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Cases: We report 2 cases of compressive myelopathy secondary to spontaneous neuroaxial bleed in dengue infection. One was treated by surgical decompression during the recovery phase of illness, whereas the other was treated nonoperatively. Conclusion: A conscious decision for surgical decompression should be taken in cases not responding to initial medical management and planned during the recovery phase of dengue infection. [ABSTRACT FROM AUTHOR]

Case: A 35-year-old man suffered electric injury with 220 V alternating current when he was connecting electric wires at approximately 5 feet height and accidentally touched a live wire. He was diagnosed to have fracture involving superior and inferior endplates of L2 vertebral body without involvement of posterior elements. He, subsequently, underwent spinal stabilization with percutaneous pedicle screws fixation. Conclusion: Electric shock can cause vertebral fractures even at a low voltage. These fractures tend to have coronal plane involvement and involve both superior and inferior end plates. [ABSTRACT FROM AUTHOR]

Case: A 43-year-old man suffered household electric shock from 220 V alternating current when he accidently touched a live wire with his left hand. Subsequently, he was diagnosed to have osteonecrosis of the left femoral head and underwent total hip arthroplasty. Conclusion: We suggest that the electric current could have thrombosed the terminal subsynovial vessels of the femoral head, leading to osteonecrosis. To the best of authors’ knowledge, only 2 cases of osteonecrosis of the hip after electric shock have been reported in the literature. A literature review of the delayed consequences of electric shock injuries pertaining to orthopaedics is also presented. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 25-year-old man with a paramedian painful lump over the anterior chest wall. Laboratory examination revealed an increased leukocyte count of 13,400 square millimeters. The differential diagnosis includes pyogenic abscess, a parasitic cyst, and an isolated tuberculosis pyomyositis. A needle aspiration revealed necrotizing epitheliod granulomas and acid-fast bacilli (AFB) suggestive of tuberculosis.

Background: There is scarce information on craniovertebral junction tuberculosis even in developing countries. The pendulum of treatment in craniovertebral junction tuberculosis has periodically vacillated between nonoperative management and radical surgery. Methods: We performed a retrospective review of prospectively collected clinical and radiographic data on twenty-six consecutive patients with craniovertebral junction tuberculosis who were treated nonoperatively in our institution. The patients who had weakness of the limbs, pyramidal signs, or evidence of atlantoaxial dislocation and/or basilar invagination were immediately managed with immobilization with Crutchfield tongs traction (Group A), followed by halo-vest application. Patients without a neurological deficit, pyramidal signs, or atlantoaxial dislocation or basilar invagination were treated with cervical immobilization with early application of a halo vest (Group B). Results: The common presenting features were neck pain, restriction of neck movement, and spastic weakness of limbs. A retropharyngeal purulent fluid collection and osseous involvement of the dens and lateral mass of the atlas were the common radiographic findings. Twelve patients were partially or completely dependent on others for activities of daily living, and marked ligamentous and bone destruction with displacement at the atlantoaxial level was seen in eight patients at the time of presentation. The twenty patients in group A had cervical traction for a mean of 5.9 weeks, and a halo vest was applied for a mean of 6.9 months with antitubercular therapy for eighteen months. The mean follow-up period was 25.2 months (range, eighteen to forty-two months). All of the patients were independent in activities of daily living at the time of the last follow-up. Conclusions: In the Indian subcontinent, the disease process of craniovertebral junction tuberculosis is usually quite advanced at the time of presentation. On the basis of our study, patients with craniovertebral junction tuberculosis can be managed successfully with nonoperative treatment even with advanced involvement of bone or soft tissues at this spinal level. [ABSTRACT FROM AUTHOR]

Background: Computed tomography can be an adjunct to radiographs when evaluating intra-articular fractures of the distal part of the radius. Acute-phase multidetector computed tomography has better temporal, spatial, and contrast resolution than a conventional scanner has. The aim of this study was to determine prospectively whether the addition of a multidetector computed tomography scan (with various reconstructions) results in changes in the evaluation of intra-articular distal radial fractures and thus changes in the plans for further management.Methods: Radiographs and multidetector computed tomography scans were compared prospectively in the evaluation of 117 patients (120 wrists) with acute intra-articular distal radial fractures. The parameters that were measured included the ability to detect intra-articular step and gap displacements, central articular depression, coronal plane fracture, the number of articular fragments, comminution, and associated injuries in the wrist region (carpal bone fractures, distal radioulnar joint disruption, and ulnar styloid fracture).Results: The average measurements for intra-articular step and gap were 0.4 mm and 0.9 mm, respectively, on post-reduction radiographs and 1.3 mm and 2.4 mm, respectively, on sagittal multidetector computed tomography images (p < 0.0001 for each). Central articular depression was found in twenty-one wrists (18% of the total) on radiographs, but on multidetector computed tomography it was found to be present in seventy-four wrists (62% of the total) (p < 0.0001). Twenty-six radiographically occult injuries in the wrist region, including six scaphoid fractures, were detected with the help of multidetector computed tomography. Overall, the recommended treatment plan changed in 23% of the cases when the evaluation included multidetector computed tomography images in addition to conventional radiographs. Interobserver and intraobserver agreements were significantly increased when radiographs and multidetector computed tomography images both were available for evaluation (κ = 0.73 and 0.91, respectively) as compared with interobserver and intraobserver agreement with radiographs alone (κ = 0.43 and 0.69, respectively).Conclusions: Multidetector computed tomography provides more accurate information regarding the anatomy of intra-articular distal radial fractures than radiography provides. The addition of multidetector computed tomography to plain films frequently changes the therapeutic recommendations for such cases. [ABSTRACT FROM AUTHOR]

Background: The literature on tuberculosis of the posterior spinal elements without involvement of the vertebral body is scarce. In this study we report our experience with twenty-four cases of neural arch tuberculosis that were treated at our center. Methods: We performed a retrospective review of the clinical and radiographic data of twenty-four consecutive patients who had tuberculosis of the posterior spinal elements with total sparing of the vertebral bodies and intervertebral disc space. We categorized the patients into two groups on the basis of the clinical and radiographic evaluation. The patients who had rapid onset weakness of the lower limbs or pyramidal signs or who showed evidence of epidural abscess underwent emergency decompressive laminectomy (Group A). Patients who had pyomyositis of the posterior spinal muscles without any neurological deficit, pyramidal signs, or epidural abscess were managed with antitubercular therapy alone (Group B). Results: The common presenting features were spastic limb weakness and back pain. The majority of the patients had involvement of the thoracic spine. Epidural abscess, erosion of lamina, and pyomyositis of posterior spinal muscles were common imaging findings. Group A consisted of nineteen patients and Group B consisted of five patients. The mean period of follow-up was 16.9 months (range, nine to sixty months). Patients in Group A had a poorer outcome than those in Group B. Thirteen of the nineteen patients in Group A improved to become independent in the activities of daily living, with complete neurological recovery in eight patients and partial recovery in five patients. Six of the nineteen patients continued to have spastic paraplegia and were wheelchair-dependent. All of the patients in Group B remained neurologically intact during the follow-up period. None of the patients had recurrence of the disease or developed anterior element involvement or kyphotic deformity during the follow-up period. Conclusions: Neural arch tuberculosis is often missed at the time of initial presentation. In association with epidural abscess, it leads to rapid neurological deterioration. This atypical picture of spinal tuberculosis showed a high rate of neurological deficit at the time of initial presentation for medical care. [ABSTRACT FROM AUTHOR]

Despite surgical advances in fracture management, it is not uncommon to find pediatric or adolescent patients with elbow deformities. Correction of severe deformities, often leaves the ingenuity of the treating surgeon asking for more. Various osteotomy techniques have been described in the literature for the correction of elbow deformities. Although, the concept of dome osteotomy did address certain inadequacies of the existing osteotomy techniques for distal humerus, but correction of complex deformities associated with deformation of trochlea and olecranon fossa still remain a surgical challenge which has not been adequately addressed in the literature so far. Our experience with the existing osteotomies for distal humerus led to the development of a new surgical technique of shortening dome osteotomy for correction of such complex multiplanar elbow deformities. Surgical steps, indications, and expected outcome is described., Competing Interests: Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The Ponseti method has been reported to have successful results in clubfoot patients less than 6 months of age but the literature on its efficacy in older clubfoot patients still remains sparse. In our study, we prospectively evaluated 55 clubfeet (37 patients) to determine clinically whether the Ponseti method is effective in the management of clubfoot in older children between the age of 12 and 36 months (mean: 24.8 months). All the patients belonged to moderate or severe grades of deformity as per the Pirani scoring. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 49 clubfeet. Seven patients (seven feet) developed recurrence of adduction, varus and equinus deformity whereas three patients (five feet) developed isolated recurrence of equinus deformity. These seven patients responded to repeat treatment and obtained satisfactory outcome. Four of these seven patients underwent tibialis anterior transfer to third cuneiform for dynamic supination. Three patients, those developed isolated recurrence of equinus deformity, underwent repeat tenotomy. One foot achieved satisfactory amount of dorsiflexion, three feet underwent tendoachilles lengthening whereas another foot underwent posterior release to obtain satisfactory dorsiflexion. Six to 12 numbers of casts (mean: 10) were required to obtain correction of clubfoot deformities. Mean period of immobilization in a cast was 13.9 weeks (10-15 weeks). We found that the Ponseti method is effective in children between the age of 12 and 36 months.