Vol 9 | Issue 2 | July – Dec 2024 – Page 2 – Journal of Clinical Orthopaedics

Evaluation of Investigations Suitable To Stop Treatment in Spinal Tuberculosis

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.646

Open Access License: CC BY-NC 4.0

Submitted Date: 13 Jul 2024, Review Date: 09 Aug 2024, Accepted Date: 14 Sep 2024 & Published Date: 10 Dec 2024

Author: Vishal Kumar [1], Parth Bansal [1], Sarvdeep Singh Dhatt [1], Tensubam Tomthin Meetei [1], Arvind Vatkar [2], Sachin Kale [3]

[1] Department of Orthopaedics, PGIMER, Chandigarh, India
[2] Orthopaedics Department, Fortis Hiranandani Hospital, Vashi, Apollo Hospital, Navi Mumbai, Belapur, Maharashtra, India.
[3] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Arvind Vatkar,
Department of Orthopaedics, MGM Medical college, Nerul, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com

Abstract

Spinal tuberculosis is the most common extrapulmonary manifestation of tuberculosis and accounts for half of the cases of skeletal tuberculosis and 2% of all tuberculosis cases. The prevalence of spinal tuberculosis is widespread in an endemic county such as India where many people live under poor socioeconomic demographics. It is still a major cause of morbidity and economic loss as it generally affects the productive age groups and the deformities of spinal tuberculosis can have long-lasting effects on the affected population. Detection of drug-resistant strains is another worrying factor that contributes to the reemergence of spinal tuberculosis as a major cause of concern as it can lead to prolonged treatment and failure if not properly addressed on time. There is no proper gold standard investigation to reliably detect the endpoint of treatment in spinal tuberculosis and there is a lack of consensus regarding the exact duration of antitubercular therapy. This remains a gray area even today. This review article aims to look into some of the investigations that can help determine the endpoint of treatment with a special focus on magnetic resonance imaging (MRI) and positron emission tomography scan (MRI scan).
Keywords: Spinal tuberculosis, magnetic resonance imaging scan, positron emission tomography scan

References

1. Misra UK, Warrier S, Kalita J, Kumar S. Spinal neuroradiology MRI findings in Pott’s spine and correlating clinical progress with radiological findings. Neuroradiology 2020;62:825-32.
2. Jain AK, Rajasekaran S, Jaggi KR, Myneedu VP. Tuberculosis of the spine. J Bone Joint Surg Am 2020;102:617-28.
3. Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, et al. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 2017;145:448-63.
4. Ansari S, Amanullah M, Ahmad K, Rauniyar RK. Pott’s spine: Diagnostic imaging modalities and technology advancements. N Am J Med Sci 2013;5:404-11.
5. Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis 2015;32:87-93.
6. Rajasekaran S, Soundararajan DC, Shetty AP, Kanna RM. Spinal tuberculosis: Current concepts. Glob Spine J 2018;8(4 suppl):96S-108.
7. Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med 2011;34:440-54.
8. Currie S, Galea-soler S, Barron D, Chandramohan M, Groves C. MRI characteristics of tuberculous spondylitis. Clin Radiol 2011;66:778-87.
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10. Rivas-Garcia A, Sarria-Estrada S, Torrents-Odin C, Casas-Gomila L, Franquet E. Imaging findings of Pott’s disease. Eur Spine J 2013;22 (Suppl 4):567-78.
11. Lee IS, Lee JS, Kim SJ, Jun S, Suh KT. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography imaging in pyogenic and tuberculous spondylitis: Preliminary study. J Comput Assist Tomogr 2009;33:587-92.
12. Kimizuka Y, Ishii M, Murakami K, Ishioka K, Yagi K, Ishii K, et al. A case of skeletal tuberculosis and psoas abscess: Disease activity evaluated using F-fluorodeoxyglucose positron emission tomography-computed tomography. BMC Med Imaging 2013;13:37.
13. Vorster M, Sathekge MM, Bomanji J. Advances in imaging of tuberculosis: the role of 18F-FDG PET and PET/CT. Curr Opin Pulm Med 2014;20:287-93.
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15. Mittal S, Jain AK, Chakraborti KL, Aggarwal AN, Upreti L, Bhayana H. Evaluation of healed status in tuberculosis of spine by fluorodeoxyglucose-positron emission tomography/computed tomography and contrast magnetic resonance imaging. Indian J Orthop 2019;53:160-8.
16. Dureja S, Sen IB, Acharya S. Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: A prospective clinical observational study. Eur Spine J 2014;23:2449-54.
17. Kim SJ, Kim IJ, Suh KT, Kim YK, Lee JS. Prediction of residual disease of spine infection using F-18 FDG PET/CT. Spine 2009;34:2424-30.
18. Fuster D, Tomás X, Mayoral M, Soriano A, Manchón F, Cardenal C, et al. Prospective comparison of whole-body 18 F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2015;42:264-71.
19. Jain TK, Sood A, Basher RK, Battacharya A, Mittal BR, Aggarwal AK. “Pine tree” appearance on 18F-FDG PET/CT MIP image in spinal tuberculosis. Rev Esp Med Nucl Image Mol 2017;36:122-3.
20. Bassetti M, Merelli M, Di Gregorio F, Siega PD, Screm M, Scarparo C, et al. Higher fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in tuberculous compared to bacterial spondylodiscitis. Skeletal Radiol 2017;46:777-83.
21. Liu W, Li X, Yin J, Li X, Wang X. Diagnostic value of (18) F-FDG PET/CT in extrapulmonary tuberculosis. J South Med Univ 2013;33:1083.
22. Jeon I, Kong E, Kim SW. Simultaneous 18F-FDG PET/MRI in tuberculous spondylitis: Independent method for assessing therapeutic response – case series. BMC Infect Dis 2019;19:845.

How to Cite this article: Kumar V, Bansal P, Dhatt SS, Meetei TT, Vatkar A, Kale S. Evaluation of Investigations Suitable To Stop Treatment in Spinal Tuberculosis. Journal of Clinical Orthopaedics July-December 2024;9(2):11-16.

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Assessment of Knowledge, Attitude, and Practice Toward Materiovigilance Among the Health Care Workers in Mumbai: A Questionnaire-Based Study

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.676

Open Access License: CC BY-NC 4.0

Submitted Date: 10 Oct 2024, Review Date: 28 Oct 2024, Accepted Date: 15 Nov 2024 & Published Date: 10 Dec 2024

Author: Sachin Kale [1], Deepak Langade [2], Vaishali Thakare [2], Anant Patil [2], Sonali Das [1], Arvind Vatkar [3]

[1] Department of Orthoaedics, Dr. DY Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India.

[2] Department of Pharmacology, Dr. DY Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India.

[3] Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sonali Das,

Department of Orthopaedics, Dr. DY Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India.

Email- drsonalidas@hotmail.com

Abstract

Introduction: Materiovigilance is an organized method for locating, obtaining, recording, and evaluating any unfavorable occurrences associated with medical devices to protect a patient’s health by preventing recurrences. Recent advancements in science and technology have led to a significant expansion in the role of medical devices in the healthcare delivery system. This questionnaire-based cross-sectional study was conducted among physicians and nurses in a teaching hospital that offers tertiary care and is part of the MvPI MDAE reporting system.

Case report: Among the participants, the worst performers were junior nurses, with 66.7% unaware of the term materiovigilance itself, and the best performers were professors, at 73.5%. Participants self-rated their knowledge, and 31.0% considered it average regarding the subject. However, only 53% of respondents were aware of MvPI systems in their institution, and 60.5% were aware of the reporting process.

Conclusion: This study shows that our tertiary care teaching institute’s medical practitioners lack sufficient materiovigilance knowledge. A campaign of ongoing materiovigilance awareness among healthcare practitioners and nurses, however, would enhance their understanding and inspire them to report MDAEs.

Keywords: Materiovigilance, healthcare, awareness, questionnaire.

References

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2. Jefferys DB. The regulation of medical devices and the role of the medical devices agency. Br J Clin Pharmacol 2001;52:229-35.
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5. Maisel WH. Medical device regulation: An introduction for the practicing physician. Ann Intern Med 2004;140:296-302.
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8. Mazeau V, Grenier-Sennelier C, Paturel DX, Mokhtari M, Vidal-Trecan G. Telephone survey of hospital staff knowledge of medical device surveillance in a Paris hospital. Eval Health Prof 2004;27:398-409.
9. Alsohime F, Temsah MH, Hasan G, Al-Eyadhy A, Gulman S, Issa H, et al. Reporting adverse events related to medical devices: A single center experience from a tertiary academic hospital. PLoS One 2019;14:e0224233.
10. Nabi N, Rehman S. A study on knowledge, attitude and practices among healthcare professionals regarding the adverse drug reaction monitoring and reporting at a tertiary care teaching hospital. Bangladesh J Med Sci 2022;21:648-58.
11. Mirel S, Colobatiu L, Fasniuc E, Boboia A, Gherman C, Mirel V. Materiovigilance and Medical Devices. In: International Conference on Advancements of Medicine and Health Care through Technology. Cluj-Napoca, Romania; 2019. p. 101-6. Available from: https://link.springer.com/chapter/10.1007/978-3-319-07653-9_21
12. Gagliardi AR, Ducey A, Lehoux P, Turgeon T, Ross S, Trbovich P, et al. Factors influencing the reporting of adverse medical device events: Qualitative interviews with physicians about higher risk implantable devices. BMJ Qual Saf 2018;27:190-8.
13. Teow N, Siegel SJ. FDA regulation of medical devices and medical device reporting. Pharm Regul Aff 2013;2:110.
14. Hefflin BJ, Gross TP, Schroeder TJ. Estimates of medical device–associated adverse events from emergency departments. Am J Prev Med 2004;27:246-53.
15. Ventola CL. Social media and health care professionals: Benefits, risks, and best practices. P T 2014;39:491-520.
16. Shrestha S, Palaian S, Shrestha B, Santosh K, Khanal S. The potential role of social media in pharmacovigilance in Nepal: Glimpse from a resource-limited setting. J Clin Diagn Res 2019;13:FE4-7.
17. Coyle YM, Mercer SQ, Murphy-Cullen CL, Schneider GW, Hynan LS. Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior. Qual Saf Health Care 2005;14:383-8.

How to Cite this article: Kale S, Langade D, Thakare V, Patil A, Das S, Vatkar AJ. Assessment of Knowledge, Attitude, and Practice Toward Materio-vigilance among the Health Care Workers in Mumbai: A Questionnaire Based Study. Journal of Clinical Orthopaedics July-December 2024;9(2):83-87.

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Uncommon Inferior Shoulder Dislocation in the Emergency Department

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.692

Open Access License: CC BY-NC 4.0

Submitted Date: 18 Aug 2024, Review Date: 20 Sep 2024, Accepted Date: 22 Sep 2024 & Published Date: 10 Dec 2024

Author: Mansoor Malnas [1], Bhavya Patwa [1], Parag Munshi [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Mansoor Malnas,

Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, 12, New Marine Lines, Mumbai – 400 020, Maharashtra, India.

E-mail: malnasmansoor@gmail.com

Abstract

Introduction: Inferior shoulder dislocations, also known as luxatio erecta, are a rare subset of shoulder dislocations, accounting for <1% of cases encountered in emergency settings. This unique injury involves the inferior displacement of the humeral head below the glenoid cavity, often resulting from a downward force applied to an abducted arm. Clinically, luxatio erecta presents with the arm fixed in an abducted, overhead position, and is frequently associated with additional injuries, such as rotator cuff tears,
fractures, or neurovascular compromise.
Case Report: This case report details the presentation, diagnosis, management, and outcomes of a 52-year-old male with an inferior shoulder dislocation complicated by a fracture of the greater tuberosity following a fall. Initial reduction attempts in the emergency department were unsuccessful, necessitating reduction under general anesthesia. A post-reduction CT scan revealed a displaced greater tuberosity fracture, which was subsequently stabilized through surgical fixation and rotator cuff repair.
Conclusion: This case underscores the critical importance of early recognition, appropriate imaging, and individualized treatment planning to ensure optimal recovery in cases of luxatio erecta with concomitant injuries.
Keywords: Luxatio erecta, greater tuberosity fracture, shoulder dislocation, closed reduction under anesthesia, inferior shoulder dislocation.

References

1. Enger M, Skjaker SA, Melhuus K, Nordsletten L, Pripp AH, Moosmayer S, et al. Shoulder injuries from birth to old age: A 1-year prospective study of 3031 shoulder injuries in an urban population. Injury 2018;49:1324-9.
2. Farrar NG, Malal JJ, Fischer J, Waseem M. An overview of shoulder instability and its management. Open Orthop J 2013;7:338-46.
3. Neviaser RJ, Wilson JH, Lievano A. Inferior (luxatio erecta) dislocation of the humerus. J Bone Joint Surg 1983;65:658-61.
4. Boffano M, Mortera S, Piana R, Bait C. Luxatio erecta humeri: A systematic review of the literature and a report of 4 cases. J Shoulder Elbow Surg 2013;22:1484-9.
5. Budoff JE. In: Trumble TE, Budoff JE, Cornwall R, editors. Core Knowledge in Orthopaedics, Hand, Elbow and Shoulder. Philadelphia, PA: Elsevier Science; 2006.
6. Yang AP, Behn A, Jahangir A, Zuckerman JD. Shoulder dislocations: Evaluation and treatment. J Am Acad Orthop Surg 2017;25:179-87.
7. Murty A, Veluvolu PK. Inferior shoulder dislocation: Case report and review of the literature. Trauma Case Rep 2016;2:36-8.
8. Mallina R, Chan S, Williams R. Inferior shoulder dislocation (luxatio erecta): A review of the literature and a case study. Shoulder Elbow 2013;5:298-300.
9. Dogan SK, Ayhan C, Caglar O. Inferior shoulder dislocation (luxatio erecta humeri) with accompanying rotator cuff tear and brachial plexus injury. Orthop Rev 2017;9:7101.

How to Cite this article: Malnas M, Patwa B, Munshi P. Uncommon Inferior Shoulder Dislocation in the Emergency Department. Journal of Clinical Orthopaedics July-December 2024;9(2):122-125.

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Bilateral Supracondylar Humerus Fracture in an Infant – A Rare Case Report and Review of Literature

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.694

Open Access License: CC BY-NC 4.0

Submitted Date: 10 Jul 2024, Review Date: 09 Aug 2024, Accepted Date: 13 Sep 2024 & Published Date: 10 Dec 2024

Author: Deepak Jain [1], Janhavi Bhende [1], Aditya More [1], Tushar Agrawal [1]

[1] Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

Address of Correspondence

Deepak Jain,

Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

E-mail: deepaksjain1993@gmail.com

Abstract

Supracondylar humerus fractures are the most common elbow injuries seen in the pediatric population. Predominantly they are unilateral injuries, and bilateral injuries are exceedingly rare. Here we present a unique case of a bilateral atypical supracondylar humerus fracture seen in a 7-month-old boy after he suffered a fall from the bed. These injuries occur infrequently, and it requires keen clinical suspicion to identify them.
Keywords: Bilateral, supracondylar, humerus, atypical, remodeling.

References

1. Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. J Pediatr Orthop 1999;19:344-50.
2. Dimeglio A. Growth in pediatric orthopaedics. In: Morrissy RT, Weinstein SL, editors. Lovell and Winters’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA: LippincottWilliams and Wilkins; 2006. p. 35-65.
3. Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg 1997;5:19-26.
4. Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.
5. Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 1986;57:309-12.
6. Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B 2001;10:63-7.
7. Naik P. Remodelling in children’s fractures and limits of acceptability. Indian J Orthop 2021;55:549-59.
8. Nikolić H, Bukvić N, Tomašić Z, Bosak A, Cicvarić T. Bone remodeling after supracondylar humeral fracture in children. Coll Antropol 2014;38:601-4.
9. Gamble JG, Vorhies JS. Remodeling of sagittal plane malunion after pediatric supracondylar humerus fractures. J Pediatr Orthop 2020;40:e903-9.
10. Ding BT, Wong KP. An unusual case of bilateral pediatric flexion-type supracondylar humeral fractures. Vis J Emerg Med 2022;29:101498.
11. Alanazi B, Fakeeha J, Pasha A, Alqulaiti H, Alharbi H, Mahmoud J. Bilateral supracondylar humerus fracture in pediatric after a fall on an outstretched hand. Case Rep Orthop 2019;2019:4893563.
12. Guo M, Xie Y, Su Y. Open reduction of neglected supracondylar humeral fractures with callus formation in children. J Pediatr Orthop 2020;40:e703-7.
13. Tiwari A, Kanojia RK, Kapoor SK. Surgical management for late presentation of supracondylar humeral fracture in children. J Orthop Surg (Hong Kong) 2007;15:177-82.

How to Cite this article: Jain D, Bhende J, More A, Agrawal T. Bilateral Supracondylar Humerus Fracture in an Infant – A Rare Case Report and Review of Literature. Journal of Clinical Orthopaedics July-December 2024;9(2):126-128.

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Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.666

Open Access License: CC BY-NC 4.0

Submitted Date: 05 Aug 2024, Review Date: 25 Aug 2024, Accepted Date: 11 Oct 2024 & Published Date: 10 Dec 2024

Author: Shivam Mehra [1], Nindiya Kapoor Mehra [1], Arvind J. Vatkar [2], Kamal Mehra [1], Bharat Veer Manchanda [3], Sachin Kale [4]

[1] Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India,
[2] MGM Medical College, Nerul, Navi Mumbai, Maharashtra, India,
[3] Arthritis and Breast Care Centre, Kurukshetra, Haryana, India,
[4] Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India

Address of Correspondence

Dr. Shivam Mehra,
Mehra Hospital and Research Institute, Lucknow – 226012, Uttar Pradesh, India.
E-mail: drshivammehra@gmail.com

Abstract

Introduction: Idiopathic retrocalcaneal pain is frequently linked to overuse injuries or inflammation around the Achilles tendon and surrounding bursae. However, systemic conditions such as gout, characterized by monosodium urate crystal deposition, can also present as retrocalcaneal pain. Gout commonly affects the first metatarsophalangeal joint, but atypical presentations like retrocalcaneal involvement are increasingly recognized. This study aims to assess the presentation, diagnosis, and treatment outcomes of gout in patients presenting with idiopathic retrocalcaneal pain.
Materials and Methods: This retrospective study analysed clinical data from 400 patients diagnosed with gout and presenting with idiopathic retrocalcaneal pain between 2019 and 2023 at a tertiary care centre. Diagnosis was based on clinical examination, serum uric acid levels, imaging, and in some cases, synovial fluid analysis. Patient demographics, diagnostic methods, and treatment outcomes, including pain (VAS) and functionality (FADI) scores, were evaluated.
Results: Of the 400 patients, 290 (72.5%) were male, and 110 (27.5%) were female, with a mean age of 56.8 ± 12.3 years. Pre-existing gout was present in 58% of patients, and serum uric acid levels were elevated in 75%. Synovial fluid analysis, performed in 65 patients, confirmed monosodium urate crystals in 92.3% of cases. Treatment resulted in significant reductions in pain (VAS: 7.8 ± 1.4 to 3.2 ± 1.1, p < 0.05) and improved functionality (FADI: 58.4 ± 5.7 to 85.7 ± 6.3). Recurrence of symptoms occurred in 25% of patients, particularly in those who did not adhere to urate-lowering therapy.
Conclusion: This study emphasizes the importance of considering gout in the differential diagnosis of idiopathic retrocalcaneal pain. Early diagnosis and appropriate management can lead to favourable outcomes and lower recurrence rates. Clinicians should remain vigilant for atypical presentations of gout to prevent prolonged discomfort and functional impairment.
Keywords: Idiopathic retrocalcaneal pain, gout, hyperuricemia, monosodium urate crystals, Achilles tendon, atypical gout, urate-lowering therapy

References

1. Duran E, Bilgin E, Ertenli Aİ, Kalyoncu U. The frequency of Achilles and plantar calcaneal spurs in gout patients. Turkish Journal of Medical Sciences. 2021;51(4):1841-8.
2. Sarkar D, Hoque TM. Association of High Serum Uric Acid with Retrocalcaneal Buristis. International Journal of Medical Science and Health Research. 2019;3(3):ISSN:2581-3366.
3. Yates B. The painful foot. Merriman’s Assessment of the Lower Limb. 3th. Ed. Edinburgh: Elsevier. 2009:469-98.
4. Aronow MS. Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy). Clinics in podiatric medicine and surgery. 2005;22(1):19-43
5. Pascual E, Sivera F. Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Annals of the rheumatic diseases. 2007 Aug 1;66(8):1056-8.
6. Sarkar¹ D, Hoque TM. Association of High Serum Uric Acid with Retrocalcaneal Buristis.

How to Cite this article: Mehra S, Mehra NK, Vatkar AJ, Mehra K, Manchanda BV, Kale S. Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients. Journal of Clinical Orthopaedics July-December 2024;9(2):58-62.

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Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.690

Open Access License: CC BY-NC 4.0

Submitted Date: 10 Aug 2024, Review Date: 12 Sep 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Somasekhara Reddy Nallamilli [1], Mohan Krishna Althuri [1], Shruti Patwal [2], Manish R Garg [3]

[1] Department of Orthopedics, Apollo Hospitals, Hyderabad, Telangana, India,
[2] Department of Medical Affairs, Universal NutriScience, Mumbai, Maharashtra, India,
[3] Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Manish R Garg,
Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India
E-mail: manish_rgarg@yahoo.co.in

Abstract

Introduction: Bisphosphonates (BPs) have emerged as the mainstay of osteoporosis treatment. However, over the past 10 years, atypical femoral fractures (AFFs) have been identified as a possible side effect of BP.

Case Report: A 73-year-old male with a history of prostate carcinoma and an isolated rib metastasis was being treated with zoledronic acid. Despite a successful intramedullary nail fixation and a healed fracture, 5 months later, he developed another fracture in the same femur in the subtrochanteric area. This case report delves into the intricate pathogenesis of BP-induced atypical femoral fractures (AFF) and explores the potential role of bioactive collagen peptides in their pathogenesis.

Conclusion: Significant challenges exist in diagnosing and managing BP-induced AFFs. Using anabolic agents and bioactive collagen peptides is a successful therapeutic intervention for these patients.

Keywords: Collagen peptides, nutraceuticals, osteoporosis, bisphosphonate-induced atypical fractures.

References

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12. Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995;333:1437-44.
13. Adam M, Spacek P, Hulejova H, Galianova A, Blahos J. Postmenopausal osteoporosis. Treatment with calcitonin and a diet rich in collagen proteins. Cas Lek Cesk 1996;135:74-8.
14. Im GI, Jeong SH. Pathogenesis, management and prevention of atypical femoral fractures. J Bone Metab 2015;22:1-8.
15. König D, Oesser S, Scharla S, Zdzieblik D, Gollhofer A. Specific collagen peptides improve bone mineral density and bone markers in postmenopausal women-a randomized controlled study. Nutrients 2018;10:97.
16. Schneider JP, Hinshaw WB, Su C, Solow P. Atypical femur fractures: 81 individual personal histories. J Clin Endocrinol Metab 2012;97:4324-8.
17. Lin TL, Wang SJ, Fong YC, Hsu CJ, Hsu HC, Tsai CH. Discontinuation of alendronate and administration of bone-forming agents after surgical nailing may promote union of atypical femoral fractures in patients on long-term alendronate therapy. BMC Res Notes 2013;6:11.
18. Miyakoshi N, Aizawa T, Sasaki S, Ando S, Maekawa S, Aonuma H, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: A comparison between treatment with and without teriparatide. J Bone Miner Metab 2014;33:553-9.
19. Gao J, Liu X, Wu X, Li X, Liu J, Li M. A brief review and clinical evidences of teriparatide therapy for atypical femoral fractures associated with long-term bisphosphonate treatment. Front Surg 2023;9:1063170.
20. Zdzieblik D, Oesser S, König D. Specific bioactive collagen peptides in osteopenia and osteoporosis: Long-term observation in postmenopausal women. J Bone Metab 2021;28:207-13.

How to Cite this article: Nallamilli SR, Althuri MK, Patwal S, Garg MR. Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report. Journal of Clinical Orthopaedics July-December 2024;9(2):118-122.

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Our Initial Experience of First 50 Cases of Robotic-Arm-Assisted Total Knee Arthroplasty

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.662

Open Access License: CC BY-NC 4.0

Submitted Date: 09 Aug 2024, Review Date: 26 Aug 2024, Accepted Date: 17 Sep 2024 & Published Date: 10 Dec 2024

Author: Chandan Mehta [1], Mohan Madhav Desai [1], Swapnil Chitnavis [1], Kushagra Jain [1], Urvil Shah [1]

[1] Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Chandan Mehta,

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
E-mail: drchandanmehta01@gmail.com

Abstract

Purpose: Robotic-arm-assisted total knee arthroplasty (RA-TKA) has been criticized for an increased operative time, longer incision, the extra incision for insertion of pins and various other potential complications. We want to describe our initial experience of the first 50 cases of RA-TKA (of fully automatic robot) regarding the learning curve for operative time, accuracy of implant positioning, and the accuracy of achieving a well-balanced knee through the assessment of gaps.
Materials and Methods: Retrospective analysis of the first 50 patients was done who underwent RA-TKA, all of which were performed by a senior surgeon experienced in conventional manual jig-based TKA. Operative time, accuracy of implant positing, restoration of limb alignment, and intraoperative gap balancing were assessed. Linear regression analysis and cumulative sum (CUSUM) sequential analysis were used to assess the learning curve for the operative time.
Results: In our experience, the learning curve for operative time in RA-TKA is around 25 cases as per CUSUM sequential analysis. The linear regression analysis showed a gradual decrease in the operative time as the number of RA-TKA performed cases increased (cases 1–10 = 76.8 ± 16 min, cases 11–20 = 72.5 ± 13 min, cases 21–30 = 63.6 ± 7 min, cases 31–40 = 61.3 ± 6 min, and cases 41–50 = 57.3 ± 10 min) – statically significant (P < 0.05) after 20 cases. There is no learning curve for the accuracy of achieving the planned implant position (P = n.s.) and limb alignment (P = n.s.). Only three cases were outliers, HKA angle <174° for varus phenotype, and HKA >183° for valgus phenotype. Forty-six cases (out of 50) had all the gaps within 3 mm of each other (sensitivity of the robot is <1 mm).
Conclusion: Implementation of RA-TKA into the surgical workflow is associated with a learning curve for the operative times, which eventually decreases but this does not lead to any compromise in the accuracy of implant positioning or overall limb alignment. The RA-TKA has shown improved accuracy in implant positioning, improved limb alignment, thereby reducing outliers, and improved gap balancing. All this translates to better clinical outcomes and patient satisfaction.
Keywords: Robotic arm assisted Total Knee Arthroplasty, Learning Curve, Operative time, Implant Positioning, Gap Balancing

References

1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Bautista M, Manrique J, Hozack WJ. Robotics in total knee arthroplasty. J Knee Surg 2019;32:600-6.
3. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019;32:239-50.
4. Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007;464:111-6.
5. Moon YW, Ha CW, Do KH, Kim CY, Han JH, Na SE, et al. Comparison of robot-assisted and conventional total knee arthroplasty: A controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 2012;17:86-95.
6. Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. Singapore Med J 2014;55:529-34.
7. Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional alignment philosophy in total knee arthroplasty – rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J 2022;8:11.
8. Shatrov J, Foissey C, Kafelov M, Batailler C, Gunst S, Servien E, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the valgus morphotype using an image based robotic platform and individualized planning. J Pers Med 2023;13:212.
9. Sodhi N, Khlopas A, Piuzzi NS, Sultan AA, Marchand RC, Malkani AL, et al. The learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018;31:17-21.
10. Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in Asian patients: A prospective study. BMC Musculoskelet Disord 2023;24:332.
11. Vermue H, Luyckx T, Winnock de Grave P, Ryckaert A, Cools AS, Himpe N, et al. Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing. Knee Surg Sports Traumatol Arthrosc 2022;30:593-602.
12. Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J Knee Surg 2022;35:409-15.
13. Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019;27:1132-41.
14. Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, et al. Robotic-arm assisted total knee arthroplasty demonstrated soft-tissue protection. Surg Technol Int 2017;30:441-6.
15. Kayani B, Konan S, Peitrzak JR, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: A prospective cohort study and validation of a new classification system. J Arthroplasty 2018;33:2496-501.
16. Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013;471:118-26.
17. Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994;299:153-6.

How to Cite this article: Mehta C, Desai MM, Chitnavis S, Jain K, Shah U. Our Initial Experience of First 50 Cases of Robotic-Arm Assisted Total Knee Arthroplasty. Journal of Clinical Orthopaedics July-December 2024;9(2):47-51.

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Prof Dr K V Chaubal – A Requiem

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.642

Open Access License: CC BY-NC 4.0

Author: Aseem Parekh [1]

[1] Consultant Orthopaedic Surgeon, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Aseem Parekh,
Consultant Orthopaedic Surgeon, Mumbai, Maharashtra, India.
E-mail: docaseemparekh@gmail.com

Prof Dr K V Chaubal – A Requiem

“An Institution Is The Lengthened Shadow Of One Man.”

~ Ralph Waldo Emerson

Prof Dr K V Chaubal, “KVC”, cast a very long, and indeed broad, shadow over the world he lived in.

He was an institution in himself.

Over many decades of a busy practice he brought succour to an untold number of patients.
He also contributed to the development and growth of his many students, as also the orthopaedic fraternity of which he was a leader.

KVC was born into a traditional family, where great emphasis was laid on personal discipline, probity and education.

After his Intermediate Science from the Elphinstone College, he gained entry into the prestigious Seth G S Medical College in 1945.
He gained his MS in general surgery and then left for England, and found himself in a country which was in its post war decade of austerity.
He trained with giant figures in the fields of surgery and orthopaedics, and impressed his teachers with his intelligence and diligence. Mr Harold Bolton and Sir Lloyd Griffiths were but two of them, the latter provided him with a glowing testimonial when KVC moved to Liverpool for his MCh Orth.
He remembered and was ever grateful to his teachers.
His training culminated with his gaining the FRCS(Eng) and the MCh Orth. (L’pool).

On his return to India he was appointed Asst Hon Surgeon to the St George’s Hospital, an event he described as a windfall, for
there he learned much about what is now called “networking” and dealing with persons in high office.
He was selected for a J&J fellowship which enabled him to travel across India and he decided to become a “generalist” practitioner of his craft.

Shortly thereafter he was appointed to the staff of Nair Hospital, where he soon became Chief and set about developing the department in his now trademark meticulous way.

Laurels ensued, and he wore his honours lightly.
With each accomplishment, his fame spread.
He was soon regarded as an authority in his subject, especially the treatment of spinal ailments.

He was a spartan, austere figure, always immaculately turned out and speaking always to the point, softly but always firmly.

He suffered fools not at all, and to many he appeared aloof, even distant.
Indeed, such was his focus that unless you were participating productively you rapidly felt like a piece of furniture in the room.
Yet a colleague, even a rank junior, who approached him with a problem of any magnitude or nature was assured of a sympathetic hearing and invariably got a solution to the predicament posed.

KVC had well settled ideas on all subjects.

And the views he held were considered over years of wide reading, personal experience and a vast understanding of human nature.
He rose to the front rank of the profession, an authority, a visionary and an opinion maker.

His dedication to personal probity and integrity led him to evolve as the final arbiter on all issues related to professional and personal ethics.
He practised what he preached, a rare phenomenon.

He was fully comprehending of the follies and foibles of others, but he never lost his compassion for them.
He was something of a paradox, in that he was at the same time inflexible yet remarkably open to new thought.
He considered everything before altering his stand, and if he did he stood committed to it.

Yes, he was a paragon, a man of many parts, and yet the sum of these was not greater than the whole.

An ethical man, a brilliant teacher an erudite academic and a skilful surgeon.. we will not see the like of him again.

Prof. Dr. Aseem Parekh
Consultant Orthopaedic Surgeon,
Mumbai, India.
Email: docaseemparekh@gmail.com

How to Cite this article: Parekh A. Prof Dr K V Chaubal- A Requiem. Journal of Clinical Orthopaedics July-December 2024;9(2):06-07.

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Use of Skeletal Traction in Distal 1/3rd Tibia Intraoperatively for Achieving Reduction in Proximal Tibia Fracture

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.674

Open Access License: CC BY-NC 4.0

Submitted Date: 02 Oct 2024, Review Date: 28 Oct 2024, Accepted Date: 01 Nov 2024 & Published Date: 10 Dec 2024

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1], Garvit Khatod [1]

[1] Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Sonali Das,
Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharshtra, India.
Email: drsonalidas@hotmail.com

Abstract

Introduction: Skeletal traction is a technique used to manage fractures by applying continuous axial force directly to the bone through a pin inserted through it. This method is particularly useful in maintaining proper alignment of fracture fragments, reducing pain, and preventing muscle spasms. It is commonly employed in the management of long bone fractures, such as those of the femur, especially when immediate surgical intervention is not possible. Skeletal traction stabilizes the fracture, facilitating proper healing and often serving as a temporizing measure before definitive surgical fixation. This study focuses on skeletal traction applied for the reduction of proximal tibia fractures. Studies on this subject are lacking as most established data focuses on its use for shaft femur fractures.
Materials and Methods: This study was conducted in a tertiary care teaching hospital by a single skilled surgeon team on 30 skeletally mature patients. Skeletal traction was applied for each patient using a Steinmann pin and 15% of the patient body weight over distal 1/3rd tibia shaft immediately post-trauma for 1 week and continued intraoperatively during primary fixation as plating. Pre-operative and post-operative radiographs were taken. Knee range of motion was measured using a goniometer at 2 weeks, 1 month, 3 months, and 6 months post-operative. Serial radiographs were taken immediately, 1 month, 3 months, and 6 months post-operative.
Conclusion: Skeletal traction applied over the distal 1/3rd shaft tibia shows promising results for comminuted proximal tibia fractures. It reduces fracture fragment displacement commonly occurring during manual traction.
Keywords: Skeletal traction, Proximal tibia, Tibial fractures, Lower extremity trauma.

References

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13. Dubina AG, Paryavi E, Manson TT, Allmon C, O’Toole RV. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury 2017;48:495-500.
14. Paziuk T, Sutton R, McEntee R, Farronato D, Krieg J. Lateral femoral distraction is a safe and necessary adjunct for articulator visualization during the operative treatment of tibial plateau fractures. J Orthop 2022;33:44-7.
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How to Cite this article: Butala RR, Das S, Khatod G. Use of Skeletal Traction in Distal 1/3rd Tibia Intraoperatively for Achieving Reduction in Proximal Tibia Fracture. Journal of Clinical Orthopaedics 2024:July-December:9(2);78-82.

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A Novel Approach to Medial Malleolus Fracture of Ankle using Adjustable Loop Suspensory Fixation

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.698

Open Access License: CC BY-NC 4.0

Submitted Date: 29 Jul 2024, Review Date: 15 Aug 2024, Accepted Date: 18 Sep 2024 & Published Date: 10 Dec 2024

Author: Sandeep Deore [1], Sachin Kale [1], Sunil Shetty [1], Ajit Chalak [2], Rohan Jayaram [1], Roonam Patir [1]

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

Address of Correspondence

Dr. Rohan Jayaram,
Department of Orthopaedics, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India.
E-mail: drrohanjayaram@gmail.com

Abstract

Medial malleolar fractures are traditionally treated by orthopaedic surgeons using cancellous screws, plates, and tension banding with stainless steel wires. However, a considerable proportion of these patients eventually require revision surgery or implant removal due to complications such as wire migration, impingement, breakage, and infection. Revision surgeries for previously operated malleolar fractures pose challenges due to dilated bone tracks and osteopenia which complicate securing the mechanical hold of the implant. A potential solution to mitigating these factors could be the use of high strength polyethylene suture material such as fibre-wire to fix the fracture fragments which are held in place by a cortical button on either side. This study aims to evaluate the clinical and radiological outcomes in a patient with medial malleolus fracture fixed by fibre-wire fixation as an alternative modality of treatment.
Keywords: Medial malleolar fractures, tension band principle, stainless steel wire, implant breakage, revision surgery, suspensory fixation using fiber-wire, magnetic resonance imaging compatible construct.

References

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How to Cite this article: Deore S, Kale S, Shetty S, Chalak A, Jayaram R, Patir R. A Novel Approach to Medial Malleolus Fracture of Ankle using Adjustable Loop Suspensory Fixation. Journal of Clinical Orthopaedics July-December 2024;9(2):132-136.

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Author: Vishal Kumar [1], Parth Bansal [1], Sarvdeep Singh Dhatt [1], Tensubam Tomthin Meetei [1], Arvind Vatkar [2], Sachin Kale [3]

Abstract

References

Author: Sachin Kale [1], Deepak Langade [2], Vaishali Thakare [2], Anant Patil [2], Sonali Das [1], Arvind Vatkar [3]

Abstract

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Author: Mansoor Malnas [1], Bhavya Patwa [1], Parag Munshi [1]

Abstract

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Author: Deepak Jain [1], Janhavi Bhende [1], Aditya More [1], Tushar Agrawal [1]

Abstract

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Author: Shivam Mehra [1], Nindiya Kapoor Mehra [1], Arvind J. Vatkar [2], Kamal Mehra [1], Bharat Veer Manchanda [3], Sachin Kale [4]

Abstract

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Author: Somasekhara Reddy Nallamilli [1], Mohan Krishna Althuri [1], Shruti Patwal [2], Manish R Garg [3]

Abstract

References

Author: Chandan Mehta [1], Mohan Madhav Desai [1], Swapnil Chitnavis [1], Kushagra Jain [1], Urvil Shah [1]

Abstract

References

Author: Aseem Parekh [1]

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1], Garvit Khatod [1]

Abstract

References

Author: Sandeep Deore [1], Sachin Kale [1], Sunil Shetty [1], Ajit Chalak [2], Rohan Jayaram [1], Roonam Patir [1]

Abstract

References

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Journal of Clinical Orthopaedics