Early quadriceps tendon rupture after primary total knee arthroplasty.

BACKGROUND: Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare complication and results in significant morbidity and severe functional limitations. Quadriceps tendon rupture in the early postoperative period after TKA is one limitation about which there is a significant paucity of available information. METHODS: In this retrospective study of 2404 patients who underwent primary TKA between June 2015 to May 2016, there were 10 quadriceps tendon ruptures in seven patients (three bilateral, four unilateral) presented within 3 months after surgery. The rupture was due to a sudden fall while walking or getting up from a chair. All seven patients presented with haematoma formation around the knee, inability to get up and inability to walk. Diagnosis was confirmed by ultrasonography and managed by exploration and end-to-end tendon repair by suturing. RESULTS: In our study, incidence of quadriceps tendon tear in the early postoperative period (within 3 months) after TKA is 0.29% (seven of 2404). All patients had rupture within 90days of primary TKA; early primary repair was performed in all cases. All patients achieved preoperative range of motion without extension lag or restriction in range of movement within 6 months of repair of the quadriceps tendon. CONCLUSION: Early identification and prompt treatment of quadriceps tendon injury followed by controlled postoperative rehabilitation results in excellent short-term and mid-term outcomes.

Optimization of selective production media for enhanced production of xylanases in submerged fermentation by Thielaviopsis basicola MTCC 1467 using L16 orthogonal array.

Enzymes have been the centre of attention for researchers/industrialists worldwide due to their wide range of physiological, analytical, food/feed and industrial based applications. Among the enzymes explored for industrial applications, xylanases play an instrumental role in food/feed, textile/detergent, paper and biorefinery based application sectors. This study deals with the statistical optimization of xylanase production by Thielaviopsis basicola MTCC 1467 under submerged fermentation conditions using rice straw, as sole carbon source. Different fermentation parameters such as carbon source, nitrogen source, inorganic salts like KH2PO4, MgSO4 and pH of the medium were optimized at the individual and interactive level by Taguchi orthogonal array methodology (L16). All selected fermentation parameters influenced the enzyme production. Rice straw, the major carbon source mainly influenced the production of xylanase (~34 %). After media optimization, the yield of enzyme improved from 38 to ~60 IU/ml (161.5 %) indicating the commercial production of xylanase by T. basicola MTCC 1467. This study shows the potential of T. basicola MTCC 1467 for the efficient xylanase production under the optimized set of conditions.

The first total synthesis and biological evaluation of marine natural products ma'edamines A and B.

We have developed the first total syntheses of marine natural products ma'edamines A (18) and B (20). Structurally, they contain a pyrazine-2-(1H)-one core and were screened for antiproliferative activity on several cancer cell lines. Out of the six cell lines tested, ma'edamines A and B showed significant cytotoxicity against human colon cancer line COLO 205 (IC(50) 7.9 and 10.3 µM, respectively), breast cancer cell line MCF-7 (IC(50): 6.9 and 10.5 µM, respectively) and human lung adenocarcinoma cell line A549 (IC(50): 12.2 and 15.4 µM, respectively). The apoptotic effect of ma'edamines was confirmed by comet assay. Hence ma'edamines are likely to be useful as leads for development of a new class of anti-cancer agents.

Greater Trochanter Reconstruction in Unstabl Intertrochanteric Fractures Treated With Cemented Bipolar Hemiarthroplasty: A Technical Note.

Cemented Bipolar arthroplasty is an established method for treatment of comminuted Intertrochanteric fractures. Reconstruction of greater trochanter is an essential technical step to avoid complications like abductor lurch gait. We here describe a technique of reconstruction and fixation of greater trochanter using cancellous screws with wide washers made of reconstruction plate and tension band wiring. This gives a stable fixation of greater trochanter and avoids cut out, slippage of implants.

Bilateral symmetrical periprosthetic (mirror) fractures of knee fixed with dual plating technique.

INTRODUCTION: Periprosthetic fracture following total knee arthroplasty is a potentially serious condition. Here we report a case of bilaterally symmetrical (mirror) fracture of supracondylar area following trivial trauma. PRESENTATION OF CASE: Both fractures were OTA 33A2 and according to Rorabeck classification they were type II. Both fractures were fixed by dual plating technique using non locking plates. Intra operative fracture site biopsy revealed marked osteopenia and hence the patient was treated for osteoporosis. DISCUSSION: Both fractures united well at 14 weeks. At final follow up of 6 years there were no radiological signs of implant loosening and the patient was able to walk without any aids and had a range of 80° and 60° flexion in the right and left knees respectively. CONCLUSION: We conclude that in the pre locking plate's era such difficult case has been successfully managed by dual plating technique.

Total Knee Arthroplasty as Salvage for Non Union in Bicondylar Hoffa Fracture: a report of two cases.

INTRODUCTION: Bicondylar Hoffa fracture is a rare injury with implant failure and non unions as known complications. CASE REPORT: Two cases of Bicondylar Hoffa fractures with implant failure and nonunion treated successfully with long stem total knee arthroplasty are reported here. At a minimum follow up of 2 years both the implants were well fixed and the fractures have united. The knee society scores in both the patients improved from 14 and 19 to 86 and 82 respectively. To our knowledge there are no reports of such rare fractures managed successfully with non hinged arthroplasty. CONCLUSION: A long stem total knee arthroplasty can be used as a treatment option in cases of nonunion bicondylar Hoffa fractures.