Anil K Bhat

Prosthetic rehabilitation in traumatic upper limb amputees (an Indian perspective)

IntroductionRehabilitation of traumatic upper limb amputees depends on a multitude of factors. This study attempts to evaluate the success of prosthetic rehabilitation in this group of patients, determine the reasons for non-compliance and find ways to increase prosthetic acceptance.Materials and methodsThe prosthetic rehabilitation status of 71 traumatic upper-limb amputees was assessed by a questionnaire and clinical review. A Prosthetic Rehabilitation Scoring (PRS) system, based on patient satisfaction, prosthetic usage and activity level, was devised to quantify the success of rehabilitation.ResultsThe rehabilitation was found to be equally good in above-elbow and below-elbow amputees. The delay in fitting of the prosthesis had no correlation with successful rehabilitation. Chances of successful rehabilitation decreased when the prosthesis fitting was done in older patients. The main reasons for inadequate use of the prosthesis were repeated mechanical failure and the high cost of repair and replacement.ConclusionIn order to achieve an optimum benefit for the patient in a developing country, the prosthesis should be durable, inexpensive and have a low cost of maintenance.

Mechanical failure in intramedullary interlocking nails

Purpose. To study clinical and mechanical factors that predispose to failure of interlocking nails. Methods. Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after nailing, and union status were reviewed after a mean follow-up of 22 months. Results. Nail failure occurred in 27 fracture repairs (17 femoral, 9 tibial, and one humeral; 13 from our institution and 14 referred from elsewhere). In 55% of failed repairs, the fracture was distal. A high rate of tibial nail failure was noted. Conclusion. Distal fractures and stress concentration at the distal screws predispose to interlocking nail failure and can be prevented by protected weight bearing combined with the use of longer and larger nails. Routine supplementary cancellous bone grafting is unnecessary during renailing surgery when adequate reaming and a larger nail are used.

The Reverse Posterior Interosseous Artery Flap: Technical Considerations in Raising an Easier and More Reliable Flap

PURPOSE Major injuries of the hand with skin loss often require early flap cover, which should be versatile, simple in technique, and safe. The reverse posterior interosseus flap satisfies all of these requirements. Over the years, refinements in the technique of harvesting this flap have evolved to prevent venous congestion and flap necrosis. This study presents adaptations to avoid such complications and raise a successful flap. METHODS A total of 21 patients underwent this flap reconstruction between January 2008 and November 2010 for injuries around the wrist and hand. The average follow-up period was 6 months; 19 were male and 2 were female. The average age was 33 years (range, 9-70 y). In 17 patients, the flap reconstructions were done for posttraumatic injuries, in 2 after skin defects following tumor resection, and 1 each after defects resulting from release of first web contracture in multiple congenital contractures and burns. Average size of the flap was 51 cm(2) (range, 90- 30 cm(2)). The donor area was covered by a split skin graft. RESULTS All flaps survived without major complications. Generally the flap matched the surrounding skin except for palmar defects. No patients reported donor skin graft color mismatch. CONCLUSIONS The reverse posterior interosseous flap is a reliable and safe flap for soft tissue cover to the wrist, palm, dorsum of hand, first web space, and metacarpophalangeal joints. Thorough attention to the technical details, including performing a proximo-distal flap dissection with the deep fascia, avoiding dissection of the anastomotic arc between posterior and anterior interosseous artery, creating a broad pedicle with a cutaneous handle, and avoiding its tunneling for inset, will contribute to survival of the flap.

Static progressive stretching using a turnbuckle orthosis for elbow stiffness: a prospective study

Purpose. To assess the effectiveness of a turnbuckle orthosis as a means of improving the range of motion in patients with elbow stiffness. Methods. 17 males and 11 females aged 8 to 68 (mean, 32) years underwent static progressive stretching using a turnbuckle orthosis for elbow stiffness secondary to trauma or surgery. Patients were instructed to wear the orthosis during the daytime for a mean of 15 hours and remove it during sleep as well as at breakfast, lunch, and dinner. One hour of range-of-motion exercise was performed during each break. Patients were followed up every month and the range of motion was recorded with a standard goniometer. The use of orthosis was discontinued when there was no further improvement. Range-of-motion exercise was encouraged thereafter to maintain the results. The extent of flexion contracture and range of motion before and after the treatment were compared. Results. The mean duration of orthosis use was 5 (range, 3–8) months. The mean flexion contracture reduced from 59° to 27° and the range of motion improved from 57° to 102°. 19 of the patients achieved a functional range of motion. Improvement in the range of motion was excellent in 6 patients, good in 11, satisfactory in 7; at the end of follow-up (mean, 29 months), the results were maintained or improved further in 20 patients (even in those with long-standing contractures). Conclusion. Static progressive stretching using a turnbuckle orthosis is reliable and cost-effective for treating elbow stiffness.

Radiographic imaging of the wrist.

Imaging techniques play an important role in evaluating the complex anatomy of bone and soft tissues of the wrist. The standard wrist radiographs and specialized views still form a very important imaging modality to unravel the wrist pathology in their simplest forms. This article discusses the routine radiography of the wrist followed by ancillary views and dynamic studies for each of the routine view described that helps reveal both static and dynamic pathologies. The literature search was carried out using the search strings or key words, and the databases were searched using the time frame of 1990 to 2011 that included Scopus, MD consult, Web of Knowledge, Pub Med, Ovid Medline and Cochrane Library. The print journals and books available at Manipal University library were hand searched and secondary search was done for the relevant articles included in the references of primary articles. Full articles as well as abstracts were used for the review.

Pachydermoperiostosis: Three Case Reports

Three patients with pachydermoperiostosis are reported. All patients presented with moderate pain and swelling in multiple joints unresponsive to treatment, characteristic facial features which were marked in two cases, clubbing of nails and enlargement of distal parts of the extremities. One patient had spondylolisthesis of L5-S1 vertebrae, an association not previously described in this syndrome. The natural history of the disease is reviewed and the differential diagnosis is discussed.

PREVALENCE OF CUMULATIVE TRAUMA DISORDERS IN CELL PHONE USERS

Purpose: In recent years, ownership and usage of cell phones have become widespread, especially amongst young people. The increasing use of text messaging on mobile phones has focused concern on possible musculoskeletal disorders for the users. Hence the purpose of this study was to find the prevalence of cumulative trauma disorders (CTDs) of the upper limb in cell phone users. Methods: A questionnaire-based survey was undertaken to detect the prevalence of CTDs in 1500 college students. Results: The response rate of the survey was 91.9%. Overall prevalence of CTD in the upper limb was found to be 18.5%. Maximum symptoms were noted in thumb (52%). Pain (61.7%) and fatigue (44.3%) were the two most common symptoms reported by the respondents. Conclusions: Mild form of CTD is present in students using cell phones and mainly depends on the pattern of phone usage.

Extensor Pollicis Longus Injury in Addition to De Quervain’s with Text Messaging on Mobile Phones

OBJECTIVE To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. BACKGROUND Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. MATERIALS AND METHODS Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. RESULTS Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. CONCLUSION Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. APPLICATION Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist.

A variant of mirror hand: a case report.

We report a variant of mirror hand in a 3.5-year-old boy who presented with multiple fingers. The x-ray revealed an attempt at fusion of 2 hypoplastic radii, 1 ulna, and multiple fingers. The unique feature of this case is a broad radius with proximal notching suggesting failed incomplete duplication. The reasons for this duplication and duplication of the fingers appear to be different.

Recurrent Primary Synovial Sarcoma of Median Nerve: A Case Report and Literature Review

We report a case of intraneural synovial sarcoma of the median nerve in a 39 year old lady with multiple local recurrences over thirteen years with no distant metastasis. The diagnosis of biphasic type of synovial sarcoma was confirmed by histopathology and immunohistochemistry. At the time of the fourth recurrence below elbow amputation was performed. This case is being reported for its rarity and propensity for local recurrence without distant metastasis.