Sanjay Meena

Dorsal wrist ganglion: Current review of literature

Ganglion cyst is the most common soft tissue tumour of hand. Sixty to seventy percent of ganglion cysts are found in the dorsal aspect of the wrist. They may affect any age group; however they are more common in the twenties to forties. Its origin and pathogenesis remains enigmatic. Non-surgical treatment is unreliable with a high recurrence rates. Open surgical excision leads to unsightly scar and poor outcome. Arthroscopy excision has shown very promising result with very low recurrence rate. We reviewed the current literature available on dorsal wrist ganglion.

Fractures of distal radius: an overview.

Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed.

Causality of injury and outcome in patients admitted in a major trauma center in North India

Context: Trauma in South Asia is an increasingly significant problem, particularly in light of increasing motorization. Societal changes are resulting in alterations in the epidemiology of trauma. Aims: To assess various epidemiological parameters that influence causation of injury in the patients admitted in a major trauma center in Northern India. Settings and Design: Prospective, cross-sectional, Hospital based study from August 2008 to July 2009. Materials and Methods: A prospective study of 748 patients chosen by random assortment was carried out over a period of 1 year (August 2008 to July 2009) and following parameters were noted: Age group, sex, mode of trauma, type of injury, place where the trauma occurred and factors leading to injury. The length of stay of patients, Kampala trauma score (KTS) and mortality depending on the arrival time in emergency department was also noted. Statistical Analysis: Data analysis was performed using SPSS Version 16. Results: Overall trauma was most common in the age group 15-30 years (Mean age: 29.43 ± 16.87 years), with male constituting 85.29% of the total patients. It was observed that road side injuries were the most frequent (66.71%) site of injuries, whereas household injuries (23.66%), farm site (6.28%), work place (1.60) were the next most common modes of trauma. Mean time of presentation of injured patient was 2.53 ± 4.92 days. About 48.13% patients were admitted after more than 24 h after the injury. Two wheelers (32.09) were found to be the most common mode of injury. Maximum injuries (65.31%) occurred in the rural setting. The overall length of hospital stay ranged from 2 days to 178 days (median15.6 days). Mortality is more in patients who arrive in night (between 9 pm and 5 pm). Conclusions: We conclude that the majority of injuries are preventable and the epidemiological trends differ from that of developed countries. Therefore, preventive strategies should be made on the basis of these epidemiological trends.

Validation of the Ottawa Ankle Rules in Indian Scenario

Background: Ankle injuries are one of the most common presentations in emergency department. Ottawa Ankle Rules (OARs) have been used to predict the requirement of radiographs. Objectives: This study aimed to validate the OARs protocol for predicting ankle and midfoot fractures in Indian population. Patients and Methods: A prospective study was conducted in a teaching hospital in north India, during a period of nine months, including all patients who presented with complaints in the ankle region and evolution of less than 48 hours. The study excluded patients with multiple trauma and Glasgow coma scale of less than 15. All patients underwent clinical evaluation, followed by radiographs depending upon the location of the complaints. Radiographic study results were evaluated by orthopedic surgeons who had not seen the patient. Results: We evaluated 140 patients (84 males and 60 females) with the mean age of 35.2 (range, 8 - 76 years). Of the 140 evaluable patients, 71 had positive criteria for radiological evaluation of which 43 presented with fracture, 69 had negative criteria for radiography with no fracture. The sensitivity of OARs to detect fractures was 100%. The implementation of the OARs appears to have the potential to reduce the number of radiographs for the assessment of these patients by about 51%. Conclusions: The implementations of OARs have the potential to reduce the number of X-ray graphics needed to assess these patients by about 51%. The results of this study demonstrate no false negatives and are in agreement with results from other similar studies. It encourages us to implement these criteria in our services urgently, with all the resulting socio-economic implications.

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.

Bilateral anterior shoulder dislocation

Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome.

Spinal Tuberculosis: Which Is the Best Surgical Approach?

cral TB were subjected to anterior radical debridement and strut grafting and instrumentation, while cases with a large paraspinal abscess, especially lumbar TB, were given the surgical treatment of posterior instrumentation. The differential selection of the patients in each group may itself have influenced the results. In group B (posterior approach), either a titanium cage filled with morcelized rib bone or large autoilliac or costal grafting were used. What were the criteria for choosing either of them? One hundred and eighty-one patients with spinal TB were included in the study. Of these, only 25 patients had a neurological deficit. What was the indication for surgery in the other patients? They could very well have been managed conservatively or with a middle-path regimen [5] . The development of anti-TB drugs has revolutionized the treatment of patients with spinal TB, as most patients do not have extensive destruction of bone, and sequestration can be successfully treated conservatively with chemotherapy, external bracing and prolonged rest [6] . Spinal TB with the lesion situated in the thoracic spine is more prone to develop kyphosis. In their study [1] , the majority of patients in group A had TB in the dorsal spine while those in group B mostly had lesions in the lumbar spine. The poor results in group A cannot be attributed to instrumentation alone. The surgical time and blood loss which are critically important parameters for the choice of approach were not mentioned. Although the mean age was mentioned, the age range in each group was not. In children and young adults, vertebral destruction is more severe because most bone is cartilaginous. In addition, angulation is more significant due to the growth retardation of the anterior column and unrestricted growth of the posterior column. We read the article entitled ‘Outcomes of different surgical procedures in the treatment of spinal tuberculosis in adults’ by Cui et al. [1] with great interest. Despite being an age old disease debate still surrounds the choice of approach. The authors concluded that posterior approach was superior to anterior approach for correcting deformity and maintaining correction. However, this conclusion is drawn from study groups that were not comparable from the beginning. There were statistically significant differences in the preoperative kyphosis angle in the anterior and posterior groups. Hence, the conclusion may not be appropriate. The anterior approach popularized by Hodgson et al. [2] in 1960 is currently considered the gold standard for debridement and decompression in Pott’s spine [3] . Advocates of the traditional anterior approach cite the ability to directly access the disease pathology and perform decompression, the fact that there is less muscle dissection and the ability to place a large graft under compressive load for fusion [2, 4] . In the study of Cui et al. [1] , anterior instrumentation was found to be inferior to posterior instrumentation. One of the reasons given by the authors was that the screws in the vertebral body cannot provide the same strength as the pedicle screws due to osteoporosis of the vertebral body caused by spinal TB. We disagree with the authors, as the screws were put into the normal healthy vertebral body and the affected vertebrae were removed. If there were osteoporosis of the vertebral body, then the hold of the posterior screw would also be poor. The vertebra level operated on and the range of kyphosis angle in each group have not been mentioned. The anterior approach should be avoided in patients with lesions above T5 (as instrumentation above T4 body is difficult), in patients with kyphosis of more than 60° (anterior-only correction causes spinal lengthening), in patients with disease involving the posterior elements and in patients with a bad preoperative chest condition. It would be interesting to know how the authors managed the 28 patients with a kyphosis angle of between 61 and 70°. The size of paraspinal abscess decided the choice of approach. The cases lacking a large paraspinal abscess and without lumbosaPublished online: August 21, 2013

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.

Uncoiling of reamer during intramedullary nailing for fracture shaft of femur

Intramedullary nailing is considered the standard of care for closed femoral shaft fractures. Several studies have shown that reamed intramedullary nailing is a safe procedure in fracture shaft femur with lower nonunion rates than unreamed nailing. Reamed intramedullary nailing provides better stability because of increased contact between the nail and medullary canal. However, careful attention to reaming techniques as well good instrumentation is necessary while undertaking such a procedure. We report what is, to the best of our knowledge, the first case of uncoiling of reamer while reaming the medullary canal. Possible causes and measures to avoid such a complication are discussed.