Umesh Kumar Meena

WHOQOL-BREF Hindi questionnaire: Quality of life assessment in acetabular fracture patients

Background: The incidence of acetabular fractures in India has increased over the past years but so has the operating skills of pelvi-acetabular trauma surgeons. The outcomes of surgical management need to be assessed so as to be able to devise proper treatment plan and execute the same during and after surgery, which in turn requires assessment of quality of life indices as well as functional scores. While there are studies assessing Harris Hip scores (HHS) and world health organization quality of life BREF (WHOQOL BREF) in the western population there is no study which assesses the same in Indian population. We designed this study to evaluate and define reference values for use of WHOQOL BREF Hindi scores in QOL Assessment in patients with acetabular fractures and to assess the relationship between it and HHS. Materials and Methods: 118 patients with acetabular fractures who were treated surgically were included in this retrospective study. Assessment of reduction quality (Mattas radiological criteria), clinical outcome (HHS) and functional outcome (WHOQOL-BREF score) were done. The affect of age, gender, fracture displacement, hip dislocation, delay in surgery and associated injury on the clinical and functional outcome was evaluated. Results: The mean HHS was 90.65 (42–100) which showed an overall good to excellent outcome in 78.8% cases. WHOQOL-BREF Hindi score of domain-one was 63.06 ± 20.31 (13–94), of domain-two was 58.22 ± 19.57 (13–100), of domain-three was 70.49 ± 17.92 (13–100) and of domain-four was 64.48 ± 18.46 (13–100), which showed significant functional deficit in domain-one (P = 0.0001) and domain-two (P = 0.0001) but not in domain-three (P = 0.458) and domain-four (P = 0.722) when compared to score of general healthy population. The domain scores of general population norms were achieved in 59.3%, 61.9%, 69.5% and 66.1% cases in domain one, two, three and four respectively. Conclusions: Based on these results one can conclude that WHOQOL-Hindi questionnaire is good enough for assessment of QOL in addition to clinical measures in acetabular fracture patients.

Multicentric spinal tuberculosis with sternoclavicular joint involvement: a rare presentation.

Background. Tuberculosis is a chronic disease which may have varied presentations. Though pulmonary tuberculosis is the commonest, extrapulmonary tuberculosis involving skeletal system is often seen. Individuals with poor nourishment and immunological status are especially susceptible for disseminated and multicentric tuberculosis. Case Report. We here present a case of tuberculosis involving multiple anatomical locations in an immune-competent patient which was diagnosed with radiological studies and confirmed with histological examination. Patient was put on multidrug antitubercular therapy and responded well to the treatment with improvement in clinical and radiological picture. Clinical Relevance. This report of a rare case makes us aware of the varied presentations which tuberculosis can present with. It should be kept as a differential diagnosis in patients with cough and fever but not responding to conventional treatment. This is even more important in countries with poor socioeconomic conditions.

Intraneural Ganglion of Digital Nerve of Thumb: A Case Report and Review of Literature

Ganglions are the most common cause of focal masses in the hand and foot, but they can appear in nearly all anatomic locations [1]. Ganglions commonly arise either from the synovium of joints, tendon sheaths or epineurium of nerves and are filled with synovial fluid that may become jelly-like over time [2]. Intraneural ganglions are rare and most frequently arises from the epineurium of nerves around the knee (popliteal, common peroneal or tibial nerve) near the fibular head but can involve other sites also [3–6]. We present a rare case of a symptomatic intraneural ganglion of the ulnar digital nerve of thumb in a 30 years old female that was successfully treated with surgical excision with complete postoperative neurological recovery. On our search of literature we could only find few cases of digital nerve ganglion [7–9, 11, 12] thus establishing its rarity.

Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture

Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

Sternoclavicular joint tuberculosis: A series of 9 cases

Tuberculosis (TB) is a chronic disease that may affect any part of the human body. Though the osteoarticular TB is not uncommonly seen, TB of the sternoclavicular joint (SC joint) is an infrequently reported condition. The very fact that many physicians have never seen a single case of SC joint TB in their entire career makes them never think of this condition in cases of chronic swellings of the medial end of clavicle. We are reporting here our experience with nine cases of SC joint TB that were treated by us. Delay in diagnosis in each of the case was a common feature, and they had been treated in line of inflammation elsewhere. Diagnosis was arrived at by clinical, radiological, and microscopic examinations. Six of the reported cases responded well to antitubercular chemotherapy, and in one of the cases, chemotherapy was combined with debridement, which was actually done during biopsy and primarily for tissue diagnosis; in another two cases, immunomodulation therapy for HIV was given along with antitubercular therapy. Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation, and a high index of suspicion by the treating physician is necessary to make early diagnosis and appropriate treatment.

Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study

Introduction The management of pilon fractures is controversial primarily due to the high rate of complications irrespective of the mode of treatment. Limited internal fixation with external fixation is associated with minimal soft tissue handling. This may reduce the chances of wound dehiscence and infection. This study was designed to evaluate the functional and clinical outcomes in patients treated with limited internal fixation combined with external fixation in pilon fractures. Material and methods This study was conducted as a prospective clinical study on 56 skeletally mature patients with closed fractures with poor skin condition, and with open grade 1 and grade 2 distal tibial intra-articular fractures. All patients were treated with combined limited internal fixation and ankle spanning external fixation. Results All fractures in this series united with an average time period of union of 18.3weeks (ranging from 13 weeks to 30 weeks). There was no non-union in any case. There was malunion in 4 cases, varus malunion (>5 degree) in 2 cases and recurvatum in another 2 cases). Excellent to good functional results were observed in 88% cases based on the modified Ovadia and Beals score. The mean ankle dorsiflexion and planter flexion movements were 10.2±5.3 degrees and 27.4±7.2 degrees respectively. infections occurred in 6 patients which included 4 pin tract infections and 2 superficial wound infection, all 6 healed after removal of pin tract and with oral antibiotics. Conclusion The technique of combined external fixation with internal fixation is safe and effective management option for intra-articular distal tibial fractures.

Tubercular dactylitis in children

Tubercular dactylitis is a rare manifestation of skeletal tuberculosis in the paediatric population. Its clinical diagnosis is often delayed as local symptoms may easily be missed in children and constitutional features such as loss of weight, loss of appetite, night sweats, evening rise of temperature and history of close contact with a patient of tuberculosis may not always be present. Parents seek treatment only when they notice significant swelling or tenderness of fingers or hand in their children. Radiology and fine-needle aspiration cytology may help in establishing an early diagnosis. Astute multidrug antitubercular therapy is curative.

Evaluation of Spinal Instability after Single Level Fenestration Discectomy: A Prospective Study

Introduction: Failed back surgery syndrome (FBSS) represents a clinical condition of patients that undergo one or more surgical procedures for lumbosacral disease and still present unsatisfactory long-term relief of symptoms, with persistent or recurrent low back pain. One of the sources of failed back surgery syndrome is segmental instability of the lumbar spine. There is very limited evidence in the literature regarding the incidence of spinal instability following fenestration and discectomy. Materials and Methods: This study was conducted on 50 patients who were between 17 and 52 years and who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse. Results: Results were evaluated using Prolo economic and functional outcome scoring which showed good outcome in 41 (82%) patients and moderate outcome in 9 (18%) patients after fenestration. Clinical instability as per criteria was noted in 9 (18%) patients post operatively while radiological instability was noted in 1(2%) patient . All 9 (100%) patients with clinical instability showed a moderate outcome. 13(26%) patients showed a decrease in the disc height more than 30% as compared with there preoperative images before lumbar fenestration. Patients with radiological sign of instability showed a good outcome. Conclusion: Standard fenestration discectomy does not destabilize the spine. Further studies are required to truly evaluate the development and progression of segmental instability in patients treated for lumbar disc herniation using different surgical methods.

Triceps Tendon Avulsion in an Army Recruit: A Case Report

Army recruits are prone to injuries of the musculoskeletal system primarily due to the sudden increase in physical activities. While stress fractures of the metatarsals, tibia and other lower limb bones as well as injury of tendons is common, triceps tendon avulsion in an army recruit has not been reported in literature. As such, triceps tendon avulsion is an uncommon injury. We are reporting a case of a 24-year-old army recruit who had an avulsion of triceps tendon during training and which was missed initially. We managed him surgically by using non-absorbable Ethibond sutures. The patient recovered his full range of elbow motion and at the end of one year had no functional limitations. A physician needs to have high degree of suspicion to avoid delayed diagnosis and prolonged disability. Surgical repair of complete ruptures using transosseous sutures leads to excellent functional results and would probably be the best method of managing these injuries.