Ashish Jaiman

Introduction: Although the prevalence of intercarpal ligament injuries with distal radius fractures ranges from 0.5 to 75 percent, these injuries are often missed by the untrained eye. Currently, wrist arthroscopy is considered gold standard for diagnosis and treatment, but in Indian setting it is an impractical proposition. Scapho-lunate and luno-triquetral injuries can be identified on X rays easily by Gilula’s arc, scapholunate distance and angle, carpal height ratio etc. The aim of this study is to estimate the prevalence of intercarpal ligament injuries in distal radius (DER) fractures and determine their functional outcome at one year. Material and methods: The study was conducted over 18 months at VMMC and Safdarjung Hospital. Patients with distal radius fractures were subjected to wrist X rays in 100% magnification and earlier mentioned parameters were measured. Patients who needed surgery were operated for fracture DER. Immediate post-operative X rays and X rays at 1 year were compared with that of the contralateral wrist. Patients’ clinical outcomes like range of motion, grip strength, quick DASH score and pain on VAS were measured at one year to assess the clinical outcome. Results: The study population was of 103 patients. Prevalence of intercarpal injuries in patients with DER fractures was 11.7%. Out of these 12 patients, 50% had broken Gilula’s arc, 66.6% had increased scapho-lunate distance and 42% had increased scapho-lunate angle. Carpal height ratio was significantly less in patients with intercarpal ligament injuries at one year. Similarly, functional outcome was worse in these patients at one year. Conclusion: Intercarpal injuries are associated with worse outcomes in patients with fracture DER. These injuries can reliably diagnosed on X rays using the parameters mentioned. Since the prevalence is quite high, we should learn to diagnose them early, so that patients can be explained about the prognosis of their injury.

Introduction: The lumbo-sacral stabilization using iliac screw is gaining popularity in such cases of long multi segment lumbar constructs. Iliac screws help to achieve strong spinopelvic fixation, augments and protects sacral screws. However, there is a great variability found in literature for iliac screw fixation in terms of trajectory, screw length and screw diameter. Also, to the best of our knowledge, there is lacunae in current literature regarding the optimal pathway, screw length and screw diameter in the Indian population. Hence, we planned the study with the aim to analyze the available screw pathways to determine optimal iliac screw trajectory, screw length and diameter for the Indian population. Material and methods: This was a tertiary center-based retrospective study. One hundred pelvic CT scans of patients in 18-70 years age, who underwent abdominal CT on Siemens 256-slice dual source CT scanner for various indications were evaluated. Subsequently, 4 iliac screw trajectories were assessed by connecting the points given below using double oblique reformats on which the lengths and narrowest zones of these trajectories were measured. Path A: Posterior Superior Iliac Spine (PSIS) to Anterior Superior Iliac Spine (AIIS); Path B: point between PSIS and posterior inferior iliac spine (PIIS) to Anterior Inferior iliac spine (AIIS); Path C: iliac crest intersection point (CLIC) point to Upper acetabulum; Path D: CLIC point to acetabular center. [p1] [a2] Results: Statistically significant difference was found in the lengths of various pathways. Path A (PSIS to AIIS) was found to be the longest (mean 13 cm). The second longest path in our study was path C (CLIC point to Upper acetabulum). The narrowest widths of each path were not found to have any statistically significant difference. Conclusion: Iliac screw fixation is of paramount importance for lumbosacral stabilization. Of the studied paths, trajectory from posterior-superior iliac spine to Antero-inferior iliac spine has the longest passage length and is the most optimal path for the Indian population. In case additional screws are required, the trajectory from CLIC point to Upper acetabulum provides the second largest screw passage.

Air pollution is widely recognized as a future biohazard, yet its direct effects on human health, particularly in relation to bone health and vitamin D levels, are inadequately understood. While the detrimental impact on respiratory and cardiovascular health is well-documented, the correlation with vitamin D deficiency remains weak. To explore the relationship between air pollution and vitamin D levels, an extensive search of scientific literature was conducted. This comprehensive search encompassed databases such as PubMed, Cochrane Library, and DOAJ, while also examining the bibliographies of relevant articles. The inclusion criteria focused on studies that specifically investigated the association between air pollution and vitamin D levels, while excluding systematic reviews, case reports, editor's letters, and studies lacking pertinent explanations or causative factors. Each included study underwent rigorous evaluation of its methodological quality, with data extraction performed to assess the reliability and robustness of the evidence for each research question. The majority of studies have consistently demonstrated a negative correlation between ambient air pollution and vitamin D levels in humans. Several mechanisms have been proposed to explain this relationship, including reduced exposure to sunlight due to increased air pollution, production of reactive oxygen particles, and inflammation leading to decreased vitamin D synthesis. Moreover, certain pollutants, such as particulate matter and nitrogen dioxide, have been found to have a more pronounced impact on vitamin D levels. Variables such as age, gender, season, and geographical location may also influence the association between air pollution and vitamin D levels. Lifestyle factors, including indoor confinement and pre-existing vitamin D deficiency, may exacerbate the detrimental effects of air pollution. In conclusion, air pollution detrimentally affects vitamin D levels primarily through increased body inflammation and the generation of free radicals. The presence of elevated levels of particulate matter and nitrogen dioxide further compounds this effect. Additionally, decreased cutaneous production of activated vitamin D, resulting from reduced ultraviolet B radiation penetration due to decreased Air Quality Index, contributes to the negative impact. Studies suggest that the intake of exogenous vitamin D supplements and adherence to a calcium-rich diet may confer benefits to individuals residing in highly polluted areas. To address this issue, public health policies should emphasize outdoor exposure to sunlight, promote healthy dietary choices, and reduce overall exposure to pollutants.

Background: Sub-Acromial Impingement Syndrome (SAIS) spectrum ranges from acute inflammation to chronic degeneration of the bursa and of rotator cuff tendons in sub-acromial space. It may lead to a full-thickness tear of rotator cuff tendons and degenerative joint disease of the shoulder girdle leading to functional loss and disability if not treated early and adequately. This study aimed to determine the early functional outcome of arthroscopic sub-acromial decompression in chronic SAIS due to mechanical causes. Material and methods: This was a prospective cohort study. Patients were operated on arthroscopically for sub-acromial decompression between September 2018 and March 2020. Thirty-five patients with a range of 20 to 65 years of age diagnosed clinically with primary chronic sub-acromial impingement syndrome meeting the inclusion criteria were included in this study. All the patients under study were initially kept for at least four weeks of a course of conservative treatment and persisted in having symptoms were treated surgically with arthroscopic sub-acromial decompression. The UCLA (The University of California at Los Angeles) shoulder rating scale was used to assess shoulder function. The assessment was done in the pre-operative period, four weeks, 12 weeks, and 16 weeks post arthroscopic sub-acromial decompression surgery. Results: Compared to pre-operative UCLA shoulder function score at the end of non-operative conservative treatment, the patients under study showed a statistically significant improvement at the end of the 16th week of post-arthroscopic subacromial decompression (p<0.0001). Conclusion: This study concludes that arthroscopic sub-acromial decompression provides a good functional outcome in patients having primary shoulder impingement due to extrinsic mechanical causes such as shape and slope of the acromion in the absence of significant (total or near total) rotator cuff tear after 16 weeks of follow-up.

Introduction: Retro calcaneal bursitis is an inflammation of the bursa located between the posterior surface of the heel bone and the anterior surface of the Achilles tendon. This study was conducted to evaluate the clinical efficacy of endoscopic decompression and debridement in patients with retrocalcaneal bursitis who had not responded to conservative treatment. Our primary objective was to estimate the improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score after surgery, and our secondary objectives were to estimate the average surgical duration and the incidence of post-operative complications. Material and methods: This was a single-centre intervention study at a tertiary institution's level. Included in the study were all patients who were diagnosed with retrocalcaneal bursitis and who had failed a minimum 6-month trial of conservative treatment. 36 patients (36 heels) underwent endoscopic decompression. Results: A prospective interventional cohort study was conducted on a total of 36 adult patients (18-70 years) with clinical and radiological findings suggestive of retrocalcaneal bursitis, duration of failed conservative treatment prior to surgery > 6 months, and refractoriness to other forms of non-operative treatment like steroid injections regardless of duration. There were no patients lost to follow-up. The mean duration of follow-up was 6 months [6 months to 2 years]. The average pre-operative AOFAS score was 56.42 6.8, ranging from 44 to 70. The difference between preoperative and postoperative AOFAS scores at 1 week, 2 weeks, 4 weeks, 3 months, and 6 months was statistically significant (p 0.0001). Conclusion: In patients with retrocalcaneal bursitis, arthroscopic decompression is a safe, effective, and simple procedure. Within the first three months, the majority of study participants experienced pain relief and a significant improvement in function.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

It is said that first sign of civilization in human history was a femur that had been broken and then healed with the care of the loved ones. Such deep is the association of mankind and fractures. Since time immemorial, fracture patients are taking varied therapies to enhance fracture healing. Some are evidence based, some are not. With renewed interest in complementary and alternative medicine; it becomes wise to make primary care physicians aware of the viewpoints of dietician, homeopathy doctor and an ayurveda doctor on the medicines prescribed by them for fracture cases. A physician should be aware of different treatment methodologies to have an intelligent discussion with a curious patient. Dieticians emphasize on a healthy balanced diet. Ayurveda physicians focus on shali rice and clarified butter; while homeopathy physicians vouch on Symphytum.

Introduction: Tennis elbow is a commonly encountered problem in orthopaedic clinical practice. The patients are usually in their financially productive years and many a times, this is a work related disorder that becomes severe enough leading for lost work days. Conservative treatment is almost always the first choice; but once it fails, there is no clear consensus for the management of recalcitrant cases. We undertook this study to evaluate the clinical outcomes of percutaneous tenotomy in cases of resistant lateral epicondylitis. Materials and methods: This was a prospective study done over a period of 5 years. A total of 108 patients with recalcitrant tennis elbow were recruited and underwent percutaneous tenotomy. They were followed up for an average period of 14 months. The outcomes measured were: tenderness, DASH score, Roles & Maudsley scale, Visual analogue scale (VAS), and Grip strength. Statistical analysis was done using Paired t-test. Results: 95% patients were pain free after an average of 12 weeks. The 6 months postoperative improvement in VAS score was 6.84 and change in mean DASH score was 23.04. The average increase in mean grip strength was 13.30 kg. These results were statistically significant. Conclusion: Percutaneous tenotomy can be considered as a useful treatment option for resistant cases of tennis elbow.

Introduction: Musculoskeletal tuberculosis is a significant form of extra pulmonary tuberculosis (EPTB) which has substantial consequences if not diagnosed and treated early. Reliable and rapid confirmation of the diagnosis is now possible by advent of Polymerase Chain Reaction (PCR), Cartridge Based Nucleic Acid Amplification Test (CB-NAAT/Gene-Xpert) and radiometric method (BACTEC) However, most of these sensitive technologies are not available at places with constrained resources. Hence, diagnosis of tuberculosis at these places, continues to rely on smear microscopy using Ziehl-Neelsen (ZN) staining. Specificity of ZN staining and microscopy is high, but its overall sensitivity is variable (20-53%). Despite of low sensitivity, it is still an easy, cheap, efficient and accessible tool due to its high specificity. Aim: Aim of the present study was to assess the role of ZN staining in diagnosis of extra-spinal musculoskeletal tuberculosis in resource limited settings. Material and methods: A retrospective study was done from 1st January 2016 to 31st December 2019 on specimens received in microbiology laboratory for ZN staining from clinico-radiologically suspected cases of extra-spinal musculoskeletal tuberculosis. The clinical information of the cases was noted from the Orthopaedics Department case files, while results of ZN microscopy were retrieved from the records maintained in Microbiology Department. Results: Specimens from 95 patients with clinico-radiologically suspected extra-spinal musculoskeletal tuberculosis were examined for Acid Fast Bacillus (AFB) by ZN staining technique. Out of 95 patients; 11 patients (11.58 %) were found to be AFB positive. Conclusion: Owing to low yield percentage of ZN staining in extra spinal musculoskeletal tuberculosis; ZN stain alone cannot be used as a tool for diagnosis of this form of tuberculosis.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.