ABSTRACT
Zoledronic acid is a bisphosphonate that has recently gained interest in adjuvant therapy for giant cell tumor of bone (GCTB). It has an apoptotic effect on osteoclasts that are precursors of GCTB. However, the evidence suggesting the role of zoledronic acid in preventing GCTB recurrence is mixed, and therefore, a consensus is yet to be established. The purpose of the current meta-analysis was to analyze the impact of zoledronic acid supplementation on tumor recurrence in surgical treated GCTB. A systematic search was conducted on PubMed, Embase, and Web of Science databases to identify studies that analyzed the impact of local or systemic zoledronic acid supplementation on clinical outcomes in surgically treated GCTB. The data from the comparative studies were pooled and analyzed to investigate the association of zoledronic acid supplementation with tumor recurrence. Additionally, other factors such as age, gender, soft tissue extension, polymethyl methacrylate (PMMA) cement application, recurrent presentation, and extended curettage were also investigated for any association with tumor recurrence. Of the 271 results, 13 unique studies reported the clinical outcomes in GCTB. Seven studies compared the outcomes of zoledronic acid supplementation with control groups. Six studies presented the tumor recurrence-related data among the comparison groups. The zoledronic acid supplementation was associated with significantly lower tumor recurrence rates (p = 0.007). Additionally, a significant association of soft tissue extension and non-usage of PMMA cement with tumor recurrence were observed. The current meta-analysis suggests that zoledronic acid supplementation reduces tumor recurrence rates in surgically treated GCTB. We, therefore, recommend the use of zoledronic acid following aggressive extended curettage of the tumor. Further, well-planned randomized controlled trials will help strengthen this evidence.
ABSTRACT
Seizure disorders have been commonly linked with fractures and dislocations of the shoulder region. However, catastrophic failure of plate osteosynthesis of a proximal humerus fracture, following a seizure episode in an early postoperative period, has not been reported. We present a case report of a middle-aged male patient who was treated satisfactorily for a right proximal humerus fracture with plate osteosynthesis but experienced a seizure episode in the early postoperative period. The seizure episode resulted in a catastrophic failure of the plate fixation. The patient was then managed with plate and screw removal and revision fixation with a lightweight pin-based external fixator. Further, the functional outcomes were satisfactory. Extreme caution must be exercised to manage proximal humerus fractures in people with epilepsy concerning anticonvulsant drug compliance and osteoporosis.
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OBJECTIVE: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data. METHODS: Keywords such as "fracture" and "COVID or COVID-19" were searched through three major databases includes PubMed, EMBASE, and Google Scholar. Selection criteria were all published reports providing the mortality related information of COVID-19 positive fracture patients. Published papers containing mortality data of COVID-19 positive fracture patients were considered for qualitative review. For meta-analysis, the presenting individual's data were considered to study the different parameters association with mortality. RESULTS: The rate of mean mortality in COVID-19 positive fracture patients was 34%, and 91.7% of patients had hip fractures. Older age and hip fractures had a significant association with higher mortality rates in COVID-19 positive fracture patients. CONCLUSION: The mortality rates are considerably higher in COVID-19 positive patients with fractures compared to COVID-19 positive patients without fractures and to the COVID-19 negative fracture patients. Early surgical intervention should be preferred in hip fractures among COVID-19 positive patients for general stabilization and improved respiratory function. Older age and hip fractures are the main predictors of mortality in these patients.
ABSTRACT
PURPOSE: Displaced intraarticular fractures of the calcaneum often require plate fixation. The complex fractures are usually fixed with standard lateral plates and are approached via the extensile lateral approach which is fraught with the risk of wound complications. Oversized calcaneal plates produce tension on the wound closure site and can, thus result in wound healing problems. The current study analyses the morphometry of the lateral surface of the calcaneus for the ideal configuration of the calcaneal plates for Indian patients using a CT based analysis of intact calcanei. METHODS: Fifty CT based studies of normal calcanei were retrospectively analyzed using Horos® software version 3.3.5. The cross-section of the lateral third of calcaneum was assessed for the morphometric measurements relevant to the dimensions of the standard plating devices for calcaneum. We measured the overall plating length of calcaneum, the vertical heights at the anterior process and calcaneal tuberosity, the height of the posterior facet, the lengths of the anterior process, and the posterior facet. The inclination angles of the posterior facet, cuboid facet were also measured. The findings were compared between male and female cases. RESULTS: The mean plating length of the calcaneus was 60.06 ± 4.05 mm. The mean vertical height of the anterior process and the calcaneal tuberosity were 24.3 ± 2.71 mm and 39.48 ± 4.73, respectively. The length of the anterior process and the posterior facet were 21.36 ± 1.72 and 25.02 ± 4.17, respectively. The mean Gissane angle and the angle of inclination of posterior facet in relation to the plating length were 118.04 ± 5.99° and 47.3 ± 5.20°. The mean anterior slant angle of the cuboid facet was 96.64 ± 4.39°. Significant differences were observed in the measurements among male and female groups except for the angular parameters. CONCLUSION: The current analysis suggests the individual morphometric variations of the lateral plating surface of the calcaneus. Although female calcanei have smaller dimensions compared to male calcanei, the angular parameters are comparable among the two groups. Considering the wide variations in the majority of the morphometric parameters, it is difficult to standardize the plate dimensions. However, a few serial increments in the plate dimensions can help in providing the best fit rather than an ideal fit. Also, the plates should be available with multiple inclination angles of the facet limbs according to the local population variations.
ABSTRACT
Record keeping is an important aspect of orthopedic teaching, training, and practice for both documentation purpose and academic use. Physical logbooks may act as important documents but do not provide quick searchable access to the data they contain. Through this technique, we describe a simple method of creating personalized clinical records/logbook on WhatsApp through which individual records can be accessed with minimal basic key information in a span of a few seconds.
ABSTRACT
INTRODUCTION: The standard anteroposterior and lateral fluoroscopic projections used during femoral neck fracture fixation provide a two-dimensional representation of the cephalocaudal and anteroposterior extents of the femoral neck. The radiographic representation differs from the actual extent of the femoral neck. The anterosuperior (AS) and posterosuperior (PS) surfaces of the femoral neck are at risk of bony breach by the fixation screws and that may get easily missed with standard fluoroscopic views. The current study aims at investigating the special fluoroscopy views, based on the orientation of the AS and PS surface of the femoral neck, that can help in the safe placement of screws near these surfaces without bony breach. METHOD: A computed tomography-based analysis of fifty intact proximal femora was performed. The longitudinal axis of the proximal femoral shaft and the center of the femoral head were aligned along a common horizontal plane. The cephalocaudally constricted zone of the femoral neck was identified along its axis. The surface inclinations of the AS surface and the PS surface at the constricted zone of the femoral neck were measured in relation to the horizontal plane. The mean, standard deviation, overall range, interquartile ranges and gender-based variation of each of the two surface inclinations were measured. RESULTS: The mean surface inclinations of the AS surface and the PS surface with reference to the horizontal plane were 55° ± 7.76° and 123.32° ± 7.88°, respectively. There were no significant side to side and male to female differences. CONCLUSIONS: The modified radiographic views based on the surface inclinations of the AS and the PS surfaces can help in the localization of the critical zones of these surfaces which are at risk of bony breach with screw placement close to the surface. A prior fluoroscopic evaluation of these surfaces before guidewire placement can help in preventing the surface violation.
