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   Table of Contents - Current issue
January-April 2020
Volume 3 | Issue 1
Page Nos. 1-27

Online since Thursday, April 30, 2020

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Insights in current orthopaedic practice p. 1
Alok Chandra Agrawal
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Is Vertebral artery compression a cause of cervicogenic vertigo in cervical spondylosis patients? A color doppler ultrasound correlation study p. 3
Kranti Bhavana, Subhash Kumar, Sudeep Kumar, Pragya Kumar, Anup Kumar, Prem Kumar
Introduction: Pathophysiology of vertigo in patients having neck pain is not well understood, and many theories have been postulated. Cervical spondylitis is one of the most common causes of neck pain, and these are the group of patients who often complain of vertigo. The role of vascular flow alteration in these patients in causing vertigo is under investigation. We intended to study the vascular flow pattern in the vertebral circulation using color Doppler ultrasound in these patients and compare it with controls. Material and Methods: Fifteen cases and 11 controls were evaluated using color Doppler ultrasound. All these patients were evaluated in detail by the Ear, Nose, Throat and the orthopedics department. The statistical analysis was done by IBP SPSS version 22 software. Independent t-test was performed to compare the case and control groups. Results: The mean intimal thickness of common carotid artery of cases was significantly less than the controls (0.35 mm vs. 0.51 mm for the right common carotid artery and 0.38 mm vs. 0.54 mm for the left common carotid artery, P < 0.05). The diameter of the right vertebral artery (VA) in neutral and left rotation positions was less in cases than in controls, but the difference was not significant, whereas the diameter in the right rotation position was the same both in cases and controls. The blood flow velocity in the right VA was less in the cases than controls, but this difference was not statistically significant. The diameter of the left VA in all the three positions (neutral, right rotation, and left rotation) was less in cases than in controls, and this was statistically significant (P < 0.05) for neutral and left rotation positions. The blood flow velocity in the left VA was less in the cases than controls for all the three positions, but this difference was not statistically significant. Conclusion: 1. Our study demonstrates the role of vascular compromise in the VA circulation in patients suffering from cervical spondylosis and vertigo. Narrowing of VA was present in cases and that too on the left side. The cause behind left-sided predilection could not be ascertained with certainty. Since the difference in blood flow was not significant in cases and controls, a definitive correlation is possible only if the sample size is more and results are replicated 2. Mild relief in symptoms after physiotherapy in the form of transcutaneous nerve stimulation and interferential therapy also points toward a possible role of nerve irritation in causing vertigo in patients of cervical spondylosis. The causation seems to be multifactorial in nature.
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Pinhole effect and manual bowel gas displacement: Simple two tricks for better fluoroscopy imaging in iliosacral screw fixation p. 8
Sandeep Patel, Mandeep S Dhillon, Saurabh Vashisht, Vishal Kumar
Introduction: Presently written abstract. Material and Methods: Total 50 out of 75 patients with pelvic fractures were managed with ilio-sacral screws. Results: At mean followup of 18 months non had iatrogenic injuries and ilio sacral screws were well within bony corridors. Conclusion: The use of pin hole effect and manual displacement of bowel gas shadows can reduce the margin of error while passing percutaneous iliosacral screws.
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Incidence of lumbosacral tuberculosis: A pilot study in a tertiary center p. 11
Vishal Kumar, Saurabh Agarwal, Sarvdeep Singh Dhatt, Raj Bahadur
Introduction: Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all musculoskeletal tuberculosis, affecting mostly the young population in their productive years of life. Characteristically, there is destruction of intervertebral disc and adjacent vertebral bodies radiologically, leading to deformities and neurological symptoms. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness and neurological symptoms. Patients with tuberculosis affecting the lumbar and sacral region may be confused with benign conditions such as prolapsed intervertebral disc until late due to absent neurological symptoms. Magnetic Resonance Imaging is the most sensitive investigation for diagnosis of spinal tuberculosis. Material and Methods: From July 2014 to September 2014, all the patients presenting to the orthopaedic outpatient department with nontraumatic back pain were evaluated. Results: Out of 16 patients diagnosed as spinal tuberculosis 11 had lumbar and Lumbosacral, 3 had dorsal, 2 had dorsolumbar region involvement. Conclusion: MRI is most sensitive investigation to diagnose undefined back pain. These back pain are due to spinal tuberculosis. Lumbosacral tuberculosis is more common than dorsolumbar region.
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Luxatio erecta of the hip- A report of five cases and the literature review p. 13
Ganesh Singh Dharmshaktu, Navneet Adhikari, Binit Singh
Hip dislocation is a serious injury which most commonly presents as posterior dislocation. Inferior dislocation is a rare event with a few anecdotal case reports or series described in the literature. This has also been called luxatio erecta of the hip borrowing from similar affliction at shoulder. We report five cases of luxatio erecta of the hip managed by reduction and conservative care in all but one. All five cases were males (mean age 31.8 years, range 18–52 year) with three cases being isolated injuries, whereas associated fracture of ipsilateral superior ramus and shaft femur was found in two separate cases. All were managed conservatively following closed reduction, except the case with shaft femur that was managed by additional operative fixation following the reduction of hip. The results were excellent in all cases without radiological evidence of avascular necrosis during the mean follow-up of 7.6 months (range 4–10 months).
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Recurrence of giant cell tumor in fibular graft after resection of distal end radius p. 17
Nishant Kashyap, Abhijeet Subhash, Ritesh Runu, Ashutosh Kumar, Gaurav Khemka
Giant cell tumor (GCT) of the distal radius accounts for 10% of skeletal GCTs, next to distal femur and proximal tibia. It has high propensity for recurrence. Treatment consists of extended curettage or en bloc resection of the lesion with subsequent reconstructions. We report a case of a 31-year-old female with recurrence of tumor in the well-united grafted ipsilateral fibula used for reconstruction of the wrist after excision of GCT in the left distal radius. Surgical plan of the ulnar translocation was changed to carpus centralization and wrist arthrodesis due to intraoperative radial artery injury. Computed tomographic angiography must be done before planning as single artery is contraindicated for ulnar translocation.
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Diagnostic duplicity of spindle cell sarcoma: Stitch in time saves nine p. 22
Amit Kumar Salaria, Vishal Kumar, Ajay Savlania, Sarvdeep Singh Dhatt
The prime cause of low backache with radiculopathy is prolapsed intervertebral disc, but in conditions where the radiology and scans of the lumbosacral spine are insignificant and the symptoms are progressive, it can be a tumor involving the sciatic nerve. Here, we present a case of a 26-year-old female managed conservatively for her low backache with radiculopathy which ultimately turned out to be an undifferentiated malignant nerve sheath tumor of the sciatic nerve. It is one of the largest nerve sheath tumors reported in the literature. Combined transabdominal and Kocher–Langenbeck approaches were used to resect the tumor. Histopathology confirmed the diagnosis of the undifferentiated malignant nerve sheath tumor. Through this case report, we emphasize to screen the pelvis early if symptoms of sciatica are progressive along with insignificant scans of the spine.
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Professor (Dr) Hareram Singh p. 26
Dilip K Sinha
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