Bilateral Paired Calcaneal Spur: A Rare Entity.

Introduction: Heel pain is one of the most common painful conditions of the foot. There are many causes of heel pain, which are usually associated with calcaneal spurs. Hence, it becomes imperative to diagnose and treat them effectively. The development of calcaneal spur is somewhat not well known but is often said to be developed from inflamed plantar fascia. Heel being weight-bearing part of the body, it is very painful something and adversely affects the activity of daily living. Calcaneal spurs are fibrocartilaginous triangular projections from an insertional area of the plantar fascia. Calcaneal spurs are usually single in number but can vary in size. Paired or double calcaneal spurs are not yet reported in the literature and further, the occurrence of bilateral paired calcaneal spurs is extremely rare too. The aim of this case report is to report the occurrence of bilateral paired or double calcaneal spurs. Case Report: A 56-year-old man presented himself at the orthopedics outpatient department with spontaneous onset bilateral heel pain for the past few months. The pain was more in the morning as soon as he gets up from bed and persisted throughout the day with variable intensity. Conclusion: The presence of calcaneal spur is usually symptomatic and may be asymptomatic sometimes. The presence of symptomatic bilateral paired calcaneal spur is rare and the present case report may be helpful for further study.

Intralesional Steroid Injection Versus Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Comparative, Prospective, Case Series Study.

Background This study aimed to compare and evaluate the outcomes of intralesional steroid injections (ultrasound-guided) versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Methodology Between January 2021 and March 2022, 120 (84 male, 36 female) patients with a confirmed diagnosis of plantar fasciitis were identified. Subjective assessment was done using Mayo Clinical Score, and objective evaluation was done by measuring plantar fascia thickness using ultrasonography. For this study, two groups were made, wherein group A was administered a high dose of extracorporeal shockwave therapy, and group B was administered ultrasound-guided intralesional or local steroid injections. Results Plantar fascia thickness was considerably reduced after therapy in both groups; however, the difference in thickness reduction was not statistically significant between both groups. Mayo Clinic Scores showed statistically significant improvement in pain; however, the difference in pain reduction was not statistically significant between both groups. Conclusions A considerable clinical and radiological improvement was noted in both groups; however, we did not record statistically significant and superior results in either group. Intralesional steroid injections provided faster clinical improvement and better patient compliance.

The Outcome of Placing the Medial K-wire First and Then the Lateral K-wire in Treating Supracondylar Humerus Fractures in Children Treated by Closed Reduction.

Background Displaced Gartland type III and IV supracondylar fractures are difficult to reduce and invariably require closed pining. After closed reduction, taking the anteroposterior (AP) view does not present any problem but when the elbow is placed in flexion and the limb is rotated internally to take a lateral view, the reduction is invariably lost. However, the reduction stays when the arm is rotated outwards, keeping the medial condyle up. This stimulates the idea of whether the medial pin can be placed first and then the two lateral pins to stabilize the fracture. It is very frustrating for young orthopedic surgeons to see reduction getting lost during internal rotation after first doing lateral pinning. There is no clear guideline on which side should be fixed first. Hypothesis We hypothesized that placing the medial pin first maintains the reduction and facilitates the subsequent placing of lateral pins without the loss of reduction. Materials and methods A total of 170 children with displaced supracondylar humerus fractures were included in the study. A total of 120 children were grouped in the medial wire first group, and 50 were placed in the lateral wire first group, which was the control group. The mean age of the children was 7.5 years (range 2-13 years). The gender ratio (M: F) was 5:3; the left elbow was involved in 68% of the injuries, whereas the right elbow was involved in 32% of the injuries. All 170 children had an extension-type injury, with 91 (53.5%) fractures being Gartland type III and 79 (46.45%) fractures being type IV. Results Results were recorded as per Flynn's criteria. At the end of two years of follow-up, the children in the medial wire first group 117 (97.5%) showed excellent results and three (2.5%) children showed good results, whereas, in the lateral wire first group, 48 (96%) children showed excellent results and two (3.8%) children showed good results. There was a significant difference in the mean surgical time of 20.11±15.43 minutes in the medial wire first group vs 41.23±19.65 minutes in the lateral first group (p = 0.0021). None of the children developed permanent ulnar nerve palsy. Conclusions Placing the medial K-wire first rather than the conventional placing of the lateral wire first helps in maintaining the reduction and allows for the subsequent placement of lateral K-wires without losing the reduction, thus minimizing fixation time and producing good results.

A Case Series on Whether Arthroscopic Bankart Repair Following Primary Traumatic Anterior Shoulder Dislocation or Recurrent Dislocation in Soldiers Has an Effect on the Postoperative Recurrence Rate.

Background Anterior traumatic shoulder dislocation is very common among soldiers or any young population following injury, which is invariably treated by closed reduction. The dislocation when treated nonsurgically has a 71% high rate of recurrence. There is not much data available on the rate of recurrence when primary dislocation (first time) was treated by arthroscopic Bankart repair and in those who have recurrent (multiple) dislocations before surgery. Aim This study aims to report the postoperative recurrence rate in soldiers with first-time dislocation versus those with recurrent dislocations before surgery. Study design The present study is a level IV case series treatment study. Methods In this prospective study, 143 soldiers were included, of which 82 patients had first-time dislocation (F group) and 61 patients had recurrent dislocation before surgery (R group). The patients were evaluated and followed up for over three years. Nonabsorbable PEEK suture anchors (Chetan Meditech, India) were used for arthroscopic Bankart repair. The recurrence rates, Rowe scores, visual analog scale (VAS) scores, subjective shoulder values (SSVs), and satisfaction were compared. We also used the Simple Shoulder Test (SST) score for evaluation. The scores were recorded preoperatively and at three-year follow-up. The range of motion, postoperative function, recurrence rates, and return to pre-injury state was evaluated. Results A total of 143 patients were included, providing 97.3% follow-up at an average of 36 months. The postoperative recurrence rate was 19.7% in the F group and 58.3% in the R group (P < 0.001). The odds of postoperative recurrence were five times higher in the recurrent dislocation group (odds ratio (OR): 5.23). Conclusion Patients who underwent repair after first-time dislocation show a lower postoperative recurrence rate as compared with those who had multiple dislocations before surgery. It is prudent to advise early repair even after the first dislocation especially in young active soldiers to reduce the risk of postoperative recurrence.

Comparative study of role of physiotherapy alone versus physiotherapy combined with yoga in rehabilitation after a sports injury. What can a primary physician offer?

Background: Posttraumatic rehabilitation of sports injuries involves physiotherapy. Additionally, nonsurgical treatment of sports injuries involves regular physiotherapy as a major treatment therapy. This study aimed to evaluate the effects of yoga in addition to regular physiotherapy on these patients. Materials and Methods: In the present comparative study, we evaluated the effects of regular physiotherapy alone versus physiotherapy combined with yoga on 212 patients following various knee injuries treated nonsurgically. The study was conducted after obtaining hospital ethical, committee clearance, and written informed consent from patients. The patients were assigned into two groups: group C (Conventional) and group Y (Yoga group). The patients in the regular group received physiotherapy rehabilitation program, whereas the yoga group received additional yoga once every day by a yoga expert during their hospital stay. We provided written guidelines and photographs of the yoga asanas and instructed to perform them 3 days/week once they were home. The data on WOMAC score were collected at 6 weeks, 3 months, and at 6 months from the day of discharge from the hospital. Results: We noted that the yoga group patients showed a significant improvement (P < 0.05) in all modalities like pain, stiffness, and function subscales of the WOMAC scale. They experienced significant reduction in pain and stiffness compared with the regular or conventional group on the seventh postinjury day, 6 weeks, 3 months, and 6 months after the initial injury. Conclusion: In this study, a combination of regular physiotherapy and yoga provided better functional outcomes than physiotherapy alone.

Does parity and duration of lactation have any effect on the bone mineral density of the femur and lumbar spine in Indian women? A cross-sectional study from the Northeast region of India.

BACKGROUND: The effects of multiple pregnancies and period of lactation on bone density have not been studied till date and there is very less data available, especially from developing countries like India. Lumbar spine and femoral neck were used to measure BMD and results were recorded. OBJECTIVE: To find out the effect of parity and period of lactation on occurrence of osteoporosis in spine and femoral neck in women of the Northeast region of India. MATERIALS AND METHODS: The cross-sectional study included 294 perimenopausal and postmenopausal women aged 30-65 year old. Age, body mass index (BMI), parity, total lactation period, menopausal status, duration of menopause socioeconomic status, and nutritional history were noted. The dual-energy X-ray absorptiometry system was used to measure the BMD of lumbar and femoral neck BMD. Multiple regression analysis was done for finding out the association of parity and lactation with BMD. RESULTS: The parity was inversely related with BMD of lumbar spine (ß = -0.138, P = 0.00423) and BMD of femoral neck (ß = -0.142, P = 0.00487). This relation remained significant after adjusting for age, BMI, and duration of menopause. Period of lactation was also inversely correlated with BMD for lumbar spine (ß = -0.0812, P = 0.0012) and BMD of femoral neck (ß = -0.033, P = 0.0031). CONCLUSION: The number of parity and prolonged period of lactation have a negative effect on BMD in both regions especially in the lower socioeconomic strata with poor nutritional intake. Our data supports that parity and duration of lactation can be associated with future osteoporosis.

To study the awareness of osteoporosis in postmenopausal Indian women in a Northeast part of India: An evaluation of the Osteoporosis Health Belief Scale.

AIM AND OBJECTIVE: Our study's objective is to determine the level of awareness in postmenopausal women in Guwahati, Northeast part of India, using the Osteoporosis Health Belief Scale (OHBS). SETTINGS AND DESIGN: Osteoporosis is the most common silent health problem in postmenopausal Indian women. An awareness level among this subset of women needs to study. The present study is based on a self-explanatory questionnaire. METHODS: We conducted a self-explanatory questionnaire study on 2000 postmenopausal women in Guwahati, North East region of India. The bone mineral density (BMD) was measured using calcaneum Quantitative ultrasound (QUS) to assess BMD. Baseline characteristics were noted and analyzed. RESULTS: The awareness level was noted only in757 (37.85%). Women with education level 12th standard and above have some awareness regarding osteoporosis. CONCLUSIONS: Based on the present study, we can conclude that there is a lack of awareness in postmenopausal women regarding osteoporosis in India's North-East region. This subset of women is unaware of the condition that can leads to fragility fracture if not address in time. The study emphasizes that health care professionals should conduct frequent awareness programs in the community to prevent this silent disease, and morbidities so arise from osteoporosis can be minimized.