Buddhadev Chowdhury

Outcome-based Classification for Assessment of Thoracic Pedicular Screw Placement

Study Design. Prospective cohort study. Objective. We propose a simple outcome-based classification for assessment of pedicle screw positions based on postoperative computed tomography scan. This bridges the gap between high rates of pedicle screw misplacement and minimal complications reported. Summary of Background Data. The main deterrent for the use of thoracic pedicular screws is the feared neurovascular complications due to screw “misplacements.” The literature shows that only a small fraction of the misplaced screws actually causes any complication, and some misplacements can be acceptable both in terms of safety and their biomechanical strength. Methods. Sixty patients with various spinal disorders were included in the study. The mean age was 29.6 years (range, 12–72 years). The patients were divided into 2 groups for assessment of pedicle screw placements using postoperative computed tomography scans: scoliosis group with 24 patients and the nonscoliosis group with 34 patients. Placements of screws were assessed using the outcome-based classification and the Rongming Xu criteria of screw placement. Results. A total of 341 screws were assessed from 60 patients with various spinal disorders (scoliosis and nonscoliosis groups). Using the Rongming Xu criteria, the overall screw misplacement in scoliosis group was 50.72% (68 of 138) and that in nonscoliosis group was 45.45% (80 of 176 screws). Assessment of these screws using the outcome-based classification showed a high percentage of acceptable screw placements (type 1) − 89.85% (124 of 138 screws) in the scoliosis group and 86.93% (153 of 176 screws) in the nonscoliosis group. Conclusion. The literature shows consensus over high rates of pedicle screw misplacement, but low clinical complications, in the hands of the best of spine surgeons. The concept of acceptable screw placements and the outcome classification makes the pedicle screw assessment results correlate better with the clinical outcome.

Pedicle morphometry in patients with adolescent idiopathic scoliosis.

Background: The key to the safe and effective use of thoracic pedicle screws in the deformed spine is to thoroughly understand pedicle anatomy. There are a few studies related to pedicle anatomy in the Indian population and no pedicle morphometric studies in scoliosis patients. The present study aims to highlight the differential features of pedicle morphometry, including pedicle width, transverse pedicle angle and the depth to anterior cortex on the concave and convex side, in a group of Indian patients with adolescent idiopathic scoliosis and compare this to that of a western population. Materials and Methods: This is a prospective study of 24 patients with adolescent idiopathic scoliosis. The average age is 14.6 years (12.3-18.3 years) of which 14 were females and 10 were males. All the patients underwent CT scan using Siemens 4th generation scanner. The scans were analyzed by measuring the transverse pedicle width, transverse pedicle angle and the chord length; all the measurements being made both on the convex as well as the concave pedicle. Statistical analysis was performed with unpaired ‘t’ test. Results: A total of 1295 measurements were performed from 24 patients and an average of 215 pedicles were assessed for each set of the measurements made. The transverse pedicle width was consistently found to be smaller on concave side in comparison with the convex side at all levels except at T1. The transverse pedicle angle was greater on the concave side at all levels as compared to the convex side, though there was wide individual variation. The depth to anterior cortex was lesser on convex side in comparison to the concave side except at T1. Conclusions: The concave pedicle is much thinner and directed more medially than the convex side, especially at the apical region of the scoliotic curve. The pedicle anatomy in scoliosis patients shows very high individual variations and a careful study of pre-operative CT scans is essential for planning proper pedicle screw placement. Slightly longer screws can be accommodated on the concave side as compared to the convex side, though the difference in the chord length is not statistically significant at most levels.

Web-based information on minimally invasive total knee arthroplasty

Purpose. To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA). Methods. The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword ‘minimally invasive knee replacement’. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted. Results. Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery. Conclusion. Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.

Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma

Background: The epidemiological data of a given population on spinal trauma in India is lacking. The present study was undertaken to evaluate the profile of patients with thoracolumbar fractures in a tertiary care hospital in an urban setup. Materials and Methods: Four hundred forty patients with thoracolumbar spinal injuries admitted from January 1990 to May 2000 to the All India Institute of Medical Sciences were included in the analysis. Both retrospective data retrieval and prospective data evaluation of patients were done from January 1998 to May 2000. Epidemiological factors like age, sex and type of injury, mode of transport, time of reporting and number of transfers before admission were recorded. Frankels grading was used to assess neurological status. Functional assessment of all patients was done using the FIM™ instrument (Functional Independence Measure). Average followup was 33 months (24-41 months). Results: Of the 440 patients, females comprised 17.95% (n=79), while 82.04% (n=361) were males. As many as 40.9% (n=180) of them were in the third decade. Fall from height remained the most common cause (n=230, 52.3%). Two hundred sixty (59.1%) patients reported within 48 hours. Thirty-two (7.27%) patients had single transfer, and all 32 showed complete independence for mobility at final followup. 100 of 260 (38.5%) patients reporting within 48 hours developed pressure sores, while 114 of 142 (80.28%) patients reporting after 5 days developed pressure sores. Conclusion: The present study highlights the magnitude of the problems of our trauma-care and transport system and the difference an effective system can make in the care of spinal injury patients. There is an urgent need for epidemiological data on a larger scale to emphasize the need for a better trauma-care system and pave way for adaptation of well-established trauma-care systems from developed countries.

A prospective comparative study of clinical and functional outcomes between anatomic double bundle and single bundle hamstring grafts for arthroscopic anterior cruciate ligament reconstruction

BACKGROUND Despite a number of studies comparing postoperative stability and function after anatomic single bundle and double bundle anterior cruciate ligament reconstruction, it remains unclear whether double bundle reconstruction has better functional outcome than single bundle anterior cruciate ligament reconstruction. PURPOSE To compare the subjective functional outcome as well as clinical stability in patients treated with either anatomic single bundle or anatomic double bundle anterior cruciate ligament (ACL) reconstruction. We hypothesized that there would be no difference in the postoperative functional outcome and clinical stability between anatomical double bundle anterior cruciate ligament reconstructions when compared to single bundle anterior cruciate ligament reconstructions. METHODS We prospectively followed 40 patients out of which, 20 patients were operated for anatomic single bundle ACL reconstruction and other 20 patients underwent anatomic double bundle ACL reconstruction. Patient evaluation using the laxity tests and outcome scales was done preoperatively and at 12, 24 and 48 months after the surgery. Clinical stability was assessed by Lachman test, Pivot shift test and Delhi active test. Functional outcome was assessed by International Knee Documentation Committee (IKDC), Lysholm and Modified Cincinnati scores. Patients in both groups were evaluated at regular intervals for a minimum period of 48 months (mean 51 months, range 48-56 months). RESULTS For all subjective scores, double bundle group patients reported statistically significant higher scores compared to single bundle group patients. Graded stability results of the Lachman, and Pivot shift tests were significantly higher in the anatomically reconstructed double bundle patient group. CONCLUSION We suggest that functional outcome and clinical stability may be better with anatomical double bundle anterior cruciate ligament reconstruction as compared to anatomical single bundle anterior cruciate ligament reconstruction.

Change detection study of islands in Hooghly estuary using multidate satellite images

River estuarine environment constitutes a highly dynamic fluvio-morphological setting where processes of accretion and deposition are active. Hooghly estuary, being one of the largest of estuaries in the east coast of India, needs constant monitoring. Multidate satellite images of IRS-1A L1SS-I and Landsat MSS for 1975–1991 period are studied to detect long term morphological changes in this estuary. The study reveals that the estuarine islands like Sagar, Ghorarmara and Suparbhanga are eroding whereas Lohachara islands has completely eroded off Nayachara island near Haldia due to its shape and size bifurcates the river into two channels. The island as revealed from Satellite images is in accretional phase where the total surface area has increased. The study, therefore, indicates that constant monitoring of spatial and temporal changes in this type of environment would help to understand physical processes.

Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years.

BACKGROUND Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction. PURPOSE To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population. METHODS We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores. RESULTS At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively. CONCLUSION Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

How international are the leading orthopedic journals: a look at the composition of the editorial board members of the top orthopedic journals

BackgroundResearches from the developing world contribute only a limited proportion to the total research output published in leading orthopedics journals. Some of them believe that there is substantial editorial bias against their work. We assessed the composition of the editorial boards of leading orthopedic journals.MethodsThe editorial boards of 18 leading orthopedic journals according to their impact factor were retrieved from their website. We evaluated in which countries the editorial board members were based and classified these countries using the World Bank income criteria.ResultsIndividuals from number of countries can be found on the editorial boards of the investigated journals, but most of them are based in high-income countries. While 1,302 of the 1,401 editorial board members are based in countries with a high income according to the World Bank criteria, 37 are based in an upper middle income, 2 in lower middle income and none in a low-income economy.ConclusionThe percentage of editorial board members in leading orthopedic journals is dominated by high-income countries with serious underrepresentation from low-income countries.

Stress fracture of ulna due to excessive push-ups

Stress fractures are most common in the weight-bearing bones of the lower extremities and spine, but are rarely found in non-weight-bearing bones of the body. Stress fracture of the ulna is extremely rare. We report a case of complete stress fracture of ulna caused due to excessive push ups in a young athlete. Conservative management was successful in healing of fracture and returning this patient back to his previous activity level. Physician should have high index of suspicion, whenever they encounter a young athlete complaining of forearm pain.

CT based management of high energy tibial plateau fractures: A retrospective review of 53 cases

Objectives The management of high energy tibial plateau fractures is a surgical challenge. Recently described Luos classification is based on CT scans and is more objective with a better inter-observer agreement as compare to Schatzker and AO/OTA classifications. We describe the functional results of a series of 53 cases classified and managed according to the Luos column concept. Methods A retrospective review of 53 high energy tibial plateau fractures, operated between January 2012 and March 2015 at a Level I trauma center, was performed. CT scans were used to classify these injuries based on the number of columns involved. Plating configuration and surgical approach were chosen based on the number of independent articular fragments on axial sections at the level of fibular head. Results 1 one-column, 51 two-column and 1 three-column fractures were studied. Triple plating was done in 5 patients. Mean follow-up was 2.7 years and mean Insall Knee score was 95.42. Four patients had varus malalignment and 1 had joint depression in the post-operative period. These were due to imperfect reduction during the surgery itself, and no case of late collapse was detected. Conclusion Utilizing Luos classification for treating these complex injuries will assist in better understanding of fracture pattern and hence help in achieving a better functional outcome. Each fractured column needs to be independently addressed.