Computed tomography-based morphometric analysis of normal distal tibiofibular syndesmosis in the Indian population.

BACKGROUND: In suspected Ankle Instability, the parameters that can be defined in the X-ray have their limitation owing to their variability in positioning and rotation of the tibiofibular joint. This inaccuracy further increases due to variability in morphometric parameters of distal tibiofibular syndesmosis among different populations based on race and sex. This research aims to study morphometry of normal distal tibiofibular syndesmosis based on computed tomography imaging in the Indian population. METHODS: An Prospective observational study was performed from December 2020 to October 2022 on normal ankle CT scans of 100 Indian population using axial, sagittal, and coronal CT images. Anterior and posterior tibiofibular distance, Morphology of the incisura fibularis based on depth, Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO), Transverse and longitudinal length of the fibula, and Relationship between the center of the talus and the center of a line joining the outer aspect of malleoli in the coronal plane were measured and analyzed by two different observers. RESULTS: Out of the 100 participants, 77 (77 %) were male, and 23 (23 %) were female. The overall mean age of participants was 34.69 ± 9.7 years. The incisura fibularis was concave in 54 %, and shallow in 46 %. Anterior tibiofibular distance, Posterior tibiofibular distance, and Tibiofibular overlap were significantly different in comparison to the male with female populations (p-value < 0.05). CONCLUSION: This study gives the indices that describe normal variations in the anatomical relationship between the fibula and fibular incisure in the Indian population, which will be helpful for improving the diagnostic accuracy of distal tibiofibular syndesmoses and providing optimal treatment in order to improve functional outcomes and reduce the risk of complications. LEVEL OF EVIDENCE: III.

Impact of tumbling on production of biomethane from household waste.

This study utilized nine anaerobic digesters (ADs) with individual capacities of 10 l to investigate methane (CH4) gas generation from various waste combinations and operating conditions, employing both non-tumbling and tumbling processes with the aid of the Taguchi method. The experimentation encompassed different varieties of fruit waste (FW), raw vegetable waste (RVW), and mixed cooked waste (MCW) at varying proportions (1:1, 1:1.5, and 1:2) and temperatures (35 °C, 40 °C, and 45 °C), along with multiple feed inputs. Additionally, the study assessed the impact of tumbling, examining durations of 0, 10, and 20 min at a speed of 15 rpm. The results yielded substantial insights, revealing coefficient of determination (R2) values of 94.76% and 98.48% for non-tumbling and tumbling processes, respectively. Under the conditions of 40 °C and a 1:1.5 ratio, the average optimal methane (CH4) gas generation in FW without tumbling was determined to be 37.12%. For RVW and MCW at ratios of 1:1.5 and 1:2, respectively, the estimated CH4 values were 26.7% and 26.68% at a temperature of 35 °C. Comparison between tumbling and non-tumbling conditions demonstrated noteworthy improvements in CH4 gas production. For FW, tumbling for 10 and 20 min resulted in 11% and 6% increases in CH4 gas production, respectively. Tumbling also led to substantial boosts in CH4 gas production for RVW, with 31.1% and 47.9% increases after 10 and 20 min, and for MCW, with 25.7% and 12.2% increases after 10 and 20 min, respectively. Tumbling enhances CH4 gas production in anaerobic digesters, promising for waste-to-energy conversion.

Zone-wise biogas potential in India: fundamentals, challenges, and policy considerations.

The current manuscript focuses on the advancements made in establishing zone-based biogas plants in India from 1990 to the present. India generates various types of waste from agricultural, industrial, and human activities. Several methods are available to manage and derive energy from these waste materials, such as incineration, gasification, and anaerobic digestion (AD). Among these options, AD stands out as one of the most viable and environmentally friendly alternatives for biogas production, thanks to its low energy consumption. However, developing biogas plants in developing countries faces significant challenges, primarily due to governments' inadequate application of policy, financial, social, market, information, and technical constraints. To compile this information, data from various agencies in India have been gathered, revealing that 1.81 million biogas plants are currently installed in the West Zone, 1.48 million in the South Zone, 1.106 million in the North Zone, and 0.65 million in the East Zone. These biogas plants across the zones generate 7.02 lakh m3 per day. Additionally, 22 bio-CNG plants produce 84,759 kg/day of compressed biogas, and 201 waste plants generate 330.935 MW of electricity. Recently, the government has emphasized several initiatives, including GOBAR-DHAN, New National Biogas and Organic Manure, Sustainable Alternative Towards Affordable Transportation, and the waste-to-energy program. These initiatives aim to enhance the utilization of waste, promote cleanliness in villages and towns, and support the Swachh Bharat Mission and Atmanirbhar Bharat campaign, leading to tremendous overall success.

Return to sports after ankle reconstruction with tendon grafts in chronic lateral ankle instability: A systematic review and meta-analysis.

Purpose: Anatomic reconstruction using grafts is being performed more frequently in athletes experiencing recurrent chronic lateral ankle instability (CLAI). The purpose of the study was to systematically review the current literature to determine the rates of return to sports (RTS) along with timing in patients with CLAI undergoing ligament reconstruction. Methods: The databases PubMed, Scopus, Cochrane, and Embase were searched based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles quoting on the return to sports rate after lateral ankle reconstruction were included. The rates of return to any sports, return to pre-injury sports, and return to competitive sports along with the timing of return were evaluated and a proportion meta-analysis was performed. Results: A total of 720 patients in 20 studies met our inclusion criteria. The RTS rates for any sports were 95.3%, and 84.3% for pre-injury sports The average time taken for return to sports was 17 weeks. Postoperative functional outcomes, ankle stability, and ROM were significantly improved in comparison to preoperative status. Conclusion: The RTS rates following lateral ankle reconstruction in CLAI showed a high return to any sports, but moderate to high rates for the pre-injury or competitive level of sports. Level of evidence: Level of evidence II.

Transfibular ankle arthrodesis with use of sagitally split fibula as a biological plate leads to excellent outcome: A retrospective analysis.

Background: We studied ankle arthrodesis with a transfibular approach using sagitally spilitted fibula as a biological plate (onlay grafting) as well as other half of fibula as morcellised local interpositional graft (inlay grafting) to achieve bony union. Material and methods: Retrospective clinico-radiological evaluation of 36 operated cases was done at 3, 6, 12 and 30 months follow-ups. Clinically union was considered once ankle became pain free on full weight bearing. Pain assessment was done by using VAS (visual analogue scale) score and functional evaluation was done by AOFAS (American Orthopaedic Foot & Ankle Society) hind foot score preoperatively and at different follow ups. Radiologically, sagittal plane ankle alignment and fusion status was determined at each follow up. Results: Mean age of patients was 40.36 ± 10.56 years (range 18-55), who were evaluated for mean duration of 33.32 ± 11.25 months (range 24-65). Thirty-three (91.7%) ankles were fused adequately and mean duration to achieve bony union was 5.09 ± 1.3 months (range 4-9 months). Mean post-operative AOFAS score at final follow up was 76.65 ± 4.87 in comparison to 45.76 ± 3.38, preoperatively. VAS score improved significantly from 7.8 (pre-operative) to 2.3 (final follow-up). Non-union in three patients (8.3%) and ankle malalignment in one patient was observed. Conclusion: Transfibular ankle arthrodesis achieves excellent bony unions and functional outcomes in severe ankle arthritis. Biologically incompetent fibula that to be judged individually by the operating surgeon to use it as a graft. Patients having inflammatory arthritis have more dissatisfaction than other aetiologies.

Investigation of combustion and emission characteristics of an SI engine operated with compressed biomethane gas, and alcohols.

Alternative fuels in spark-ignition engines significantly reduce engine exhaust emissions and improve fuel efficiency. This research investigates the performance of a multicylinder SI engine using 10%, 20% (ethanol, methanol, methyl acetate), and 100% compressed biomethane gas (CBG) as alternative fuels. Engine performance parameters (BTE, ITE, ME, BP), BSFC, ISFC, FF, combustion phenomenon (cylinder pressure, crank angle, cylinder volume, mass fraction burned, net heat release, mean gas temperature, cumulative heat release, rate of pressure rise), and emission characteristics (HC, CO, CO2, NOx) are measured. CBG achieved a maximum BTE of 23.33% compared to all other fuels. Minimum fuel consumption rate of 1.72 kg/h at maximum rpm achieved BSFC value of 0.44 kg/kWh and ISFC value of 0.261 kg/kWh. The highest cylinder pressure of 6.79 bar was achieved in the G90M10 with a cylinder volume of 48.58 cc. NHR of 3.08 j/deg was found in the G80M20 at a crank angle of 376°, and the maximum MGT was 390.20 °C in the G80E20. The highest CHR values of 0.12 kJ at crank angles of 432°, 420°, 422°, and 427° were achieved in the G100, CBG, G80E20, and G90E10. G90M10 reached a maximum value of 0.14 bar/degree of rate of pressure rise at a crank angle of 374°. Average minimum emission gas was found in CBG at a minimum and maximum RPM, indicating that CBG gives the best emission result with engine performance compared to all alternative fuels.

Comparison of Topical Oxygen with Vacuum Assisted Closure in Wound Healing in a Low Resource Setting.

Background: The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. Methods: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. Results: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. Conclusions: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward.

Swashbuckler approach for distal femur fractures: A systematic review.

PURPOSE: The review aims to reach a common consensus regarding the swashbuckler approach for distal femur fractures by a systematic review of the available literature and to evaluate the complications, union, and outcomes. METHODS: Electronic database search engines like Cochrane Library, PubMed, Google Scholar, and Scopus were searched until May 2021. Studies comparing the clinical complications, and functional outcome scores of Swashbuckler approach for distal femur were considered. The quality of the articles were evaluated using Methodological Index for Non-Randomized Studies score. RESULTS: Eleven studies were included for the final analysis. An anterior midline incision was used in the majority of studies. Superficial infection was the most common complication seen followed by knee stiffness and deep infections. 66.45% of the patients had excellent/good outcomes. 1.08% had a painful implant and 1.89% had deep infection. CONCLUSION: Swashbuckler approach offers itself as a viable option in cases of distal femur fractures, especially in AO type C. The quadriceps sparing approach provides excellent/good outcomes in approximately 66.45% of the patients.

Bilateral Proximal Humerus Fracture with Anterior Shoulder Dislocation and Unilateral Chronic Bankart Lesion - A Case Report.

INTRODUCTION: Anterior shoulder dislocation is a common presentation in orthopedic emergency but a bilateral fracture dislocation is a rare entity. Only a few cases have been reported in the literature and their management is still not clear. We present a bilateral four part fracture dislocation with Bankart lesion on right side in a 48 years old. CASE REPORT: A 48-year-old male presented with bilateral proximal humerus fracture with anterior shoulder dislocation following a seizure. He was managed with bilateral PHILOS and Latarjet procedure on right side for a chronic bony Bankart lesion. Superficial infection on left side was managed with debridement. After 1 year period patient had a satisfactory outcome with DASH score of 19.2. CONCLUSION: Bilateral four part proximal humerus fracture with shoulder dislocation is encountered rarely. Recurrent dislocations results in chronic glenoid bones loss which needs fixation along with fracture. Addressing both sides subsequently or in a single sitting is still debatable.

Outcome of Neglected Talus Neck Fracture and it's Management: A Case Report.

INTRODUCTION: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6-8). A high level of clinical suspicion is required to avoid missing such injuries. CASE REPORT: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. CONCLUSION: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity.

Combined Talus Fracture with Medial Malleolar Fracture: A Case report with Review of Literature.

INTRODUCTION: Combined talar body fracture with a medial malleolar fracture is rare in literature. CASE PRESENTATION: A 30-year-old female presented to our hospital with complaints of pain and swelling over the right ankle joint with difficulty in bearing weight following a motor vehicle accident. Investigation showed talar body fracture of type 2 Sneppen (classification) with an ipsilateral medial malleolar fracture. Fractured talus was openly reduced with the help of reduction clamp and appropriate sized Herbert screw applied to hold the reduction. The medial malleolar fracture was fixed with an appropriate-sized cannulated cancellous screw after confirming satisfactory reduction. The patient was followed up for wound complications, AVN changes, early osteoarthritic changes, and functional outcome. CONCLUSION: The combined talar body fracture, ankle dislocation with a medial malleolar fracture, should be managed; as soon as, a diagnosis is made to get a good functional outcome, even though the incidence of skin complication, AVN risk, and post-traumatic ankle arthritis could not be predicted even though it was absent in our case.

Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy: a rare case report with literature review.

Introduction: Holocord spinal cord epidural abscess is an uncommon condition that may result in serious neurological complications. Prompt diagnosis and early treatment is of paramount importance for an optimum clinical outcome. This case report describes a novel technique of interval laminectomy at two sites in the thoracic spine and surgical decompression with the help of infant feeding tubes in a case of holocord spinal epidural abscess (HSEA). Case presentation: An 18-year-old male presented to the emergency department with high-grade fever and low back ache of 2 weeks duration and loss of bowel and bladder control for 4 days. Neurological examination revealed intact motor power and sensation in all four limbs at presentation; however, there was a rapid deterioration to complete quadriplegia within 24 h. A diagnosis of holocord epidural abscess was made. Emergent decompression via interval thoracic laminectomy was done and appropriate antimicrobial therapy was instituted. At 10 months of follow-up, the individual showed complete neurological recovery. Discussion: The technique used in this case is unique with respect to the level of laminectomy and the manoeuvre employed for pus evacuation. Complete neurological and functional recovery was achieved despite complete paralysis pre-operatively. The outcome indicates that there may be good prognosis for individuals with HSEA accompanied with neurological deficit and emergent surgical decompression.

Computerized Tomography-Based Morphometric Analysis of Subaxial Cervical Spine Pedicle in Asymptomatic Indian Population.

BACKGROUND: The purpose of this study was to analyze morphometry of the subaxial cervical spine pedicles in an Indian population based on computed tomography (CT), and thus assess the safety and feasibility of cervical pedicle screw in the subaxial cervical spine. METHODS: CT scans of 500 subaxial cervical spine vertebrae were analyzed from 100 patients presenting to our institution and undergoing cervical spine CT scan for an unrelated cause as part of ATLS protocol. Pedicle width (PW), pedicle axis length (PAL), pedicle transverse angulation (PTA), and lateral pedicle distance (LPD) were calculated on axial CT scans, and pedicle height (PH), pedicle length (PL), superior pedicle distance (SPD), and pedicle sagittal angulation (PSA) were calculated on sagittal CT scans. RESULTS: The mean PW ranged from 4.3 mm at C3 to 5.7 mm at C7. Mean PH ranged from 5.5 mm at C3 to 6.1 mm at C7. Mean PTA ranged from 44.5° at C3 to 37.1° at C7. PSA ranged from 16.65° at C3 to 3.29° at C7. Mean LPD ranged from 1.6 mm at C3 to 3.4 mm at C6. Mean SPD ranged from 3.5 mm at C3 to 1.15 mm at C7. Mean PAL ranged from 29.6 mm at C3 to 33.04 mm at C7. Mean PL ranged from 5.2 mm at C3 to 5.78 mm at C7. CONCLUSIONS: Our CT-based morphometric study confirms that cervical pedicle screw placement is possible in most of the Indian population except at C3 in females. A thorough understanding of pedicle anatomy with proper CT-based preoperative planning can mitigate the risk associated with pedicle screw placement in subaxial cervical spine.

Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study.

PURPOSE: To compare the short-term functional outcome between bipolar hip arthroplasty (BHA) and total hip replacement (THR) in displaced femoral neck fractures in elderly patients in a developing country. MATERIALS AND METHODS: A prospective study was conducted which included a total of 42 patients of age more than 60 years with closed displaced femoral neck fractures, and the patients were randomized into two groups of 21 patients each and their outcomes were compared. RESULTS: At 24-month follow-up, patients in BHA group had a mean modified Harris hip score of 83.85 ± 6.62 and patients in THR group had a mean modified Harris hip score of 88.00 ± 5.76 (p value = 0.067). Seven (35%) patients in BHA group and 11 (55%) patients in THR group had hip scores from 91 to 100 (excellent), 9 (45%) patients in BHA and seven patients (35%) in THR had hip scores 81-90 (fair) and 4 (20%) patients in BHA group and 2 (10%) patients in THR group were rated 71-80 (good) and none was found in poor category. Total amount of blood  loss while performing BHA was 238.15 ± 20.43 ml compared to 336.85 ± 23.56 ml in THR (p < 0.0001). Mean of total duration of surgery was found to be 51.80 ± 8.70 min in BHA group which was significantly lesser than 119.10 ± 16.75 min of THR group (p < 0.0001). CONCLUSION: BHA being comparable to THR in terms of functional outcome by modified Harris hip scoring with significantly less blood loss during surgery, less duration of surgery, more cost-effective can be recommended as first line of surgical management in elderly patients with displaced femur neck fractures in developing countries. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.

Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study.

OBJECTIVE: To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. METHODS: A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. RESULTS: The mean age of resection group was 44.5 ± 6.6 years and mean age of reconstruction group was 37.1 ± 6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4 ± 4.1 and mean Broberg Morrey score of 94.9 ± 5.1 showed better results compared to radial head resection group with mean extension lag of 15.7 ± 4.1 (p=0.022) and mean Broberg Morrey score 88.3 ± 5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4 ± 4.7, mean pronation of 74.4 ± 4.1 and mean Broberg Morrey score of 89.8 ± 6 showed better results when compared with radial head reconstruction group with mean supination of 64.2 ± 4 (p<0.001), mean pronation of 59.2 ± 8.4 (p=0.003) and mean Broberg Morrey score of 81.9 ± 5 (p=0.031). CONCLUSION: The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.

Asthma-like peak flow variability in various lung diseases.

BACKGROUND AND OBJECTIVES: Bronchodilator reversibility and diurnal peak flow variability are considered characteristic of asthma patients. Patients with chronic obstructive pulmonary disease (COPD) show poor reversibility. But reversibility and variability in other pulmonary diseases manifesting with airflow obstruction in not known. Therefore, we assessed reversibility and peak flow variability in patients with various lung diseases to recognize the pattern. MATERIALS AND METHODS: Seventy consecutive patients with a diagnosis of lung diseases manifesting with airflow obstruction were recruited in the study. These included 23 patients with asthma, 11 patients with bronchiectasis, 16 patients with post-tubercular lung disease (PTLD), and 20 patients with COPD. Ten healthy matched control subjects were also selected to pair with asthmatic patients. Bronchodilator reversibility test was done initially and peak expiratory flow rate (PEFR) was measured for a duration of 1 week by patients themselves on a chart that was given to them. The mean amplitude percentage of these records were analyzed. RESULTS: The mean values of peak flow variability were 14.73% ± 6.1% in asthmatic patients, 11.98% ± 7.5% in patients with bronchiectasis, and 10.54% ± 5.3% in PTLD. The difference in the mean values of peak flow variability between asthma and bronchiectasis, that is, 14.73 (6.1) vs 11.98 (7.5) was not statistically significant (P > 0.05). Forced expiratory volume one second (FEV(1)) reversibility values were 14.77% ± 26.93%, 11.24% ± 20.43%, 10.85% ± 13.02%, 16.83% ± 22.84%, and 5.47% ± 4.99% in asthma, COPD, PTLD, bronchiectasis, and healthy subjects, respectively. CONCLUSION: Both reversibility and diurnal peak flow variability were higher in patients with various lung diseases compared with normal healthy subjects. Although these are characteristic of asthma, some cases of bronchiectasis and PTLD patients may also manifest asthma-like PEFR variability and reversibility.

Respiratory morbidity attributed to auto-exhaust pollution in traffic policemen of Jaipur, India.

AIMS: This study was conducted to evaluate pulmonary effects of traffic pollution on traffic police. METHODS: The traffic police working in Jaipur city were given a predetermined respiratory health questionnaire, and their clinical profile and lung functions were measured. RESULTS: This study showed that there were prominent respiratory symptoms and reduced forced expiratory volume in 1 second (FEV(1)) in subjects exposed to traffic pollution. When smokers were excluded, it showed a significant difference in FEV(1) data of non-smoking subjects exposed to traffic generated pollution and those not exposed. The difference observed was 95.3 +/- 13.6 versus 87.8 +/- 0.95%, respectively, and 95%CI = 4.420-10.517, p = 0.001. CONCLUSIONS: Respiratory morbidity with respect to lung function tests is observed more in groups working in heavy traffic than the control group.