Siddhartha Sharma

Is There a Genetic Predisposition to Anterior Cruciate Ligament Tear? A Systematic Review

Background: Injuries to the anterior cruciate ligament (ACL) are among the most common knee ligament injuries and frequently warrant reconstruction. The etiopathogenesis of these injuries has focused mainly on mechanism of trauma, patient sex, and anatomic factors as predisposing causes. Several genetic factors that could predispose to an ACL tear have recently been reported. Purpose: This systematic review summarizes the current evidence for a genetic predisposition to ACL tears. The principal research question was to identify genetic factors, based on the available literature, that could predispose an individual to an ACL tear. Study Design: Systematic review. Methods: The PubMed, EMBASE, Cochrane, and HuGE databases were searched; the search was run from the period of inception until June 21, 2015. A secondary search was performed by screening the references of full-text articles obtained and by manually searching selected journals. Articles were screened with prespecified inclusion criteria. The quality of studies included in the review was assessed for risk of bias by 2 reviewers using the Newcastle-Ottawa Scale. Results: A total of 994 records were identified by the search, out of which 17 studies (16 case-control studies and 1 cross-sectional study) were included in the final review. Two studies observed a familial predisposition to an ACL tear. Fourteen studies looked at specific gene polymorphisms in 20 genes, from which different polymorphisms in 10 genes were positively associated with an ACL tear. In addition to these polymorphisms, 8 haplotypes were associated with ACL tear. One study looked at gene expression analysis. Conclusion: Although specific gene polymorphisms and haplotypes have been identified, it is difficult to come to a conclusion on the basis of the existing literature. Several sources of bias have been identified in these studies, and the results cannot be extrapolated to the general population. More studies are needed in larger populations of different ethnicities. Gene-gene interactions and gene expression studies in the future may delineate the exact role of these gene polymorphisms in ACL tears.

A new technique for closed reduction of traumatic posterior dislocations of the hip: the 'PGI technique'

Many techniques have been described for closed reduction of posterior hip dislocations, but most require forceful and sustained traction, assistants to stabilise the pelvis and awkward positioning of the surgeon and/or the patient. We describe a new technique of closed reduction that does not need traction-countertraction or special positioning and can be safely and effectively performed by one surgeon. Fifteen patients, mean age 36.4 years, were subjected to reduction. There were five type I, four type II and six type III dislocations; ipsilateral injuries included one knee dislocation with patellar fracture, and two cases of tibia fracture. Closed reduction was achieved in 14 (93.3%) hips, with single attempt successful in 13 cases, while one needed two attempts. One hip could not be reduced due to incarceration of a posterior wall fragment and was managed by open reduction and internal fixation. Our new technique has proved to be a reliable, safe and effective alternative for closed reduction of posterior hip dislocations. It can be carried out by one surgeon, does not need traction and can be especially beneficial in polytrauma patients and also in those patients who have pelvic fractures and ipsilateral lower limb injuries.

Current Concepts in Paediatric Femoral Shaft Fractures

Pediatric femoral shaft fractures account for less than 2% of all fractures in children. However, these are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospital stay, prolonged immobilization and impose a significant burden on the healthcare system as well as caregivers. In this paper, the authors present a comprehensive review of epidemiology, aetiology, classification and managemement options of pediatric femoral shaft fractures.

Drill bit failure and retrieval during arthroscopic ACL reconstruction

A case of broken drill bit during arthroscopic ACL reconstruction and the technique adopted to overcome this complication is presented. We also review the literature for intra-operative incidents and technical complications during arthroscopic ACL reconstruction and various precautions we should implement to prevent such technical pitfalls from coming into reality.

Stress fractures in football

Football (soccer) is one of the most popular sports in the world with high-reported injury rates; many injuries are potentially career ending. Stress fractures represent the inability of a normal or weakened bone to withstand repeated stresses and are reported to account for 0.5% of all football-related injuries. The pathophysiology of stress factors is multifactorial and involves a complex interplay of several extrinsic and intrinsic factors. A high degree of suspicion and adequate imaging is necessary to diagnose these injuries, as plain radiographs may miss the diagnosis in many cases. Once the diagnosis of a stress fracture has been confirmed, treatment consists of activity modification and relative or complete rest, depending on the site and nature of the stress fracture. Surgical intervention may be necessary in the ‘high-risk’ stress fractures, which are prone to displacement, delayed union and non-union. This review looks at the epidemiology, aetiopathogenesis, classification, diagnosis and treatment of stress fractures in football.

The Foot and Ankle

The foot and ankle enables upright posture and locomotion in humans. The human foot has 28 bones and 57 articulations. Normal functioning of the foot and ankle, which is often taken for granted, depends on a complex interplay of bony architecture, ligamentous support, dynamic effects of the supporting muscles and overall control by the nervous system. Therefore, a problem in any of these can lead to potential problems, which can often be severly disabling for the patient.

General Principles of Orthopedic Examination

A focussed examination is the key to correct orthopaedic diagnosis. It should be remembered that diagnostic tests and imaging techniques should aid and not replace clinical diagnosis. The clinician needs to obtain a precise history of the patient’s complaints and examine the patient as a whole, rather than just focus on the anatomical area of involvement. This chapter provides a brief outline of the orthopedic clinical examination. The reader is encouraged to develop his or her own scheme of examination and ensure all essential parts are covered.

Surgical approaches for open reduction and internal fixation of intra-articular distal humerus fractures in adults: A systematic review and meta-analysis

BACKGROUND A number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C). METHODS A systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures (<18 years of age), delayed unions, non unions, malunions, cadaveric studies, pathological fractures and studies with <10 patients were excluded. Studies that looked at surgical modalities other than internal fixation (for e.g. total elbow arthroplasty) for intra-articular distal humerus fractures or those that did not report a validated functional outcome scoring system were also excluded. RESULTS 11 studies were included in the qualitative analysis, of which 5 were comparative studies and 6 were non-comparative. Quantitative analysis was performed on two sets of two studies, each set comparing the Bryan and Morrey or the triceps-split approach to the olecranon osteotomy approach, and revealed no significant differences in the Mayo Elbow Performance Score, range of motion and rates of complications. The overall methodological quality of the studies included in the review was low. CONCLUSIONS High-quality evidence on surgical approaches for ORIF of IDH fractures in adults is lacking. Evidence from low-quality studies indicates that there is no difference in the functional outcomes or complication rates when comparing the Bryan and Morrey or triceps-split to the olecranon osteotomy approach. Future research in the form of high-quality randomized controlled trials is needed to determine which approach is superior in terms of functional outcomes and complications.

Push back technique: A simple method to remove broken drill bit from the proximal femur.

Broken drill bits can be difficult to remove from the proximal femur and may necessitate additional surgical exploration or special instrumentation. We present a simple technique to remove a broken drill bit that does not require any special instrumentation and can be accomplished through the existing incision. This technique is useful for those cases where the length of the broken drill bit is greater than the diameter of the bone.