Police vs doctors: Harassment of Covid "heroes", by Covid "heroes"?

Violence against medical professionals and destruction of hospital property by frustrated patients and their relatives occur frequently in India (1) and in other countries (2, 3). However, harassment of healthcare workers by the police has, so far, not been an issue in the Indian healthcare system. Now, cases of harassment of medical professionals by the police have emerged during the Covid-19 pandemic. Ironically, both doctors and police personnel have been considered "frontline heroes" against the pandemic in India. We present some cases of such attacks.

Treatment of Rolando Fractures by Open Reduction and Internal Fixation using Mini T-Plate and Screws.

INTRODUCTION: Rolando fractures being intra-articular fractures of the most mobile joint of the thumb, assume significance because any residual incongruity of the articular surface may result in loss of motion as well as secondary osteoarthritis and hence serious disability. This fracture continues to pose difficulties to the treating surgeons and although several treatment options have been described for these fractures, there are no definite guidelines. METHODS: The present study describes the results of open reduction and internal fixation of nine Rolando fractures with large and single fragments, using mini T-plate and screws. RESULTS: At 3-year follow-up all the fractures had united, functional results were excellent or good in most cases, and all the patients had returned to previous activities. Significant complications such as deep infection and loss of reduction were not encountered in any patient. CONCLUSION: Open reduction and internal fixation with mini T-plates in properly selected cases of Rolando fracture with large and single palmar and dorsal articular fragments offers several advantages such as allowing direct visualization of the joint, removal of interposed soft tissues, and exact anatomical restoration of the articular surface. The fixation in most cases is rigid enough to allow early mobilization without loss of reduction. Thus, complications such as stiffness as well as future arthrosis may be minimized. However, the technique is demanding and needs high degree of precision. The possibility of implant removal should be discussed beforehand with the patient.

A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

UNLABELLED: This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case study.

Deformity Correction about Knee with Ilizarov Technique: Accuracy of Correction and Effectiveness of Gradual Distraction after Conventional Straight Cut Osteotomy.

BACKGROUND: The aim of the study was to retrospectively analyse the long term clinical outcome, accuracy of correction, and the complication rate in patients treated for deformities around the knee with gradual distraction with or without additional limb lengthening using Ilizarov technique. MATERIAL AND METHODS: The study presents a retrospective analysis of 26 patients treated for deformities about the knee by gradual distraction with Ilizarov technique with an average follow-up of 6.1 yrs (2-13 yrs). Preoperative and post-operative radiographs of all patients were assessed for the deformities. Deformity involved the tibia in 16 patients and the femur in 9 patients and one patient had both components. The deformity comprised of varus in 15 patients and valgus in 11 patients, and deformity in two planes (oblique plane) in 2 patients, while 8 patients had either deformity with associated average shortening of 4.75 cms (2-7 cm).The mean angle of deformity in the frontal plane was 30 degrees (15-60 degrees) and 48 deg on sagital plane. The CORA (centre of rotation of angulation) was located in the juxtaepiphyseal region in 15 patients, metaphysis in 6 patients and at the metadiaphyseal junction in 5 patients. RESULTS: All except two adult patients achieved exact correction with gradual distraction at an average correction of 30 degrees. Exact limb lengthening was achieved in all 8 patients with shortening. Complications involved mild procurvatum in three patients, mild mismatch of the mechanical and anatomical axes in two patients with tibial deformities, pin tract infection in two patients and one incidence of pin breakage, however, with no true complications. CONCLUSION: Gradual distraction after conventional corticotomy provides excellent results with deformities around the knee with or without additional limb lengthening.

Reconstruction of Unstable Hips with Ilizarov Technique. Role of Pelvic Support and Distal Lengthening Realignment Osteotomy.

BACKGROUND: Hips can suffer severe damage due to untreated developmental dysplasia, septic arthritis, tuberculosis, a neglected fracture of the neck of femur and neglected hip dislocation. The Ilizarov technique offers an effective treatment by providing a stable hip with abolished Trendelenburg lurch and equalizing limb length discrepancy through distal lengthening realignment osteotomy. MATERIAL AND METHODS: 20 patients with hip instabilities due to various etiologies were treated with the Ilizarov technique of pelvic support osteotomy and distal lengthening realignment osteotomy. There were 12 females and 8 males in the study group and the age range was 13 to 30 years. Average limb length discrepancy was 5.95 cms (range 4-8.5 cms).The pre-operative and post-operative range of motion and Harris hip score was collected and data analyzed by Student's paired t test. A p value of < 0.05 was taken to be statistically significant Results. The functional Harris hip score improved in all the patients at final follow-up. The mean Harris hip score was 56.95 (range 33-71) pre-operatively, which improved to 83.25 (range 73-85) at final follow up and was statistically significant (P-value < 0.05). The mean length achieved was 5.53 cms (4-8 cms). The mean external fixation time was 8.6 months and the mean healing index was 1.54 months /cm. CONCLUSIONS: 1. Ilizarov hip reconstruction is an excellent method of salvage in patients with unstable hips diverse etiologies especially in this part of the world, where patients demand unrestricted range of motion at hip, and in the younger age group, where other procedures do not offer a long term solution. 2. It provides an excellent functional outcome in hips of different etiologies. 3. However, for an excellent outcome, surgical expertise, patient compliance and meticulous follow-up are mandatory.

Unstable metacarpal and phalangeal fractures: treatment by internal fixation using AO mini-fragment plates and screws.

BACKGROUND: Accurate open reduction and internal fixation for metacarpal and phalangeal fractures of the hand is required in less than 5% of the patients; otherwise, closed treatment techniques offer satisfactory results in most of these cases as these fractures are stable either before or after closed reduction. AO mini-fragment screws and plates, when used in properly selected cases, can provide rigid fixation, allowing early mobilization of joints and hence good functional results while avoiding problems associated with protruding K-wires and immobilization. The advantages of such internal fixation urged us to undertake such a study in our state where such hand injuries are commonly seen. METHODS: Forty patients with 42 unstable metacarpal and phalangeal fractures were treated with open reduction and internal fixation using AO mini-fragment screws and plates over a period of three years in a prospective manner. RESULTS: The overall results were good in 78.5% of cases, fair in 19% of cases and poor in 2.5% of cases, as judged according to the criteria of the American Society for Surgery of the Hand. CONCLUSION: This technique is a reasonable option for treating unstable metacarpal and phalangeal fractures as it provides a highly rigid fixation, which is sufficient to allow early mobilization of the adjacent joints, thus helping to achieve good functional results.

The role of composite technique in managing peri implant re-fractures in a case with supracondylar fracture of the femur: a case report.

INTRODUCTION: Osteoporosis of the long bones challenges the orthopaedician in several ways. Amongst the difficulties encountered are the reduced bone mass, increased bone brittleness and medullary expansion, which must be factored in when deciding the type of surgical method to be used. One of the commoner complications of fixation of fractures in such bone is the occurrence of peri implant fractures with subsequent management requiring significant surgical acumen and judgment. CASE PRESENTATION: We report a case who sustained a supracondylar fracture of the femur, which was managed initially by a dynamic condylar screw assembly. The patient sustained a peri implant fracture during her rehabilitation, which was managed by the application of a longer side plate. 4 months postoperatively the patient sustained another peri implant fracture. Using a minimally invasive method we removed the screws from the plate and passed an intramedullary implant. The whole assembly was rotationally stabilized using an Ilizarov fixator. The union proceeded uneventfully. CONCLUSION: Use of such minimally invasive methods can be beneficial in such complicated situations.