Do the clinical scores (Pirani and Dimeglio scores) correlate with the radiological parameters in idiopathic club foot in infants? A cross-sectional study.

This study was done to identify how well clinical scores and their sub-scores correlate with the radiographic parameters in idiopathic clubfoot. We studied 76 patients of idiopathic clubfoot who are from 5 months to 12 months of age. Deformity was assessed clinically with Pirani and Dimeglio scores and radiologically using eight parameters. Correlation between clinical and radiological scores was studied. All the eight radiological parameters were showing statistically significant correlation with clinical scores - both Pirani and Dimeglio scores. The mean total Pirani score at the time of X-ray was 2.31 with a SD of 1.58 (N = 118 minimum score = 0 and maximum score = 5.5), whereas the mean radiographic score was 3.67 with a SD of 2.1 (N = 118, minimum score = 0, maximum score = 8). The mean total Dimeglio score at the time of X-ray was 9.03 with a SD of 3.54 (N = 118, minimum score = 4 and maximum score = 15), whereas the mean total radiographic score was 3.67 with a SD of 2.1 (N = 118, minimum score = 0, maximum score = 8). Clinical scores correlate well with radiological parameters in infants with idiopathic clubfoot and hence the routine use of radiographs can be avoided in evaluation and follow-up thereby avoiding exposure to radiation.

Does age, time since injury and meniscal injury affect short term functional outcomes in arthroscopic single bundle anterior cruciate ligament reconstruction?

PURPOSE: We conducted this study to correlate the short term clinical outcomes after anterior cruciate ligament (ACL) reconstruction with patients' age, time since injury and associated meniscal injury. METHODS: A total of 43 patients who underwent ACL reconstruction between October 2013 and February 2015 were taken for the study. Preoperative demographic data, clinical scores (Lysholm, IKDC) were recorded for each patient. Time since injury and associated meniscal injuries were recorded. Then a standardized surgical technique was used for each graft type. They were followed up for 6 months and the Lysholm and IKDC scores were evaluated. RESULTS: Only 33 patients completed 6 months follow-up at the end of this study. Twenty-four patients (72.7%) were in the age group of 18-30 years. Nine patients belonged to age group 30-50 years (27.3%). The p value for differences in Lysholm scores between the two age groups was not significant (0.339). The p value for differences in IKDC scores between the two age groups was not significant either (0.138). The mean Lysholm scores were 93.86 ± 3.024 for the group who presented <6 months post-injury, 92 ± 5.494 for the group who presented between 6 months and 1 year and 94.64 ± 3.104 for the group who presented after 1 year; whereas the mean IKDC scores were 92.43 ± 0.793, 90.64 ± 6.598 and 90.89 ± 2.113 respectively. The correlation of outcomes with meniscal injury had no statistical significance. CONCLUSION: Based on our study, we conclude that age, time since injury and associated meniscal injury does not affect short term functional outcome in ACL reconstruction.

Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study.

OBJECTIVE: To study the correlation between tunnel widening and tunnel position with short-term functional outcomes post-ACL reconstruction with patellar tendon and hamstring autografts in young adults. MATERIALS AND METHODS: A total of 33 patients who underwent ACL reconstruction between October 2013 and February 2015 were included and followed up for 6 months. A standardized surgical technique was used for each graft type. Intra-op arthroscopy findings and drilled tunnel diameters were noted. They were followed up for 3 and 6 months. Radiological assessment was done at 3 and 6 months with clinical score assessment at 6 months. RESULTS: At 6 months, clinical scores were comparable in both groups. Tunnel widening in both femoral and tibial tunnel at 3 and 6 months were significantly higher in STG group (p values <0.05). The rate of widening was higher in 0-3 months and reduced in 3-6 months. There was statistically significant negative correlation between femoral tunnel widening by CT and IKDC score at 6 months (p value 0.049). We found a positive correlation between posterior positioning of femoral tunnel and Lysholm and IKDC scores. The correlation with Lysholm scores was statistically significant (p value 0.046). CONCLUSION: To conclude, tunnel widening is more with hamstrings graft. Femoral tunnel widening has significant negative correlation with that of IKDC scores at 6 months. Posterior femoral tunnel positioning and Lysholm scores at 6 months had significant correlation.

Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis.

OBJECTIVES: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively. MATERIALS AND METHODS: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. RESULTS: The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%). CONCLUSIONS: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.

Clinical and haematological predictors of acute hematogenous Methicillin Resistant Staphylococcus aureus (MRSA) osteomyelitis & septic arthritis.

INTRODUCTION: In the present study, we observed differences in the clinical and haematological parameters in patients of MRSA and non MRSA acute osteoarticular infection. METHODOLOGY: For the patients of acute haematogenous osteomyelitis/septic arthritis, clinical features, haematological parameters and blood & aspirate cultures were recorded. RESULTS: Of 81 patients enrolled in the study, 61 were culture positive (22% MRSA). Statistically significant difference was found only in CRP (P < 0.001). ROC curve analysis shows that CRP levels of >13.9 mg/L, MRSA bone and joint infection could be predicted with 92.9% sensitivity and 79.1% specificity (AUC = 89.1). CONCLUSION: Estimation of serum CRP levels at the time of presentation can aid in distinguishing MRSA osteomyelitis from non MRSA one.

Tumor(s) induced osteomalacia--a curious case of double trouble.

CONTEXT: We report a case of tumor-induced osteomalacia with evidence of synchronous multifocal fibroblast growth factor 23 (FGF23) production. OBJECTIVE: The aim is to present a case of tumor-induced osteomalacia and to highlight the fact that incomplete removal of multifocal FGF23-producing tumors, which are not entirely picked up by functional imaging, could be the cause of treatment failure. SETTING: The patient was treated in the Department of Endocrinology of a tertiary care center in India. PATIENT: We report the case of a 42-year-old male with tumor-induced osteomalacia. INTERVENTION: We treated the tumor-induced osteomalacia with staged surgery of the two tumors. The 18F-fluorodeoxyglucose (FDG)-avid lesion (considered the sole culprit lesion after functional imaging) was resected first, followed by the non-FDG-avid lesion. The sequential removal of both tumors resulted in complete cure. RESULTS: The patient had hypophosphatemia and hyperphosphaturia. C-Terminal FGF23 level was elevated. Positron emission tomography-computed tomography showed two lesions-an FDG-avid lesion in the right leg, and a non-avid lesion in the left thigh. After removal of the FDG-avid lesion, the hypophosphatemia persisted, and the FGF23 level showed only modest reduction. The patient had complete clinical and biochemical resolution only after removal of the second non-FDG-avid tumor. CONCLUSIONS: We present the case of a tumor-induced osteomalacia whose biochemical parameters did not improve after removal of the FDG-avid tumor initially. The possibility of multifocal FGF23 production was considered, and the second, non-FDG-avid lesion was resected, which resulted in complete cure. Thorough clinical examination and meticulous follow-up with documentation of the biochemical resolution are necessary for management of all patients with this rare disorder.

Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis.

BACKGROUND: Early diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. Total Count, ESR and CRP are not specific as they can also be elevated in non pyogenic causes of inflammation. Pus Culture and sensitivity is not a true gold standard due to its varied positivity rates (40 - 70%). Serum Procalcitonin (PCT), at 0.5 ng/ml is found to be an accurate marker for pyogenic infections. The objectives of this study were to show that PCT is an accurate marker in differentiating Acute Osteomyelitis and Septic Arthritis from viral and non infective inflammatory bone and joint conditions. METHODS: Patients of all age groups (n = 82) with suspected Acute Osteomyelitis and Septic Arthritis were prospectively included in this study. All patients were subjected to TC, CRP, PCT, IgM Dengue, IgM Chikungunya, pus and blood culture and sensitivity. At the end of the study, patients were classified into 3 groups: Group 1 = Confirmed Pyogenic (n = 27); Group 2 = Presumed Pyogenic (n = 21); Group 3 = Non - infective inflammatory (n = 34). RESULTS: Group 1 has higher mean PCT levels than Group 2 and 3 (p < 0.05). PCT, at 0.4 ng/ml, was 85.2% sensitive and 87.3% specific in diagnosing Septic Arthritis and Acute Osteomyelitis. In comparison, PCT at conventional cut - off of 0.5 ng/ml is 66.7% sensitive and 91% specific. CONCLUSION: Serum Procalcitonin, at a cut - off of 0.4 ng/ml, is a sensitive and specific marker in the diagnosis of Septic Arthritis and Acute Osteomyelitis.

Congenital insensitivity to pain and anhydrosis: a report of two cases.

We report on 2 patients with congenital insensitivity to pain and anhydrosis. The first one was a 7-month-old boy who presented with non-traumatic, haematogenous septic dislocation of the right elbow with physeal separation of the distal humerus. The second one was a 3-year-old girl suspected to have Job syndrome with an altered immunological profile.

Calcium sulfate as bone graft substitute in the treatment of osseous bone defects, a prospective study.

BACKGROUND: Calcium sulfate belongs to synthetic ceramic group of bone graft substitutes having an osteoconductive property. Calcium sulfate is an easily available, economic bone graft substitute. It is a bio-inert material which over a period of weeks get resorbed and fibrovascular tissue takes its place which eventually allows neovascularisation and bone formation within the area. Use of calcium sulfate as a bone graft substitutes avoids the complications and morbidity associated with autograft like infection, second surgery, and finite amount of graft. MATERIAL AND METHODS: A total of 15 patients with benign bone lesions and chronic osteomyelitis were operated and the osseous defects were filled with calcium sulfate which was comprehensively sterilized. Patients were followed with serial radiographs at six week intervals. Calcium sulfate resorption and new bone formation was studied. RESULTS: Thirteen cases out of 15 showed calcium sulphate resorption and new bone incorporation. Calcaium sulphate resorption occurred at an average of 14.5 weeks (range,13-18weeks) whereas new bone incorporation occurred at an average of 6months ( range,5-7months). Thirteen patients out of these 15 cases returned to full activities of daily living. One patient had pathological fracture at the osseous defect postoperatively. One patient with GCT of distal end of tibia had recurrence of tumor and had to undergo second surgery. CONCLUSION: Although autogenous bone graft is the gold standard for bone grafting, it has limitations like finite amount, additional surgery and donor site morbidity. Calcium sulphate is safe, efficient and easily available bone graft substitute in the treatment of osseous defects. Most common complication encountered was aseptic serous discharge. Functional results were favorable in most of the cases.

Acute osteomyelitis caused by Rhodococcus equi in an immunocompetent child.

Rhodococcus equi is an unusual pathogen causing infections mostly in immunocompromised patients, particularly in those with human immunodeficiency virus (HIV). It has rarely been reported to affect immunocompetent hosts, where it usually presents as an isolated extrapulmonary lesion. We report a case of osteomyelitis caused by this organism in an immunocompetent host.