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   Table of Contents - Current issue
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July-December 2019
Volume 11 | Issue 2
Page Nos. 75-124

Online since Tuesday, March 24, 2020

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ORIGINAL ARTICLES  

Integrated screws with cage spacer system in the treatment of cervical spine degenerative disease with a minimum follow-up of 2 years p. 75
Umesh Takhelmayum, Shankar Acharya, Rupinder Chahal, KL Kalra, Pravin Gupta, Nagendra Palukuri
DOI:10.4103/jotr.jotr_44_15  
Background: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for cervical degenerative disease.Integrated screws with cage spacer system is a relatively new device designed for patients undergoing ACDF with the dual properties of plating and standalone cage. We are reporting our findings in term of clinico-radiological outcomes following the use of such devices in the treatment of cervical spine degenerative diseases. Materials and Methods: Retrospectively, we studied 18 patients treated with integrated screws and cage spacer system for cervical degenerative diseases with a minimum follow up period of 2 years.We compared the preoperative Visual analogue scale (VAS) pain score both neck and for arm, neck disability index (NDI), overall cervical sagittal alignment (OSA) and segmental sagittal alignment (SSA) with the postoperative data. The final outcome was assessed with Odom's criteria. Paired student t test was used for statistical analysis. Results: The mean age of the patient was 46 years (range: 29-63 years) with the mean follow up period of 28 months (range: 24-47 months). The total operated levels were 19.Out of which 11 were at C5-C6 level. The mean pain VAS score for neck and arm along with NDI improved significantly after surgery at last follow up. The mean OSA and SSA improved from 8.00 ± 5.00 to 10.61 ± 3.50 and 3.50 ± 3.20 to 8.11 ± 4.65 at last follow up. X ray showed 100% fusion rate and majority of the patients had a good outcome. Conclusion: Integrated screws and cage spacer device is a safe and effective alternative for the treatment of cervical degenerative diseases.
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Clinical and functional outcome comparison for platelet-rich plasma with steroid injection in patients with isolated subacromial impingement syndrome p. 79
Atul Mahajan
DOI:10.4103/jotr.jotr_34_17  
Objective: The objective of this study is to compare the 6-weeks, 3-, and 6-month outcome in 80 patients who received an injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). Materials and Methods: Forty-two males and 38 females received a single-dose injection of PRP (n = 40) or steroid (n = 40) for SIS that had not responded to conservative treatment for more than 6 months. Both groups were put on physiotherapy protocol followed in our institution. The use of nonsteroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks, 3 and 6 months after treatment using the constant score, visual analog scale (VAS) for pain, and range of motion (ROM) of the shoulder. Results: No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at 6 weeks, 3-, and 6-months was clinically better following steroid than PRP injection. However, this difference was statistically insignificant. The two groups were comparable for improvement in ROM of the shoulder. Conclusion: PRP injection was not more effective than steroid injection for the treatment of SIS in terms of at the end of 6 months. However, long-term studies should be indicated to substantiate the findings.
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Cognizance of road safety among young adults based on unmediated and mediated responses p. 84
Ashutosh M Apte, Amol J Kadu, Sudhir S Babhulkar, Alankar A Ramteke, Tejas A Apte
DOI:10.4103/jotr.jotr_1_18  
Background: Road traffic accident (RTA) has been increasing to significantly higher percentages leading to disabilities and fatalities among the inhabitants, thereby causing social, emotional, and economical losses. In this study, an attempt was made to observe the prompt and the deferred effects of an “audiovisual program on road safety,” on the attitude and the knowledge of adolescents and young adults regarding the catastrophes on roadways and on how safety can be ensured. Materials and Methods: About 1760 students between 16 and 24 years were selected at random from various educational institutes in the city of Nagpur. With the aid of structured questionnaires, the participants were tested for their knowledge and attitude toward the traffic rules. At the end of this assessment, there was an interactive educational audiovisual PowerPoint presentation that highlighted the likely complications and long-term adverse effects of RTA. After the presentation phase, two questionnaire rounds were scheduled: one immediately following the presentation and another after 3 months to observe the change in their knowledge and attitude. Results: The resultant positive attitudinal change immediately after the intervention was significant. However, the positive attitudinal change dropped significantly after 3 months to a percentage almost comparable to the preexposure attitudinal level. Conclusion: It can be concluded that adolescents and young adults need to be repeatedly administered by indulging them in such enlightening pedagogical programs, in order to reduce the incidence of road accidents.
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Outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of Northern India p. 89
Chanchal Kumar Singh, Ghanshyam Narayan Khare, Juhi Deshpande, Mohit Kumar, Sushil Prajapati
DOI:10.4103/jotr.jotr_12_19  
Objective: The objective of this study lies in the outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of northern India. Study Design: Retrospective study. Setting and Duration: This study was conducted at the Department of Orthopaedics, Institute of Medical Sciences, Benaras Hindu University (BHU), at a trauma center setting from January 2015 to January 2017 and were followed up for an average duration of 12 months. Methods: Patients of displaced neck of femur fracture (Pauwell's Types III and IV) divided into two groups who were treated with osteosynthesis with cannulated cancellous screws versus hemiarthroplasty at a trauma center, BHU, were considered for this study, and their retrospective data were analyzed for the incidence of union, infection, functional outcome, and complications in the osteosynthesis versus hemiarthroplasty group. Out of a total of 84 patients studied, 40 belonged to the osteosynthesis group and 44 belonged to the hemiarthroplasty group. Results: In terms of functional outcome, the hemiarthroplasty group consistently outperformed the osteosynthesis group using Harris Hip Score and Palmer and Parker mobility score. This difference was found statistically significant (P = 0.003). As for the complications, in the osteosynthesis group, 6 patients suffered avascular necrosis of the femoral head and 12 patients suffered nonunion of the femoral head with screw cutout. This led to the reoperation of 16 patients. None of the patients in the osteosynthesis group suffered infection. In the hemiarthroplasty group, one patient suffered infection leading to reoperation and thorough debridement of one hip. Hemireplacement group showed a significantly lower percentage of complication as compared to the osteosynthesis group. Conclusion: It is evident that the functional outcome is much better in the hemiarthroplasty group as compared to the osteosynthesis group in displaced femoral neck fractures. Advantages of hemiarthroplasty are early mobilization and rehabilitation, early return to work as compared to the osteosynthesis group which has higher incidence of nonunion, screw cutout, delayed rehabilitation, and prolonged period of nonweight bearing. A significant disadvantage of osteosynthesis is prolonged immobilization, which has cost implications and loss of daily wages in a low-resource country like India.
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Role of quantitative c-reactive protein and erythrocyte sedimentation rate for evaluation and management of acute osteoarticular infections in pediatric patients p. 95
Anand Ajmera, Mahendra Solanki, Rajeev Lohokare, Vipin Mishra
DOI:10.4103/jotr.jotr_25_19  
Background: Acute bone and joint infections in children are at times difficult to diagnose and pose serious consequences if not diagnosed and treated in time. We conducted a prospective and observational study from September 2016 to July 2018. Aims and Objects: Our study included 30 children between the ages of 3 months and 14 years, with suspected acute osteoarticular infection, with a predetermined series of ESR, CRP measurements. Material and Methods: 21 patient had a diagnosis of acute septic arthritis (SA) (70%) and 9 patient had acute osteomyelitis (OM) (30%). Boys were predominantly affected (63% boys as compared to 37 % girls), and the mean age was 6.65 years. The average ESR on day of admission, 3rd, 10th, 28th day and two month was 35 mm, 41 mm, 28mm, 18mm and 13mm at one hour respectively. Average CRP on day of admission, 3rd, 10th, 28th day and two month was 80mg/l, 54mg/l, 17.6mg/l, 8mg/l, 5.5mg/l respectively. Results: The observed peaks of the ESR reached on day 3 and peak in CRP titre generally was seen on day of admission. After peaking, ESR started a slow descent; the <20-mm/hour level was reached on day 28. CRP started a more rapid normalization, descending to less than 20 mg/L in 10 days. CRP normalizes faster than ESR, providing a clear advantage in monitoring recovery. CRP normalized earlier in patients with OM, whereas normalization was slower in patients with SA. Conclusion: Serial measurements of ESR and CRP not only help in diagnosing Acute bone and joint infections in children but also help in monitoring response to treatment and duration of antibiotics.
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Hydrodilatation: The effective treatment modality in adhesive capsulitis p. 100
Prasenjeet Singh, Munish Sood, Amresh Ghai, GR Joshi, Romesh Dubey, Anjan Prabhakara
DOI:10.4103/jotr.jotr_28_18  
Introduction: Adhesive capsulitis of the shoulder joint is the commonly seen condition by the orthopedic surgeon. Hydrodilatation (HD) has been used as one of the treatment options in the management of adhesive capsulitis but with variable results. The aim of this prospective interventional study was to assess the functional outcome using the HD technique. Materials and Methods: Forty-one patients with adhesive capsulitis who were managed with HD technique and were meeting the inclusion criteria were included in the study. Patients were evaluated before the intervention and at the regular follow-up after the treatment using the constant score for functional assessment and Visual Analog Scale (VAS) for pain. Results: Seventeen (41.5%) patients were male and 24 (58.5%) were female. The mean age of the patients was 54.75 years (range 29–75 years). Eight out of 41 (19.5%) were patient with diabetes. At the final follow-up of 13.48 months (range 12–16 months), the mean constant score improved significantly from the preintervention level of 29.85 ± 9.09 to 82.02 ± 8.147 (P = 0.001), whereas the median VAS improved from before the intervention level of 8 (range 05–10) to 1 (range 0–3), respectively. Conclusions: HD technique yield satisfactory functional outcome and is an effective treatment modality in the management of adhesive capsulitis.
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Correction of cubitus varus with lateral closed wedge osteotomy and cross k-wire fixation: results of a prospective series of 19 patients p. 104
Sumedh Durwas Chaudhary, Santosh D Ghoti, Amol M Bochare
DOI:10.4103/jotr.jotr_39_19  
Background: Cubitus varus is the most common late complication of displaced supracondylar fractures of the humerus in children and may lead to long-term problems such as increased chances of lateral humeral condyle fractures, posterolateral instability of the elbow, and tardy ulnar nerve palsy. Various complex corrective osteotomies have been described in literature with no consensus. We conducted this study to evaluate whether a simple lateral closed wedge osteotomy can give predictably good results in these patients. Materials and Methods: Nineteen children with malunited supracondylar fracture humerus leading to cubitus varus deformity underwent lateral closed wedge osteotomy, which was fixed with cross K-wires. Patients were evaluated for carrying angle, elbow range of motion, complications if any, and radiological correction of humeroulnar angle. Results: Osteotomy healed in all patients by 8 weeks (range 4–8 weeks, mean of 5.5 weeks). Excellent correction was achieved in 18 patients, whereas one patient had inadequate correction. Preoperative varus ranging from 10° to 30° (average – 17°) improved to 0°–12° valgus (average-8°). Two patients had minor complications in the form of pin tract infections which resolved with local care and antibiotics. There was no loss of correction or pin loosening. Sixteen patients had excellent result, whereas three patients had fair result as per Bellemore's criteria. Conclusion: Complex three-dimensional osteotomy is not always necessary for cubitus varus correction and a simple lateral closed wedge osteotomy fixed using cross K-wires can give good results with proper planning and execution.
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CASE SERIES Top

Management of periarthritis of shoulder joint by suprascapular nerve block p. 109
Alok Chandra Agrawal, Buddhadeb Nayak, Mayank Kumar, Sharath Kowshik
DOI:10.4103/jotr.jotr_38_19  
Introduction: Periarthritis of the shoulder is a condition characterized by painful and global restriction of active and passive glenohumeral range of motion in at least two directions, most notably shoulder abduction and external rotation. Therapeutic options for the management of periarthritis shoulder are as follows: nonsteroidal anti-inflammatory drugs, intra-articular steroid injections, suprascapular nerve block (SSNB), platelet-rich plasma injection, manipulation under general anesthesia, or arthroscopic capsular release. SSNB is an old and effective method for the treatment of periarthritis of shoulder. Recently, ultrasonography (USG)-guided nerve blocks have been found to be safer and more efficacious compared to landmark guided nerve blocks. In this case series, SSNB has been done under USG guidance to check for its efficacy. Aim: This study aims to assess the efficacy of SSNB in the treatment of periarthritis of the shoulder joint. Materials and Methods: Patients with periarthritis of shoulder received single injection of SSNB (n = 20) (40 mg methylprednisolone + 5 ml 2% lignocaine). All participants were also advised to perform a home-based 10 min exercise therapy after injection. The outcome was measured using Constant and Murley shoulder score. Participants were evaluated at 0, 3rd day, and 1 month. Unpaired t-test was used to determine significant differences. Results: SSNB treatment resulted in statistically significant improvements in CONSTANT score on both 3rd day and 1-month follow-up. No major adverse effects were seen in SSNB. Conclusion: This study demonstrates that single injection of SSNB improves both in pain and all range of motion of shoulder joint.
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CASE REPORTS Top

Tourniquet-induced purpura during hand surgery p. 115
Sanjay Saraf
DOI:10.4103/jotr.jotr_47_15  
We report a rare case of acute dermal capillary rupture secondary to tourniquet application during hand surgery, which presented as severe purpuric rashes (Rumpel–Leede phenomenon) distal to the tourniquet site. The likely cause was capillary fragility subsequent to diabetic microangiopathy and hypertension.
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Management of Flexion Contractures of the Wrist by Differential Distraction p. 118
Alok C Agrawal, Sharath Kowshik, Buddhadeb Nayak
DOI:10.4103/jotr.jotr_37_19  
Flexion contractures of the wrist are a dreaded complication of Volkmann's ischemic contracture, postinfective/posttraumatic destruction of the wrist, or tuberculosis of the wrist joint. Most of the times, the patient is advised an amputation with prosthetic replacement as the treated limb also is like a dead limb. To avoid it, a simple alternative is to use the principle of controlled differential fractional distraction histogenesis. Joshi's external stabilization system (JESS) distractors allow gradual distraction of contracted soft tissues and align all the joints of the hand so as to bring corrections of all aspects of hand and wrist deformity simultaneously. This study was done with the aim to analyze the role of differential distraction in correcting cases of flexion contractures of the wrist in terms of cosmetic, functional, and anatomical outcome. Three flexion contractures of the wrist and hand underwent differential fractional distraction. Patients were assessed preoperatively for morphology, functionality, and radiology period of correction varied from 5 to 8 weeks. Once correction was obtained, then apparatus for differential distraction (JESS) is locked in that position for the same period and later converted to plaster cast for maintenance and followed up regularly. Excellent-to-good results were obtained in all the cases as assessed with patient-rated wrist evaluation. There were only minor complications in patients. Differential distraction by JESS frame is a simple, versatile, and cheap method suited for correcting flexion contractures of the wrist and hand, which were neglected and resistant.
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Isolated rupture of the vastus lateralis tendon: Case report p. 122
Muhammet Bozoglan, Cem Zeki Esenyel
DOI:10.4103/jotr.jotr_47_19  
We report a patient with a history of bariatric surgery who have an isolated rupture of the unilateral vastus lateralis tendon from the adhesion site on the patella. The diagnosis was missed in this case and was placed with magnetic resonance (MR) investigation of the patient during follow-up. A 40-year-old male patient felt pain in his knee after an awkward movement. Initially, because of his bariatric surgery, he had some other complaints, the diagnosis was missed, and the patient had conservative treatment and physical therapy applied. When complaints did not improve, MR was taken, and the vastus lateralis tendon was identified to have ruptured from the patella in isolation. Treated surgically, the patient had no new rupture on check-up performed 1 year later. The patient is fully healed. After the bariatric surgery, some metabolic changes and weakness at the osteotendinous junction of muscles may occur. Isolated vastus lateralis rupture is rarely observed, and diagnosis may be missed. In these patients, surgical treatment is required and other accompanying pathologies of the knee should also be treated at the same time.
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