Vinod Kumar Sharma

Role of Joshi's external stabilisation system fixator in the management of idiopathic clubfoot.

Purpose. To explore the role of Joshis external stabilisation system fixator in correcting cases of clubfoot peculiar to India, we studied cases of neglected clubfoot, dropout cases of plaster-of-paris cast treatment, or failed surgical procedures that had been followed for a minimum period of 2 years. Methods. 26 children underwent 44 Joshis external stabilisation system procedures at the Central Institute of Orthopaedics at the Safdarjung Hospital, New Delhi, between January 1998 and December 1999 for the conditions of interest. Three-dimensional correction was achieved by use of the distractor device. Results. Excellent results were obtained in 77% of the cases, good results in 13%, and poor results in 9% of the cases. Complications in half of the cases were -pintract infections, which eventually healed on an out-patient basis without any residual sequelae. Conclusion. The Joshis external stabilisation system frame is ideally suited for the child in whom clubfoot deformities remain uncorrected by plaster-of-paris casts and manipulation, as well as for recurrent clubfoot. Casting after complete correction not only protects the osteopenic bones while the pin-tracts heal, but also maintains correction and allows gradual weightbearing.

Closed reduction and external fixation for displaced proximal humeral fractures

Purpose. To assess results of closed reduction and external fixation for displaced proximal humeral fractures. Methods. 18 men and 2 women aged 18 to 60 (mean, 38) years underwent closed reduction and external fixation using a standard AO fixator for displaced fractures of the proximal humerus. Injury mechanisms were road traffic accident (n=15) and fall from a height (n=5). 15 were 2-part fractures of the surgical neck, 4 were 3-part fractures of the greater tuberosity and surgical neck, and one was a 4-part fracture. One patient also had a grade-1 open fracture. The quality of reduction and shoulder function were assessed. Results. The mean duration of external fixation was 38 (range, 29–46) days. The mean time to radiological union was 11 (range, 9–13) weeks. The mean follow-up period was 11 (range, 6–18) months. Reduction was good (position equivalent to minimal displacement) in 12 patients and fair (good bony contact between the fragments) in 8 patients. Seven patients had pin site infection; all responded to local dressings and oral antibiotics. No patient had avascular necrosis of the humeral head. The mean Neer score was 85 (range, 42–98) out of 100. Shoulder function was excellent in 10 patients, satisfactory in 6, unsatisfactory in 2, and a failure in 2. Conclusion. External fixation preserves the vascularity of the fracture fragments, enables early mobilisation, and achieves safe healing and good function. It is effective for management of displaced proximal humeral fractures.

Neglected isolated plantar dislocation of middle cuneiform : a case report

BackgroundFour cases of plantar dislocation of middle cuneiform have been reported in the english literature. All of them were fresh cases and treated with open reduction. We are reporting a case of neglected plantar dislocation of middle cuneiform which was treated with excision.Case presentationA farmer presented with a painful plantar dislocation of middle cuneiform bone after 9 months of injury. The bone was deformed and was excised by a plantar incision. It resulted in painless foot with no disability.ConclusionThe neglected plantar dislocated middle cuneiform bone becomes deformed due to repeated weight bearing. The gap gets filled with Fibrous tissue. Excision of the cuneiform gives good results.

Role of calf muscle stimulation in the prevention of DVT in Indian patients undergoing surgeries for fractures around the hip

Background: The venous stasis of soleal vein during surgery may be an important factor in the development of deep vein thrombosis (DVT). The stimulation of calf muscle during surgery may help in preventing DVT. The present study is conducted to evaluate the role of peroperative calf muscle electrostimulation in prevention of DVT in patients undergoing surgeries around the hip joint. Materials and Methods: The study comprised 200 patients undergoing surgeries around the hip joint. The patients having risk factors (such as previous myocardial infarction, malignancies, paraplegia or lower limb monoplegia, previous history of DVT or varicose veins, etc.) for the development of DVT were excluded. They were randomized into two groups: 100 cases were given peroperative calf muscle electrostimulation for DVT prophylaxis (Group A) and the remaining 100 patients were taken as controls without any prophylaxis (Group B). The color Doppler ultrasound was performed to exclude pre-existing DVT and on 7th day postoperative to find out the incidence of DVT in both the groups. Results: Two patients among Group A and six patients among Group B demonstrated DVT on ultrasonography, but the difference was not found to be statistically significant (P=0.279). None of the patients had any clinical evidence of DVT. Conclusion: The role of peroperative calf muscle electrostimulation for DVT prophylaxis remains controversial. The risk of developing DVT in patients undergoing surgeries around the hip joint is very less in patients analysed in our series.

Chlamydia trachomatis elementary bodies in synovial fluid of patients with reactive arthritis and undifferentiated spondyloarthropathy in India.

Reportedly, there is little information on the magnitude of genitourinary‐induced reactive arthritis (gReA) from India. Genital infection with Chlamydia trachomatis is a major health problem in India because of its high prevalence; therefore, this study was conducted with the aim to screen ReA/undifferentiated spondyloarthropathy (uSpA) patients (n = 20) attending a major city hospital in New Delhi, for investigating the presence of intra‐articular chlamydial antigen in knee joints. Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) served as controls (n = 20).

Use of amplified Mycobacterium tuberculosis direct test (Gen-probe Inc., San Diego, CA, USA) in the diagnosis of tubercular synovitis and early arthritis of knee joint

Background: The diagnosis of knee joint tuberculosis, especially in early stages of synovial disease, has more often been based on clinicoradiological suspicion, with no single test claiming to be a dependable rapid diagnostic test with high sensitivity and specificity. Nuclear amplification tests in vogue like the polymerase chain reaction have shown variable sensitivity and false positivity rates in various studies. We evaluated the role of Amplified Mycobacterium tuberculosis Direct Test (AMTDT) or Genprobe in the diagnosis of knee joint tuberculosis in early, especially, early synovitis and arthritis cases. Patients and Methods: Thirty two patients of suspected knee joint tuberculosis were subjected to diagnostic arthroscopy during the study period. The synovial fluid and tissue were subjected to mycobacterial culture, histopathology, and AMTDT. A comparative analysis of the sensitivity and specificity of this new test with culture and histopathology was done and the time taken for reporting was calculated for each test. Results: Out of 32 tissue samples, 8 were found to be positive with mycobacterial culture [Lowenstein Jensen (LJ)/Bactec], 11 were positive with histopathology, and 5 were found to positive with AMTDT. The sensitivity of AMTDT was found to be 62.5% and specificity was 100% with a P value of 0.083. The results were obtained earliest with AMTDT with a mean reporting time of 1.2 days, while the results of histopathology were obtained in a mean time of 6.8 days, BacT alert in 22.5 days, and conventional LJ medium culture results in 48.6 days. Conclusion: AMTDT or Genprobe is a rapid diagnostic test for early diagnosis of tubercular arthritis, but has low sensitivity in knee joint tuberculosis. Nuclear amplification tests are still far from being a single promising alternative to conventional tests in cases of joint tuberculosis. Routine use of arthroscopic biopsies in all suspected cases is helpful in the early diagnosis of knee joint tuberculosis.

Traction apophysitis of medial malleolus: a case report with review of the literature.

Traction apophysitis of medial malleolus is very rare and presented in view of its rarity. A 13 years old boy presented with pain and swelling without history of trauma around left ankle of 3 months duration. The swelling was diffuse with tenderness on anterior aspect of medial malleolus. The overlying skin was normal. The X-rays revealed fragmented accessory ossification centre of medial malleolus an left side. MRI revealed multiple foci of hypointensity in T1 and T2 weighted images of left medial malleolus apophysis. Patient was treated in below knee plaster for three weeks with restriction of sports activities for 5 weeks. The patient became asymptomatic in 8 weeks.

Results of titanium elastic nailing in paediatric femoral diaphyseal fractures----report of 30 cases.

Objective: Fractures of the femur are the most incapacitating fractures. For children aged 6‐14 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer recommended. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. Methods: Thirty patients in the age group of 6‐16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 1 year. The final results were evaluated using Flynns criteria. Technical difficulties and complications associated with the procedure were also analysed. Results: Overall results were excellent in 20 cases and satisfactory in 10 cases. No patient had poor result. The average hospital stay was 9 days. All the fractures healed with an average time to union of 6.86 weeks. The most common complication encountered was soft tissue irritation at the nail entry site seen in 6 cases. Clinically, lengthening was noticed in 4 cases, while no patient had shortening. Malalignment was seen in only 6 cases. Perioperative difficulties encountered were failure of closed reduction seen in 6 cases and corkscrewing of nails in one case. Conclusion: Titanium elastic nails are a relatively easy to use, minimally invasive, physeal‐protective implant system with high rate of good and excellent outcomes in children aged 6‐16 years. Technical pitfalls can be eliminated by adhering to the basic principles.

Chlamydia trachomatis-induced reactive arthritis in India: frequency and clinical presentation

Chlamydia trachomatis ( C. trachomatis )-induced reactive arthritis (ReA)/undifferentiated spondyloarthropathy (uSpA) are unrecognised/underestimated entities, and clinicians often fail to recognise them. In India, our group was the first to report intra-articular C. trachomatis infection in patients with ReA/uSpA having genitourinary symptoms.1 Males were predominant (78%) and majority of patients presented with an oligoarthritic profile (80%), enthesitis (11%) and human leukocyte antigen (HLA) B27 (40%); however, none reported ocular infection. Despite this observation, it is also very likely that C. trachomatis -induced ReA/uSpA is underdiagnosed in women. Intra-articular C. trachomatis …