Breaking the Mold: Surgical Exploration for Spinal Impalement Injury Without Neurological Deficit.

Spinal cord injuries (SCI) are a significant burden on society, particularly affecting the working population. Traumatic SCI can result from violent confrontations, involving firearms, knives, or edged weapons. Although surgical techniques for these injuries are not well defined, surgical exploration, decompression, and removal of the foreign body are currently indicated for patients with spinal stab wound injuries with neurologic impairment. We present a case of a 32-year-old male patient who presented to the emergency department with a stab injury with a knife. Radiographs and CT scans revealed a broken knife blade with a midline trajectory in the lumbar spine, moving toward the vertebral body of L2 occupying less than 10% of the intramedullary canal. The patient underwent surgery, and the knife was successfully extracted without any complications. Post-operative MRI showed no signs of cerebrospinal fluid (CSF) leak, and the patient did not exhibit any sensorimotor deficit. The acute trauma life support (ATLS) procedure must be followed while treating a patient with penetrating spinal trauma with or without neurological impairment. After availing appropriate investigations, any attempt to remove a foreign object should be done. Although spinal stab wound injuries are uncommon in developed nations, they continue to be a source of traumatic cord damage in underdeveloped countries. Our case highlights the successful surgical management of a spinal stab wound injury with a good outcome.

Achieving Rapid Healing and Low Complication Rates in Patellar Fracture Fixation: The Benefits of Cerclage and Figure-of-Eight Configuration.

Background and objective Patellar fractures account for around 1% of all fractures. Conservative treatment is advised in patients without any incompatibility of articular surfaces or those with intact extensor mechanisms. More than a 2-mm articular gap due to fracture warrants surgical intervention. Tension band wiring (TBW) is a commonly used practice for fixation, However, there is still controversy about its effectiveness and complications arising due to the hardware. Modification of this technique by using K-wires has been considered a method of choice, but this technique is associated with complications due to K-wires. The Pyrford technique is a method for patellar fracture fixation by circumferential cerclage and anterior TBW. We employed the figure-of-eight configuration over the circumferential wire. This study aimed to analyze the outcomes of TBW of the patella without K-wires by assessing the rate of complication and functional outcomes. Materials and methods A total of 38 patients with OTA 34C type, simple and comminuted type of patella fractures aged between 22 and 70 years were treated with circumferential cerclage and figure-of-eight TBW. All patients underwent patellar fixation with cerclage and through direct purchase of SS wire via quadriceps and patellar tendon. Patients were followed up for one to three years. We analyzed differences in the range of motion, fracture reduction, fracture healing time, Bostman score for knee function, and complications. Results The mean age of the patients was 45 years. After TBW without K-wires, fracture healing and functional outcomes were satisfactory according to patient feedback and clinocoradiological examinations. Of note, 35 out of 38 patients (92%) had gained up to 90 degrees of active flexion at the end of one week. One patient (2.42%) developed a superficial infection. All fractures had achieved union at the end of 16 weeks. Malunion or nonunion was not noted in any of the cases. There was no case of implant removal. The average Bostman score at the 12-month follow-up was 28.5 ±1.5. The incidence of complications due to K-wire was nullified. Conclusion Based on our findings, the described method leads to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminuted fractures. The fracture healing and functional outcomes and rate of complications were satisfactory.

Combined Pyogenic and Tuberculous Osteomyelitis of the Clavicle: A Case Report.

INTRODUCTION: Tuberculous osteomyelitis of the clavicle accounts for 1-3% of cases of osteoarticular tuberculosis. It presents with non-specific symptoms and may have superadded infections with pyogenic organisms, requiring a high degree of suspicion to adequately diagnose and initiate appropriate treatment. CASE REPORT: We describe a case of a 35-year-old male with osteolytic clavicular lesion and abscess in the supraclavicular fossa. Tissue diagnosis revealed tuberculous osteomyelitis with superadded infection with Staphylococcus aureus. He was managed with debridement and anti-tubercular therapy. CONCLUSION: A high degree of suspicion is required to adequately test and diagnose the cause of osteomyelitis of the clavicle, in the absence of a predisposing event, as staphylococcal and tuberculous infection can present simultaneously.

Geometric analysis of the humeral head and glenoid in the Indian population and its clinical significance.

BACKGROUND: Total anatomic and reverse shoulder prostheses are designed to match the dimensions of the native bony anatomy. Chinese and Japanese bony dimensions of the shoulder have been found to be different from that of the Caucasian population. We hypothesized that the geometric dimensions of the humeral head and glenoid in the Indian population would also be different from that of the Caucasian population. METHOD: Fifty patients underwent computerized tomographic scans of their normal shoulders. We calculated the superoinferior (SI) diameter of the humeral head, anteroposterior diameter of the humeral head, radius of curvature of the humeral head, humeral head retroversion, humeral head thickness, inclination angle, critical shoulder angle, greater tuberosity angle, glenoid width, glenoid length, radius of curvature of the glenoid, glenoid inclination angle, and glenoid version. RESULTS: The radius of curvature of the humeral head averaged 22.9 ± 1.7 mm, the articular surface thickness 17.1 ± 1.6 mm, and the SI diameter 42.3 ± 3 mm. The SI diameter strongly correlated with the thickness (r = 0.617, P = .001). The anteroposterior/SI articular surface diameter ratio averaged 0.9 ± 0.9, the articular surface thickness/radius of curvature ratio 0.7 ± 0.9, the inclination angle 133.8 ± 6.4, and the retroversion angle 33.5° ± 8.5°. The radius of curvature of the glenoid averaged 23.3 ± 3.4 mm, the glenoid width 24.0 ± 2 mm, the SI length 31.3 ± 2.2 mm, the glenoid inclination angle 78.7° ± 4.8°, and the glenoid retroversion 1.8° ± 3.8°. DISCUSSION: Compared with the Western population, our cohort had a smaller humeral radius of curvature (P = .04), smaller articular surface diameter (P = .001), smaller inclination angle (P = .003), larger retroversion angle of the humeral head (P < .001), and smaller glenoid length and width (P < .0001). Most of the implant companies did not have smaller sized combinations of humeral heads with thickness to match our population. The glenoid width of females in our cohort was found to be smaller for the smallest size of the glenoid base plate. CONCLUSION: Smaller sized options in humeral head diameter and thickness of the anatomic prosthesis and glenoid baseplate of the reverse shoulder prosthesis need to be made available to suit our population and avoid a mismatch.

The Distance between the Pectoralis Major Tendon Insertion and the Top of the Humeral Head is a Reliable Landmark: An Anatomic Study.

Purpose This study aimed to analyze the distance between the superior edge of the pectoralis major and the top of the humeral head and evaluate whether this distance is a consistent measurement. Methods Twenty-two shoulders in eleven cadavers were dissected and the attachment of the pectoralis major tendon was preserved. Two distances were recorded with the help of digital vernier caliper: the distance between the upper edge of pectoralis major and tangent to the top of humeral head (PM-T) and the distance between the superomedial tip of greater tuberosity (GT) and the upper edge of the pectoralis major tendon (PM-G; ± standard error of the means). Results The mean PM-T distance was 53.8 mm (±0.8 mm) and the mean PM-G distance was 46.8 mm (±0.9 mm). The distance between the top of humeral head and tip of the GT was 7 mm. The PM-T distance was a significant outlier in three shoulders as it inserted high on the humerus. Conclusion We can conclude that the PM-T and PM-G distances were a consistent measurement. Clinical Relevance The distance between the pectoralis major tendon and top of the humeral head was measured in this study as a reliable method that can be used intraoperatively to decide the height of the humerus prosthesis in comminuted fractures of the proximal humerus.

Insertion anatomy of the pectoralis major tendon.

BACKGROUND: Pectoralis major tendon tears are encountered in young active patients. METHODS: In 10 fresh cadaveric shoulders we measured-1. Proximal to distal insertion width of the pectoralis major tendon.2. The distance of the superior border of the tendon from the supero-medial tip of the greater tuberosity (GT). RESULTS: The average insertion width was 46 mm. The average distance between the superior border of the tendon and the tip of the GT was 48.5 mm. CONCLUSION: The superior border of the tendon should be repaired with two anchors at a distance of 48.5 mm from the tip of the GT so as to cover a width of 46 mm.

Intraoperative and anatomic dimensions of the coracoid graft as they pertain to the Latarjet-Walch procedure.

BACKGROUND: Our objective was to study the anatomic and intraoperative coracoid measurements with an aim to closely replicate the Latarjet-Walch technique and find the similarities and dissimilarities in our population. METHODS: In the cadaveric study, 20 shoulders in 10 fresh cadavers were dissected, and the coracoid length, width, and thickness were measured. In the intraoperative study, 10 patients underwent the classic Latarjet procedure according to the Walch technique. The harvested coracoid graft was analyzed for the length of the coracoid, the distance of the inferior hole from the lateral margin of the coracoid graft, and the width of the coracoid graft at the inferior and superior hole. RESULT: The average distance from the tip of the coracoid to the trapezoid insertion was 25.4 mm (standard deviation [SD], 1.7 mm). The mean width of the undersurface of the coracoid was 14.2 mm. The average length of the graft after harvesting was 25.1 mm (SD, 1 mm). The average distance between the lateral border and the inferior hole was 5.5 mm (SD, 1.1 mm). We used 25-mm malleolar screws in 3 shoulders and 30-mm malleolar screws in 7 shoulders. CONCLUSION: The"7-mm" rule of Walch could be followed in our population. The medial surface width of the coracoid in our Indian morphology was an average of 7 mm; hence, malleolar screws of 30 and 25 mm were used to fix the graft on the glenoid.

The natural history of knee osteoarthritis: India-based knee osteoarthritis evaluation (iKare): a study protocol.

METHODOLOGY: Multi-center, cross-sectional, observational study. STUDY CENTER(S): Multiple centers in India. NUMBER OF PARTICIPANTS: 1,000. PRIMARY RESEARCH OBJECTIVE: To characterize patients and treatment utilized for orthopedic patients presenting to both private and public hospital centers in India with knee pain and symptoms suggestive of knee arthritis. INCLUSION CRITERIA: All patients 18 years of age or older who present to a recruiting hospital for treatment of knee pain will be eligible for participation. The subjects must be able to understand and complete the questionnaire. EXCLUSION CRITERIA: Patients with total knee replacement, open wound or evidence of recent surgery, or with a current or a history of tumor and/or fracture in the tibial plateau, femoral condyle or patella, in the affected knee are not eligible. STUDY OUTCOMES: This study aims to characterize the following: general demographics of patients presenting with knee pain, severity of knee symptoms at time of presentation, severity of knee pathology at time of presentation, factors associated with the decision to seek medical care, previous treatments and health care contacts, planned treatment, and gaps in treatment perceived by the patient and treating surgeons.

Intervertebral disc calcification in a child.

Disc calcification in children is a rare condition of which only approximately 200 cases have been reported worldwide and one from India and we report one such case. A five year-old boy presented with neck pain, torticollis and limitations of cervical motions following a fall while playing 3 months back. He had low grade fever cervical lymphadenopthy, paraspinal muscle spasm. His blood counts and ESR was raised. Fine needle aspiration cytology of lymph node revealed reactive lymphadenitis. His cervical radiograph slowed calcification of C 6-7. MRI scan showed hypointense signals in C6-C7 and D5-D6 disc on both T1 and T2 W images. Cerebrospinal fluid examination was normal. He improved on analgesics, bed rest and cervical traction.

Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks postinjury in the absence of a fracture table or C-arm.

BACKGROUND: We present our technique of closed nailing in diaphyseal femoral fractures treated between 1 to 14 days postinjury. The purpose of the study was to demonstrate the fact that such fractures can be treated closed in the absence of a fracture table or C-arm. METHODS: In all, 200 consecutive closed femoral fractures were fixed 1 to 14 days postinjury during a period of 2 years. Skeletal traction was applied immediately at admission and sufficient weight was applied to overcome muscle spasm. In most cases, a closed nailing was successfully performed. Distal locking was achieved with either a medinov nail with wings for distal locking, or a standard nail with a jig for the distal lock. RESULTS: The average age of the patients was 30 years. Follow up ranged from 6 to 12 months. Mean duration of follow up was 10 months. All patients had a functional range of movement at the hip and knee with a normal gait. The average time taken for surgery was 90 minutes with an average blood loss of 50 to 100 mL. Time in hospital after surgery was 2 to 10 days. CONCLUSIONS: Delayed closed nailing of femoral fractures can be achieved without a C-arm or a fracture table provided adequate skeletal traction is applied preoperatively and proper attention is paid to the surgical steps as described.