou P, Odantzis N, Angelis K, Psychogios V. Shoulder arthroscopy with versus without suprascapular nerve release: Clinical outcomes and return to sport rate in elite overhead athletes. Arthroscopy 2018;34:2552-7.
    83. Vigasio A, Marcoccio I. Hourglass-like constriction of the suprascapular nerve: A contraindication for minimally invasive surgery. J Shoulder Elbow Surg 2018;27:e29-37.
    84. Gerber C, Meyer DC, Wieser K, Sutter R, Schubert M, Kriechling P. Suprascapular nerve decompression in addition to rotator cuff repair: A prospective, randomized observational trial. J Shoulder Elbow Surg 2020;29:1633-41.
    85. Memon M, Kay J, Ginsberg L, Simunovic N, Bak K, Lapner P, et al. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates. Knee Surg Sports Traumatol Arthrosc 2018;26:240-66.
    86. Tirman PF, Feller JF, Janzen DL, Peterfy CG, Bergman AG. Association of ganglion labral cyst with labral tears and glenohumeral instability: Radiologic findings and clinical significance. Radiology 1994;190:653-8.
    87. Kim DS, Park HK, Park JH, Yoon WS. Ganglion cyst of the spinoglenoid notch: Comparison between SLAP repair alone and SLAP repair with cyst decompression. J Shoulder Elbow Surg 2012;21:1456-63.
    88. Nolte PC, Woolson TE, Elrick BP, Tross AK, Horan MP, Godin JA, et al. Clinical outcomes of arthroscopic suprascapular nerve decompression for suprascapular neuropathy. Arthroscopy 2021;37:499-507.
    89. Chen AL, Ong BC, Rose DJ. Arthroscopic management of spinoglenoid cysts associated with SLAP lesions and suprascapular neuropathy. Arthroscopy 2003;19:E15-21.
    90. Lichtenberg S, Magosch P, Habermeyer P. Compression of the suprascapular nerve by a ganglion cyst of the spinoglenoid notch: The arthroscopic solution. Knee Surg Sports Traumatol Arthrosc 2004;12:72-9.
    91. Youm T, Matthews PV, El Attrache NS. Treatment of patients with spinoglenoidcysts associated with superior labral tears without cyst aspiration, debridement, or excision. Arthroscopy 2006;22:548-52.
    92. Chochole MH, Senker W, Meznik C, Breitenseher MJ. Glenoid-labral cyst entrapping the suprascapular nerve: Dissolution after arthroscopic debridement of an extended SLAP lesion. Arthroscopy 1997;13:753-5.

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Guest Editorial: Covid and Orthopaedics.

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.

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.



  1. (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.


(Abstract    Full Text HTML)   (Download PDF)

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

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


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


1. Pachore JA, Vaidya SV, Thakkar CJ, Bhalodia HK, Wakankar HM. ISHKS joint registry: A preliminary report. Indian J Orthop 2013;47:505-9.
2. Zhao DW, Yu XB. Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency. J Surg Res 2015;194:614-21.
3. Nally FJ, Zanotti G, Buttaro MA, Dilernia FD, Mansilla I, Comba FM. THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis. Hip Int 2018;28:189-93.
4. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int 2011;21:206-10.
5. Meyers MH. The surgical treatment of osteonecrosis of the femoral head with an osteochondral allograft. Acta Orthop Belg 1999;65:66-7.
6. Ligh CA, Nelson JA, Fischer JP, Kovach SJ, Levin LS. The effectiveness of free vascularized fibular flaps in osteonecrosis of the femoral head and neck: A systematic review. J Reconstr Microsurg 2017;33:163-72.
7. Aldridge JM 3rd, Urbaniak JR. Vascularized fibular grafting for osteonecrosis of the femoral head with unusual indications. Clin Orthop Relat Res 2008;466:1117-24.
8. Dean GS, Kime RC, Fitch RD, Gunneson E, Urbaniak JR. Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft. Clin Orthop Relat Res 2001;386:106-13.
9. Ding H, Gao YS, Chen SB, Jin DX, Zhang CQ. Free vascularized fibular grafting benefits severely collapsed femoral head in concomitant with osteoarthritis in very young adults: A prospective study. J Reconstr Microsurg 2013;29:387-92.
10. Gangji V, Toungouz M, Hauzeur JP. Stem cell therapy for osteonecrosis of the femoral head. Expert Opin Biol Ther 2005;5:437-42.
11. Baksi DP, Pal AK, Baksi DD. Long-term results of decompression and muscle-pedicle bone grafting for  steonecrosis of the femoral head. Int Orthop 2009;33:41-7.
12. Alves EM, Angrisani AT, Santiago MB. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: A systematic review. Clin Rheumatol 2009;28:1247-51.
13. Aaron RK, Lennox D, Bunce GE, Ebert T. The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompression and pulsing electromagnetic fields. Clin Orthop Relat Res 1989;249:209-18.
14. Camporesi EM, Vezzani G, Bosco G, Mangar D, Bernasek TL. Hyperbaric oxygen therapy in femoral head necrosis. J Arthroplasty 2010;25 Suppl 6:118-23.
15. Morita D, Hasegawa Y, Okura T, Osawa Y, Ishiguro N. Long-term outcomes of transtrochanteric rotational osteotomy for non-traumatic osteonecrosis of the femoral head. Bone Joint J 2017;99-B:175-83.
16. Berend KR, Gunneson E, Urbaniak JR, Vail TP. Hip Arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients. J Arthroplasty 2003;18:411-9..
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

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.


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


1. American College of Sports Medicine-ACSM. Available from: Last accessed on 15.10.2021.
2. Australasian College of Sport and Exercise Physicians-ACSEP. Available from: Last accessed on 15.10.2021.
3. International Olympic Committee-medical and Scientific Commission. Available form: Last accessed on 15.10.2021.
4. FIFA Medical Commission. Available form: 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: [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: [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

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.


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


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

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.


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


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.
4. McKillip R, Ernst M, Ahn J, Tekian A, Shappell E. Toward a resident personal finance curriculum: Quantifying resident financial circumstances, needs, and interests. Cureus 2018;10:e2540.
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

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


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


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

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


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


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

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.


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


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

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


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


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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