Year : 2020 | Volume
: 3 | Issue : 1 | Page : 1--2
Insights in current orthopaedic practice
Alok Chandra Agrawal
MS, DNB, PhD Orthopaedics, FAMS, All India Institute of Medical Sciences, Raipur, India
Alok Chandra Agrawal
MS, DNB, PhD Orthopaedics, FAMS, All India Institute of Medical Sciences, Raipur
|How to cite this article:|
Agrawal AC. Insights in current orthopaedic practice.J Orthop Dis Traumatol 2020;3:1-2
|How to cite this URL:|
Agrawal AC. Insights in current orthopaedic practice. J Orthop Dis Traumatol [serial online] 2020 [cited 2020 Jul 11 ];3:1-2
Available from: http://www.jodt.org/text.asp?2020/3/1/1/283675
I feel privileged to write on Insights in current orthopaedic practice for the Journal of Orthopedic diseases and Traumatology. In this issue, there are 6 articles which are on orthopedic problems which we face in our day to day practice but with a different practical approach.
The first paper is on the Incidence of Lumbosacral Tuberculosis: A Pilot Study in a Tertiary Center by Dr. Vishal Kumar, Dr. Saurabh Agarwal, Dr. Sarvdeep Singh Dhatt and Dr. Raj Bahadur, one of the senior most orthopaedic teachers in India from the Department of Orthopaedics, PGIMER, Chandigarh, and Baba Farid University of Health Science, Faridkot, Punjab, India. This is a small study on 16 cases of tuberculosis of the spine but it informs us of the changing trends in the incidence of spinal tuberculosis whereby initially the disease was more common at the dorsolumbar junction may be because of the area being in proximity to the lungs and cysterna chylie or due to the spine having extra loads due to change from dorsal-kyphosis to lumbar-lordosis or stable segment with mobile segment being injured more. The author want to emphasize that now it is predominantly affecting the lumbo-sacral junction, this may be due to the better imaging facilities like CT and MRI leading to an early diagnosis and timely treatment, and preventing the spread to other parts of the spine. Although this is a small study but the insight will motivate us towards multicentre and larger studies to confirm this changing scenario.
With the increase in high speed vehicular accidents, the pattern of injuries have changed and more patients are coming with pelvic fractures. Percutaneous iliosacral screw fixation is one such management protocols, but at centers where O -Arm or CT guided imaging operative facilities are not available, the surgeon faces the problem of operating with C arm image intensifier without proper visualization of image. A solution to this problem has been projected by Dr. Sandeep Patel, Dr. Mandeep S. Dhillon, Dr. Saurabh Vashisht and Dr. Vishal Kumar from the Department of Orthopaedics, PGIMER, Chandigarh, India in their article on “Pinhole Effect and Manual Bowel Gas Displacement: Simple Two Tricks for Better Fluoroscopy Imaging in Iliosacral Screw Fixation”. The authors have mentioned the procedure in two series of 50 and 20 patients with success and the study needs to be evaluated by more surgeons in the form of multicentric studies for a widespread acceptability.
Vertigo is a common multi-departmental problem in patients having neck pain. It has been hypothesized that cervical spondylosis may also be one of the causes. Dr. Kranti Bhavana, Dr. Subhash Kumar, Dr. Sudeep Kumar, Dr. Pragya Kumar, Dr. Anup Kumar and Dr. Prem Kumar from the Departments of Otorhinolaryngology, Radiology, Orthopaedics and Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India, have thrown light on through their article “Is Vertebral Artery Compression a Cause of Cervicogenic Vertigo in Cervical Spondylosis Patients? A Color Doppler Ultrasound Correlation Study” on 15 patients of cervical spondylosis and 11 controls has found that - the diameter of left vertebral artery in all the three positions (neutral, right rotation, and left rotation) was less in cases than controls, and this was statistically significant. This could explain some kind of vascular compromise to the posterior cerebral circulation in cervical spondylosis patients, especially on changing posture of the neck. This could be one of the reasons for dizziness and vertigo in these patients. This is a finding which will gradually necessitate the need of cervical colour Doppler in younger patients apart from the elderly where it was routinely done to assess atherosclerosis as a cause of vertigo.
There are three case reports published in this issue. In a case report on “Recurrence of Giant Cell Tumor in Fibular Graft after Resection of Distal End Radius” by Dr. Nishant Kashyap, Dr. Abhijeet Subhash, Dr. Ritesh Runu, Dr. Ashutosh Kumar, and Dr. Gaurav Khemka from the Department of Orthopaedics, IGIMS, Patna, Bihar, India, the author have found a recurrence in the fibula which was used to reconstruct the wrist following excision of a Giant cell tumour of distal radius. It is extremely important to know whether this was a recurrence as the fibula initially never had a GCT or it is seedling of GCT during the initial reconstructions by the K wires stabilizing the wrist or it is a primary GCT in the fibula. Genetic research in this field is being done to identify markers of malignancy and recurrence like Ki-67, mutant p63, over expression of C-myc oncogene and CD147. A genetic screening with CD147 done in this case may have thrown light on this issue as CD147 has been found to be an adequate marker for GCT recurrence. It is worthy to write that recurrence in fibular graft had not been reported till date and this problem following centralization of the carpal bones and wrist fusion has not recurred till date.
Dr. Amit Kumar Salaria, Dr. Vishal Kumar, Dr. Ajay Savlania and Dr. Sarvdeep Singh Dhatt from the Department of Orthopaedics and Surgery, PGIMER, Chandigarh, India are reporting on a case of a 26-year-old female who presented with low back pain and was suspected as a case of intervertebral disc prolapse. The MRI done at this stage was normal but when symptoms worsened a pelvic MRI and histopathology reported the diagnosis as intra-pelvic spindle cell sarcoma extending from the greater sciatic notch. The authors want to give the insight that if patients are symptomatic inspite of therapy, an Orthopaedic surgeon should get an additional MRI pelvis so that the diagnosis is not missed or patient presents with flaring of symptoms.
The last paper on five cases of anterior dislocations of the hip joint which otherwise is a rare entity. As posterior dislocation of hip joint is more common the young orthopaedic surgeons are not conversant with anterior dislocation and there is a need for formulating proper guidelines as suggested by. Dr. Ganesh Singh Dharmshaktu, Dr. Navneet Adhikari and Dr. Binit Singh from the Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India in their paper on “Luxatio Erecta of the Hip- A Report of Five Cases and the Literature Review”. They write the term “Luxatio erecta” is commonly used to describe inferior shoulder dislocation and similar affliction in the hip region, be called “luxatio erecta femoris”, although it is not an authentic medical terminology. I feel that the agony and pain associated with an abducted shoulder in luxatio erecta should be contained in the shoulder only avoiding confusion for new learners.
All the articles provide a new insight and direct you to think the pros and cons of these studies, which will benefit you in your practice. These articles have a level of evidence 3 and 4, scientifically written and have brought forward new concepts worthy of publication.