Pradeep K Singh

Pathological Fracture of the Fibula Due to a Late Presenting Posterior Tibial Artery Pseudoaneurysm

Accidental penetrating injury of the leg is common in the emergency room setting, and some patients have no bone injury on radiographs. We report a delayed sequel of vascular injury to the posterior tibial artery, following penetrating injury to the leg, which was later additionally complicated by pathological fracture of the proximal part of the fibula. Early diagnosis is important to provide timely treatment. The case of this patient illustrates that the delayed sequel of vascular injury may be confused clinically and on radiographs with a soft-tissue neoplasm. The patient was informed that data concerning the case would be submitted for publication, and he consented. A thirty-year-old man sustained a penetrating wound to the lateral aspect of the proximal part of the right leg fifteen months before presenting to our institution. After a radiograph showed normal findings, he was diagnosed as having a simple penetrating wound and was treated at a primary health center. He subsequently developed constant dull pain and mild swelling over the proximal part of the leg. The swelling and pain gradually increased. When the pain began to interfere with his daily activities, he presented to a private tertiary-care hospital. The radiographic provisional diagnosis was soft-tissue neoplasm. For further evaluation, fine-needle aspiration cytology, magnetic resonance imaging, and a radionucleotide scan were recommended. For economic reasons, he was unable to obtain these studies. He next presented to us with leg swelling and severe pain that interfered with his sleep and daily activities fifteen months after the injury. Clinical examination revealed a diffuse, tender 8 × 10-cm mass on the posterolateral aspect of the proximal part of the right leg. The overlying skin was warm and shiny. The mass was fixed with variable consistency from soft to firm. There was no palpable or …

Outcome analysis of obesity in trauma surgery related to closed injuries of lower limb in orthopedic surgery.

Background: Obesity is fast becoming a global epidemic and has profound effect on lower limb trauma surgeries is not well defined. This study aimed to evaluate and investigate the influence of obesity on health related quality of life (HRQL), patient reported outcome, incidence of postoperative surgical site infection (SSI), perioperative and postoperative complications. The specific association of obesity and outcome is not examined and measured previously in trauma surgery of lower limbs. Methods and Materials: During 2005 to 2014, a total of 12853 patients underwent different lower limb trauma surgeries and outcome measurement was based according to Body Mass Index (BMI). 10885 Patients with BMI of < 30kg/m2 were classified as non-obese and used as control groups. 1968 Patients with BMI of ≥ 30 kg/m2 were classified as obese and data analyzed in terms of outcome, adverse effects, complications and health related quality of life (HRQL) Results: The Increase in BMI leads to increased perioperative complications in terms of Intubation difficulty, blood loss, and duration of surgery. The post-operative adverse incidences in early period like deep venous thrombosis (DVT), surgical site infections (SSI), cardiac and renal events, superficial and deep infections were significant statistically. The delayed adverse effects relate to complications like late development of surgical site infection (SSI), implant loosening and orthopedic implant failure, re-operation rates for different complications. The improvement in health related quality (HQRL) is low among obese patients. Conclusions: Obesity has an inverse influence on patient outcome as compared to non obese patients. However, despite these increased obese patients do benefit from trauma surgeries of lower limb and patient reported outcome was found to be slightly lower among obese patients

Dorsal Herniation of Cauda Equina Due to Sequestrated Intradural Disc

Intradural lumbar disc herniation (ILDH) is uncommon pathology. In present report, authors present a case of ILDH associated with dorsal herniation of the cauda equina rootlets in a 30-year-old male laborer who had chronic backache since last two years. To the best of our knowledge we are reporting this for first time. Report demonstrates the natural course of ILDH.

Hepatotoxicity and Changes in Liver Enzymes Due to Use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs) in Non-Traumatic Musculoskeletal Painful Disorders

The present study aims at critical analysis and investigation of liver function test and hepatotoxity with use of NSAIDs in patients of Non- Traumatic musculoskeletal painful disorders. NSAIDs are most commonly used by medical fraternity worldwide for relief from acute, recurring or chronic pain conditions and are easily available in India in many forms over-the-counter analgesic, sometimes resulting in adverse drug reactions (ADR). The use of NSAIDs and gastrointestinal and renal disturbance is well known. The most frequent ADR due to NSAIDs use was gastrointestinal effects leading to discontinuation of treatment The liver plays a central role in drug metabolism. However, little is known about the cause and effect of NSAIDs on liver and liver enzymes. Most NSAIDs induce hepatic toxicity are due to individual patient susceptibility (idiosyncrasy), and intrinsic associated with mainly hepatocellular tissue. Hepatic toxicity response ranges from asymptomatic or transient derangement in liver function test to fulminant liver damage. The hepatotoxicity due to risk factors associated with NSAID toxicity must be kept in mind by physicians whenever prescribing NSAIDs, because much of underreporting is usually due to transient and asymptomatic effects on liver.

Gastrointestinal Adverse Effects due to Use of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) in Non-Traumatic Painful Musculoskeletal Disorders

Background: The present study aims at investigation of the gastrointestinal adverse drug reactions (ADRs) with use of NSAIDs in patients of Non-Traumatic musculoskeletal painful disorders. Our study is unique in terms that it aims at investigations and evaluations of the gastrointestinal adverse drug reactions (ADRs) with use of NSAIDs in patients of non-traumatic musculoskeletal painful disorders, where most of the concurrent and concomitant risk factors like hepatobiliary system, renal system are mostly excluded, along with a dedicated follow up of large population included in our study. Non-Steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac sodium, Ibuprofen and others are effective for non-traumatic musculoskeletal painful disorders ranging from acute to chronic conditions. NSAIDs are probably most commonly used medications by medical fraternity worldwide for relief from acute, recurring or chronic pain conditions and are easily available in India in many forms as over-the-counter analgesic. Prolonged unsupervised use of these medications leads to disturbance in achieving pain relief and risk of gastrointestinal symptoms ranging from dyspepsia to acute and chronic gastrointestinal ulcer. The most frequent ADRs due to NSAIDs use was gastrointestinal effects leading to discontinuation of treatment. The other ADRs for which NSAIDs are blamed widely are alteration of renal or cardiac parameters in a small subset of patients. Renal and cardiac side effects are well documented and evaluated by clinicians prior to administration of NSAIDs, but the gastrointestinal adverse reactions are overlooked by medical fraternity while

Palliative surgical approach to rehabilitate spinal injury patient in Indian rural setup

Objective: To evaluate the usefulness of conventional spinal surgery as palliative procedure to rehabilitate dorsolumbar injuries in a rural setup. Materials and Methods: Twenty-three patients with dorsolumbar spine injury with complete paraplegia were assessed on the clinical and social rehabilitation parameters after surgical stabilization at Acharya Vinoba Bhave Rural Hospital Sawangi, Wardha, India. The study group comprised 21 male and 2 female patients. The dorsolumbar spine injury was fixed by conventional posterior instrumentation using short-segment pedicle screw system and Harrington rod system with or without fusion. Functional and neurologic outcome was recorded in the follow-up period by using Functional Independence Measure and Frankel grade, respectively. Correlation and analysis of results was established statistically. Results: Functional outcome showed statistically significant improvement. Social cognition was found intact in a significant number of patients. Conclusion: This study demonstrates the usefulness of conventional instrumentation as palliative surgical approach to stabilize and rehabilitate patients from deprived sector of rural India.

A rare variant of tibial hemimelia and its treatment.

Tibial hemimelia is a rare condition. We present a variant of tibial hemimelia not reported in literature before. In this variant, we were able to successfully salvage the limb with excellent function to carry on with life.

An unusual presentation of postauricular swelling: cholesterol granuloma

Post auricular swellings are not uncommon encounterances in surgical practice. Common differential diagnosis would include dermoid and lymph nodes. Cholesterol granulomas are cystic swellings formed with a multi-nucleated giant cell reaction to red blood cells’ breakdown products, haemosiderin and cholesterol crystals. Any aerated portion of the temporal bone may develop a cholesterol granuloma; the mastoid air cells are the most common location and are the most common cystic lesion of the petrous apex. This is the first, unique and rare case of post auricular presentation of a cholesterol granuloma. 21-year-old female presented with a painless swelling behind the left ear from last four years. The radiological examination revealed a left-sided, soft-tissue mass extending into the posterior fossa. She underwent a surgical exploration and complete resection was achieved. The histopathological and radiological features were consistent with a cholesterol granuloma. Authors have seen first case of a mastoid cholesterol granuloma presented as a postauricular swelling. This case illustrates the need to consider cholesterol granuloma in daily clinical practice. Otologists should be aware of uncharacteristic invasive cholesterol granulomas of the mastoid, which require aggressive surgical obliteration.

Epidemiology of Delayed Union of Long Bones

Aim: To study the epidemiology of delayed union of long bones. Introduction: In India, the availability of fracture healing therapies to the general public is limited. The infrastructure of the health system in India, involving both public and private sector does not provide adequate opportunity for rural and low-income inhabitants to access the needed care. Due to these reasons, majority of the global burden of injuries are borne by low and middle-income countries. Material and methods: Patients getting admitted in AVBRH hospital above the age of 18 years of either sex with radiological features of delayed union. Study was a prospective, case control observational type carried out in a rural health setup at AVBRH. It comprised of 153 patients out of which 43 patients had delayed union of a long bone, 53 patients had non-union. These patients were compared with 57 patients that had postoperative fracture union which were included as a control group who had the same risk factors for delayed union. Results: Aging, female gender, comminuted and segmental fractures, higher grades of soft tissue injury, smoking, and infection were found to be independent risk factors for delayed union in long bone fractures. Among the risk factors, smoking and infection can be controlled to decrease the prevalence of delayed union. Conclusion: It is necessary that we create awareness about the importance of primary treatment like immobilization and wound debridement, as patients should reach as early as possible. Patient’s relative’s moral support is necessary in order to get early hospitalization so as to reduce the risk of delayed union among patients and so that appropriate modality of treatment (surgical and conservative) with use of bone regeneration substitutes such as bone grafting and PRP can be done to promote faster healing keeping infection in control.

The Role of Nursing Staff in Spinal Cord Injured Patients

Sohael M Khan1*, Kedar Phadke2, Pradeep K Singh3 and Shashank Jain1 1Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India 2Department of Orthopedics, Vadodara Institute of Orthopaedics, Vadodara, Gujarat, India 3Department of Orthopaedics, Dr H L Hiranandani Hospital, Mumbai, Maharashtra, India *Corresponding author: Sohael M Khan, Assistant Professor and Consultant Spine Unit, Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, Tel: 9890310177; E-mail: drsohaelkhan@hotmail.com