Proximal Humerus Nonunion: Operated with Fibular Strut Allograft and Locking Plate.

Proximal humerus fracture is one of the common fractures seen in practice. Being metaphyseal region, it is less prone for nonunion. Although more than 80% of these heal with no surgical intervention, displaced unimpacted surgical neck fractures are associated with a higher incidence of nonunion with rates varying from less than 1% to as high as 23%. We report a case of 35-year-old male with nonunion following fracture of left proximal humerus.

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women.

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women. Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated. Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1. Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

Plexiform Neurofibroma from Palmaris Longus with Carpal Tunnel Syndrome.

Plexiform neurofibromas (NF) involving the palmaris longus tendon are rare diseases difficult to diagnose when the classical manifestations, e.g. skin pigmentation, sub cutaneous nodules, lisch nodules, family history, etc are absent. We report a case of 26 years male with plexiform NF of palmaris longus tendon which is a relatively rare site. Plexiform NF commonly involve the cranial nerves.

Expanding horizons of anticoagulant therapy: Dabigatran etexilate a novel oral anticoagulant.

Thrombo-embolic disease is a major challenging clinical problem associated with significant mortality and morbidity. Anticoagulation with the existing heparin products and vitamin K antagonist (VKA) anticoagulants are still the mainstay of management. However, due to the risk of bleeding and well-documented drawbacks, the quest for a novel oral anticoagulant has led to the clinical development of dabigatran etexilate. Dabigatran etexilate is a direct thrombin (IIa) inhibitor which has recently been approved in India for prevention of venous thromboembolic events (VTE) in patients who have undergone major orthopaedic (total knee or hip replacement) surgery and for prevention of stroke, systemic embolism and reduction of vascular mortality in adult patients with atrial fibrillation. Thus dabigatran etexilate is a promising alternative to the current heparin products and VKAs in patients who require long-term oral anticoagulation.