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Arora S.,Maulana Azad Medical College | Goel N.,C o Mr. Sham Khanna | Goel N.,Sushruta Trauma Center | Cheema G.S.,Maulana Azad Medical College | And 2 more authors.
Clinical Orthopaedics and Related Research

Background The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm. Questions/purposes We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve. Materials and Methods We performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function. Results The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients' height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group. Conclusion The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus. © 2011 The Association of Bone and Joint Surgeons. Source

Beniwal R.K.,Central Institute of Orthopaedics | Bansal A.,Max Hospital
Journal of Clinical Orthopaedics and Trauma

Introduction: Regular monitoring of tissue compartmental pressures and hence a timely intervention in patients with impending compartment syndrome has been shown to prevent morbidity and permanent disability. Material and methods: Intra-compartmental pressure in flexor compartment of forearm and various compartments of legs following recent trauma presenting within 6. h of injury was carried out in 30 subjects using Whitesides' technique and patients were classified into 3 categories for treatment purposes i.e., Category I: pressure <30. mmHg, Category II: pressure 30-40. mmHg and Category III: pressure >40. mmHg. Results: Category I had 17 subjects, Category II had 6 subjects whereas 7 subjects fell into Category III. 6 patients out of the 30 studied needed fasciotomy, out of which 5 had fair or good result. Conclusion: Whitesides' technique, though not much widely favoured, is a safe, inexpensive, easily assembled and reliable method for measurement of intra-compartmental pressure as a guide for decompression. © 2016 Delhi Orthopedic Association. Source

Singh D.,Central Institute of Orthopaedics
Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association

Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC) joint and dislocation of the metacarpophalangeal (MCP) joint is considered as a rare injury pattern. We report an unusual case of dorsal dislocation of MCP joint of the thumb associated with extraarticular fracture of the base of the first metacarpal in a 28-year-old man. The dislocation of MCP joint had been missed during initial presentation at a peripheral centre. The patient made an uneventful recovery following open reduction and fixation with 1.25 mm Kirschner wire of the MCP joint along with repair of the ulnar collateral ligament. This injury pattern has not been previously reported to the best of our knowledge in the English-language based medical literature. Source

To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict outcomes for patients with acute subaxial cervical spine injury (CSI). 42 men and 18 women (mean age, 41 years) with acute subaxial (C3-C7) CSI and a neurological deficit were evaluated clinically and radiologically after crutch-field skeletal traction. The comprehensive CSIRPS comprised 5 predictor variables: American Spinal Injury Association (ASIA) impairment scale, maximum cord compression, maximum canal compromise, signal intensity pattern in the cord, and Cervical Spine Injury Severity Score (CSISS). Point values of each predictor were weighted based on consensus and experience, and the total effect was computed using the CSIRPS. A receiver operating characteristic (ROC) curve was plotted with the CSIRPS data to obtain the critical value that can predict walkers from non-walkers. The Chi squared value for CSIRPS was 55.771 and the contingency coefficient was 0.694 (p<0.0001), both of which were highest among each predictor's corresponding values. A ROC curve was plotted with the CSIRPS data. With 100% area under the ROC curve, the critical value of 50 was identified with a sensitivity and specificity of 100%. All the patients with CSIRPS above this level regained the useful functions on follow-up, whereas patients with lower scores did not. The CSIRPS is a practical and accurate means of predicting outcomes in patients with acute subaxial CSI. Source

Arora S.,Maulana Azad Medical College | Kumar R.,Central Institute of Orthopaedics
Journal of Infection in Developing Countries

Musculoskeletal tuberculosis is known for its ability to present in various forms and guises at different sites. Tubercular spinal epidural abscess (SEA) is an uncommon infectious entity. Its presence without associated osseous involvement may be considered an extremely rare scenario. We present a rare case of tubercular SEA in an immune-competent 35-year-old male patient. The patient presented with acute cauda equina syndrome and was shown to have multisegmental SEA extending from D5 to S2 vertebral level without any evidence of vertebral involvement on MRI. The patient made an uneventful recovery following surgical decompression and antitubercular chemotherapy. The diagnosis was confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus. Such presentation of tubercular SEA has not been reported previously in the English language based medical literature to the best of our knowledge. © 2011 Arora and Kumar. Source

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