Nazia Hassan

Correlation Between Magnetic Resonance Imaging and Arthroscopic Findings in the Knee Joint

Background: The knee joint is the largest and the most complex joint of the human body. It is not covered by any thick muscular covering anteriorly. Objectives: The purpose of this study was to explore the diagnostic capabilities of clinical examination, magnetic resonance imaging (MRI), and arthroscopy in traumatic disorders of the knee joint, to seek correlation between clinical findings, MRI findings and arthroscopic. Patients and Methods: A total of 26 patients with a presentation suggestive of traumatic knee pathology were studied prospectively. A detailed history was taken and relevant clinical examination was done, which was followed by MRI of the knee. The patients were scheduled for arthroscopy under general/spinal anesthesia, whenever indicated. Results: Keeping arthroscopic examination as standard, the correlation between clinical and arthroscopy showed a sensitivity of 80%, specificity of 86%, accuracy of 63.16%, negative predictive value of 93.48%; whereas MRI vs. arthroscopy showed a sensitivity of 74.42%, specificity of 93.10%, accuracy of 84.21%, and negative predictive value of 88.04%. Conclusions: The clinical examination is an important and accurate diagnostic modality for evaluation of traumatic derangement of the knee joint. It is noninvasive, easy, available, and valuable diagnostic modality. The MRI is an accurate diagnostic modality. It can be used whenever there is an uncertain indication for arthroscopy. However, costs have to be kept in mind, especially in patients with low socio-economic status.

Short Term Results with Z Plasty for Checkrein Deformity Following Tibia Fractures

Introduction: Checkrein deformity is rarely seen following fracture in the leg bones. The surgical treatments is the method of choice but the site of release at the fracture site or at the midfoot are debatable. Since the deformity is rare the literature is scarce. We evaluated six cases of such deformity after releasing the tendon behind the medial malleolus. Methods: Six patients were followed after releasing the tendon and performing Z plasty lengthening midway between the previously described procedures. Results: We achieved full correction of the deformity with satisfaction in all the six cases and had no recurrence with minimum 2 years following surgery. Conclusion: The method described is simple, effective with less learning curve however larger series is required to compare it in a randomised control manner.

Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

Changes in Serum Level of Vitamin D During Healing of Tibial and Femoral Shaft Fractures

Dear Editor, We read with interest the article by Ettehad et al. (1), in which the authors provide a detailed discussion of the variations in serum vitamin D levels during the course of fracture healing. We have a few considerations regarding this study. The authors have not mentioned the treatment modalities used for these fractured limbs. Operatively managed fractures are mobilized early; consequently, the serum vitamin D levels of an ambulatory person may differ from those of a bedridden person. Ambulatory persons are also more likely to be exposed to sunlight, and vitamin D 3 (cholecalciferol) is synthesized by the human skin on exposure to the ultraviolet-B radiation of sunlight (2). Both dietary intake and endogenous synthesis contribute to the body’s vitamin D status. Since different factors modulate the extent of endogenous vitamin D formation, quantification is hardly possible. Regarding the objective of this study, the authors mentioned studying the role of vitamin D supplementation in the process of bone formation. However, they have not mentioned whether vitamin D supplementation was started in these patients. In addition, no mention is made regarding the effects of the low measured vitamin D levels on the final results of fracture healing. Tibia and femoral fractures take a longer time to unite, (3), so the serum vitamin D levels at the time of fracture union (i.e., six months and/or at the time of delayed union/non-union) should have been reported to make the study more effective. The levels of vitamin D showed uniform decreases in all age groups and among both genders in the first week, indicating that the fracture healing takes the same course (direct or indirect healing). All persons with fractured bones may not be targets for vitamin D supplementation, and only patients with previously low levels or patients with refractures might benefit from these supplementations (4). Further studies are required to determine the effect of low initial levels of vitamin D on fracture healing. The authors should expand on the present study by checking the levels of vitamin D at the time of radiological or clinical union of the fractures and then checking the effect of vitamin D supplementation on the fracture healing process. Furthermore, refracture in these patients may be an eye opener for developing countries, where we often see hypovitaminosis in the general populations.