Shortening dome osteotomy for correction of severe cubitus varus secondary to malunited supracondylar fractures in children.

The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities. PATIENTS AND METHODS: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively. RESULTS: Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure. CONCLUSION: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.

Accuracy and Efficacy of Software-guided Bony Realignment in Periarticular Deformities of the Lower Limb.

AIM AND OBJECTIVE: Software-guided realignment is proposed as an easy and accurate method of achieving simultaneous multiaxial correction. The accuracy and efficacy in periarticular problems have not been investigated fully. This study investigates the results and possible clinical benefits. MATERIALS AND METHODS: A retrospective review was performed in 24 patients with 27 periarticular deformities of the lower limb treated by the Ilizarov technique. Bony realignment was achieved by a software-guided hexapod realignment device. The deformity category, deformity severity score (DSS) and individual deformity component scores were measured for objective quantification of each deformity. The periarticular level, number of manoeuvres, correction period and any difficulties in the execution of the correction manoeuvre were noted. Pre-procedure and post-procedure values of deformity parameters were analysed to estimate the accuracy and efficacy of the realignment device. RESULTS: The correction manoeuvre was accomplished successfully in all patients except two. The mean correction period was 14.9 days (range, 5-38 days). The mean pre-procedure DSS was 18.7 (range 6.3-27.3), which reduced to a mean post-procedure value of 1.5 (range, 0-7.9) with a 92.0% deformity correction (p-value < 0.001)). There was a significant reversal of individual deformity components. DSS values were achieved to an excellent level (< 3.5) in 25 deformities and to good and poor levels in one deformity, respectively. CONCLUSION: Software-guided realignments are effective for accurate realignment of periarticular deformities using Ilizarov fixators. These devices offer simultaneous multidimensional corrections even in complex multiplanar deformities and simplify the task of deformity correction. CLINICAL SIGNIFICANCE: The present study assesses the accuracy and efficacy of software-guided realignments using novel concepts of deformity category, DSS and individual deformity component scores, which may overcome some of the shortcomings of conventional assessment methods. HOW TO CITE THIS ARTICLE: Singh P, Sabat D, Dutt S, et al. Accuracy and Efficacy of Software-guided Bony Realignment in Periarticular Deformities of the Lower Limb. Strategies Trauma Limb Reconstr 2021;16(2):65-70.

Shortening Dome Osteotomy for Correction of Complex Multiplanar Elbow Deformities: A New Surgical Technique.

Despite surgical advances in fracture management, it is not uncommon to find pediatric or adolescent patients with elbow deformities. Correction of severe deformities, often leaves the ingenuity of the treating surgeon asking for more. Various osteotomy techniques have been described in the literature for the correction of elbow deformities. Although, the concept of dome osteotomy did address certain inadequacies of the existing osteotomy techniques for distal humerus, but correction of complex deformities associated with deformation of trochlea and olecranon fossa still remain a surgical challenge which has not been adequately addressed in the literature so far. Our experience with the existing osteotomies for distal humerus led to the development of a new surgical technique of shortening dome osteotomy for correction of such complex multiplanar elbow deformities. Surgical steps, indications, and expected outcome is described.

Pediatric conjoint Hoffa's fracture: An uncommon injury and review of literature.

Coronal plane fracture of femoral condyles was first elaborated by Hoffa. These are difficult articular injuries, often described in adult skeleton and very rarely in pediatric age group. Conjoint variety with intact bone bridge between condyles in intercondylar notch area is rare. We report a conjoint variety of bicondylar Hoffa's fracture in a child which was surgically treated using headless compression screws along with a brief review of literature about fracture entity and complexities associated with it.

Scarf-related injuries at a major trauma center in northern India.

PURPOSE: Scarf is a long loose piece of cloth worn around the neck and shoulder. Despite cultural association of this apparel, it is part of numerous injury episodes of varying enormity. Entanglement of loose scarf in spoke wheels of bike, tricycle, belt driven machines like sugarcane juice machine, thresher, grinding machines, etc is observed both in social and industrial milieu. This study aims to investigate the scarf-related injuries at a major trauma center in northern India. METHODS: From June 2013 to May 2015, a hospital-based prospective observational study was done in patients who presented to a level 1 trauma center in northern India with the mode of injury involving scarf around the neck. Demographic profile, mode of trauma, contributing factors, injury pattern, and the early management as well as early complications were recorded. RESULTS: There were 76 injuries directly related from scarf with the mean age of patients being 32.4 years. The most common primary factor involved was rotating wheel of motorbike/tricycle (46.1%), followed by belt driven machines (28.9%). The spectrum of injuries was diverse, including minor abrasions or lacerations (53.9%), large lacerations (15.8%), fractures and spine trauma (18.4%), mangled extremity and amputations (7.9%) and death (3.9%). More severe injury patterns were noted with belt driven machines. CONCLUSION: Scarf-related injuries constitute a sizable proportion of trauma, with varying degrees of severity. Devastating consequences in significant proportion of cases dictate the call for a prevention plan comprising both educational and legislative measures. Urgent preventive measures targeting scarf-related injuries will help reduce mortality and morbidity.

A muscle sparing posterior approach to the elbow joint for total elbow arthroplasty.

We describe a muscle sparing approach in which the triceps is elevated without injuring the muscle or disturbing its insertion. The entire extensor mechanism is preserved in continuity, thus preventing any extensor weakness. This can be used preferentially in cases of non-union intraarticular distal humerus fractures planned for Total Elbow Arthroplasty.

Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population.

The purpose of this randomized study was to compare clinical and surgical outcomes of total knee replacements (TKRs) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner. Forty-two knees each were operated using midvastus approach and the medial parapatellar approach. Clinical parameters that were evaluated included Knee Society score (KSS); knee pain using visual analogue scale (VAS) on day 1, 1 week, and 1 month; time required to straight leg raise (SLR); patellar tracking; mean extensor lag at 1 week and 1 month; and time of discharge from the hospital. Surgical parameters that were evaluated included tourniquet time, incidence of lateral retinacular release, estimated blood loss, and any complications during the surgery. KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group; though similar at 3 months, 6 months, and 1 year. The patients in midvastus group required fewer number of lateral retinacular releases; achieved SLR earlier; had less mean extensor lag at 1 week; had less mean VAS score at day 1, 1 week, and 1 month; and had shorter hospital stay. There was no significant difference in the mean tourniquet time and estimated blood loss. One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group. Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach.

Comparative Analysis of Interbody Cages Versus Tricortical Graft with Anterior Plate Fixation for Anterior Cervical Discectomy and Fusion in Degenerative Cervical Disc Disease.

INTRODUCTION: Multiple techniques and modalities of fixation are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), each with some merit and demerit against others. Such pool of techniques reflects lack of a consensus method conducive to uniformly good results. AIM: A prospective study was done to analyse safety and efficacy of tricortical autograft and anterior cervical plate (Group A) with cylindrical titanium cage filled with cancellous bone (Group B) in procedure of ACDF for single level degenerative cervical disc disease. MATERIALS AND METHODS: Twenty patients with degenerative cervical disc disease were included in study for ACDF. After a computer generated randomisation, ten patients (10 segments) were operated with anterior locking plating and tricortical iliac crest graft (Group A, Tricortical graft group), while ten patients(10 segments) were operated with standalone cylindrical titanium cages filled with cancellous bone harvested using minimally invasive methods (Group B, Cage group) from April 2012 to May 2015. Odoms's criteria, visual pain analogue score and sequential plain radiographs were obtained to assess for clinic-radiological outcome. RESULTS: According to Odom's system of functional assessment, 9 patients from each group (90%) experienced good to excellent functional recovery and 9 of 10 (90%) patients of each groups were satisfied with outcome. In both groups, relief in neck pain or arm pain was similar without any statistical difference as assessed by visual analogue score. Fusion was present in 10 of 10 (100%) patients in tricortical graft group and 10 of 10 (100%) in cage group at the end of 6 months. There was no implant related complications in cage group. Transient postoperative dysphagia was recorded in 3 patients (2 in Group A and 1 in group B), which resolved within 3 days. In tricortical graft group, graft collapse and partial extrusion was detected in one patient, which did not correspond with good results obtained in particular patient. CONCLUSION: Use of cylindrical titanium cage packed with cancellous bone graft provide adequate stability and reliable functional outcome after fusion in cervical disc disease. Titanium cages for fusion after cervical discectomy constitute a safe and equally efficient alternative to tricortical autograft with anterior cervical plate by providing adequate stability and cessation of rediculopathy symptoms.

Nonpathological Lesser Trochanter Fracture in Adult: Case Report and Brief Review of Literature.

Lesser trochanter fractures are rare in adult bones. Few cases have been reported in the literature. When fracture of lesser trochanter is met in patients with closed growth plates, it is likely to be precursor of a silent neoplastic process. A case of lesser trochanter fracture in middle aged female with traumatic aetiology is presented here, which came out to be non-pathological despite high degree of suspicion for contrary. Patient responded positively to conservative line of treatment. Correct evaluation and anticipation of further complication take precedence in case rather than rarity.

An Unsuspected Pharmacological Vitamin D Toxicity in a Child and its Brief Review of Literature.

Inordinate administration of Vitamin D beyond required doses and duration occurs as a sporadic event among frequent empirical therapies of pharmacological Vitamin D. Such instances lead to Vitamin D intoxication. Systemic hypertension is an unsuspected after-effect of Vitamin D toxicity in a child unlike other toxicity effects such as hypercalcemia, neurological deterioration, etc., Here, we report a case of a 1-year-old child who developed acute hypertension and severe hypercalcemia due to Vitamin D toxicity which was masked by initial dehydration such as illness and brief review of literature about clinical entity.

Citrobocter kasori spinal epidural abscess: a rare occurrence.

Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.

Intramedullary spinal epidermoid cyst of the cervicodorsal region: A rare entity.

Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. We are reporting a case of a 10-year-old female child who presented with symptoms of meningitis with progressive paraparesis. Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst from C6 to D5. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.