Changes in sagittal and axial plane alignment in medial opening wedge high tibial osteotomy: a prospective observational study.

PURPOSE: Deformity correction during high tibial osteotomy is generally based on coronal plane alignment. The aim of this study was to measure changes in sagittal and axial plane alignment following medial opening wedge high tibial osteotomy [mHTO], using pre- and postoperative computed tomography [CT] scans, and correlate them with changes in coronal plane. The secondary objective was to correlate changes in functional outcomes with changes in alignment in each plane. The null hypothesis was that sagittal and axial plane alignment does not change significantly following mHTO. METHODS: This was a prospective, observational study including 30 patients of isolated medial compartment osteoarthritis of the knee joint, between 30 and 60 years of age. Preoperative and postoperative computed tomography scan of bilateral lower limbs from hip to ankle was performed. Varus angle, mechanical axis deviation [MAD] of the lower limb, medial proximal tibial angle [MPTA], tibial torsion and posterior proximal tibial angle [PPTA] were measured. Visual Analogue Scale [VAS 0-10 cm scale] was used for assessment of pain. Functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12 Item Short Form Survey [SF 12] and Tegner Lysholm knee scoring scale. RESULTS: Mean age of patients was 44.59 ± 8.157 years. Mean preoperative varus deformity was 11.13 ± 1.5 degrees, which got corrected to a mean valgus alignment of 3.8 ± 0.93 degrees postoperatively. The mechanical axis deviation was 4.32 ± 1.76 mm lateral to the knee joint center postoperatively. Preoperatively, all knees had external tibial torsion [27.08 ± 2.18 degrees] which was corrected to a mean external tibial torsion of 19.80 ± 3.72 degree after the surgery [P < 0.001]. The overall decrease in sagittal alignment in the present study was 3.70 ± 3.14 degree, 3.97 ± 3.06 degree, 3.92 ± 2.33 degree, for medial, middle and lateral cuts, respectively. There was a significant correlation between change in varus/valgus angle and change in TT and PPTA. Significant positive correlation was seen between change in coronal alignment and functional outcome scores. CONCLUSION: This study has shown that mHTO significantly changes torsional and sagittal alignment. This is the first study to establish relation between correction in coronal plane and associated changes in sagittal and torsional alignments.

INCIDENTAL INTRAOSSEOUS CALCANEAL LIPOMA IN A PATIENT SUFFERING FROM PLANTARFASZIITIS.

Intraosseous calcaneal lipoma is a rare benign bone tumor. The incidence of intraosseous lipoma involving the calcaneus has been noted to account for fewer than 8-15% of all intraosseous lipoma. The etiology of the lesion is unknown. A post-traumatic secondary bone reaction, healing bone infarct, and benign neoplasm have been discussed. The symptoms can be nonspecific, varying from dull, intermittent pain to activity-related plantar pain. This pain can predictably be misdiagnosed as plantar fasciitis. We present the case of a 49-year-old male patient suffering from plantar fasciitis for three months and incidental asymptomatic intraosseous calcaneal lipoma, which was diagnosed by x-ray and CT scan. As the patient was out of complaints, the typical CT findings we saw no indication for biopsy but recommended regular CT and MRI controls.;

INTRAMUSCULAR MYXOMA OF THE BUTTOCK- A CASE REPORT.

Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. IM is rare, with an incidence of between 0.1 and 0.13 in every 100,000 individuals. Onset is usually between the fourth and seventh decades of life, predominantly in women (70%). The thigh is the common site of involvement seen in 51% patients, followed by upper arm (9%), calf (7%), and rarely in buttocks. We present the case of a 63-year-old female patient with a 6-month history of a growing IM of the right buttock. Due to rapid tumor growth resection of the tumor was indicated to obtain histopathological examination and to rule out malignancy. Marginal surgical removal was performed. Histopathological examination brought the diagnosis of a big intramuscular myxoma. There is no recurrence at latest follow-up.

Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial.

PURPOSE: Local subacromial infiltration with steroids is a common method of treatment of subacromial impingement syndrome. However, the use of steroids has concerns like tendon rupture, articular cartilage changes and infections. Local NSAIDs infiltration has recently been tried in literature. This study compares the effect of subacromial injections of ketorolac with steroids. METHODS: A randomized controlled study was planned with 35 patients in each group. Patients in group-1 were infiltrated with subacromial ketorolac (60 mg with 2% lignocaine) and in group-2 with a steroid (methylprednisolone-40 mg with 2% lignocaine). A similar rehabilitation protocol was followed, and clinical outcomes were analyzed using visual analog scale (VAS) for pain and shoulder pain and disability score (SPADI) and range of motion at one-month and three-months follow-up. RESULTS: Total data of 67 patients were analyzed, as three patients were lost to follow-up. In group 1, mean VAS improved from 7.9 [Formula: see text] 0.95 to 3.19 [Formula: see text] 0.81 (p < 0.001) and SPADI improved from 61.41 [Formula: see text] 11.86 to 28.91 [Formula: see text] 9.06 (p < 0.001) at three months, respectively. In group 2, mean VAS improved from 8.05 [Formula: see text] 0.94 to 2.9 [Formula: see text] 0.64 (p < 0.001) and SPADI improved from 63.45 [Formula: see text] 9.64 to 25.32 [Formula: see text] 6.87 (p < 0.001) at three months, respectively. However, there were no differences in functional outcomes between the groups (p = 0.21 for VAS, p = 0.16 for SPADI). CONCLUSION: Subacromial ketorolac infiltration has an equivalent outcome as that of steroid infiltration. Ketorolac could be considered as a reasonable alternative to steroids in cases where it is contraindicated.

Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study.

PURPOSE: Acute traumatic and chronic non-traumatic rotator cuff tears are etiologically distinguishable entities. However, prospective studies comparing tear characteristics and outcomes between these two types of tears are lacking. The purpose of this study was to compare the tear characteristics, clinical and functional outcomes, and tendon healing as assessed on magnetic resonance imaging (MRI), between traumatic and non-traumatic rotator cuff tears. METHODS: MRI proven rotator cuff tears were allocated into two groups according to the history of injury: Group 1 included 28 patients with traumatic tears and group 2 included 33 patients of non-traumatic cuff tears. Both the groups were compared for preoperative tear characteristics (tear size, muscle atrophy, fatty degeneration), range of motion, strength of shoulder abduction and external rotation, functional outcomes, and tendon integrity on MRI, 2 years after the surgery. RESULTS: Postoperative mean active range of abduction (p = 0.005), abduction strength (p = 0.013), external rotation strength (p = 0.027), University of California at Los Angeles score (p < 0.001), Constant score (p = 0.002), American Shoulder and Elbow Surgeons scores (p = 0.028) and visual analog scale for pain (p = 0.02) were significantly better in group 1 as compared to group 2. The postoperative structural integrity of the cuff on MRI was better in group 1 as compared to group 2, but the values did not reach statistical significance (p = 0.13). CONCLUSION: Findings from this study suggest that traumatic tears affect younger patients and while having a larger tear size, they have lesser muscle atrophy, fatty degeneration, and tendon retraction. Functional outcomes are better after treatment of traumatic tears as compared to non-traumatic tears. Chronicity of the tear and tendon retraction negatively affected healing in traumatic cuff tears. Muscle atrophy was found to be associated with poorer healing in non-traumatic tears. However, tear size was not associated with healing. LEVEL OF EVIDENCE: II, Prospective cohort study.

Comparative functional outcomes of patients with adhesive capsulitis receiving intra-articular versus sub-acromial steroid injections: case-control study.

PURPOSE: This is a prospective case-control study comparing short- and medium-term outcomes between sub-acromial and gleno-humeral corticosteroid injections in adhesive capsulitis. METHODS: The study population consisted of 105 patients (33 males, 72 females; mean age, 56.1 years). They were divided into three groups: (1) patients receiving 40 mg of methylprednisolone acetate as intra-articular injection (n = 35) followed by physical therapy; (2) patients receiving 40 mg of methylprednisolone acetate as sub-acromial injection (n = 35) followed by physical therapy; (3) patients receiving only physical therapy (heat, passive stretching exercises and wall climbing) and no injections (n = 35). Functional outcome scores (Constant shoulder score and Shoulder Pain and Disability Index), visual analogue scale for pain and range of motion of shoulder joint were noted at 3, 6 and 12 weeks and 6 months. RESULTS: There was a statistically significant improvement in VAS scores in group 1 and 2 at 3, 6, 12 weeks and 6 months compared to that before the injections. There was no statistically significant improvement in the group 3 at 3 and 6 weeks, but improvement was noticed at 12 weeks and 6 months. There was no statistically significant difference in VAS, CS score, SPADI and ROM between groups 1 and 2 at 3, 6, 12 weeks and 6 months. These scores were significantly better in group 1 and 2 compared to group 3 at 3, 6, 12, weeks and 6 months. CONCLUSIONS: Corticosteroid injections into the sub-acromial space and into the gleno-humeral joint produce similar results in terms of pain relief and improvement in function in patients with adhesive capsulitis.

Nonunions and malunions of the pelvis.

INTRODUCTION: Neglected pelvic fractures manifesting as pelvic nonunion or malunion are usually due to inadequate initial fixation or negligence of the injury because of increased attention towards other associated life-threatening conditions. The management of such injuries is complex. A systematic review was conducted to spot the clinical manifestations, evaluation, management and outcome of pelvic nonunion and malunion. MATERIALS AND METHODS: Two databases ("Pubmed" and "Google scholar") were searched to look for relevant literature on pelvic non-union and malunion.  The search was limited to 'English language' and 'Human being'. RESULTS: A total of 500 articles found, of which 10 articles were only reviewed which met the inclusion criteria. These articles discussed the clinical management and treatment of pelvic malunion and non-union following trauma without associated acetabular injury. CONCLUSION: The usual presentations of pelvic non-union and malunion are pain, deformity, gait abnormality or instability. A detailed preoperative evaluation is essential as a majority of them have associated hip and spine injury which may be the cause of symptoms. Radiographs and 3D CT scans have helped surgeons in deciding the best way of management. The surgeries are usually complex and may need multiple-staged procedures. Soft tissue release, multiple osteotomies to achieve anatomical or near-anatomical reduction, augmentation of healing process using bone graft and stabilizing the nonunion/ osteotomy site using plates/screws/rods is the basic principle of surgery. Per-operative use of somato-sensory evoked potential evaluation helps the surgeon in preventing iatrogenic nerve injury. Despite these precautions and surgeries, most of the patients do not regain their preinjury functional activity.

Care of post-traumatic spinal cord injury patients in India: An analysis.

BACKGROUND: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. MATERIALS AND METHODS: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. RESULTS: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. CONCLUSION: Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon.

Transformation of Candida oleophila and survival of a transformant on orange fruit under field conditions.

Histidine auxotrophs of wild-type strain I-182 of Candida oleophila, produced using ethyl methanesulfonate, were transformed with plasmids containing the HIS3, HIS4 and HIS5 genes of Saccharomyces cerevisiae. Histidine auxotrophy was complemented by the HIS5 gene of S. cerevisiae. Stability of the transformants under non-selective conditions and DNA gel-blot analysis suggested that the transforming DNA had integrated into the C. oleophila genome. There were no detectable physiological differences between the wild-type and the transformants. The biological control ability of C. oleophila was not affected by the transformation. A genetically marked transformant (with a beta-glucuronidase gene) colonized wounds on oranges, and its population increased under field conditions. The identity of the genetically marked transformant was established by PCR-amplification of a portion of the beta-glucuronidase gene.

Control of Brown Rot and Blue Mold of Sweet Cherry with Preharvest Iprodione, Postharvest Cryptococcus infirmo-miniatus, and Modified Atmosphere Packaging.

The effectiveness of preharvest iprodione and postharvest Cryptococcus infirmo-miniatus treatments alone and in combination for control of decay of sweet cherry fruit was studied. Also, the effect of a modified atmosphere on brown rot control was evaluated as a part of the iprodione-C. infirmo-miniatus combinations. A single preharvest application of iprodione at 1.13 kg a.i./ha reduced brown rot in stored sweet cherry fruit in both years of this study. Significantly better control of brown rot was obtained when cherry fruit that received a preharvest iprodione application also were treated with a postharvest dip in a suspension of C. infirmo-miniatus containing 0.5 to 1.5 × 108 CFU/ml. Brown rot was reduced by modified atmosphere packaging (MAP) alone and further reduced as a result of a C. infirmo-miniatus-MAP synergism. Incidence of brown rot was reduced from 41.5% in the control to 0.4% by combining preharvest iprodione and postharvest C. infirmo-miniatus treatments with MAP.

A method for studying the population dynamics of Candida oleophila on oranges in the grove, using a selective isolation medium and PCR technique.

Populations of the biological control agent Candida oleophila on fruit in an orange grove were monitored by plating fruit washes and peel homogenates on a selective medium, followed by PCR analysis of DNA from yeast colonies resembling C. oleophila. The C. oleophila transformant ADGus-10 formed colonies on a selective medium that suppressed the development of 99% of the filamentous fungi and the indigenous yeasts, Aureobasium (a yeast-like fungus) and Rhodotorula. Only 6-8 indigenous yeasts/cm2 fruit surface gave rise to colonies that resembled C. oleophila on the selective medium. The identity of the C. oleophila transformant colonies was verified by PCR analysis of yeast DNA. The presence of a 599-bp band in the PCR product primed by beta-glucuronidase gene primers, confirmed the identity of C. oleophila transformant ADGus-10. Colony-forming units of C. oleophila were recovered efficiently from fortified washes of the fruit surface and from homogenates of wounds excised from fruit sprayed in the grove with C. oleophila.

Enumeration of bacterial and yeast colonists of apple fruits and identification of epiphytic yeasts on pear fruits in the Pacific Northwest United States.

A procedure for the isolation of diverse culturable microflora for the estimation of the population size of yeasts and bacteria on the surface of pome fruits is described. Maximum numbers of morphologically distinct colonies of both yeasts and bacteria were recovered from apple fruit surfaces when fruits were shaken for 5 min in sterile phosphate buffer plus tween, sonicated for 5 min, and aliquots of the buffer plated onto diluted yeast malt agar and diluted nutrient broth agar, respectively. The yeast and bacterial populations on the surface of unsprayed Golden Delicious apple fruits were approximately 8.0 x 10(3) and 9.5 x 10(4) colony forming units (cfu) per cm2, respectively. The densities of yeasts on the surface of pear fruits collected from Yakima, Wa, Cascade Locks, Medford, and Hood River, OR, were approximately 7.3 x 10(3), 6.4 x 10(3), 4.1 x 10(3), and 9.9 x 10(2) cfu.cm-2, respectively. The highest number of morphologically different yeast isolates were recovered from pear fruits from Cascade Locks and Hood River, Oregon and Yakima, Washington. Aureobasidium pullulans was present on fruits in all pear orchards sampled whereas Cryptococcus albidus and Rhodotorula glutinis were isolated from 80% of the orchards. Other yeasts colonizing pear fruit surfaces in 20-60% of the orchards were Cryptococcus infirmo-miniatus, Cryptococcus laurentii, Debaryomyces hansenii, Rhodotorula aurantiaca, R. fujisanensis, R. minuta and Sporobolomyces roseus.