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Isolated periosteal avulsion injuries of the flexor retinaculum on the medial side of the ankle are rare and may mimic osseous injuries or deltoid ligament tears. We describe a case series of 3 individuals with isolated, stripping injuries of the tibial attachment of the flexor retinaculum without underlying fracture or deltoid ligament disruption. A new classification system of flexor retinaculum periosteal stripping injuries of the ankle is proposed with clinico-radiological features., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Delhi Orthopedic Association. All rights reserved.)

Rheumatoid Arthritis (RA) is the most common auto-immune, chronic inflammatory joint disease. Predominantly a musculoskeletal condition with a wide spectrum of skeletal and extra-skeletal manifestations, RA has a significant footfall in orthopaedic clinical practice worldwide. RA is essentially a clinical diagnosis; however, laboratory and radiographic investigations can provide complementary diagnostic and prognostic information about the disease. Early diagnosis and initiation of appropriate management are crucial since RA patients can develop chronic, erosive arthritis if left untreated or if treatment is delayed. Rheumatoid Factor (RF) antibody test is routinely employed for diagnostic purposes in patients with suspected RA. However, RF is present only in 70%-80% of patients with RA and can be non-specific. Therefore, Anti-cyclic citrullinated peptide antibody (ACPA), a novel immunological marker for RA is increasingly being utilised to provide higher specificity and a better prognostic indicator in RA patients. We describe the immunological basis of ACPA test and highlight its current applications in the diagnosis, prognosis and monitoring of RA in clinical practice., Competing Interests: None., (© 2021 Delhi Orthopedic Association. All rights reserved.)

Osteoarticular Tuberculosis (TB) of the Sacroiliac (SI) joint is an uncommon site affected by Mycobacterium Tuberculosis infection. The SI joint is involved in approximately 5-10% of all cases of TB. Diagnosis of SI joint TB can be delayed in early stages due to its varied and hidden presentation and probability of being confused with other spinal diseases. Delay in diagnosis can lead to chronic pain, joint destruction, and a natural progression to symptomatic bony ankylosis. A focused clinical examination, complementary imaging, microbiological and histopathological confirmation of Mycobacterium tuberculosis can direct a targeted therapy. Anti-Tubercular Therapy (ATT) regime remains a cornerstone in the overall management of SI joint TB. Early diagnosis allows conservative or non-operative management. Surgical interventions like abscess drainage, debridement, and arthrodesis with or without bone grafting may be required to achieve an excellent functional outcome., Competing Interests: None., (© 2021 Delhi Orthopedic Association. All rights reserved.)

Trauma remains a major public health concern due to the high cost, associated morbidity, and mortality both in developed and developing countries. Management of polytrauma patients has advanced and improved over the last few decades with a better understanding of the pathophysiology of shock, resuscitation, and hemodynamic changes. Anaesthesia and application of anaesthetic principles have consequently evolved and can be applied in polytrauma patients throughout their journey of treatment beginning from pre-hospital care, emergency department resuscitation, surgical procedures, and rehabilitation. Providing immediate pain relief is an important component in the management of these patients. Performing peripheral nerve blocks in the pre-hospital setting when feasible or on arrival in the emergency room provides rapid pain relief, better patient co-operation, decreases the risk of chronic pain syndromes. This narrative evaluates the role of anaesthesia and anaesthesiologists in the management of polytrauma patients. The authors performed a thorough review of the literature using various databased of Medline, PubMed, Embase, and Google Scholar. The relevant papers were also searched manually from the cross-referencing of retrieved papers. Full papers published in English till September 25, 2020 were included for this review. The keywords included 'trauma', 'difficult airway', 'anaesthesia', 'fluid and blood', 'monitoring', 'critical care', 'resuscitation' and 'surgery' in various combinations. The holistic management of trauma victims requires a multidisciplinary time-based approach for an optimal outcome. The management starts from assessment and simultaneous management for the optimization of the trauma victim from the first point of contact itself. The anaesthetic technique of choice in the perioperative management of trauma patients depends on different factors such as neurological status, cardiovascular stability, type and duration of surgery, coagulation status. Regional techniques are to be used whenever possible due to the beneficial effects observed with these techniques. Various important aspects are being discussed in subsequent sections., Competing Interests: The authors declare No conflict of interest., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Recently most of the journals charge a fee known as article processing charge (APC) for publication of an article. These charges can vary from journal to journal. This publication fee is often paid by the author, the author's institution, or their research funder organization. Though low- and middle-income countries are usually exempted from APC, India does not come under the category of waiver by most of the journals that ask for the APC. Most of the Indian institutes do not pay for publication and research thus individual researcher suffers huge financial burden due to APC. Hence, less affluent institutions, scholars, and students are unable to publish their work due to these barriers. These articles highlight the challenges faced by authors and solutions for publishers and journals to avoid APCs., Competing Interests: None., (© 2020 Delhi Orthopedic Association. All rights reserved.)