Aamir Bin Sabir

Management of Congenital Talipes Equinovarus by Ponseti Technique : A Clinical Study

The purpose of this study was to evaluate the early results of treatment of idiopathic congenital talipes equinovarus (CTEV) by the Ponseti method and compare the results with those of other manipulation techniques and surgical treatment reported in the literature. A total of 100 patients with 156 clubfeet (80 males, 20 females), were treated for idiopathic CTEV by the Ponseti method. The average age at presentation was 4.5 months. Scoring of each foot was done according to the Pirani score. Photographs showing the deformity and podograms were taken to have an objective record against which the results were compared. The mean total Pirani score at the start of treatment was 4.26 and mean foot print angle (FPA) was 14.2 degrees. Post correction, there was a significant difference (P < .001, z = 18.638) in the mean FPA. There was also a statistically significant difference between the pre- and postcorrection Pirani scores (P < .001, z = 55.427). In 95% of the patients correction of the deformity was achieved. The Ponseti technique is based on sound understanding of the pathoanatomy of clubfoot. The good results obtained by the Ponseti technique show that posteromedial soft tissue release may no longer be required for most cases of idiopathic CTEV.

Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution

Purpose. To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution. Methods. 18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. Results. The mean delay in presentation after injury was 3.2 (range, 1–12) days. The mean delay in operation was 8.8 (range, 5–21) days. The mean follow-up period was 2 (range, 1–4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2–7) months. In 5 patients, the bone was united with a mean of 10° of varus collapse and a mean of 1 cm of shortening. Six patients had nonunion. Other complications included screw migration in the joint space (n=1), graft migration into the joint space (n=3), and screw pullout (n=5). No patient had avascular necrosis of the femoral head. Conclusion. Osteosynthesis and fibular grafting for freshly displaced femoral neck fractures with posterior comminution is an inexpensive and technically less demanding procedure for retaining a stable, painless, mobile, and functional hip.

Comparison of Magnetic Resonance Imaging Findings between Pathologically Proven Cases of Atypical Tubercular Spine and Tumour Metastasis: A Retrospective Study in 40 Patients

Study Design Retrospective study. Purpose To note the magnetic resonance imaging (MRI) differences between pathologically proven cases of atypical spinal tuberculosis and spinal metastasis in 40 cases. Overview of Literature Spinal tuberculosis, or Potts spine, constitutes less than 1% of all cases of tuberculosis and can be associated with a neurologic deficit. Breast, prostate and lung cancer are responsible for more than 80% of metastatic bone disease cases, and spine is the most common site of bone metastasis. Thus, early diagnosis and prompt management of these pathologies are essential in preventing various complications. Methods We retrospectively reviewed 40 cases of atypical tuberculosis and metastasis affecting the spine from the year 2012 to 2014, with 20 cases each that were proven by histopathological examination. MR imaging was performed on 1.5 T MR-Scanner (Magnetom Avanto, Siemens) utilizing standard surface coils of spine with contrast injection. Chi-square test was used for determining the statistical significance and p-values were calculated. Results The most common site of involvement was the thoracic spine, seen in 85% cases of metastasis and 65% cases of Potts spine (p=0.144). The mean age of patients with tubercular spine was found to be 40 years and that of metastatic spine was 56 years. The following MR imaging findings showed statistical significance (p<0.05): combined vertebral body and posterior elements involvement, skip lesions, solitary lesion, intra-spinal lesions, concentric collapse, abscess formation and syrinx formation. Conclusions Tuberculosis should be considered in the differential diagnosis of various spinal lesions including metastasis, fungal spondylodiskitis, sarcoidosis and lymphoma, particularly in endemic countries. Spinal tuberculosis is considered one of the great mimickers of disease as it could present in a variety of typical and atypical patterns, so proper imaging must be performed in order to facilitate appropriate treatment.

Giant cell tumor of the first metatarsal

Giant cell tumor (GCT) is a benign locally aggressive tumor with a tendency for local recurrence. GCT of metatarsal is of rare occurrence with very few cases reported so far. GCT in this location is rare and should be considered in the differential diagnosis of a destructive bony lesion in both skeletally immature and mature patients. We report the case of GCT of 1 st metatarsal in a 28-year-old female and discuss the difficult aspects of diagnosis.

Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population

&NA; The purpose of this randomized study was to compare clinical and surgical outcomes of total knee replacements (TKRs) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner. Forty‐two knees each were operated using midvastus approach and the medial parapatellar approach. Clinical parameters that were evaluated included Knee Society score (KSS); knee pain using visual analogue scale (VAS) on day 1, 1 week, and 1 month; time required to straight leg raise (SLR); patellar tracking; mean extensor lag at 1 week and 1 month; and time of discharge from the hospital. Surgical parameters that were evaluated included tourniquet time, incidence of lateral retinacular release, estimated blood loss, and any complications during the surgery. KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group; though similar at 3 months, 6 months, and 1 year. The patients in midvastus group required fewer number of lateral retinacular releases; achieved SLR earlier; had less mean extensor lag at 1 week; had less mean VAS score at day 1, 1 week, and 1 month; and had shorter hospital stay. There was no significant difference in the mean tourniquet time and estimated blood loss. One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group. Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach.

Minimally Invasive Percutaneous Plate Osteosynthesis (Mippo) in DistalTibial Fractures â A Prospective Study from Developing Nation

Background: The management of distal tibial fractures can be challenging because of scarcity of soft tissues, their subcutaneous nature and poor vascularity. Consequently, operative treatment can lead to complications. The surgical treatment of fractures has evolved a great deal since the development of the original “open reduction and internal fixation” technique by the AO group. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues by minimally invasive percutaneous plate osteosynthesis (MIPPO). This technique utilizes indirect reduction and internal fixation with locking compression plates. Our aim was to observe the outcome of the distal tibial fracture fixation (extra-articular and intra-articular) with locking compression plate (LCP) using MIPPO technique. Material and Methods: 26 consecutive patients were prospectively underwent minimally invasive percutaneous plate osteosynthesis for distal tibial fractures between January 2010 and December 2011. Patients were aged between 20 to 65 years with seventeen males and nine females. Both open and closed AO types 43A, 43B and 43C fractures were included. Patients were managed with LCP using MIPPO technique. Postoperative regimen consisted of knee and ankle bending exercises starting on 1st postoperative day. Non weight bearing ambulation started on 3rd post-operative day, progressing to partial weight bearing at 6 to 8 weeks. Full weight bearing ambulation was allowed after clinico radiological union at 12 to 14 weeks. Observation and Results: RTA was the commonest cause of injury. All fractures healed with good functional outcome. Mean union time was 4.5 months (range 3.5–8 months). Mean follow-up was 14.3 months. For all fractures acceptable active range of ankle movement was achieved. Mean AOFAS score was 88. There were 2 cases of superficial infection, treated successfully with antibiotics. No deep infection, wound dehiscence and hardware failure was noted. Conclusion: MIPPO is a well-documented technique that offers biological advantages and appears to be a reasonable treatment option for complex unstable distal tibial or pilon fractures that are not suited for intramedullary nailing. The literature is full of studies from developed nations, but studies from developing nations are lacking. Nevertheless small numbers of patients were involved in our study to draw any definitive conclusions, but our encouraging results will motivate the trauma surgeons from the developing nations to use MIPPO technique in managing distal tibial fractures, in an endeavor to reduce morbidity and associated complications, especially of the soft tissues.