Balaji Zacharia

Idiopathic chondrolysis of the hip (ICH) joint is rare after skeletal maturity. This study aimed to describe two cases of ICH in adolescent girls after skeletal maturity. The authors conducted a retrospective analysis of the clinical features, investigations, and management of two adolescent girls with ICH: a 16-year-old with bilateral hip involvement and an 18-year-old with unilateral hip involvement. Both of them presented with pain and limitation of hip movement. There was apparent lengthening, pelvic obliquity, and muscle wasting. The X-ray showed severe narrowing of the joint space consistent with ICH. This was managed with traction, analgesics, and a short course of steroids. A subtotal capsulectomy was subsequently performed. Both patients experienced symptom relief and an increase in the range of movement. In conclusion, ICH is diagnosed by excluding other causes of painful hips in children. It has characteristic clinical and radiological features. Traction and analgesics can provide short-term pain relief. Subtotal capsulectomy can improve the range of movement.

Background: A primary concern regarding anterior surgery for adolescent idiopathic scoliosis (AIS) is its potential impact on pulmonary function. Objectives: The objective of this study was to evaluate the impact of anterior surgery on long-term postoperative pulmonary function in children with AIS. Material and Methods: A retrospective analysis was conducted on 25 children with AIS who underwent anterior scoliosis surgery between 2008 and 2014. Pulmonary function was evaluated using the single-breath holding test, resting respiratory rate, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV ₁ ), and percent predicted FVC and FEV ₁ . Results: The mean preoperative FVC was 2.79 L (range: 2.2–3.4 L), and FEV ₁ was 2.72 L (range: 2.1–3.2 L). At long-term follow-up, these values were 2.65 L (range: 2–3.6 L) and 2.6 L (range: 2.2–3.6 L), with P = 0.03 and 0.013, respectively. The mean preoperative percent predicted FVC and FEV ₁ were 80.64% (range: 72%–90%) and 80.52% (range: 69%–90%). Long-term follow-up values were 78.72% (range: 60%–97%) for FVC and 79% (range: 68%–98%) for FEV ₁ , with P = 0.19 and 0.23, respectively. The mean preoperative single-breath holding time was 46.84 ± 2.21 s, which improved to 48.08 ± 2.41 s ( P = 0.0015). The mean preoperative resting respiratory rate was 21.52 ± 2.38 breaths/min, and the postoperative rate was 20.96 ± 1.33 ( P = 0.076). Conclusions: In children with normal pulmonary function, anterior surgery for AIS does not result in significant long-term postoperative changes in pulmonary function.

Introduction: The COVID-19 pandemic and similar calamities can prevent learners from attending offline classes. Simulation is a valuable alternative in such a situation. Aim: To compare learner perceptions and efficacy between simulated patients (SPs) and bedside clinics (BSCs) as a teaching-learning method for the clinical skill training of orthopedic residents. Methods: Our study was an exploratory study conducted at a tertiary care teaching institution in 2021. We randomly divided 21 residents into the BSC group (Group A) and the SP group (Group B). These participants underwent training in five essential clinical skills. We assessed the learners’ perceptions with a Likert scale and focus group discussion. The Likert scale covers seven important domains: liking, understanding, confidence in performance, memorization, interest, willingness to recommend to other faculty, and the need for alternative teaching methods. Furthermore, we effectively compared the efficacy of both approaches by analyzing scores obtained from the MCQ and OSCE examinations. Results: Among the 23 invited participants, 21 participated (participation rate of 91.3%). There were 55 responses (A) and 50 from the group (B). The Likert scale scores for all the cases were not significantly different between the two groups for understanding and confidently performing the concept (P value < 0.05). Learners’ perceptions were similar between the two groups in most domains regarding neurological cases (p value <0.05). The perception was similar in domains such as interest and confidence for ortho cases. We assessed learner perceptions by conducting focus group discussions. There was no significant difference in the final scores obtained on the MCQ and OSCE. Discussion: We can use SP as an alternative to BSC for training in orthopedic clinical skills. SPs are as effective as BSCs. Both methods have no uniformity in terms of learners’ perceptions of different domains.

Parallel or orthogonal plating is used to treat supracondylar intercondylar (SCIC) fractures of the humerus. The aim of the study is to determine the short-term functional outcomes of orthogonal plating in adult patients with SCIC fractures of the humerus and the factors affecting these outcomes. We conducted a prospective study between 2017 and 2020, following approval from the Institutional Ethics Committee. Twenty-six patients, aged 20 to 70 years, were included in the study. Patients with open fractures, severe soft tissue injuries, or comminution were excluded. We performed orthogonal plating for fixation. The outcomes were analyzed using the rating of Jupiter et al. Mann–Whitney U and Kruskal–Wallis tests were used to analyze the factors affecting the outcomes. Most patients were males aged between 20 and 29 years. Most of the patients underwent surgery between 18 and 24 hours. The low T-type fracture pattern was the most common. Among male patients, 10 were rated as excellent, three as good, and one as fair. However, among females, four received excellent ratings, four received good ratings, three received fair ratings, and one received poor ratings. Males had a significantly better rating than females (p-value of 0.03). Younger patients had better outcomes (p-value of 0.04). The mode of injury and laterality were not significantly associated with the final rating (p-value >0.05). Orthogonal plating ensures stable fixation and good outcomes for SCIC fractures of the humerus. We got better outcomes in younger patients.

Background: Type III osteogenesis imperfecta (OI) is very rare. In this article, we describe the clinical features and management of a case of type III osteogenesis imperfecta with a review of the literature. Case Report: A 5 – year - old girl presented with deformities of the bilateral lower and upper limbs. Posterior bowing of both humerus, cubitus varus deformity of both elbows, shepherd crook deformities of the femur, and anterolateral bowing of both legs were observed. She was unable to walk. Her face was triangular, and she had a kyphoscoliotic deformity of the spine. Radiographs showed osteopenia and multiple fractures at different stages of healing. The clinical and radiological findings were consistent with those of type III OI. She was treated by deformity correction of the right femur and tibia using the Sofield technique. Discussion: OI is a disorder caused by a mutation in type 1 collagen. It is characterized by increased bone fragility, dentigerous imperfecta, and generalized ligamentous laxity. There are 18 types of OI. We describe a case of type 3 OI in which the child developed deformity of the spine and limb at a later age without involvement of the sclera. Lower limb deformities were corrected using the Sofield technique of multiple osteotomies and intramedullary nailing. The implants were removed once the osteotomies were united. After implant removal, anterolateral bowing of the tibiae recurred. Conclusions: Long bone deformities can be managed using the Sofield technique. Long-term follow-up is essential for the early detection and correction of recurrence.

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