Study design Retrospective cohort study. Objectives The purpose was to analyze the effect of care... more Study design Retrospective cohort study. Objectives The purpose was to analyze the effect of care bundle protocol on SSI in our institution. Summary of background data Postoperative surgical site infections (SSI) pose significant health burden. In spite of the use of prophylactic antibiotics, surgical advances and postoperative care, wound infection continues to affect patient outcomes after spine surgery. Methods Retrospective analysis of 9607 consecutive patients who underwent spine procedures from 2014 to 2018 was performed. Preventive care bundle was implemented from January 2017 consisting of (a) preoperative bundle-glycemic control, chlorhexidine gluconate (CHG) bath, (b) intra-operative bundle-time specified antibiotic prophylaxis, CHG+ alcohol-based skin preparation (c) postoperative bundle-five moments of hand hygiene, early mobilization and bundle auditing. Patients operated from January 2017 were included in the post-implementation cohort and prior to that the pre-implementation cohort was formed. Data were drawn from weekly and yearly spine audits from the hospital infection committee software. Infection data were collected based on CDC criteria, further sub classification was done based on procedure, spinal disorders and spine level. Variables were analyzed and level of significance was set as < 0.05. Results A total of 7333 patients met the criteria. The overall SSI rate decreased from 3.42% (131/3829) in pre-implementation cohort to 1.22% (43/3504, p = 0.0001) in post-implementation cohort (RR = 2.73, OR = 2.79). Statistically significant reduction was seen in all the groups (a) superficial and deep, (b) early and late and (c) instrumented and uninstrumented groups but was more pronounced in early (p = 0.0001), superficial (p = 0.0001) and instrumented groups (p = 0.0001). On subgroup analysis based on spine level and spinal disorders, significant reduction was seen in lumbar (p = 0.0001) and degenerative group (p = 0.0001). Conclusions Our study revealed significant reduction of SSI secondary to strict bundle adherence and monitored compliance compared to patients who did not receive these interventions. Level of evidence III.
Introduction: Synovium has been documented as a primary site of inflammation and a major effector... more Introduction: Synovium has been documented as a primary site of inflammation and a major effector organ in a variety of joint diseases. Study of simple technique like synovial biopsy can help in early diagnosis and treatment of diseases significantly improving outcome of patient in cases of rheumatoid arthritis, osteoarthritis, etc., Only limited data exist on utility of synovial biopsies. Aim and Objectives: To analyze the pattern of synovial lesions to differentiate between different kinds of arthritis. Also, to identify early stages of arthritis so as to prevent unnecessary invasive surgical procedure. Materials and Methods: It's a retrospective study to analyze 103 cases of synovial lesions diagnosed in last five years at a tertiary care orthopedic center. All synovial biopsies obtained mainly by open method and few by arthroscopic method, that came to the Dept of Pathology were included. Lesions were classified into four categories that is, inflammatory joint diseases, degenerative joint diseases, tumor-like conditions and tumors. Results: Age group most affected was between 61 and 70 years, with male predominance. Osteoarthritis (OA) was the most common histopathological diagnosis. Early OA tissues showed greater lining layer thickness, vessel proliferation, and inflammation, while surface fibrin deposition along with fibrosis was noted in later stages. Conclusion: The histo-morphological observations made in this study may have important therapeutic implications for some patients during the early evolution of arthritis and could prevent unnecessary operative intervention of later stages.
Objectives: Femoral neck fractures in the elderly are associated with high morbidity and mortalit... more Objectives: Femoral neck fractures in the elderly are associated with high morbidity and mortality. The optimal treatment remains controversial regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. Methods: This study included 84 patients over 64 years of age with fracture neck femur treated with cemented and uncemented Modular Bipolar hemiarthroplasty. The patients (49 female, 35 male; mean age: 79.5 years; range: 64-95 years) included and were followed-up regularly till 02 years. Patients were divided equally into two groups: group A(n = 42) was treated with cement; and group B(n = 42) without cement. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre-and postoperative complications, mortality rates, pain and activity levels, and hip scores. Results: We found no statically significant between-groups differences in terms of length of hospital stay, Harris Hip Score and complications. However in Uncemented group 03 patients developed loosening of implant at the end of 2 year without any clinical of biochemical sign of infection. Walking ability and pain scores were better in the cemented group in the early follow-up period. Conclusion: Based on our study we reached the conclusion that the use of cement during hip hemiarthroplasty in patients over 64 years of age who invariably has osteoporotic bone and wide femoral canal had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.
Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the glo... more Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants' degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2%) were in the age group 45-60 years, and 52.2% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5% (46/368), 29.3% (108/368), and 50.8% (187/368) health care workers, respectively. Moreover, 31.5% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers.
In multilevel posterior cervical fusion, whether to stop distal fixation at C7 or T1, remains a m... more In multilevel posterior cervical fusion, whether to stop distal fixation at C7 or T1, remains a matter of debate. We aimed to assess clinical feasibility of C7 as distal fixation point and sought to compare complication rates and radiological outcome between lateral mass screws and pedicle screws at C7. Overview of literature: Current literature remains inconclusive regarding need for thoracic extension of instrumentation in multilevel posterior cervical fusion. Methods: We did a retrospective review of 44 consecutive patients who underwent posterior instrumented cervical decompression and fusion for degenerative cervical myelopathy with C7 as distal fixation point, and a minimum follow-up period of two years. We had two groups of patients based on C7 instrumentation. Group 1: Lateral mass screw fixation. Group 2: Pedicle screw fixation. Primary outcome: Post-operative clinico-radiological evaluation of whole study population Secondary outcome: Comparison of complication rates and radiological outcome between groups 1 and 2. Results: Mean age was 58.06 ± 14.4 years with average follow-up duration of 35.4 ± 4.5 months. There were 18 patients in Group 1 and 26 patients in Group 2. Mean pre-operative mJOA score was 10.51 and post-operative mJOA score was 15.74 with mean recovery rate (RR) 69.82%, of which 30 patients (70.23%) had good recovery and 14 patients (29.77%) had fair recovery at final follow up. The two groups didn't show any significant difference in complication rates and outcome. Conclusion: C7 as distal fixation anchor is safe and effective in maintaining cervical sagittal balance following multilevel posterior cervical fusion. C7 lateral mass screws are found to be equally efficacious as pedicle screws in preventing worsening of sagittal profile.
To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military coh... more To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center. Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting. Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or selfvoiding [S]); we correlated these data with the findings of the renal tract US. Results: The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time since injury was 6-12 months for 42.5% of the subjects and 12-18 months for 57.5% of the subjects. A normal US scan was recorded in 65.7% patients, and bladder trabeculation was the commonest finding in 15.1% of the subjects, followed by hydronephrosis (HDN) in 12.3%, and renal calculus and atrophy in 1.3% participants each. We found 22.22% of the IC group participants had higher US abnormalities than those in the reflex voiding group (statistically nonsignificant difference, p=0.7). Trabeculations (21.4%) and HDN (19%) were more common in those who had sustained the injury 12-18 months previously as compared to that in those who had injured themselves 6-12 months previously (p=0.04). The proportion of patients who had a normal US scan was higher in the group who sustained the injury 6-12 months previously versus those who had sustained the injury 12-18 months previously; the difference was statistically significant (p=0.02). There was no significant (p=0.72) correlation in the bladder management method, injury level, and renal tract abnormalities between the groups. Conclusions: This retrospective study shows that 65% of TSCI participants had no renal tract abnormality on US scan and bladder trabeculation ruled out as the most common finding. Long-term supervised rehabilitation may help achieve good renal quality of life; however, further prospective trials are required on this subject.
Context: The best technique to achieve the optimum functional outcome in acute acromioclavicular ... more Context: The best technique to achieve the optimum functional outcome in acute acromioclavicular (AC) injuries in young, active patients continues to be a matter of debate. Aims: The aim of this study is to evaluate the functional outcome of a minimally invasive technique for acute AC dislocation in military soldiers. Settings and Design: The study design involves prospective study from 2012 to 2016 at a tertiary care Military Orthopaedic center. Materials and Methods: Patients with an acute Rockwood Type III, IV, and V AC injury were included polytrauma, injury older than 2 weeks or requiring an open reduction, ipsilateral limb, and neurological injuries were excluded from the study. All patients underwent minimally invasive, percutaneous reduction and fixation with a suture anchor–metallic button construct. Patients were followed up at 6, 12, 24 weeks, 1 year, and 2 years postoperatively for radiological and functional assessment (Constant score). Statistical Analysis: Using analytical tests in SPSS software for comparison of coracoclavicular (CC) distance on the injured and healthy sides. Results: There were 25 male soldiers and cadets with a mean age of 24.5 ± 5.5 years. The mean follow-up duration was 37.9 ± 6.26 weeks. Twenty-four (96%) patients achieved pain-free, overhead shoulder abduction at 24 weeks follow-up with a mean constant score of 88.4 ± 7.43. The mean constant score at the last follow-up was 94.5 ± 5.67. Twenty-three (92%) patients had a well reduced AC joint; mean CC distance on the affected side was 9.1 ± 1.2 mm, comparable to mean distance of 8.9 ± 1.4 mm on the healthy side without any evidence of sclerosis or osteolysis till the last follow-up, while one patient had a recurrent dislocation. Conclusions: Suture anchor metallic button construct is a simple, surgeon friendly technique for young, high-demand patients to restore AC biomechanics in a minimally invasive manner.
INTRODUCTION The entity “floating metatarsal” is a unique and rare presentation of proximal and d... more INTRODUCTION The entity “floating metatarsal” is a unique and rare presentation of proximal and distal disruption of the metatarsal articulation and is probably a combination of varying grades of deforming forces on the midfoot and forefoot complex. This variety of Lisfranc dislocation becomes more unique when associated with an ipsilateral open bimalleolar ankle fracture and even phalangeal fracture. The aim of presenting such a case is to highlight the impact of such an unusual injury pattern on the foot biomechanics and the significance of prompt management that is paramount for the trauma surgeon in the polytrauma scenario as well as in an isolated presentation. The patient provided informed consent for the procedure and for publication of this report.
Study Design: Retrospective pilot study.Purpose: To assess the incidence of renal tract abnormali... more Study Design: Retrospective pilot study.Purpose: To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center.Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting.Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or self-voiding [S]); we correlated these data with the findings of the renal tract US.Results: The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time s...
Purpose: The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sle... more Purpose: The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sleep outcomes and change in clinical management practices among orthopaedic surgeons following a nation-wide lockdown. Methods: We conducted an online cross-sectional study using piloted structured questionnaires with self-reported responses from Indian orthopaedic surgeons. Study participants were identified through social networking sites: Facebook and WhatsApp. The extent of anxiety and sleep quality was assessed by the standardised seven-item Generalised Anxiety Disorder (GAD-7) scale, single-item sleep quality scale, questions on unavailability of personal protective equipment, training module on COVID-19 and change in orthopaedic patient management. Results: One hundred male orthopaedic surgeons responded to the survey with majority (79%) in 30–44 years age group. Severe anxiety scores were observed in 8%; moderate, mild and minimal anxiety was observed in 12%, 27% and 53% surgeons r...
Strategies in Trauma and Limb Reconstruction, 2015
The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation o... more The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012-2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21-55 years). The mean follow-up period in this study was 23.5 months (20-26 months) after hook plate fixation and an average of 19.9 months (17-22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value \0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value \0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.
Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries... more Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1–C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1–C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infec...
Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries... more Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.
Study design: Prospective study. Purpose: Last decade has witnessed the emergence of unplanned re... more Study design: Prospective study. Purpose: Last decade has witnessed the emergence of unplanned readmissions as a tool to gauge health-care quality and hospital performance. Previous studies were limited by their retrospective designs based on database information and short-term 30-day follow-up intervals. We analyzed incidence and causes for unplanned readmissions following spine surgery at 90-d interval and its difference at 30-d, 31-60-d and 61-90-d intervals, Total Bed-Days Lost (TBL) and economic impact of readmissions and probable risk factors. Overview of Literature: Recent reports on readmission rates have suggested its contribution towards assessment of health care quality. Methods: A prospective analysis of 2860 admissions was performed over 1 year in a tertiary care orthopedic hospital. All unscheduled readmissions following spine surgery within 90 days of discharge, irrespective of type or location of surgery were included. Polytrauma, primary osseous infections and planned readmissions were excluded. Results: Our readmission rate was 3.32% (95/2860) and leading causes were surgical-site infections (SSIs) accounting for 44.21% (n=42, superficial-23, deep-11, organ space-8), followed by aseptic pain 31.58% (n=30) and medical causes 13.68% (n=13). Though 86.95% of superficial SSIs occurred within 30 days, 21.1% of deep SSIs occurred beyond 30 days. 33.68% of readmissions occurred in 30-90-day interval. Financial burden amounted to INR 41,93,660 and mean TBL was 7.33 per readmission. Hospital stay ≥10 days, health insurance and co-morbid illnesses (Diabetes, Hypertension and Liver disease) were associated with readmissions (p<0.05). Conclusions: Our study showed that SSIs and aseptic pain were leading causes of readmissions at 90-d interval. Limiting analysis to 30-day readmissions as in previous studies would lead to failure in identification of more severe complications like deep infections. Continued vigilance, particularly for patients with predisposing factors, could help alleviate the financial burden.
The aim of our study was to evaluate the
shoulder function after clavicular hook plate fixation o... more The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value \0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value\0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.
Study design Retrospective cohort study. Objectives The purpose was to analyze the effect of care... more Study design Retrospective cohort study. Objectives The purpose was to analyze the effect of care bundle protocol on SSI in our institution. Summary of background data Postoperative surgical site infections (SSI) pose significant health burden. In spite of the use of prophylactic antibiotics, surgical advances and postoperative care, wound infection continues to affect patient outcomes after spine surgery. Methods Retrospective analysis of 9607 consecutive patients who underwent spine procedures from 2014 to 2018 was performed. Preventive care bundle was implemented from January 2017 consisting of (a) preoperative bundle-glycemic control, chlorhexidine gluconate (CHG) bath, (b) intra-operative bundle-time specified antibiotic prophylaxis, CHG+ alcohol-based skin preparation (c) postoperative bundle-five moments of hand hygiene, early mobilization and bundle auditing. Patients operated from January 2017 were included in the post-implementation cohort and prior to that the pre-implementation cohort was formed. Data were drawn from weekly and yearly spine audits from the hospital infection committee software. Infection data were collected based on CDC criteria, further sub classification was done based on procedure, spinal disorders and spine level. Variables were analyzed and level of significance was set as < 0.05. Results A total of 7333 patients met the criteria. The overall SSI rate decreased from 3.42% (131/3829) in pre-implementation cohort to 1.22% (43/3504, p = 0.0001) in post-implementation cohort (RR = 2.73, OR = 2.79). Statistically significant reduction was seen in all the groups (a) superficial and deep, (b) early and late and (c) instrumented and uninstrumented groups but was more pronounced in early (p = 0.0001), superficial (p = 0.0001) and instrumented groups (p = 0.0001). On subgroup analysis based on spine level and spinal disorders, significant reduction was seen in lumbar (p = 0.0001) and degenerative group (p = 0.0001). Conclusions Our study revealed significant reduction of SSI secondary to strict bundle adherence and monitored compliance compared to patients who did not receive these interventions. Level of evidence III.
Introduction: Synovium has been documented as a primary site of inflammation and a major effector... more Introduction: Synovium has been documented as a primary site of inflammation and a major effector organ in a variety of joint diseases. Study of simple technique like synovial biopsy can help in early diagnosis and treatment of diseases significantly improving outcome of patient in cases of rheumatoid arthritis, osteoarthritis, etc., Only limited data exist on utility of synovial biopsies. Aim and Objectives: To analyze the pattern of synovial lesions to differentiate between different kinds of arthritis. Also, to identify early stages of arthritis so as to prevent unnecessary invasive surgical procedure. Materials and Methods: It's a retrospective study to analyze 103 cases of synovial lesions diagnosed in last five years at a tertiary care orthopedic center. All synovial biopsies obtained mainly by open method and few by arthroscopic method, that came to the Dept of Pathology were included. Lesions were classified into four categories that is, inflammatory joint diseases, degenerative joint diseases, tumor-like conditions and tumors. Results: Age group most affected was between 61 and 70 years, with male predominance. Osteoarthritis (OA) was the most common histopathological diagnosis. Early OA tissues showed greater lining layer thickness, vessel proliferation, and inflammation, while surface fibrin deposition along with fibrosis was noted in later stages. Conclusion: The histo-morphological observations made in this study may have important therapeutic implications for some patients during the early evolution of arthritis and could prevent unnecessary operative intervention of later stages.
Objectives: Femoral neck fractures in the elderly are associated with high morbidity and mortalit... more Objectives: Femoral neck fractures in the elderly are associated with high morbidity and mortality. The optimal treatment remains controversial regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. Methods: This study included 84 patients over 64 years of age with fracture neck femur treated with cemented and uncemented Modular Bipolar hemiarthroplasty. The patients (49 female, 35 male; mean age: 79.5 years; range: 64-95 years) included and were followed-up regularly till 02 years. Patients were divided equally into two groups: group A(n = 42) was treated with cement; and group B(n = 42) without cement. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre-and postoperative complications, mortality rates, pain and activity levels, and hip scores. Results: We found no statically significant between-groups differences in terms of length of hospital stay, Harris Hip Score and complications. However in Uncemented group 03 patients developed loosening of implant at the end of 2 year without any clinical of biochemical sign of infection. Walking ability and pain scores were better in the cemented group in the early follow-up period. Conclusion: Based on our study we reached the conclusion that the use of cement during hip hemiarthroplasty in patients over 64 years of age who invariably has osteoporotic bone and wide femoral canal had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.
Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the glo... more Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants' degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2%) were in the age group 45-60 years, and 52.2% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5% (46/368), 29.3% (108/368), and 50.8% (187/368) health care workers, respectively. Moreover, 31.5% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers.
In multilevel posterior cervical fusion, whether to stop distal fixation at C7 or T1, remains a m... more In multilevel posterior cervical fusion, whether to stop distal fixation at C7 or T1, remains a matter of debate. We aimed to assess clinical feasibility of C7 as distal fixation point and sought to compare complication rates and radiological outcome between lateral mass screws and pedicle screws at C7. Overview of literature: Current literature remains inconclusive regarding need for thoracic extension of instrumentation in multilevel posterior cervical fusion. Methods: We did a retrospective review of 44 consecutive patients who underwent posterior instrumented cervical decompression and fusion for degenerative cervical myelopathy with C7 as distal fixation point, and a minimum follow-up period of two years. We had two groups of patients based on C7 instrumentation. Group 1: Lateral mass screw fixation. Group 2: Pedicle screw fixation. Primary outcome: Post-operative clinico-radiological evaluation of whole study population Secondary outcome: Comparison of complication rates and radiological outcome between groups 1 and 2. Results: Mean age was 58.06 ± 14.4 years with average follow-up duration of 35.4 ± 4.5 months. There were 18 patients in Group 1 and 26 patients in Group 2. Mean pre-operative mJOA score was 10.51 and post-operative mJOA score was 15.74 with mean recovery rate (RR) 69.82%, of which 30 patients (70.23%) had good recovery and 14 patients (29.77%) had fair recovery at final follow up. The two groups didn't show any significant difference in complication rates and outcome. Conclusion: C7 as distal fixation anchor is safe and effective in maintaining cervical sagittal balance following multilevel posterior cervical fusion. C7 lateral mass screws are found to be equally efficacious as pedicle screws in preventing worsening of sagittal profile.
To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military coh... more To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center. Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting. Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or selfvoiding [S]); we correlated these data with the findings of the renal tract US. Results: The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time since injury was 6-12 months for 42.5% of the subjects and 12-18 months for 57.5% of the subjects. A normal US scan was recorded in 65.7% patients, and bladder trabeculation was the commonest finding in 15.1% of the subjects, followed by hydronephrosis (HDN) in 12.3%, and renal calculus and atrophy in 1.3% participants each. We found 22.22% of the IC group participants had higher US abnormalities than those in the reflex voiding group (statistically nonsignificant difference, p=0.7). Trabeculations (21.4%) and HDN (19%) were more common in those who had sustained the injury 12-18 months previously as compared to that in those who had injured themselves 6-12 months previously (p=0.04). The proportion of patients who had a normal US scan was higher in the group who sustained the injury 6-12 months previously versus those who had sustained the injury 12-18 months previously; the difference was statistically significant (p=0.02). There was no significant (p=0.72) correlation in the bladder management method, injury level, and renal tract abnormalities between the groups. Conclusions: This retrospective study shows that 65% of TSCI participants had no renal tract abnormality on US scan and bladder trabeculation ruled out as the most common finding. Long-term supervised rehabilitation may help achieve good renal quality of life; however, further prospective trials are required on this subject.
Context: The best technique to achieve the optimum functional outcome in acute acromioclavicular ... more Context: The best technique to achieve the optimum functional outcome in acute acromioclavicular (AC) injuries in young, active patients continues to be a matter of debate. Aims: The aim of this study is to evaluate the functional outcome of a minimally invasive technique for acute AC dislocation in military soldiers. Settings and Design: The study design involves prospective study from 2012 to 2016 at a tertiary care Military Orthopaedic center. Materials and Methods: Patients with an acute Rockwood Type III, IV, and V AC injury were included polytrauma, injury older than 2 weeks or requiring an open reduction, ipsilateral limb, and neurological injuries were excluded from the study. All patients underwent minimally invasive, percutaneous reduction and fixation with a suture anchor–metallic button construct. Patients were followed up at 6, 12, 24 weeks, 1 year, and 2 years postoperatively for radiological and functional assessment (Constant score). Statistical Analysis: Using analytical tests in SPSS software for comparison of coracoclavicular (CC) distance on the injured and healthy sides. Results: There were 25 male soldiers and cadets with a mean age of 24.5 ± 5.5 years. The mean follow-up duration was 37.9 ± 6.26 weeks. Twenty-four (96%) patients achieved pain-free, overhead shoulder abduction at 24 weeks follow-up with a mean constant score of 88.4 ± 7.43. The mean constant score at the last follow-up was 94.5 ± 5.67. Twenty-three (92%) patients had a well reduced AC joint; mean CC distance on the affected side was 9.1 ± 1.2 mm, comparable to mean distance of 8.9 ± 1.4 mm on the healthy side without any evidence of sclerosis or osteolysis till the last follow-up, while one patient had a recurrent dislocation. Conclusions: Suture anchor metallic button construct is a simple, surgeon friendly technique for young, high-demand patients to restore AC biomechanics in a minimally invasive manner.
INTRODUCTION The entity “floating metatarsal” is a unique and rare presentation of proximal and d... more INTRODUCTION The entity “floating metatarsal” is a unique and rare presentation of proximal and distal disruption of the metatarsal articulation and is probably a combination of varying grades of deforming forces on the midfoot and forefoot complex. This variety of Lisfranc dislocation becomes more unique when associated with an ipsilateral open bimalleolar ankle fracture and even phalangeal fracture. The aim of presenting such a case is to highlight the impact of such an unusual injury pattern on the foot biomechanics and the significance of prompt management that is paramount for the trauma surgeon in the polytrauma scenario as well as in an isolated presentation. The patient provided informed consent for the procedure and for publication of this report.
Study Design: Retrospective pilot study.Purpose: To assess the incidence of renal tract abnormali... more Study Design: Retrospective pilot study.Purpose: To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center.Overview of Literature: Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting.Methods: We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or self-voiding [S]); we correlated these data with the findings of the renal tract US.Results: The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time s...
Purpose: The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sle... more Purpose: The aim of this study was to assess the effects of the COVID-19 pandemic on anxiety, sleep outcomes and change in clinical management practices among orthopaedic surgeons following a nation-wide lockdown. Methods: We conducted an online cross-sectional study using piloted structured questionnaires with self-reported responses from Indian orthopaedic surgeons. Study participants were identified through social networking sites: Facebook and WhatsApp. The extent of anxiety and sleep quality was assessed by the standardised seven-item Generalised Anxiety Disorder (GAD-7) scale, single-item sleep quality scale, questions on unavailability of personal protective equipment, training module on COVID-19 and change in orthopaedic patient management. Results: One hundred male orthopaedic surgeons responded to the survey with majority (79%) in 30–44 years age group. Severe anxiety scores were observed in 8%; moderate, mild and minimal anxiety was observed in 12%, 27% and 53% surgeons r...
Strategies in Trauma and Limb Reconstruction, 2015
The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation o... more The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012-2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21-55 years). The mean follow-up period in this study was 23.5 months (20-26 months) after hook plate fixation and an average of 19.9 months (17-22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value \0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value \0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.
Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries... more Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1–C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1–C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infec...
Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries... more Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.
Study design: Prospective study. Purpose: Last decade has witnessed the emergence of unplanned re... more Study design: Prospective study. Purpose: Last decade has witnessed the emergence of unplanned readmissions as a tool to gauge health-care quality and hospital performance. Previous studies were limited by their retrospective designs based on database information and short-term 30-day follow-up intervals. We analyzed incidence and causes for unplanned readmissions following spine surgery at 90-d interval and its difference at 30-d, 31-60-d and 61-90-d intervals, Total Bed-Days Lost (TBL) and economic impact of readmissions and probable risk factors. Overview of Literature: Recent reports on readmission rates have suggested its contribution towards assessment of health care quality. Methods: A prospective analysis of 2860 admissions was performed over 1 year in a tertiary care orthopedic hospital. All unscheduled readmissions following spine surgery within 90 days of discharge, irrespective of type or location of surgery were included. Polytrauma, primary osseous infections and planned readmissions were excluded. Results: Our readmission rate was 3.32% (95/2860) and leading causes were surgical-site infections (SSIs) accounting for 44.21% (n=42, superficial-23, deep-11, organ space-8), followed by aseptic pain 31.58% (n=30) and medical causes 13.68% (n=13). Though 86.95% of superficial SSIs occurred within 30 days, 21.1% of deep SSIs occurred beyond 30 days. 33.68% of readmissions occurred in 30-90-day interval. Financial burden amounted to INR 41,93,660 and mean TBL was 7.33 per readmission. Hospital stay ≥10 days, health insurance and co-morbid illnesses (Diabetes, Hypertension and Liver disease) were associated with readmissions (p<0.05). Conclusions: Our study showed that SSIs and aseptic pain were leading causes of readmissions at 90-d interval. Limiting analysis to 30-day readmissions as in previous studies would lead to failure in identification of more severe complications like deep infections. Continued vigilance, particularly for patients with predisposing factors, could help alleviate the financial burden.
The aim of our study was to evaluate the
shoulder function after clavicular hook plate fixation o... more The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value \0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value\0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.
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Papers by vyom sharma
shoulder function after clavicular hook plate fixation of
acute acromioclavicular dislocations (Rockwood type III)
in a population group consisting exclusively of high-demand
military personnel. This prospective study was carried
out at a tertiary care military orthopaedic centre during
2012–2013 using clavicular hook plate for management of
acromioclavicular injuries without coracoclavicular ligament
reconstruction in 33 patients. All patients underwent
routine implant removal after 16 weeks. The functional
outcome was assessed at 3, 6 and 12 months after hook
plate removal and 2 years from the initial surgery using the
Constant Murley and UCLA Scores. All the patients were
male serving soldiers and had sustained acromioclavicular
joint dislocation (Rockwood type III). Mean age of the
patient group was 34.24 years (21–55 years). The mean
follow-up period in this study was 23.5 months
(20–26 months) after hook plate fixation and an average of
19.9 months (17–22 months) after hook plate removal. The
average Constant Score at 3 months after hook plate
removal was 60.3 as compared to 83.7 and 90.3 at
6 months and 1 year, respectively, and an average of 91.8
at the last follow-up that was approximately 2 years after
initial surgery which was statistically significant (p value
\0.05). The UCLA Score was an average of 15.27, 25.9
and 30.1 at 3, 6 months and 1 year, respectively, after
removal of hook plate which improved further an average
of 32.3 at the last follow-up, which was also statistically
significant (p value\0.05). Clavicular hook plate fixation
without coracoclavicular ligament reconstruction is a good
option for acute acromioclavicular dislocations producing
excellent medium-term functional results in high-demand
soldiers.
shoulder function after clavicular hook plate fixation of
acute acromioclavicular dislocations (Rockwood type III)
in a population group consisting exclusively of high-demand
military personnel. This prospective study was carried
out at a tertiary care military orthopaedic centre during
2012–2013 using clavicular hook plate for management of
acromioclavicular injuries without coracoclavicular ligament
reconstruction in 33 patients. All patients underwent
routine implant removal after 16 weeks. The functional
outcome was assessed at 3, 6 and 12 months after hook
plate removal and 2 years from the initial surgery using the
Constant Murley and UCLA Scores. All the patients were
male serving soldiers and had sustained acromioclavicular
joint dislocation (Rockwood type III). Mean age of the
patient group was 34.24 years (21–55 years). The mean
follow-up period in this study was 23.5 months
(20–26 months) after hook plate fixation and an average of
19.9 months (17–22 months) after hook plate removal. The
average Constant Score at 3 months after hook plate
removal was 60.3 as compared to 83.7 and 90.3 at
6 months and 1 year, respectively, and an average of 91.8
at the last follow-up that was approximately 2 years after
initial surgery which was statistically significant (p value
\0.05). The UCLA Score was an average of 15.27, 25.9
and 30.1 at 3, 6 months and 1 year, respectively, after
removal of hook plate which improved further an average
of 32.3 at the last follow-up, which was also statistically
significant (p value\0.05). Clavicular hook plate fixation
without coracoclavicular ligament reconstruction is a good
option for acute acromioclavicular dislocations producing
excellent medium-term functional results in high-demand
soldiers.