Shekhar Srivastav

Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience.

BACKGROUND Exchange nailing of ununited fractures with or without bone grafting is the most acceptable procedure for nonunion with previously implanted intramedullary nails. Though excellence of this procedure has been well documented for diaphyseal, noncomminuted fractures of long bones, its acceptability for distal femoral, metaphyseal-diaphyseal junctional fractures, and humeral locations is doubtful. A method of obtaining stability at fracture site is described wherein locking compression plates are applied over the ununited fracture with bone grafting without removal of the underlying nail. METHODS Eleven patients (six males, five females) with ununited fracture of long bones were enrolled. All these patients had previously undergone locked intramedullary nailing for fractures of long bones (seven femur, two humerus, two tibia). Fracture site was exposed, surfaces rawed, and locking compression plate (AO Synthes) was applied over the intramedullary nail. Eccentric position of the plate allowed one or two bicortical screws adding to the stability of the construct. Interlocking screws if broken were also replaced during the same sitting. Autologous bone grafting was done in all cases. RESULTS All fractures showed radiologic union at 6.2 months. No complications were encountered. CONCLUSION Locking compression plating of ununited fracture with preexisting intramedullary nails has predictable good results for specific indications.

Total hip arthroplasty following failed fixation of proximal hip fractures.

Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA) following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males) with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years). Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T) fracture and two for subtrochanteric (S/T) fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years). The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Diaphyseal Humeral Fractures

Purpose. To assess outcomes of minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP) for 42 humeral shaft fractures. Methods. 28 men and 14 women aged 18 to 68 (mean, 34; median, 29) years underwent closed reduction and MIPO using a LCP for type 12-A (n=26) and type 12-B (n=16) humeral shaft fractures. Eight of the patients were aged ≥50 years. Patients were followed up monthly until radiological union in at least 3 of the 4 cortices. Functional assessment was based on the Disabilities of Arm, Shoulder and Hand (DASH) score. Results. The mean follow-up period was 25 (range, 14–35) months. The mean DASH score was 35.1 at month 3 and improved to 8.9 at month 6 and 5.2 at year 1. The mean angulation was 4° in the coronal plane and 7° in the sagittal plane. All fractures united after a mean of 14 weeks. Two patients with transverse fractures had delayed union and received bone marrow injections at 12 or 13 weeks; they achieved union at week 20. One patient developed a radial nerve palsy immediately after surgery and underwent surgical exploration through the anterolateral approach. The plate was re-applied, and the nerve recovered in 48 hours with full power in all the muscle groups. Conclusion. MIPO with LCP is a safe and effective technique for fixation of diaphyseal humeral fractures, and results in faster bone union, better cosmesis, and minimal complications.

Prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty: Justified or not?

Background: The routine use of antibiotic-loaded bone cement (ABLC) during primary or uninfected revision arthroplasty remains controversial. Many studies quote the total joint arthroplasty (TJA) infection rate to be less than 1%. Total knee arthroplasty (TKA) has a higher infection rate than total hip arthroplasty (THA). Based on both animal and human studies in the past, ABLC has been found effective in reducing the risk of infection in primary TJA. We are presenting retrospective analysis of results in terms of infection rate in 659 TKA performed by a single surgeon under similar conditions during 2004–2007 using CMW1 (Depuy, Leeds, UK) with premixed 1 g of gentamicin. Patients and Methods: We did primary TKA in 659 knees of 379 patients during 2004–2007 using CMW1 (Depuy, Leeds, UK) cement containing 1 g of gentamicin in 40 g of cement in a premixed form. Standard OT conditions were maintained using laminar air flow, isolation suits for the operating team, pulse lavage and disposable drapes in each patients. Midvastus approach was used in all the patients to expose the knee joint. A systemic antibiotic (third-generation cephalosporin and aminoglycoside) was used preoperatively and 48 h postoperatively. We observed the patients in terms of infection in the high-risk and low-risk group till the recent follow-up with a mean of 20.6 months (9–38 months). Results: We had deep infection in six knees in six patients and all of them required two-stage revision surgery later in the high-risk group. Infection occurred at a mean of 20.5 months after surgery earliest at 9 months and latest at 36 months after surgery. The infection rate in our study was 0.91% which is comparatively less than the reported incidence of 1–2% in reported studies. Conclusion: We conclude that the use of antibiotic loaded bone cement is one of the effective means in preventing infection in primary TJA.

CityGML at semantic level for urban energy conservation strategies

The exponential growth of cities in India due to urbanization resulted in increased use of non-renewable energy resources to meet the essential power requirements of urban built environment. It is essential for urban planners to provide innovative solutions in context of urban energy simulation based on virtual 3D city models. The recent 3D geoinformation science studies are insufficient in providing optimal solutions because of lack of emerging concepts and integrated softwares. Presently 3D GIS data can be generated into various LODs (Levels of Detail) depending upon the application requirement and input data used. There are various 3D GIS softwares like Google SketchUp, ESRI CityEngine etc., which are being used mostly for data creation especially for boundary representation for geometry abstraction without semantic information. The 3D GIS data conversion from native format into City Geography Markup Language (CityGML) enhances it by providing information both at geometric and at semantic level in interoperable format. A building information model of Geoinformatics department building in IIRS campus is created using Google SketchUp and exported to energy modelling program in gbXML schema. The present investigation explores the semantic characteristics of developed CityGML model for solar thermal and photovoltaic energy production potential assessment based on building semantic components. The amount of solar irradiation incident on bounding features and also illumination obtained through openings of building is quantized using SunCast and RadianceIES application of IESVE Software, respectively. The simulated energy data are integrated with building semantic features and stored in open-source PostGIS RDBMS to address basic semantic queries.

MRI based comparison of tibial bone coverage by five knee prosthesis: Anthropometric study in Indians

This MRI based study evaluates morphological differences of proximal tibia (total cross-sectional area, mediolateral and anteroposterior distance) 8-10 mm distal to the lateral tibial plateau. We evaluated the difference in the coverage of the tibial surface between symmetric and asymmetric tibial trays and difference in coverage between males and females. 150 patients who underwent MRI scans for sports related soft tissue injury without osteoarthritis were studied. The tibial trays of the 5 total knee arthroplasty designs (4 symmetric and 1 asymmetric) were scanned. Mean total tibial coverage of all designs was more than 80%. Asymmetric baseplate had maximum total tibial coverage and maximum rate of optimal fit, with only 2% absolute overhang posterolaterally. Females had better tibial coverage as compared to males.

Land-use and land-cover change in Western Ghats of India

The Western Ghats (WG) of India, one of the hottest biodiversity hotspots in the world, has witnessed major land-use and land-cover (LULC) change in recent times. The present research was aimed at studying the patterns of LULC change in WG during 1985–1995–2005, understanding the major drivers that caused such change, and projecting the future (2025) spatial distribution of forest using coupled logistic regression and Markov model. The International Geosphere Biosphere Program (IGBP) classification scheme was mainly followed in LULC characterization and change analysis. The single-step Markov model was used to project the forest demand. The spatial allocation of such forest demand was based on the predicted probabilities derived through logistic regression model. The R statistical package was used to set the allocation rules. The projection model was selected based on Akaike information criterion (AIC) and area under receiver operating characteristic (ROC) curve. The actual and projected areas of forest in 2005 were compared before making projection for 2025. It was observed that forest degradation has reduced from 1985–1995 to 1995–2005. The study obtained important insights about the drivers and their impacts on LULC simulations. To the best of our knowledge, this is the first attempt where projection of future state of forest in entire WG is made based on decadal LULC and socio-economic datasets at the Taluka (sub-district) level.

Total knee arthroplasty in women with asymptomatic urinary tract infection

Purpose. To compare early outcome after total knee arthroplasty (TKA) in women with a positive or negative urine culture. Methods. 128 women underwent bilateral (n=89) or unilateral (n=39) primary TKA. Diabetes mellitus was present in 38%, obesity in 53%, and asymptomatic urinary tract infection (positive urine culture) in 36% of women. Women with a positive or negative urine culture were compared. Results. In the 46 women with a positive urine culture, Escherichia coli (n=29) and Klebsiella (n=17) were grown. Women with a positive or negative urine culture were comparable in terms of the incidence of diabetes (28% vs. 43%, p=0.1), obesity (52% vs. 54%, p=0.87), fever (9% vs. 15%, p=0.32), leucocytosis (28% vs. 17%, p=0.13), and delayed wound healing (0% vs. 1%, p=0.45). Conclusion. Women with or without a positive urine culture had comparable early complication rates following TKA.

Arthroscopic excision of subacromial osteochondroma causing impingement of shoulder in a patient with diaphyseal achalasia.

Impingement syndrome of the shoulder may arise from a multitude of causes. Majority of them are from intrinsic causes in the tendon itself due to degenerative and vascular causes.1 Some patients also have extrinsic impression due to anomalies in coracoacromial arch like a type III acromion. This case demonstrates an unusual cause of impingement due to a sessile osteochondroma arising from undersurface of the acromion in a patient with multiple osteochondromatosis. This condition is also known as diaphyseal achalasia.