Angiofibrolipomas belong to a subtype of lipomas that contain mature fat cells, blood vessels, and collagen. These are extremely rare growths with previous case reports having documented these tumors in various body locations. We report what appears to be the first case arising from the flexor tendon sheath at the wrist causing carpal tunnel syndrome.

Solitary enchondromas are usually seen in the tubular bones of the hands and feet. Their occurrence in the radius is extremely rare. Here, we report a male patient in his 30s with a history of pain in the right forearm for the past 7 months and swelling for the past 4 months. He was radiologically diagnosed with enchondroma of the radial shaft. He underwent an open biopsy and curettage of the lesion. The histopathological evaluation further confirmed the diagnosis. Following the surgical management, he was symptomatically better on follow-up visits. Enchondromas of the radius are rare in occurrence. A high index of suspicion and clinical evaluation is necessary to diagnose and manage such lesions.

Hereditary Sensory and Autonomic Neuropathy (HSAN) Type II is an autosomal recessive genetic disease which presents predominantly with sensory neuropathy and neuropathic ulcers. HSAN Type II is a rare disease, and in the few cases that have been reported, the focus has been on identifying genetic markers of the disease. Orthopaedic conditions may be a major presentation of the disease, and the prevention of superficial trauma and foot care is the only definitive management.

Objectives: Osteoarthritis (OA) is the most prevalent joint disease and a common cause of joint pain, functional loss, and disability. We had conducted a randomized, double blind, multi-centric, Phase 3 study (Registered prospectively in Clinical Trial Registry of India: CTRI/2018/09/015785. Study has been approved by Drug Controller General - India) to assess the efficacy and safety of intra-articular administration of stempeucel® (Allogeneic, Bone Marrow derived, Pooled, Mesenchymal Stromal Cells) in Patients with Grade II and III Osteoarthritis of Knee. Methods: 146 patients of primary osteoarthritis having Grade II & III OA based on Kellgren and Lawrence radiographic criteria were randomized to stem cell and placebo group in a ratio of 1:1. Patients having subchondral sclerosis (by X ray), complete tear of ACL / PCL, grade 3 meniscal tears and exclusive patellofemoral arthritis (by MRI) were excluded from the study. 73 patients each received either a single intra-articular injection of stempeucel ® (25 million cells) followed by 20mg hyaluronan or Placebo (saline) followed by 20mg hyaluronan under ultrasound guidance. These patients were followed up for 12 months with 7 visits. The primary end point was evaluation at one year follow up of WOMAC Composite Index score (score range 0 – 2400) as compared to the placebo arm. Secondary end points were – WOMAC sub-scores (pain [0-500], stiffness [0-200] & physical function [0-1700]), VAS [0-100] & MRI assessment (by 3T imaging) of the articular cartilage (T2 mapping [assessment of hydration & cartilage quality], volume [measured using dicom reader and calculated at midportion of medial and lateral tibiofemoral compartment] & thickness [measured at mid points of 20 predetermined sub-regions of two compartments]). Radiological evaluation was done by an Independent, blinded radiologist. Results: The mean weight and BMI of patients in stempeucel® and placebo arms were 67.1 kg & 26.5 and 65.4 kg and 26.2 respectively. Majority of patients in the study were females (Female vs Male: 64.4% vs. 35.6% for stempeucel® arm, 69.9% vs. 30.1% for placebo arm). Total 74 and 72 patients accounted from Grade II and Grade III OA respectively. 65 patients from stempeucel® and 68 patients from placebo arm completed 12 month follow up period. WOMAC composite index, the primary end point of the study, showed significant improvements in cell arm as compared to placebo at month 6 (mean difference: -349.91; 95% CI [-493.00, -206.81], P<0.0001; percentage change: -35%) and month 12 (mean difference: -632.74; 95% CI [-791.57 - -473.91], P<0.0001; percentage change: -44.3%) (Table 1, Figures 1 & 2). Additionally stempeucel® significantly improved WOMAC pain, stiffness, physical function and VAS scores at 6 and 12 months (P<0.0001 {for all parameters}) in stempeucel® arm as compared to placebo arm. Further Mixed Model Repeated Measures analysis was done and it was seen that the reduction in WOMAC total score in stempeucel® group was statistically significant when compared to placebo but MRI grade (Grade II or III) has no impact on the overall treatment effect (P=0.9658).T2 mapping shows that there is no worsening of the deep cartilage in the medial femoral tibial compartment of the knee in stempeucel® arm at month 12 follow up (change from baseline -0.6 ms, mean value 36.1 ms, P= 0.6188) within the group whereas in placebo arm there is significant and gradual worsening of the cartilage seen within the group at month 12 (change from baseline: 10.8 ms, mean value 47ms, P<0.0001) (Figure 3). Cartilage volume analyzed by Generalized Estimating Equations (GEE) method shows there is increase in average cartilage total volume of 34.07 units (95% CI [-63.08, 131.22], P= 0.492) in stempeucel® arm as compared to placebo arm irrespective of time. No change in cartilage thickness (P=0.5776 at month 12) and morphological score (P=0.7115 at month 12) were seen. CTX – II (measure of C-terminal crosslinked telopeptide type II collagen secreted into urine and indicative of disease progression) showed decrease in levels (-7.79 pg/ml, 95% CI [-96.18, 80.60], P=0.863) in stempeucel® arm irrespective of time when analyzed using GEE method. Anti – inflammatory marker IL-10 in serum was measured and within the group, its levels in placebo group decreased by -0.228 pg/ml at month 12 (p=0.0156) whereas in the stempeucel® group it increased by 0.051 pg/ml (p=0.0625). The reduction in intake of analgesic were monitored and it was found that there is no significant difference in intake or reduction of analgesics in both the groups (11 patients from stempeucel ® and 9 patients from placebo group had reduction in intake of analgesics). There was 49 AEs in 24 patients in the stempeucel® group and 33 AEs in 20 patients in the placebo group. 5 AEs (4 & 1 in stempeucel® & placebo arm respectively) were possibly / probably related to the study drug and were – injection site swelling and pain. These improved within one week of symptomatic therapy. No significant differences were found in other safety parameters like vital signs, ECG, physical examination and laboratory parameters. Conclusions: Allogeneic, pooled BM-MSCs (stempeucel®) has proven to be safe and effective for treatment of Grade II and Grade III Osteoarthritis of knee. The intervention is simple, easy to administer, does not require surgery, provides sustained relief of pain, stiffness, improves physical function, prevents worsening of cartilage quality and improves cartilage volume for at least 12 months follow up.

Background:The C-MAC ® videolaryngoscope enables better visualisation of glottis for rapid and successful endotracheal intubation.Aim: The present study is aimed at comparing the conventional C-MAC ® blade with new 'D' blade in patients with simulated cervical spine immobilisation.Methods: This was a prospective, randomised and crossover study.Eighty patients were randomised to one of two groups: Group CD or Group DC (CD -Conventional blade first, DC-D blade first).Patients in each group had laryngoscopy performed with both the blades in random order following which the patient's trachea was intubated using the blade used for second laryngoscopy.Results: The mean (± SD) age was 39.4 (± 12.4) years.There were 33 male and 47 female patients.The average weight was 57.2 kg.No patient had a grade 3 or 4 view at initial laryngoscopy (without cervical spine immobilisation) with Macintosh blade and hence not excluded.75 patients had a grade 1 view and 5 patients with grade 2 view with D blade whereas 63 patients had a grade 1 view and 17 patients had a grade 2 view with the conventional blade.The difference was clinically and statistically very significant.The time taken for laryngoscopy and intubation, and the overall satisfaction score did not differ between the groups.Conclusions: The D blade of C-MAC ® videolaryngoscope enables better visualisation of glottis as compared to the conventional blade, for endotracheal intubation in patients with simulated limitation of cervical movements.The time taken for laryngoscopy, endotracheal intubation and the overall satisfaction score did not differ between the two blades.

Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors; age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking. Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy, was used. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively.. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong relation between knee OA and CVD, with CV risk score being positively correlated to the severity of OA.

Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors (age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking) with the help of the Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively. Pearson’s correlation coefficient was used to assess the relationship between CV risk factors and knee OA. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong positive Open Peer Review

Background and Aims: Shoulder disorders are common manifestations of musculoskeletal issues affecting patients with diabetes,but get relatively little attention. The aim of the study was to evaluate prevalence of shoulder disorders and its association with glycemic control, duration, and certain epidemiological factors in a section of population with type II diabetes. Material and Method: We conducted a prospective study including 32 consecutive patients with type II diabetes and 32 consecutive patients without diabetes attending the outpatient department for shoulder symptoms. Patients underwent physical examination and the proforma and UCLA-m (modified University of California at Los Angeles) Shoulder Rating Scale form were filled. Data was compiled on frequency and contingency tables. Central tendency was measured by mean and standard deviation. For determining the co-relation unpaired t test and chi-square test were used. Results: We observed that as the fasting blood glucose and HbA1c values decrease, the UCLA scores increase. Hence, proper glycemic control may help in reducing shoulder pain and complications. There was no relation between the UCLA score and diabetic duration or the age of the patient. Conclusions: We conclude frozen shoulder was the most common shoulder disorder in the diabetic group. It is more prevalent in diabetics when comparedto non-diabetics. Evaluation of upper limb manifestations in diabetics must include estimation of glycemic control and an examination for other diabetic complications.

Purpose::The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of tourniquets have been reported. Tourniquet pain is the most common complication. This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.Methods::It is a prospective observational study conducted on 132 consecutive cases. Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study. Patients with open injuries or contraindications such as diabetes mellitus, compromised circulatory states, neurological deficit, compartment syndrome and unable to give informed consent were excluded. The parameters assessed included duration of tourniquet use, tourniquet pressure, type of anesthesia, any interval release of the tourniquet and reapplication after a reperfusion period, whether upper or lower limb surgery, severity of tourniquet pain, timing of tourniquet release and complications. Chi-square and non-parametric Mann-Whitney U test were used for data analysis. Results::In upper limb surgeries, if duration of surgery was less than 60 min, 14 (51.8%) cases experienced tourniquet pain and 13 (48.1%) had no pain, and if duration of surgery was more than 60 min, 24 (60.0%) had pain and 16 (40.0%) experienced no pain. In lower limb surgeries if duration of surgery was less than 60 min, 2 (7.7%) experienced pain and 24 (92.3%) had no pain, and if duration of surgery was more than 60 min, 14 (35.8%) experienced pain and 25 (64.8%) had no pain. Degree of tourniquet pain increases with the duration of surgery. Statistically, there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs ( p = 0.034 and 0.024, respectively) Conclusion::Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia. Other risk factors assessed including tourniquet pressure, upper or lower limb surgery, tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.

Neonatal septic arthritis is a rare entity and an important differential diagnosis of distal humeral epiphyseal separation (DHES). DHES is yet again an infrequent phenomenon seen in less than 3.9% of physeal injuries which often masquerades as elbow dislocation. We report on a 20-day old term neonate referred with a suspected diagnosis of elbow dislocation following trauma. Subsequent to evaluation in a tertiary care hospital this was found to be a rare case of septic arthritis of elbow in a neonate mimicking DHES. The diagnosis of septic arthritis in neonates is often delayed because the characteristic symptoms and signs seen in older children are absent or subtle. DHES is a rare injury, which to an untrained eye, may be misdiagnosed as an elbow dislocation. Septic arthritis and acute osteomyelitis are differential diagnoses of DHES, however, the history of incidental trauma hoodwinked us to provisionally diagnose it as the latter.

Background . Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. This study was proposed to determine the optimal greater trochanteric entry point for PFNA-2 in unstable intertrochanteric femur fractures. Methods . We conducted an observational study on 40 patients with unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. The patients were grouped into two based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning the patients to the group by alternate allocation. The quality of reduction, tip apex distance, Cleveland index, and all the complications were noted. The final follow-up was conducted at six months. The functional outcome was evaluated using modified Harris hip score. The data analysis was performed using Student’s t -test, chi square test, and Mann–Whitney test. APvalue below 0.05 was considered significant. Results . Forty patients with 20 patients treated with medial entry point were included in group M and 20 patients in group L with lateral entry point. The group L had an average tip apex distance of 20.53 and group M had 20.02 (P=0.8). The complication of screw back out was seen in 3 out of 4 patients with poor reduction in group L. As per the Cleveland index, 6 patients in each group had suboptimal position and 4 out of 6 patients in group L with suboptimal position had screw back out. The lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison (P=0.01). Three patients in group L had varus collapse with screw back out. Also, none in group M (0.05). The average modified Harris hip score in group L at six months follow-up was 71.94 and 76.8 in group M (P=0.84). Conclusion . Overall, to achieve good quality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5 mm medial to the greater trochanter tip.

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many methods have been suggested to achieve and maintain fracture reduction during operative fixation for subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with long proximal femoral nail with or without cerclage wire fixation. All available data from patient’s records available in medical records department were retrieved and evaluated. Statistical analysis were performed using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage wiring should be considered in selected cases where reduction is poor after open reduction.

In modern healthcare, diagnostic imaging is an essential component for diagnosing ailments and delivering quality healthcare. Given the variety in medical scanning techniques, a recurring issue across different modalities is that the scan quality is often affected by artifacts introduced by hardware and software faults in the imaging equipment. Significant challenges in the 3D Imaging Techniques include low quality/low-resolution scan images or the addition of unwanted artifacts due to patient movement. Researchers have put forth solutions ranging from machine learning algorithms like Gradient Descent to more complex Deep CNN models for rectifying these faults. In this paper, we aim to benchmark deep learning models for improving the quality of diagnostic images, through Super-resolution, for enabling faster and easier detection of anomalies that may be missed otherwise. Super-resolution CNN and Deep CNN architectures were employed for up-sampling medical scans for enhancing their quality. The CNN models were trained to learn motion artifact characteristics that are a result of patient movement and negate its effects in the super-resolved output. We present comparative results of six super-resolution models on a standard dataset and metrics. During the experimental evaluation, it was observed that the ResNet SRCNN model outperformed all other models used for comparison by a large margin, with an improvement of 4.87 to 8.68% over the other state-of-the-art models.

Hip fractures are common in elderly population due to osteoporosis. Proximal Femur Nail Antirotation (PFNA) system has gained more importance in management of peritrochanteric fractures than conventional Proximal Femur Nail (PFN) due to ease of application and low complication rate. We report a case of a 64-year-old male patient who has sustained fracture neck of femur, seven months' post PFNA. It's a rare association to have fracture neck of femur with PFNA insitu and hence reported. Patient treated with removal of implant and hemi replacement of hip.

The International Labour Organization (ILO) in association with, World Health Organization (WHO) had found respect musculoskeletal issue (MSDs) as a business caused infection, which is likewise alluded to as "another plague" that ought to be inquired about and solved.MSDs affect business-related nonappearance and a high extent of days lost is expected to MSDs.Therefore, it influences the strength of workers as well as makes weight on the wellbeing framework, on the organizations monetary, and on the social expenses to manage their consequences.MSDs prevention is required in various countries to empower authorities to avoid the reactions of MSDs, improve working benefit, and reduce the weight on restorative systems at the comparable time.In creating nations like India, numerous projects for the counteractive action of MSDs have been connected to the working environment.This study puts in an effort to study the reliability and validity of rula against reeba among the employees operating computers in the bank.

The peri-acetabular area of the pelvis is a common site for a variety of lesions including neoplasia, histiocytosis or infective-like tuberculosis. A biopsy is necessary before planning treatment for these patients. Access to these lesions requires extensive dissection of soft tissues and is associated with blood loss and prolonged operative time. A percutaneous fluoroscopy-guided technique can be used to perform biopsy of lesions in the roof of the acetabulum through a minimally invasive approach. We have described a simple technique for biopsy of lesions in the acetabular roof using a percutaneous fluoroscopy-guided approach.

BACKGROUND: Musculoskeletal disorders (MSDs) represent one of the leading causes of occupational injury and disability. Awkward body posture while typing is associated with MSDs among the computer users. RULA (rapid upper limb assessment) is a subjective observation method of posture analysis for use in ergonomics investigations of workplaces where work-related upper limb disorders are reported. To date, no data available on reliability and validity of RULA among the bank employee’s using computers. OBJECTIVE: To examine the validity and reliability of RULA among the bank employees’ using computers. MATERIALS AND METHODS: A sample of bank employee were recruited by simple random sampling technique to take part in this validity and reliability study. All anthropometric measurement was taken before the beginning of the study including age, height and weight. The concurrent validity of RULA was established with the criterion referenced, Rapid Entire Body Assessment (REBA). Principal investigator recorded both the scores of RULA and REBA to estimate the concurrent validity. Intra-rater reliability of RULA was established by the principal investigator across two trials on the same group of participants in the same environmental condition and same timings with a gap of 2 days. Inter–rater reliability of RULA was established by the principal investigator and another researcher on the same group of participants with in the same environmental conditions and same with a gap of 2 minutes. RESULT: Total 301 Participants were recruited in this study, in which 170 participants were males, and other 131 were females. Concurrent validity of RULA with the criterion measure REBA is found to be good as measured by spearman’s rank correlation test, ?=0.91 (p<0.001). Intra-and inter-rater reliability of RULA is found to excellent with ICC=0.92 (0.90-0.94) and 0.91 (0.89-0.93) respectively. CONCLUSION: Validity and reliability of RULA have been established among the bank employees’ using computers. There exists good validity and excellent reliability among them.

INTRODUCTION: RULA (rapid upper limb assessment) is a survey method developed for use in ergonomics investigations of workplaces where work-related upper limb disorders are reported. There are various researches available regarding the use of RULA in assessing work-related musculoskeletal disorders (WRMSDs). But till date, there is no compiled review available regarding the comprehensive research on the uses of RULA in various ergonomic assessment. OBJECTIVE: To compile the availability of article related to the uses of RULA in assessing WRMSDs among workers from various fields. MATERIALS AND METHODS: The articles related to RULA in ergonomic assessment were searched using the reputed academic databases, including PubMed, Medline, CINAHL, PsycINFO, and EBSCO from inception to July 22, 2019 using the five keywords, “ergonomics,” “musculoskeletal,” “workplace,” and “rapid upper limb assessment.” These keywords were combined using the Boolean operators “AND,” “OR,” and “NOT.” RESULTS: A total of 263 articles (n=263) were identified. After the removal of 161 duplicate articles, 102 articles were screened for the analysis. Among then, 21 articles were excluded and 81 full-text articles were assessed for eligibility. Again 68 articles were excluded due to not meeting the inclusion criteria and finally 13 articles were included in the qualitative comprehensive analysis. CONCLUSION: The wider application of RULA has been confirmed from this comprehensive review.