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   Table of Contents - Current issue
January-June 2020
Volume 17 | Issue 1
Page Nos. 1-33

Online since Monday, November 16, 2020

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Struggle for existence and survival of the fittest p. 1
Suresh S Pillai
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Difficult primary total knee arthroplasty in varus knees - A case series study p. 2
S Naufal, BP Vinodkumar, CS Vikraman
Introduction: Common indications for total knee arthroplasty (TKA) underwent in our hospital were severe grade osteoarthritis of the knee. The etiological factors are idiopathic, post-traumatic injury sequel, postinflammatory sequel, and metabolic conditions like gout and pseudogout. The risk factors include obesity, intraarticular fractures, and meniscal injuries. Materials and Methods: Study participants: A total of 12 cases were analyzed. Three of them were male and 9 were female. Four of them underwent cruciate-retaining and 8 cruciate sacrificing procedures. Discussion: The stability of the knee is a complex issue. The deformity and osteophytes affect the ligaments unequally because of different degrees of tightness or laxity in flexion and extension. We found that the most common difficulty arises in primary TKA was due to the medial tibial bony defect. The defects were secured with a graft fixed to the medial tibial condyle with or without utilizing screws. Physiotherapy was started from the next postoperative day onward. Conclusion: The TKA posed three challenges (1) Instability (2) Difficulty in soft-tissue balancing (3) The longevity of tibial tray. These three challenges were overcome by building the defect using bone graft.
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Impact of COVID 19 on orthopedic surgeons in India during the early phase of lockdown in South India: A survey-based report p. 7
Pramod Sudarshan, Radhesh Nambiar, Gowrishankar Swamy
Background/Purpose: The pandemic of COVID 19 has swept across the livelihood and economy throughout the world. We created an online survey during the 2nd week of the first phase of national lockdown and assessed the impact of COVID 19 pandemic on orthopedic surgeons in South India, who are almost forgotten in this fight. Methods: The simple survey which included questions divided into categories – demographic details, awareness of the situation, clinical practice, effects on research, training, and personal aspects. The survey was shared on social media and responses were recorded online using Google forms and analyzed. Results: A total of 132 surgeons from various states of India, mostly from South India answered the survey in 7 days. More than 50% responded that their institution had no specific guidelines nor had adequate personal protective equipment (PPEs). Sixty-percent of the surgeons used only standard precautions and not PPE for emergency surgeries. Sixty-seven percent used telecommunication for regular follow-ups and most preferred WhatsApp messenger over SMS or calls. Over 50% were not confident to handle medical emergencies. 53.6% felt postgraduate training was significantly affected due to the lockdown and 58.8% were most stressed about their personal and family health. Seventy-five percent surgeons used this leisure period to spend time with their family. Conclusion: The pandemic of COVID 19 has significantly affected different domains of work and personal life of orthopedic surgeons in India. The survey helped to identify the deficiency and necessary changes which were implemented further. The situation would lead to long lasting changes in clinical practice and view of surgeons in the field of medicine and personal life in general.
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Spontaneous spinal epidural hematoma presenting with paraparesis: A case report and review of literature p. 11
Suresh S Pillai, Amalraj P Nair, M Harisankar
Spontaneous spinal epidural hematoma (SSEH) is a rare and devastating clinical entity. The incidence is considered to be 1 in million/year. SSEH manifests due to accumulation of blood in the epidural space causing compression of the spinal cord and leading to acute neurological deficit. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurological deficit. Magnetic resonance imaging (MRI) serves as the modality of choice in diagnosing spinal epidural hematoma. Decompressive laminectomy and hematoma evacuation is considered as the mainstay of treatment, although conservative treatment can be tried in limited cases. Here, we present the case of a 48-year-old male who presented with progressive neurologic deficit. MRI revealed spinal epidural hematoma at T10-L4 level with cord compression which was promptly evacuated. Functional recovery was achieved after the surgical intervention.
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Bilateral unicameral bone cyst of the calcaneum with unilateral symptoms: An unusual cause for heel pain p. 15
PP Sunil, KR Renjith, T Ajayakumar, P Vinod Kumar
Foot is an uncommon location for unicameral bone cyst, and it is widely believed that calcaneal cysts are typically asymptomatic. We report a case of a bilateral calcaneal cyst in a 65-year-old man which produced unilateral symptoms where open curettage and autogenous bone grafting provided a significant symptomatic relief. Our patient had complete symptomatic relief following surgical curettage without any perioperative complications. Calcaneal bone cyst, although rare, forms an important differential diagnosis in patients presenting with heel pain where surgical management can be a viable option in cases refractory to conservative treatment.
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Prevalence of periarthritis in diabetic patients p. 18
RP Vishnu, M Raffic, S Anoop
In this study, we have evaluated the prevalence of periarthritis in diabetes above the age group of 50 years in a population residing in Venjaramoodu, Trivandrum. There were a few exclusion criteria. This is a cross-sectional study which includes 100 participants selected from the patients of periarthritis. Data were analyzed using the percentage analysis method. This study showed that 36% of patients of periarthritis attending the orthopedic outpatient department had diabetes mellitus. We come to the conclusion that the prevalence of periarthritis is more in diabetic individuals and that periarthritis is more common in uncontrolled diabetes.
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Cervical prevertebral abscess with Burkholderia pseudomallei: A report of two cases and review of literature p. 20
Suresh Shivadasan Pillai, Nikhil Narayanan, Dipu Kuttippala Parambil, Sudarsana , Poornima Mankara Valsan, Manikandan Thangarasu
Melioidosis is a life-threatening infectious disease caused by Burkholderia pseudomallei, seen more commonly in South East Asia and Northern Australia. Though it is an important cause of sepsis, musculoskeletal melioidosis is rare in the Indian subcontinent. We report two cases of cervical prevertebral abscess in a 60-year-old female and a 62-year-old male, caused by B. pseudomallei. No cervical prevertebral abscess due to B. pseudomallei has been reported in the literature to the best of our knowledge.
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Desmoplastic fibroma of the scapula: A case report and review of literature p. 24
M Harisankar, TS Gopakumar, C Vijesh, MS Bhuvitha
Desmoplastic fibroma (DF) of the bone is a very rare benign tumor of the skeletal system with a reported incidence <1.1% of all primary bone tumors. DF of bone is considered to be the skeletal counterpart of extra-abdominal desmoid tumors. The common sites are mandible and tibia. Here, we present a case report of DF of the scapula with a 14-year follow-up. The DF of the scapula is an extremely rare tumor with only six such cases reported in international literature till now.
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Vertebral hemangiomas: A report of two unusual cases and a review of literature p. 28
Suresh S Pillai, M Harisankar
Vertebral hemangiomas are among the most common benign lesions of the spine, with an incidence of 10%–12% in the adult population. Vertebral hemangiomas have been reported in all age groups with most prevalence in the fifth decade of life. A small proportion of the lesions (1%) may cause neurological symptoms ranging from pain to full-fledged paraplegia. Since most of the vertebral hemangiomas are asymptomatic and quiescent, no treatment is required. Treatment is to be considered only if there is back pain or neurological symptoms due to vertebral fracture or spinal cord/root compression. Because these active and symptomatic types of vertebral hemangiomas are a rare occurrence, their treatment modalities remain controversial and hence problematic. Since most of the patients are treated by a combination of modalities, the analysis of the efficacy of each treatment is difficult to assess and hence the apt choice of treatment is still controversial.
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