Rajeev Shukla

Aneurysmal Bone Cyst—An Unusual Presentation of Wrist Pain

Introduction Aneurysmal bone cyst (ABC) is a cystic benign expansile lytic bone lesion, resembling multiple intraosseous blood‐filled spaces. It is most commonly seen in the first two decades of life. Most frequent sites of involvement are metaphysis of proximal and distal femur, proximal tibia, and posterior elements of spine. It is seen more frequently in females. ABC of distal ulna is rarely reported in the literature. Case Presentation We are reporting a case of ABC of a rare location—distal ulna—in a young male, which was successfully treated with extended curettage, and the cavity was filled with bone graft, with K‐wire stabilization.

A Long-Term Study of Application of Joshi's External Stabilizing System in Displaced Intra-articular Distal End Radius Fractures

Background Fractures of the distal end radius are a common upper extremity fracture. Intra‐articular distal end radius fractures are recognized as very complex injuries with a variable prognosis. The aim of the study was to assess the long‐term functional outcome of patients treated with Joshis external stabilizing system (JESS) for displaced intra‐articular distal end radius fractures. Materials and Methods A total of 170 patients with intra‐articular distal end radius fracture were treated with JESS from 2014 to 2017. The patients were followed up at 2, 6 weeks, 6 months, 1, and 2 years (final) after the surgery. The assessment of pain, range of motion, grip strength, and satisfaction were assessed at 6 months, 1, and 2 years (final) follow‐up and scored according to modified Mayo wrist scoring system. Results The good and/or excellent results were found in 82.2% of cases. We observed that patients with age less than 50 years had greater prognosis as compared with patients with more than 50 years of age. Final outcome was also found better in males as compared with females at 6 months, 1, and 2 years postoperatively. Conclusion JESS is an effective treatment technique for intra‐articular distal end radius fractures in our community. On long‐term follow‐up of the patients treated with JESS for intra‐articular distal end radius fractures, the functional and radiological outcomes were good with low complication rate.

Outcome analysis of vitamin-D supplementation in patients with fibromyalgia

Objective: To investigate the vitamin D level and score the pain of fibromyalgia (FM) using VAS scoring at preplanned intervals. Materials and Methods: 50 patients presenting with FM, treated with vitamin D supplementations were prospectively followed for average duration of 6 months and correlation was also calculated between vitamin D and VAS score. Result: There were 60% female and 40% male and the average age of the patients with FM was 45.066±17.7 female and 43.30.±18.1 male. The mean pain VAS score decreased at intervals (day 1, 3 months and 6 month) in both age and gender group. A significant reduction in pain intensity was observed after each months of vitamin D therapy with p < 0.001. Low Vitamin D level was significantly correlated with VAS on Day 1 and 03 months intervals (r=0.23 p=0.876, r=0.18 p=0.903, r=0.268 p=0.59 and r=0.172 p=0.234, r=0.267 p=0.61, r=0.413, p=0.003) but negative correlated was found on high Vitamin D level after 06 month with VAS score (r=-0.058 p=0.691 and r=-0.070 p=0.630 in respectively) Conclusion: In conclusion, our study confirmed low vitamin D level was significantly correlated with VAS score on Day 1 and 03 months intervals and then negative correlation was found on high vitamin D level after 06 month with VAS. Furthermore, vitamin D was closely related with pain and disease severity.

Minimally Invasive Plate Osteosynthesis Using Locking Plates for AO 43–Type Fractures: Lessons Learnt From a Prospective Study

Introduction. Managing fractures of distal tibia is still a subject of debate for orthopaedic surgeons in terms of both, reduction and fixation. Subcutaneous location and soft tissue anatomy predisposes it to angular and rotational instability as well as other bony and soft tissue complexities. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis(MIPO) maintains biological configuration of distal tibia and fracture hematoma and also provides a construct, which is biomechanically more stable. Objectives. Evaluation of results of MIPO in management of distal tibia fractures considering radiological union, ankle function restoration, and complications. Materials and Methods. In our study, 25 closed distal one-third tibia fracture with/without articular extension were taken, fulfilling the inclusion criteria (AO classification: 10, 43A1; 3, 43A2; 2, 43B1; 4, 43B2; and 6, 43C1). MIPO with locking plates was the treatment undertaken. Patients were followed up for 18 months prospectively. Results. Average injury-hospital interval was 11.16 hours and average injury-operation interval was 2.44 days. All fractures showed radiological union at an average duration of 20.5 weeks (14-28 weeks). Olerud and Molander score was used for evaluation at 3, 6, and 18 months. One patient had union with valgus angulation >5° but there was no nonunion. There was 1 superficial postoperative wound infection. Conclusion. Our study shows that plating with MIPO is an effective treatment for closed distal one-third tibia fractures, considering union time and complications rate. Younger age promotes early union and functional recovery. Levels of Evidence: Therapeutic, Level II: Prospective

Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

Introduction. Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture. Materials and Methods. Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale. Results. The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results. Conclusion. Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients. Levels of Evidence: Therapeutic, Level III: Retrospective Cohort study