Background: Dupuytren's Contracture is a condition affecting the fascia in hands and fingers causing finger bends in toward the palm. This debilitating disease can affect the activities of daily living. Surgery has been the main stay of treatment, but it is not devoid of complications. Recently, Collagenase Clostridium histolyticum injection has shown better results. There is concern over the efficacy and safety. There is a need for a systematic review that provides high-quality evidence to help surgeons choose the appropriate treatment. Aims: The aim of the study was to assess the effectiveness of the Collagenase Clostridium histolyticum injection by assessing the outcome; correction of deformity, increase in range of movement (ROM) of the finger, and patient satisfaction and also to identify the adverse reactions and recurrence rate. Methods: A systematic review was undertaken. Literature search was done using strict search criteria from electronic databases (MEDLINE, EMBASE, CINAHL, BNI, and Cochrane Library) and trial registers. Two independent authors conducted the study selection, data extraction, and quality assessment of each study. Narrative approach to data synthesis was adopted. Results: Four randomized controlled trials, four observational studies, and two follow-up studies were included. In all the studies, favorable outcomes in deformity correction and increase in ROM were found. Injection treatment had more mild-to-moderate complications which was statistically significant. Conclusion: The review suggests favorable outcome following collagenase injection, especially in metacarpophalygeal joint contractures. More research is needed to assess its efficacy in proximal interphalygeal joints. There is a need for cost analysis between injection and surgical treatment.

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Masquelet technique or induced membrane technique has gained wide popularity and is now widely accepted as a simple and effective technique for the reconstruction of segmental bone defects. The technique is founded on the concept that the enclosed foreign body induces a tissue response, which leads to the formation of a surrounding biological active membrane termed as “induced membrane.” The technique was initially described for bone loss resulting from septic nonunion of the leg, and it has been extended to all long bone segments, including the clavicle, whatever may be the etiology of the bone defect. In this review, we describe the current overview of the Masquelet technique over the last decade.

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Introduction: Schatzker Type V and VI fractures are high-velocity injury; they are bicondylar fractures of proximal tibia with significant articular involvement multiple displaced condylar fracture lines, metaphysiodiaphyseal extension with comminution with high incidence of compartment syndrome and soft tissue injury. Span, scan and plan, and later open reduction and internal fixation with dual incision dual plating is gold standard; Midline incision is considered as history and associated with complications. Purpose: The purpose of the study is to evaluate functional outcome in Type V and VI Schatzker bicondylar tibial plateau fractures, with early intervention using anterior midline approach and Dual plating. Materials and Methods: We analyzed retrospectively 35 patients from 2015 to 2018 at our tertiary center. All patients were operated within 12–24 h of injury using anterior midline approach and dual plating. Patients were evaluated radiologically (coronal alignment using medial proximal tibial angle, sagittal alignment using posterior proximal tibial angle and condylar width) functional and clinical assessment was done using Rasmussen and visual analog scale scoring at regular intervals till the last follow-up. Results: Bony union was achieved at average of 14 weeks (12–20 weeks), 80% patient had excellent and good results. 22% of patient needed bone grafting which was done primarily and 11.1% patient required an additional split skin graft and flap surgery. Complications such as deep and superficial infection were seen in 8.5%, knee stiffness (range of motion <90°) in 8.5%, and varus/valgus malalignment in 14.4% was seen. None of our patients had deep vein thrombosis (DVT). Average of hospital stay was 5.6 days only. Conclusion: Early intervention with single-incision anterior midline approach with dual plating for complex Type V and VI Schatzker bicondylar tibial plateau fractures can still be considered as a method of treatment when intervened early. The excellent functional outcome in this study, lower rate of complications, less incidence of DVT and shorter hospital stay are well comparable to dual incision technique.

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Objective: The objective of this study is to determine the barriers for seeking a total knee replacement (TKR) in Indians with osteoarthritis, despite an increasing need for the surgery. Materials and Methods: Interviews were conducted with 350 Indian patients (109 males, 241 females) who underwent TKR at a tertiary care orthopedic center. The interviews were conducted with each individual based on a questionnaire of 18 questions, which emphasized the patient's reasoning and perceptions regarding TKR. Questions were asked after the patients were admitted but before undergoing TKR. Pain severity and disability before receiving TKR were measured with the Lequesne Index and Oxford Knee Score. Results: Patients requiring TKR were undergoing surgery 13 months after being advised for surgery. Multiple barriers in choosing surgery were identified: (i) wanting to manage pain and disability for as long as possible, (ii) loss of autonomy in making the decision to undergo surgery, (iii) financial issues in affording surgery, (iv) belief that the patients themselves are unfit for surgery and fear of postsurgical complications and morbidity. Conclusions: Despite there being several barriers to the surgical treatment of knee osteoarthritis, physicians must develop strategies to help bridge the gap between patients requiring TKR and the patients electing to undergo the surgery.

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We present the case of a 10-year-old boy presenting with pain and swelling on the lateral aspect of the left ankle associated with occasional fever of 1-month duration. Before he presented to us, he was treated with antibiotics and anti-inflammatory agents on two occasions in a local hospital for the same complaints. The swelling disappeared and mild pain persisted. The inflammatory markers were high, and the X-ray was not typical of either pyogenic infection or Ewing's sarcoma. Hence, a biopsy was done and the material was sent for histopathological and bacteriological studies. The histopathology report was typical of tuberculosis. The child became asymptomatic after antituberculous treatment. The case is presented because of the unusual clinical and radiological presentation of tuberculosis in one of the rarest sites reported in the literature.

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Introduction: Hospital care-associated infections prolong hospital stay and thus increased financial burden, causes long-term disability and mortality in patients and can increase resistance of microorganisms to antimicrobials. Surgical site infections (SSIs) are the most frequent type of hospital care-associated infections in the developing countries. Staphylococcus is the most commonly isolated organism with methicillin-resistant Staphylococcus aureus (MRSA) posing a great threat. The most common human reservoir for S. aureus is the nares. We propose a study to evaluate the efficacy of preoperative screening of MRSA by nasal and throat culture by correlating it with postoperative SSI. Study Design: Prospective study. Purpose of the Study: 1. To determine the prevalence of MRSA colonization in a population of patients scheduled for elective spine surgery. 2. To determine whether preoperative nasal and throat swab cultures for MRSA are predictive of postoperative SSI in patients undergoing spine surgery. Materials and Methods: Two hundred and forty-eight patients who underwent spine surgery at Baby Memorial Hospital, Calicut, from December 2018 onward are included in this study. Patients who had spine surgeries for infections were excluded from the study. Patients who developed postoperative SSIs were cross-checked with preoperative data and analyzed whether the infecting organism is same as in the preoperative nasal and throat swab culture (if it is present). The significance of the correlation between preoperative nasal and throat swab culture and postoperative SSI are assessed statistically with Chi-square test. Discussion: Among the 248 patients in this study, preoperative nasal and throat swab culture yielded MRSA in 27 patients (nasal – 24, throat – 2, and both – 1). Out of 248 patients, 6 patients developed SSIs with MRSA, but none of them had MRSA in preoperative nasal or throat swab culture. Conclusion: Preoperative MRSA screening by throat and nasal swab is not routinely needed in spine surgery as it appears to carry no positive predictive value in postoperative SSIs.

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Introduction: The previous history of fracture in the elderly confers an increased risk of subsequent future fracture. The aim of this study is to identify what proportion of fragility distal radius fracture with subsequent skeletal fracture had their osteoporosis investigation and treatment was addressed in the interval between two events. Materials and Methods: It is a retrospective study of 272 isolated, low-energy distal radius fractures above the age of 50 years, between 2011 and 2015. In addition, during the same period in the same hospital, all patients above 50 years with other skeletal injuries with the previous history of distal radius fracture were also identified. Both groups were cross referenced to produce a single cohort of patients with both injuries. It was also examined whether the patients had received any treatment relating to osteoporosis before they sustained a subsequent fracture. Results: A study cohort of 28 distal radius fracture patients with subsequent other skeletal injuries were identified. Out of these, 2 (7.1%) patients were treated for osteoporosis and 26 (92.9%) were not. The differences in event rates between patients with and without osteoporosis treatment were statistically highly significant (P > 0.001). Conclusions: A substantial proportion of hospitalized elderly, fragility distal radius fracture patients were not sufficiently evaluated and treated for their potential risk of osteoporosis. This issue warrants osteoporosis to be addressed by multidisciplinary approach to prevent further fracture.

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We present a 24-year-old man with an impending fracture of distal fibula, due to a solitary sessile osteochondroma arising from the lateral border of distal tibial metaphysis on the right side. He presented with a swelling on the anterolateral aspect of distal tibia causing mechanical limitation of dorsiflexion of ankle joint and with occasional mild pain. Imaging studies revealed a solitary sessile osteochondroma, abutting the distal epiphysis of tibia, and deforming the fibula. The swelling was excised and the histopathology was suggestive of osteochondroma.

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Introduction: Unlike volar or pulp defects of fingers, nail bed loss or defects are challenging for plastic and hand surgeons. It is difficult to achieve the best esthetic fingernails following nail bed defects. The reverse adipofascial cross-finger flap is a promising option for reconstructing more natural-looking fingernails. Materials and Methods: Twelve patients who underwent reverse adipofascial cross-finger flap for nail and pulp defects were reviewed. Results: All patients were satisfied with the esthetic appearance of their nail plate and color. Overall, 83.3% of patients graded their finger as excellent and good, compared to the normal finger on the opposite hand.

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Infection after fracture fixation (IAFF) is one of the most dreadful complications in the treatment of musculoskeletal trauma. Early detection is paramount, and the presentation can be heterogeneous with local as well as systemic features depending on the postoperative duration and microbiological virulence. We describe an unusual presentation of a young adult immunocompetent male with septicemia following late-onset IAFF, where a multidisciplinary approach helped in the early diagnosis and successful treatment.

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