Osteoporosis, the metabolic disorder has become a global epidemic1 with increase in life expectancy and changing life style.Quantitative ultrasound is a cheap, non invasive, portable and convenient method to estimate bone strength without any radiation hazard.2-5The aim of our study is to estimate the bone mineral density by using quantitative ultrasound, look for the influence of parameters like lifestyle factors, comorbidities, chronic drug intake, and other risk factors on BMD; and compare the results with those in the literature done with DEXA scans.In our study of 516 subjects, (i) BMD measures varied from -5.6 to +.5.55 with a mean of -1.8.(ii) BMD decreased significantly with age (r=.351, p<0.0001), (iii) Low BMD was associated with increase in Fragility fractures (p=.007) (iv) Antacid intake, which was pretty common in our subjects (28.7%) led to decrease in BMD (p<.005).(v) Diabetes significantly reduced BMD (p<.005).(vi) Increase in BMI led to significant increase in BMD (r=.166, p<.0001).(vii) BMD increased significantly with increase in physical activity (r=.148, p<.001).Most of the associations found in our study, except that with diabetes, were similar to those consistently associated with BMD as measured with DEXA scans.6-15Our study suggests the use of Quantitative ultrasound as powerful epidemiological tool with similar outcome measures to DEXA scan without any radiation hazards.
Background: Trauma management is an ever evolving part of orthopaedics and with the latest advancement in metallurgy, crafting processes and biomechanical studies, the implants used have been continuously changing.Distal femur fractures occur at a major joint and their management has always been complicated ranging from preoperative, intra-op to postoperative period.All the studies and research are aimed towards achieving the best functional outcome and functional outcome studies help in collecting and assimilation of the data for the same which further help in modification of techniques to further improve the same.This study focusses on the outcomes achieved by using the distal femur locking compression plate for the management of fractures distal end of femur.Materials and Methods: Prospective, unicentric, observational study from June 2018 -February 2020.All patients with distal femur facture were included.Pathological fractures, open fractures, fractures older than 3 weeks and patients with ipsilateral proximal tibia, patella and proximal femur were excluded.Surgical approach was surgeon's choice.Functional outcome was measured using Knee Society Knee Scoring system at 6weeks, 3 months, 6months and 12 months.Functional outcome measured at 12 months was used for evaluation.Results: 28 patients, 19(67.9%)males and 9(32.1%)females.89.47% of males sustained the fracture due to road traffic accident and 66.66% of females sustained due to fall and all belonged to age group more than 60 years.The average range of motion achieved was 112.3° ± 8.2.Functional outcome at 12 months 71.4% patients had excellent, 25% had good and 3.6% patients had fair and no patient had poor outcome.Conclusion: Distal femur fracture is more common in the age group of 21-40 years.The average range of motion of knee achieved in Type A and Type B fractures are significantly better than Type C fractures.Excellent functional outcome was statistically significant in Type A and Type B fractures when compared to Type C fractures.
Scapular winging is a rare, painful and debilitating condition that leads to limited functional activity of the upper extremity.The composite scapular movement of rotation, abduction, and tilting is necessary for proper shoulder function.Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects.It can result from numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury of either the serratus anterior, trapezius, or rhomboid muscles.Diagnosis is easily made by inspection of the scapula from back, with serratus anterior paralysis resulting in medial winging of the scapula while lateral winging is caused by trapezius and rhomboid paralysis.Most cases of serratus anterior and rhomboid paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective.Patients become candidates for corrective surgery if they fail a 6-24 month course of conservative treatment.This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment.
The question of primary exploration of radial nerve in cases of palsy associated with humerus fractures is still unanswered.We present a short case series of humerus fractures with radial nerve palsy where we found radial nerve transection warranting intervention.
Mucoid degeneration of the ACL is largely an underdiagnosed condition.These are often misjudged as partial tears of ACL on routine MRI evaluation.Here we histologically analyse the incidence of mucoid degeneration of the cruciate ligaments in 32 patients who underwent primary total knee arthroplasty in our institute.10 among them had bilateral total knee replacements making the total sample size 42 knees.ACL samples were sent for histopathological evaluation from 41 knees (one knee was an ACL deficient knee), and PCL samples were sent from patients who underwent total knee replacements with posterior stabilising implants.out of these 41 samples of ACL, 60.9 % turned out to be positive for mucoid degeneration.9 out of 13 PCL samples (69.5%) turned out to be having mucoid degeneration.This study shows that the real incidence of mucoid degeneration of cruciate ligaments is much more than what is reported in literature.This emphasises the role of preoperative MRI to look for coexisting painful mucoid degeneration even in elderly patients with early osteoarthritis, which is an arthroscopically treatable condition thus delaying the total knee replacements in these patients.The higher incidence of mucoid degeneration in cruciate ligaments associated with advanced arthritis raises the question of functional integrity of PCL in these patients, making the use of posterior stabilising implants more advisable in patients with advanced stages of osteoarthritis.
Segmental forearm fractures are rare injuries in adults. 1 Double segmental fractures/trifocal fractures are extremely rare, 2 and guidelines regarding their management options are lacking in literature.We hereby report a rare case of a double segmental ulnar fracture (segmental ulnar shaft fracture with a concomitant communited olecranon fracture) with ipsilateral butterfly segment fracture of the radius.We used interfragmentary screws and 3.5 olecranon locking plate for proximal ulna and 3.5 DCP for distal ulnar fracture & radial fracture.Perusal of literature showed a single case report, which suggested intramedullary nailing for radius and ulna, along with tension band wiring for olecranon. 3Here we present the outcome in terms of union, grip strength and Range of motion.
A 59-year-old male, diagnosed with advanced arthritis of left hip underwent total hip arthroplasty using a modular dual mobility with metal liner. Post-operative radiographs there was suspicion of incomplete seating of the metal liner inferiorly. The patient was reoperated the next day which confirmed the incomplete seating. The metal liner seating was corrected which was confirmed by intra operative visualization and fluoroscopy. Post-operative radiographs showed complete seating of the liner. Periodic follow ups were uneventful. Incomplete seating of dual mobility metal liner especially at the inferior part, though seldom reported is a possible complication which can lead to early failure.
Patellar tendon rupture is a rare but devastating complication following total knee arthroplasty.We report a case of a failed patellar tendon reconstruction and prosthetic joint infection following patellar tendon rupture.The objective of this case report is to highlight the favorable outcome following revision patellar tendon reconstruction with a synthetic graft and two stage revision arthroplasty.
New Beginnings Bill Johnson González This issue of Diálogo marks an important moment of transition for our journal. Since 2010, when she accepted the position as Director of the Center for Latino Research at DePaul University, Dr. Elizabeth Martínez has directed Diálogo as Editor in Chief, a role that finally came to an end with the publication of our previous issue in Fall 2019. Elizabeth shepherded the journal through its first major growth spurt: from a non-peer-reviewed, annual, magazine-style journal, to a biannual, fully refereed, academic journal, publishing work by scholars from around the world. Under Elizabeth's guidance, the journal was awarded the Council of Editors of Learned Journals' Phoenix Award in 2015 for most transformed and revitalized journal. In addition, thanks to Elizabeth's hard work and leadership, our journal is now published by the University of Texas Press, is fully indexed in the MLA International Bibliography, and is accessible online through Project Muse. As she moves on to new projects and new horizons, I wanted to express our thanks to Elizabeth for these significant editorial achievements, and for opening Diálogo up to a wider readership and greater recognition. My editorship of Diálogo officially begins with this issue, whose special theme is the Indigenous presence in contemporary Latin American cinema. This theme, which brings together scholars from across the hemisphere as well as from around the world, exemplifies our commitment to publishing outstanding scholarship that grapples with the complex cultural production and history of the Americas. In the future, we look forward to continuing to publish specially themed issues, and we encourage you to look at the guidelines for submitting new proposals included in the back of this issue. In addition to special themes, however, we are also opening up Diálogo to general submissions from scholars who are working in US Latinx and Latin American Studies. Please feel free to send us queries about whether a particular article would be a good fit for our journal by emailing dialogo@depaul.edu. We are particularly interested in proposals that explore migration, gender and sexuality, and new cultural forms, and projects that take a transnational approach. Upcoming themes already in production include an issue on violence in contemporary Argentine and Peruvian literatures, another on "Latinx Noir" (Latinx detective fiction), and finally, one that explores the histories of Latino Studies programs and departments established throughout the Midwest. We have other innovations in store as we move forward into a new era. Soon, we will be introducing a recurring section for research on Latinx communities in the Midwest. We are also expanding our book and media review section, and we welcome suggestions for book reviews from multiple disciplines. I'm excited to see where our Diálogo will take us! [End Page 1] Bill Johnson González DePaul University Copyright © 2020 University of Texas Press
Coccydynia" unresponsive to a trial of conservative treatment should be evaluated promptly.Otherwise we may be fraught with the danger of serious complications.Sacral tumors are often quiescent to start with.They may achieve enormous size before they become symptomatic.Here is a case report and literature review of such a case in a 63 year old male, which was initially treated as coccydynia, till he became severely symptomatic.Chordomas are the most common primary tumor of the sacrum in adults.They are locally aggressive with immense potential for local recurrence and metastasis to lungs and other bones.If they get to the right hands at the right time, they are mostly curable.Total sacrectomy (Enbloc resection) is the treatment of choice for sacral chordomas.In early stages, a low sacral resection all from behind is possible.Lesions extending higher than S3 requires high sacrectomy and lumbopelvic fixation depending on the integrity of the sacroiliac joints.High sacrectomy has high morbidity of permanent colostomy and bladder catheterization.A 63 year old man presented with coccydynia of long duration and was diagnosed as chordoma of the sacrum upon imaging and image guided biopsy.He was treated with anterior, posterior and anterior surgeries in a single sitting, through a multi disciplinary approach.
Spastic or contractural deformities at multiple joints of cerebral palsy patients, is the major reason for their poor quality of life. There is no cure to cerebral palsy, but various forms of therapy can help patients with this disorder to function more effectively. One such multidisciplinary intervention is “single event multi level surgery”. Our aim was to assess the improvement of cerebral palsy patients with single event multilevel surgery. It was a hospital based descriptive study done at the Govt Medical College Trivandrum, Calicut and MES medical college, Perinthalmanna with 143 patients over a period of 36 months. All patients with spastic type cerebral palsy having adequate standing balance without any significant prior surgeries were included. Different soft tissue or bony procedures were done at hip, knee and ankle at single sitting according to deformities. Postoperative improvementwas assessed with Grossmotor function classification system and gait. Postoperatively 40 patients had improvement in one level of GMFCS score, 60 had two level, 21 had three level and 13 had four level improvement, but 5 remained constant. Of the 51 who were unable to walk, 40 became household ambulators and 7 became community ambulators and of the 64 house hold ambulators, 63 became community ambulators. Overall, we appreciated a significant improvement in gait and functional ability of patients with single event multilevel surgery. Gait parameters improved much faster and to a greater degree than did functional parameters showing their nonlinear relation. Post surgical physiotherapy is vital in maintaining and improving the function.
Purpose: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL) deficiency remains controversial. The purpose was to evaluate cost and functional results after one-stage bilateral ACL reconstruction using hamstring tendon autograft. Methods: This prospective study evaluated the mid-term functional outcome of 7 patients (14 knees) who had undergone one-stage bilateral ACL reconstruction. Results: The median length of hospital stay was 4 (3–5) days. The duration of rehabilitation process in patients with bilateral ACL reconstruction was 6–8 weeks. The mean Lysholm score was 93 (90–95), IKDC score 78.7 (74.7–82.75), and Tegner activity score level 5. The median time to return to full-time work and to full sports was 9 weeks and 8 months respectively. 6 patients (85.7%) in the study group returned to their pre-injury level of activity. Conclusions: Mid-term clinical results suggested that one-stage bilateral ACL reconstruction using hamstring tendon autograft is clinically effective. For patients presenting with bilateral ACL-deficient knees, one-stage bilateral ACL reconstruction is reproducible, cost effective and does not compromise functional results.
Involvement of the spine by GCT is not unusual, constituting 7% of all cases of GCT. Due to axial location, giant cell tumours of the spine may present at a more advanced stage when compared with those of extremities and are more challenging surgically. We present the case of a 33 year old lady with GCT of L3 vertebra which was treated initially with posterior stabilisation followed by intralesional excision and vertebral body reconstruction with a cage filled with iliac crest bone graft. The tumour recurred two times—at 4 and 6 years respectively. These were again treated surgically. Histological picture of the tumour remains the same. There is no evidence of recurrence two years after the last surgery.
Coronoid process plays a critical role in ulnohumeral stability.,13 Coronoid process fractures are rare, and usually occur from avulsion by the brachialis muscle or may be part of a complex injury pattern associated with elbow dislocation.,46 Surgical treatment options described includes suture lasso, suture anchors, lag screws, and plating all of which have various merits and demerits.,1,7,8 We describe a minimal anterior incision & percutaneous K-wires to address coronoid process fractures which allowed anatomic reduction and stable internal fixation.
Non union is one of the commonest complications of intra-capsular fracture neck of femur in children as well as in adults and it is the most challenging problem to treat if femoral head salvage is attempted. Another common complication is avascular necrosis (AVN) of the femoral head with most reported incidences being
I first heard of Augusto Sarmiento when I was a PG student learning to apply PTB casts for fractured tibiae. The functional bracing technique of fracture treatment is enough to sustain Sarmiento’s orthopaedic reputation, even discounting his 170 odd published papers on, mostly, hip surgery which was his main specialty. He described the technique when open reduction with rigid internal fixation was considered the best way to treat fractures. He had a hard fight getting bracing accepted. The story of that fight is here, as are the many others he fought against the establishment, sometimes winning, often losing, but always making a point.
It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of a middle aged man with undiagnosed chronic renal failure and secondary hyperparathyroidism who presented to us with Brown tumor of bilateral patellae with pathological fracture. An initial radiograph showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the left patella and pathological fracture in right patella. Being a sesamoid bone, brown tumor of patella is extremely rare indicative of severe secondary hyperparathyroidism. Fracture was treated surgically by curettage, biopsy and wiring, and renal failure was treated by nephrologist. One and half months after the fixation of fracture and improved renal function, along with calcium and Vit D supplements, complete healing of fracture and rapid bone formation was observed on radiographs.
Congenital pseudarthrosis of the clavicle is a rare condition. Bilateral presentation is even rarer, with less than ten reports in the literature. There are no definite treatment recommendations for want of sufficient long term follow up of untreated cases. We report a 27 year old man with bilateral congenital pseudarthrosis who has no pain or functional impairment and is actively involved in all day to day activities. The radiological appearance of the case is different from previous reports in that there is a hypertrophic segmental nonunion at the pseudarthrosis bilaterally. We propose that surgical intervention as a prophylaxis for future thoracic outlet compromise is not indicated.
Introduction: Injury to the anterior cruciate ligament (ACL) is the commonest cause of knee instability. Arthroscopic intra articular ACL reconstruction with soft tissue graft is the standard treatment for symptomatic ACL deficient individuals. Non anatomical ACL reconstruction results in loss of range of movement, residual laxity and graft failure. This study aims to make an assessment of femoral tunnel length through a precise low anteromedial portal for the femoral tunnel. Materials and Methods: A prospective study was conducted on fifty patients who presented with acute or chronic ACL insufficiency to the Orthopaedics Department at Baby Memorial Hospital, Calicut, during the period April 2013 to April 2014. Males aged 18 to 45 were included. Females, revisions, associated fractures, and flexion less than 110 degrees were the exclusion criteria. All patients underwent pre-operative clinical and MRI assessment. Low anteromedial portal was used in all patients for the femoral tunnel. Results: The mean age of patients was 29.42 years. Most common mode of injury was sports injuries. Femoral tunnel length was between 50 mm and 36 mm with mean length of 42.80 mm and standard deviation of 3.938. Condyle AP diameter and tunnel measurement correlation coefficient value was 0.347 and condyle width and tunnel measurement correlation coefficient value was 0.538. Conclusion: Low anteromedial portal, placed 5mm medial to the medial border of patellar tendon just above the medial meniscus, can overcome the drawback of short femoral tunnel in anatomical ACL reconstruction. Hyper flexion of the knee is recommended for femoral tunnel drilling. Femoral tunnel length is positively correlated with the lateral condyle width and AP measurement.
