Indian orthopaedics: the past, present, and future.

The editorial summarizes the Indian orthopaedic history in brief and provides an overview of the articles to be published in the Indian traumatology edition.

Low bone mineral density in Indian patients with fragility fractures.

OBJECTIVE: Low bone mineral density (BMD) is a major risk factor for fragility fractures in osteoporosis. In recent studies, its use with clinical risk factors has been shown to enhance prediction of fragility fractures. The present study was done to assess BMD in Indian patients with fragility fractures using digital X-ray radiogrammetry (DXR-BMD). METHODS: A total of 228 patients (64 male and 164 female) admitted to an Orthopedic Hospital for management of fragility fracture were recruited. For each patient, DXR-BMD was obtained from an anteroposterior radiograph of the non-dominant hand. RESULTS: The number of subjects with hip fracture was 104 (40 male, 64 female). Vertebral fractures were seen in 67 patients (11 male, 56 female) and distal radial fracture in 57 patients (13 male, 44 female). The DXR-BMD (g/cm(2)) was significantly lower in subjects with any fragility fracture (0.51 vs. 0.58 in men and 0.41 vs. 0.54 in women). When compared to the age-matched normative reference data by decade, all subjects with fragility fracture had significantly lower DXR-BMD except male subjects in the age decade of 40-49 years. CONCLUSION: This study confirms lower DXR-BMD in Indian subjects with fragility fractures. This may have a potential role in fracture prediction when used with clinical risk factors in the Indian population.

An atypical presentation of tuberculosis of the spine.

We present a retrospective analysis of 684 patients operated on for a herniated lumbar intervertebral disc. Of the 87 patients with a failed back syndrome, 12 were confirmed to have tuberculous infection of the same disc interval. These patients responded satisfactorily to bracing and a short course of anti-tubercular chemotherapy. Histopathological confirmation of the disease was obtained by CT guided biopsy, and only a few of the patients required repeat surgery. This study highlights one of the atypical presentations of tuberculosis of the spine as a herniated lumbar intervertebral disc and a cause of a failed back syndrome. Advanced imaging techniques such as MRI and CT scans are helpful in the early detection of such conditions.

Unusual compressive neuropathies of the upper limb.

Compression neuropathies are one of the most common causes of upper extremity pain. This article has addressed the diagnosis and treatment of some of the more unusual neuropathies. As always, a thorough knowledge of anatomy and its valuation, and a careful and impulsive physical examination will guide the clinician to the appropriate diagnosis. Electrical studies, done carefully and with the clinical diagnosis as a label, will often be confirmatory. In cases not responsive to nonoperative measures, surgery to decompress the nerve and to restore missing function will usually proved a modicum of patient improvement.

Ankle instability after fibular resection.

We have reviewed 104 patients who had partial resection of the fibula for use as a graft. Only 44 were completely free from symptoms, and six had developed significant ankle instability which had required reconstruction by a sliding graft. This procedure successfully restored ankle stability in all six cases.

The hand-foot syndrome in sickle-cell haemoglobinopathy.

The hand-foot syndrome is a benign self-limiting condition seen in young children with sickle-cell haemoglobinopathy, usually at the time of a crisis. The authors have observed 36 cases among 4920 patients. The features and management of the condition are discussed and the published literature is reviewed.

Evaluation of ketorolac, ibuprofen-paracetamol, and dextropropoxyphene-paracetamol in postoperative pain.

STUDY OBJECTIVE: To compare the analgesic efficacy of ketorolac, ibuprofen-paracetamol (acetaminophen), and dextropropoxyphene-paracetamol in postoperative pain. DESIGN: Randomized, double-blind, parallel, single-dose study. SETTING: Multicenter, with five centers participating. PATIENTS: One hundred sixty patients with moderate to severe postoperative pain requiring oral analgesics were enrolled. Seventeen patients were excluded from final analysis due to deviation from protocol. INTERVENTIONS: Ketorolac tromethamine 10 mg, a combination of ibuprofen 400 mg plus paracetamol 325 mg, or a combination of dextropropoxyphene 65 mg plus paracetamol 400 mg was given orally to patients with moderate to severe baseline pain. MEASUREMENTS AND MAIN RESULTS: Pain intensity and pain relief scores were rated at baseline, at 30 minutes, and hourly to 6 hours. Until the end of first hour, analgesia was similar for all three regimens. Ketorolac had a significantly higher analgesic effect than the two combinations between hours 2 and 6. Analgesia was similar for the two combinations. For all three test drugs the frequency of adverse effects was similar. CONCLUSIONS: Ketorolac 10 mg is a superior analgesic to ibuprofen-paracetamol or dextropropoxyphene-paracetamol in the treatment of postoperative pain.

Triceps contracture caused by injections. A report of 11 cases.

Eleven cases are reported of contracture of the triceps muscle following intramuscular injections. This occurred in one arm of each of 11 children aged from 6 to 13 years, all of whom had a definite history of repeated injections. In seven of the cases the injections were of oxytetracycline. On presentation only 30 degrees to 35 degrees of flexion was possible. Physiotherapy for 4 to 12 weeks produced improvement, but in four cases early operation for excision of fibrous tissue and lengthening of the triceps was necessary to restore adequate flexion. Four other cases required operation after late relapse. The condition is rare, and is compared with similar and more commonly reported contractures in the quadriceps and the deltoid muscles.

Atypical spinal tuberculosis.

The familiar picture of spinal tuberculosis is one of destruction of adjacent vertebral bodies and of the intervening disc. There are, however, other patients without these radiographic changes and with no clinical deformity who present with symptoms and signs of compression of the spinal cord or cauda equina. These patients fall into two different groups: those with tuberculosis of the neural arch; and those with extra-osseous extradural tuberculosis. Both may require laminectomy, but whereas the first has bony involvement and a cold abscess, the second has neither.