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   Table of Contents - Current issue
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September-December 2018
Volume 1 | Issue 1
Page Nos. -

Online since Friday, December 28, 2018

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SYMPOSIUM: FRACTURE NECK OF FEMUR  

Vascularity of femoral head and its assessment after femoral neck fractures p. 1
Harshal Sakale, Alok C Agrawal, Bikram Keshri Kar, Bikas Sahoo, Sandeep K Yadav
DOI:10.4103/jodp.JODP_5_18  
Femoral neck fracture has an annual incidence of 1 per 1000 population; in young patients, functional prognosis is not good due to risk of osteonecrosis. Femoral head vascularity is mostly contributed by retinacular vessels and lateral epiphyseal artery. The vascular impact is due to displacement, interrupting retinacular vessel, interrupting ligament teres vascularization, and increased intracapsular pressure, producing a tamponade effect leading to osteonecrosis. This study reviewed the different methods of assessment of femoral head vascularity after femoral neck fractures. There are many techniques for the assessment of residual femoral head vascularity after femoral neck fractures and for the assessment of post-traumatic osteonecrosis risk. Some invasive techniques are superselective angiography, intraosseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others are noninvasive scintigraphy and conventional or dynamic magnetic resonance imaging (MRI). The future seems to lie with dynamic MRI, which gives new classification of femoral neck fractures, based on a noninvasive assessment of femoral head vascularity.
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Classification of fracture neck of femur p. 5
Bikas Sahoo, Alok C Agrawal, Bikram K Kar, Harshal Sakale, Sandeep K Yadav, Sameer Mittal
DOI:10.4103/jodp.JODP_15_18  
There are numerous classification systems for fracture neck of femur in adults. A fracture classification is proposed either for taxonomical purpose, characterization, guiding intervention, or predicting outcomes of intervention. The classifications described in this chapter are needed to decide on choice of implant, stability, acceptability of reduction, vascularity and long term prognosis.
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Early management of fracture neck of femur p. 8
Abhishek Jain, Alok C Agrawal, Bikas K Sahoo, Sandeep K Yadav, Bikram Keshri Kar, Harshal S Sakale
DOI:10.4103/jodp.JODP_8_18  
Femoral neck fracture is considered a medical emergency as an early fixation helps in getting an accurate reduction, preservation of blood supply, removal of tamponade within the capsule, and early mobilization. This article deals with the science of early management of femoral neck fractures.
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Pediatric fracture neck of femur p. 11
Sandeep K Yadav, Alok C Agrawal, Bikram Keshri Kar, Harshal S Sakale, Bikas Sahoo, Rahul K Chandan
DOI:10.4103/jodp.JODP_7_18  
The incidence of hip fractures in children about 1% of total pediatric fractures. The most common cause is a high-energy trauma, such as motor vehicle accidents and falls from a height. In old cases, magnetic resonance imaging (MRI) may be needed to assess the vascularity of femoral head. Hip fractures can have deep impact on the development of hip. Vascularity of femoral head plays a vital role in the management of femoral neck fracture. The paper deals with the cited complications related to femoral neck fracture like avascular necrosis (AVN), nonunion, mal-union, and premature closure of the proximal femoral physis, leading to leg length discrepancy.
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Delayed diagnosed femoral neck fractures p. 15
Bikram K Kar, Alok C Agrawal, Sandeep K Yadav, Harshal Sakale, Bikas Sahoo
DOI:10.4103/jodp.JODP_6_18  
Treatment of displaced femoral neck fractures includes internal fixation with/without graft supplementation or internal fixation plus osteotomy or arthroplasty. The literature contains conflicting evidence regarding rates of mortality, revision surgery, major postoperative complications, and function in patients with displaced femoral neck fractures who present delayed, treated either by internal fixation or arthroplasty. The purpose of our study was to summarize the management protocol of fracture of neck of femur when they present at different duration and at different stage.
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Neglected fracture neck of femur: Our experience p. 21
Alok C Agrawal
DOI:10.4103/jodp.JODP_9_18  
Fracture neck of femur continues to be neglected in rural India. Several salvage options tried in the past are now out of local interest in favor of some sort of arthroplasty. Although the long-term viability of this policy is not known, only the future will guide to a definite path.
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Osteonecrosis and nonunion as complication of fracture neck femur p. 23
Rudra P. S. Thakur, Alok C Agrawal, Bikas K Sahoo, Vishal K Kujur
DOI:10.4103/jodp.JODP_14_18  
Nonunion and osteonecrosis are two major problems that lead to revision surgery after treatment of intracapsular femoral neck fractures. Fixation failure and nonunion are the main modes of failure following fixation of displaced or undisplaced femoral neck fractures. The two problems are difficult to distinguish as most displaced fractures take a long time to heal after fixation, which increases the risk of fixation failure. Avascular necrosis of the femoral head occurs in 9%–18% of patients, between 2 and 8 years postfracture. Risk factors include the degree of fracture displacement, patient age, and delay in surgical treatment.
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Failure of fixation of fracture neck of femur and remedies for management p. 29
Sameer Mittal, Alok C Agrawal, Bikram K Kar, Harshal Sakale, Bikas Sahoo, Sandeep K Yadav
DOI:10.4103/jodp.JODP_10_18  
Failure of fixation is common complication of fracture neck of femur, more common in displaced fractures than in undisplaced fractures. Early diagnosis and treatment of fixation failure is very important for good outcome. Physiological age of patient, status of the hip joint, viability of the femoral head, and presence of occult infection are the factors that should be considered before deciding the suitable salvage procedure. In patients younger than 50 years, preservation of the femoral head is preferred as salvage treatment. Hemiarthroplasty or total hip arthroplasty is the choice of salvage for femoral neck fracture nonunions in physiologically older patients.
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ORIGINAL ARTICLES Top

Do we need internal fixation devices for giant cell tumors around knee joint? An outcome study p. 33
Ritesh Runu, Vidya Sagar, Ashutosh Kumar, Arnab Sinha, Santosh Kumar
DOI:10.4103/jodp.JODP_4_18  
Introduction: Giant cell tumors around the knee joint are the most common aggressive benign tumors. Several limb sparing and limb ablation surgeries are practiced with varying level of success. Here we present an original outcome study conducted on 14 patients with giant cell tumor around the knee joint, treated with intralesional curettage, bone grafting and bone cementing with or without internal fixation. Material and Methods: This is a retrospective study carried out in an institutional set up. Fourteen patients were operated and Internal fixation was used in five cases. the patients were followed up for 2 years minimum. Results: Total fourteen patients were treated with giant cell tumors around knee joint. Phenol cauterization showed reduced recurrence compared to no phenol cauterization. Collapse was noted in cases done with curettage and only cementing or only bone grafting. plating group showed no collapse. No collapse was noted in cases with subchondral bone more than 5 mm. Conclusion: For giant cell tumor, campannaci grade III, internal fixation is suggested if subchondral bone is less than 5 mm and articular involvement is more than 50%.
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Dome osteotomy in cubitus varus: Our results p. 38
Ashutosh Kumar, Vidya Sagar, Pawan Kumar, Deepak Kumar, Ritesh Runu, Gaurav Khemka
DOI:10.4103/jodp.JODP_3_18  
Introduction: Cubitus varus (gunstock deformity) is the most common complication of supracondylar fracture of the humerus. Several osteotomies and various fixation techniques are described for its correction. The most commonly used is the lateral closing-wedge osteotomy, also known as French osteotomy with variable results. Persistent lateral condyle prominence leads to cosmetically unacceptable appearance and poor patient satisfaction. To avoid this problem, dome osteotomy is performed. We have evaluated results of dome osteotomy in our population. Material and Methods: This was a retrospective study carried out in our institute. Ten patients with cubitus varus treated by dome osteotomy were evaluated at 24 months. All patients were operated by triceps-splitting approach. Pre- and postoperative carrying angle of elbow, range of motion, and lateral condyle prominence index were compared according to Banerjee criteria. Results: Ten patients with average age of 9.1 years were followed up for 2 years. Mean gap between injury and surgery was 15 months. Postoperative improvement in carrying angle and lateral condylar prominence index was significant. One case developed ulnar neuropraxia, which recovered fully within 2 weeks. Pin tract infection was seen in three cases and skin infections in two cases. Conclusion: Dome osteotomy is a technically demanding surgery. The functional and cosmetic correction is better compared to that for French osteotomy.
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CASE REPORT Top

Limb salvage for malignant bone tumors: Surgical audit in a case of osteogenic sarcoma p. 43
Alok C Agrawal
DOI:10.4103/jodp.JODP_1_18  
Limb Salvage has become the state of Art treatment used in managing maligmant bone tumours. Many times with the ignorence of tumour behaviour and natural history, absence of protocols, peer pressure and growing confidence levels, some common principles are missed leading to poor outcome. This paper deals with a surgical audit of avoidable complications following limb Salvage in a case of osteogenic sarcoma.
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