Review Article: Operative versus nonoperative treatment for displaced intraarticular calcaneal fracture: a meta-analysis of randomised controlled trials.

We reviewed 8 randomised controlled trials that compared operative and non-operative treatment for displaced intra-articular calcaneal fractures. Patients with operative treatment were more likely to resume pre-injury work (relative risk [RR]=0.60, p=0.04), had fewer problems when wearing shoes (RR=0.42, p=0.0004), and had a higher physical component summary score of SF-36 (difference in means=6.75, p<0.0001) but a higher complication rate (RR=1.74, p=0.0005).

Validation of the Ottawa Ankle Rules in Indian Scenario.

BACKGROUND: Ankle injuries are one of the most common presentations in emergency department. Ottawa Ankle Rules (OARs) have been used to predict the requirement of radiographs. OBJECTIVES: This study aimed to validate the OARs protocol for predicting ankle and midfoot fractures in Indian population. PATIENTS AND METHODS: A prospective study was conducted in a teaching hospital in north India, during a period of nine months, including all patients who presented with complaints in the ankle region and evolution of less than 48 hours. The study excluded patients with multiple trauma and Glasgow coma scale of less than 15. All patients underwent clinical evaluation, followed by radiographs depending upon the location of the complaints. Radiographic study results were evaluated by orthopedic surgeons who had not seen the patient. RESULTS: We evaluated 140 patients (84 males and 60 females) with the mean age of 35.2 (range, 8 - 76 years). Of the 140 evaluable patients, 71 had positive criteria for radiological evaluation of which 43 presented with fracture, 69 had negative criteria for radiography with no fracture. The sensitivity of OARs to detect fractures was 100%. The implementation of the OARs appears to have the potential to reduce the number of radiographs for the assessment of these patients by about 51%. CONCLUSIONS: The implementations of OARs have the potential to reduce the number of X-ray graphics needed to assess these patients by about 51%. The results of this study demonstrate no false negatives and are in agreement with results from other similar studies. It encourages us to implement these criteria in our services urgently, with all the resulting socio-economic implications.

Barbed versus standard sutures in total knee arthroplasty: a meta-analysis.

INTRODUCTION: The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty. METHODS: We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs. RESULTS: Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36-2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI -2.74, CI -3.06, -2.42, P < 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time. CONCLUSION: Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.

Tuberculosis of symphysis pubis: A case report.

Symphysis pubis is an uncommon site of tuberculosis and only few cases have been reported in the literature. It is important to distinguish it from the more common entities like Osteitis pubis and Osteomyelitis of pubis symphysis to prevent delay in diagnosis and minimize morbidity and prevent complications. We report a rare case of tuberculosis of symphysis pubis in a 50-year-old Indian female from low socioeconomic status. Diagnosis is not difficult if one is aware of the condition. A high index of suspicion along with radiograph and fine needle aspiration led to the diagnosis. The patient had an excellent outcome following a complete course of anti-tuberculous chemotherapy for tuberculosis.

Role of vitamin C in prevention of complex regional pain syndrome after distal radius fractures: a meta-analysis.

BACKGROUND: Complex regional pain syndrome is a well-known complication after distal radius fracture with incidence ranging from 10.5 to 37 %. Some studies recommend the use of vitamin C to prevent complex regional pain syndrome. The objective of this meta-analysis was to evaluate the efficacy of vitamin C in prevention of CRPS. METHODS: We searched the PubMed, EMBASE and Cochrane library databases for randomized controlled trial (RCT) and comparative studies reporting use of vitamin C to prevent distal radius fracture. Dichotomous variable was presented as risk ratio with 95 % confidence intervals. RESULTS: We obtained 220 articles from the database search. After the exclusion of duplicates, unrelated articles, letter to editor and editorials, we found four articles relevant to our topic. Meta-analysis of the CRPS incidence revealed that the incidence of CRPS was significantly lower in the vitamin C group [RD 0.41 (0.19-0.92), P = 0.03]. There was moderate to high heterogeneity in the studies included I (2) = 63 %). CONCLUSIONS: Our analysis showed a significant reduction in prevalence of CRPS with the use of vitamin C. Further high-quality RCTs with standard dosages and common diagnostic criteria are needed to be able to deliver solid conclusions.

Knee tuberculosis masquerading as pigmented villonodular synovitis.

Tuberculosis (TB), once a disease confined to undeveloped or developing nations is currently in resurgence, which is attributable to pandemic human immunodeficiency virus (HIV) infection and immigration from endemic areas. Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and nonspecific imaging findings. TB is also known as the 'great mimicker'. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS). The present report describes a young patient with tuberculous arthritis of knee joint. Accurate diagnosis and appropriate management was delayed due to magnetic resonance imaging (MRI) findings, such as, hemosiderin deposits and a nodular mass around the knee joint, suggestive of a diffuse type of PVNS. Our findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion.