Abdul Qayyum Khan

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.

Redox signaling in rheumatoid arthritis and the preventive role of polyphenols.

Rheumatoid arthritis (RA) is an autoimmune, inflammatory joint disease whose exact cause is still not completely known. Reactive oxygen species (ROS) are believed to be involved in the pathogenesis of RA. ROS are produced mostly by the phagocytic cells during oxidative burst and oxidative phosphorylation. Lipids, proteins and nucleic acids get damaged by the overproduction of ROS. Damaging effects of ROS are taken care by the enzymatic and non-enzymatic defence system of the body. Overproduction or inadequate elimination of reactive species leading to oxidative stress has been positively correlated with the disease severity in RA patients. ROS activates signal transduction pathways involved in the inflammatory response in RA. Understanding the complex interplay between signaling pathways might be useful for the development of new and effective therapeutics for RA. In this review we discuss the involvement of reactive species in the pathogenesis of RA and their elimination by antioxidant defence system. Role of various antioxidants/polyphenols which looks quite promising in the treatment of RA have also been discussed.

Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”

Background: Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique). Materials and Methods: This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months. Results: Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support. Conclusions: The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique.

Pathological Fractures in Primary Non-Hodgkin's Lymphoma of the Bone: A Case Series with Review of the Literature.

Primary non-Hodgkins lymphoma of bone (PLB) is a rare entity. Patients generally present with localized bone pain and, less frequently, soft-tissue swelling or a palpable mass. Pathological fracture of the proximal femur and proximal humerus secondary to soft-tissue tumours is well documented in the literature; however, lymphomas presenting primarily at these sites with pathological fracture is unusual. A review of the world literature shows that the incidence of skeletal manifestation from NHL is less than 5%, and in all these cases, bony involvement was reported many years after presentation of the primary cancer. Histopathologically, PLB usually represents diffuse large B-cell lymphoma. We report our experience with two cases of Primary non-Hodgkins lymphoma of proximal femur and proximal humerus with pathological fracture and their management.

Ulnar dimelia variant: a case report.

We report a case of ulnar dimelia, commonly called mirror hand, in a 2-month-old female child who had restriction of elbow flexion and forearm rotation. There was no facial or other internal organ malformation. Radiographs revealed seven triphalangeal digits with double ulnae (one following the other) and absent radius. To the best of the authors’ knowledge, this is the first report of this mirror hand deformity in which fingers are symmetrical while duplicated ulnae are not.

Metastasis from scapular Ewing's sarcoma presenting as sutural diastasis: An unusual presentation

Ewing’s sarcoma is a malignant non-osteogenic primary tumor of the bone. It is one of the most common primary malignant tumors of bone. Peak incidence is noticed in second decade of life with male preponderance of 1.6:1. It occurs most frequently in long bones and flat bones of pelvic girdles. In 30% cases, Ewing’s sarcoma is multicentric in origin. In 14-50%, multiple metastases are present at the time of diagnosis. CNS spread is rare and isolated CNS involvement is not seen. Skull metastasis of Ewing’s sarcoma is not rare compared to primary Ewing’s sarcoma of the skull, but the actual frequency is unknown. We wish to report a case of “Primary Ewing’s sarcoma of scapula with metastasis to Skull Vault in a Child resulting in sutural diastasis” diagnosed by clinicoradiological examination and confirmed by histopathology.

Epidural injections for lumbosciatica syndrome–medications and routes

Abstract It was a prospective study involving 103 patients, suffering from lumbosciatic syndrome due to various causes. Purpose of this study was to study the efficacy of two steroids methylprednisolone and triamcinolone used epidurally via lumbar and caudal route and to highlight value of this simple procedure in lumbosciatic syndrome. About 80% people suffer from back pain at some point of life. Majority of the patients can be managed effectively with conservative treatment like bed rest, analgesics, lumbar traction and transcutaneous electrical nerve stimulation (TENS), etc. The epidural steroid injection has an important role in the patients of lumbosciatic syndrome due to various causes. Its judicious use can avoid the surgery in many patients. Between September 2003 and August 2004, 103 patients received 309 injections (156 lumbar route and 153 caudal). Pain was assessed by visual analog scale, SLR, and Lasegue test. Three epidural injections were given at a monthly interval and patients followed up for minimum period of 4 months. Patients were randomly divided into 2 groups, on the basis of whether they received methylprednisolone or triamcinolone and further into 2 subgroups for either lumbar/caudal route. 78.43% in caudal group and 82.6% had excellent to good results. Complications were minimal and that to in the lumbar route only. Data was analyzed using t-test. Significant difference (p 0.05) among 2 steroid groups and 2 routes. Epidural steroid injection (triamcinolone/methylprednisolone) through either caudal or lumbar route is an excellent conservative method for treatment of LBA with sciatica. Caudal route is relatively safer than lumbar, so lumbar route should be used by experienced persons and in setups where resuscitation equipments are available.

Neglected orthopedic oncology--Causes, epidemiology and challenges for management in developing countries.

BACKGROUND Management of malignant bone and soft tissue tumors remains an overwhelming confront to orthopedic surgeons. The challenge is discriminating in developing countries due to inadequate diagnostic and therapeutic amenities and unawareness. A lot has been discussed about the neglected orthopedic trauma, but the published literature on the causes and management of neglected bone and soft tissue tumors is sparse. Hence, current study was undertaken to highlight the causes of neglect and therapeutic challenges for managing these neglected tumors in developing countries. AIMS AND OBJECTIVES To determine the causes of neglect of malignant bone and soft tissue tumors, their epidemiology (including their relative frequencies, age, gender discrimination, anatomical sites of occurrence and histological characteristics) and difficult aspect of management due to neglect or delayed presentation. MATERIALS AND METHODS This was an appraisal of the neglected malignant bone and soft tissue tumors presented to J. N. Medical College and Hospital from June 2008 to May 2013. Criteria for labeling the tumor as neglected malignant bone and soft tissue tumor was delayed presentation (>3 months), locally advanced disease, ulceration, sepsis, fungating mass or metastasis at the time of presentation. All the cases were reviewed and analyzed for age, gender, histological types, educational status and socioeconomic status of the family, any prior treatment by traditional bone setters or registered medical practitioner, cause of delay for seeking medical advice. We have also analyzed the treatment given at our institute and the outcome of the tumor. OBSERVATIONS AND RESULTS Eighteen patients fulfilled the criteria for neglected malignant bone and soft tissue tumors, hence were included in study. Eight cases were of osteosarcoma, five cases were of Ewings sarcoma, three cases were of chondrosarcoma and 1 case each was of pleomorphic liposarcoma and primary lymphoma of bone. According to Enneking staging system 11 cases were of stage III (distant metastasis) and 7 were stage II-B. Seven were females, and 11 were males. Age range was 5-68 years. 15 patients (83.3%) belonged to low socioeconomic status with 17 patients (94.4%) belonged to uneducated background. Cause of delay in seeking medical advice was neglect by the patient and family due to financial constraints, cultural and religious believes, lack of access to health care facilities, consultation with traditional bone setters and even misdiagnosis by qualified orthopedic surgeons. The tumors included were all unresectable and of huge sizes, hence were managed with amputation/dis-articulation, chemotherapy or radiation. CONCLUSION The current study tries to highlight the causes and quantity of neglect of malignant bone and soft tissue tumors prevalent in our country, which poses a therapeutic challenge for management and consequent mutilating surgeries with poor outcome resulting in loss of extremity and existence.