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Background: The aim of this study is to evaluate comparative biomechanical fixation provided with the BDSF method with the conventional CC screw fixation for treatment of femoral neck fractures with three parallel cannulated screws. Methods: This is a prospective cohort study. There were two teams of surgeons out of which one team operated the patients with BDSF technique and second with conventional CC screw fixation technique; thus, the patients were randomly distributed into two groups. Patients were included in the study as per the following inclusion and exclusion criteria. Results: Union was achieved in 15 (83.33%) patients managed by conventional CC screw technique, while union was achieved in 11 (91.67%) patients managed by BDSF technique in the present study. The average Harris hip score in present study was 90 score in patients managed by BDSF technique, while the average Harris hip score in present study was 80 score in patients managed by BDSF technique. Conclusion: Both BDSF and conventional CC screw fixation are good fixation methods for fracture neck of femur. But functional outcome and fracture union rates are better with BDSF Technique. Although, there are some minor problems noted in BDSF technique such as outer cortical fracture at the entry point of beam screw and opening up of anterior cortex of oblique fracture patterns. Thus, BDSF method provides reliable fixation in which early mobilization and partial weight bearing of the patient may be allowed. [ABSTRACT FROM AUTHOR]

The present study was conducted to collect morphometric data on the lumbar vertebrae pedicles of the adult population from the eastern parts of India and analyse the variations, if any, with other parts of the country and the world. The retrospective cross-sectional study where lumbar pedicle morphometric data was obtained via dried bone, the 3D Lumbar vertebrae images were obtained by scanning the dried lumbar vertebrae, and the 3D lumbar vertebrae model was generated from a 1 mm thin CT scan slice of the Lumbar spine of patients who were advised to have a CT scan of the abdomen for reasons other than related to the vertebral column. Both linear and angular measurements in the lumbar pedicles were made bilaterally. The transverse pedicle width is widest at L3 and the narrowest at L2 vertebra bilaterally. The sagittal pedicle width at L4 vertebrae was observed to be the widest bilaterally, while L3 had the narrowest pedicle. The pedicular and body length along the pedicular axis is longer than the central axis at all the lumbar levels. The linear measurement along the pedicular axis was longest at L5 bilaterally via both modes, with a range of 18.2–47.31 mm for bones and 21.03–49.28 mm for CT scan morphometry. The transverse pedicular angle on analysis was observed to increase as one goes down the spine from L1 to L5, with a steep rise between L4 and L5. In contrast, the sagittal pedicular angle decreased as we went caudally toward the L5 vertebrae. The present study data had significant differences among the values reported in the literature from the different populations for the parameters studied. The data obtained by this study will be highly beneficial for the success of the free-hand technique of pedicle screw insertion. [ABSTRACT FROM AUTHOR]

Achieving accurate anatomic reduction and stable internal fixation is mandatory in the management of femoral neck fractures (FNF) in adults. The spatial configuration and direction of the screws have been reported to provide stability to the fracture. The study's goal is to analyse the clinico-radiological outcome of the newer biplane double-supported screw fixation (BDSF) technique in the Indian cohort. Patients with isolated FNFs underwent osteo-synthesis by BDSF technique. Radiological outcome was evaluated by time to union and fracture healing on plain radiographs. Clinical outcome was measured using the Harris hip score (HHS) at 1, 3, 6, and 12 months after surgery. The pain reduction was measured using the VAS score. Twenty-seven patients with a mean age of 37.33 ± 9.84 years (24–55 years) were followed up for at least 12 months (12–31 months). The mean HHS at 12 months was 94.81 ± 8.18 (range: 68–100). Twenty-five patients were able to achieve radiological union within a mean time of 14.60 ± 4.69 weeks (range: 8–28). The overall complication rate was found to be 18.51% (5 out of 27 patients). Individual complications were non-union (2 patients; 7.4%), AVN (3 patients; 11.11%), and screw back out with femoral neck shortening (4 patients; 14.81%). Screw configuration using the BDSF technique provides a good union rate with minimum complications. The majority of patients resulted in a good (HHS >80) to excellent functional outcome. Based on the clinico-radiological outcome obtained, we conclude that this technique is effective in the fixation of FNF in adults. Level II. [ABSTRACT FROM AUTHOR]

Purpose: We aim to report clinical and radiological results of triangular osteosynthesis for a homogenous group of vertically unstable transforaminal sacral fractures. Methods: Between 2013 and 2018, 22 consecutive patients with unstable sacral fractures were treated with triangular osteosynthesis consisting of iliosacral screw augmented by spinopelvic fixation. Patients were followed up prospectively as a single cohort. Bone union, complications, clinical and radiological outcomes were investigated. Results: Mean follow-up was 3.1 years (12–76 months). There was one bilateral fracture. Two patients underwent anterior plating for pubic symphyseal disruption. Based on Majeed and Iowa pelvic scores, 13 patients had excellent, seven had good and two had fair clinical outcome. All the patients could perform squatting, sitting cross-legged and kneeling without any restrictions. There were no additional neurological injuries. One patient had non-union of sacral fracture, one patient had deep infection, one patient had marginal wound necrosis and two patients complained of pain related to implant prominence. Two patients had connecting rod backout. All but one patient attained pre-operative work status. Conclusion: Triangular osteosynthesis is a reliable procedure in treating unstable transforaminal sacral fractures. It permits early weight-bearing and facilitates faster functional recovery. Careful attention to details such as sacral dysmorphism, soft tissue injury, implant placement and anterior pelvic injury helps in keeping complications to an acceptable rate. [ABSTRACT FROM AUTHOR]

Background and Objective: Intra capsular fracture of the neck of femur (FNF) treated traditionally with a dynamic hip screw (DHS) or three cancellous screws (3CS) has a high incidence of complications with reoperation rates between 20 % and 45 %. We hypothesized that FNF unites by primary healing. Therefore, intra-operative compression and absolute stability post-operatively until healing are essential. We postulated that FNF requires 2 types of implants- those which provide absolute stability for young patients with good bone stock and another with sliding mechanism for elderly patients with osteoporosis. We developed three novel fixation systems at our research institute in India using a modified DHS. In patients with good bone stock, locking DHS, called LHS and GSK triangular system (GSKT) provided intra-operative compression and absolute stability during the post-operative period. In those with poor bone stock, the controlled sliding DHS (CSDHS)was used as a locking implant might penetrate the hip joint., Materials and Method: 42 patients of FNF <55 years of age were studied. Among 39 patients with good bone stock, LHS was used in five patients and GSKT system was used in 34 patients. CSDHS was used in three patients with poor bone stock or communition. The patients were followed up for a minimum of eight months up to a maximum of two years, with the average follow up duration of 14 months., Results: 32 out of 34 fractures treated by GSKT system united. Five cases managed by LHS and three by CSDHS, all united. The union rate was 95.2 %. Of the two failed cases, one patient had nonunion (NU), the other had deep infection. Avascular necrosis of the head (AVN) was detected in three patients treated with GSKT system in the second year following surgery. Two of them had hip pain while one was asymptomatic. Eight cases of FNF Pauwels type III underwent a primary valgus osteotomy. All of them united without complications., Conclusion: In patients with good bone stock, LHS and GSKT system allowed intra-operative compression and absolute post-operative stability without sliding of head fragment as the triangle construct is biomechanically the strongest. When bones are osteoporotic, a CSDHS provided controlled sliding (1 to 5 mm only). This pilot study showed a promising success rate of 95.2 %. We propose that the GSKT system may be used to treat intertrochanteric and other metaphyseal fractures as well. Further biomechanical studies are underway to strenghten the evidence needed for the widespread use of these implants., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Hip fractures account for a large proportion of hospitalization among the trauma cases. Low cost, simple technique, easy removal, and high rate of the bone union makes extramedullary (EM) fixation techniques a preferred choice. A close-fit bone and plate are essential for the success of such implantation. Various studies have found femur morphometry being related to regional features and social differences. Most of the available commercial implants are developed based on the data of the Caucasian population. Methods: In the herein study, a novel design, Double Oblique Device for Osteosynthesis of hip (DODO), is proposed while considering the regional morphometry of the Northeast (NE) population of India. This study employs finite element (FE) analysis to compare the biomechanical outcome of the new device with that of proximal femoral locking plate (PFLP) and variable angle dynamic hip screw (VA-DHS) on a femur having an Evans type-I intertrochanteric fracture. Results: The stress shielding was substantially high for the PFLP and VA-DHS in the distal bone fragment (lateral aspect) and for DODO in the femoral head. The difference in axial displacement between the post-implanted DODO-fixed femur and its respective intact femur was predicted to be almost the same as that of PFLP-fixed femur and its respective intact femur. Conclusion: The computational results found the new device to be a viable alternative to the conventional plating techniques, especially for the NE population of India, and predicted better to comparable biomechanical characteristics. [ABSTRACT FROM AUTHOR]

Introduction: Morphometric variations of the anterior column of the acetabulum have been described in the literature for its complex structure, which can influence the safe containment of intramedullary screw for fixation of its fractures. The purpose of this CT-based study is to present a preliminary report on the morphometric variations and safety of intramedullary screw fixation of the anterior column of the acetabulum in the Indian population.Methods: CT-based data from 102 uninjured pelves were retrospectively analyzed in iPlanⓇ BrainLab AG, Feldkirchen, Germany. Narrowest zones around acetabulum and superior pubic ramus were measured. We calculated the axis of the anterior column of the acetabulum by joining the centres of these narrowest zones. Standard screws trajectories were directed along this axis. Screw length up to the first cortical perforation, the distance of the exit point from the pubic symphysis, and the length of the anterior column up to the pubic tubercle were measured.Results: The osseous corridor of the anterior column of acetabulum had variable cross-section along its length with two constriction zones, first in the acetabular region and second in the superior pubic ramus. Only 54% of our cases allowed safe applicability of 6.5-mm-diameter screw trajectories with safety margin of 2 mm on either side of the screw. Significant morphometric and screw applicability-related differences were observed among male and female cases with males having a wider osseous corridor in general. Elimination of safety margin results in a significant increase in the screw applicability.Conclusion: The osseous corridor of the anterior column varies in its dimensions from individual to individual. Standard screws of 6.5-mm and 7.3-mm diameters may not be safe for intramedullary screw fixation in every patient and carry a risk of cortical violation when a 2 mm of width around the screw is considered as a safety margin. However, with a precise screw placement within the extents of the cortices of the anterior column, 6.5-mm screws can be applied in most of the female cases and 7.3-mm screws can be applied in most of the male cases for anterior column fixation. [ABSTRACT FROM AUTHOR]

Background: In this study we describe the morphology of the posteromedial fragment in pertrochanteric fractures using 3D CT scans and answer two questions 1) Do differences exist between the 3D CT appearances of posteromedial fragments and the depictions made in the AO classification 2) Does the posteromedial fragment affect stability in pertrochanteric fractures, in terms of fracture collapse?Methods: Preoperative CT scans of eight 31-A1 and fifty 31-A2 fractures were analysed. The presence of PM fragment, its fragmentation, greater trochanter (GT) involvement, lesser trochanter (LT) fragment size (in terms of its posterior and medial extent as well as LT length), LT fragment displacement (in terms of medial displacement and rotation) were determined. All fractures were treated with a DHS. Fracture collapse was determined on postoperative radiographs. The relationship between fracture collapse and patient factors including age, gender, fracture type (A1 versus A2), characteristics of the posteromedial fragment, and the presence of a lateral wall fracture were determined.Results: Three out of eight 31-A1 fractures demonstrated a separate GT fragment (three part fracture). Out of the 50 31-A2 fractures, 12 had a single PM fragment, which included the LT and GT in continuity. The more common four part fractures seem to form by further fragmentation of this basic form. In A2 fractures, the GT was almost always broken and the broken fragment comprised a mean 56% of normal GT. The LT fragment involved an average of 74% of the posterior wall, and an average of 36% of the medial wall of the proximal femur. Larger LT fragments were less displaced as compared to smaller fragments. Univariate regression analyses revealed that fracture collapse was significantly correlated with fracture type (A1 versus A2, p 0.036), GT size (p 0.002) and the presence of a lateral wall fracture (p<0.001).Conclusions: This study revealed some important differences between the 3D CT appearances and AO classification of pertrochanteric fractures. Further, neither fragmentation of the posteromedial fragment, nor the size of the lesser trochanter fragment was found to predict stability in pertrochanteric fractures. A perioperative lateral wall fracture is the main determinant of stability in these fractures. [ABSTRACT FROM AUTHOR]

Objectives: Humeral head sacrificing procedures are more favored in elderly patients with complex proximal humerus fractures because of high incidence of failures and complications with osteosynthesis. The purpose of this study is to assess the outcome of second generation locked plating techniques in 3 and 4 part fractures in active elderly patients >70years with an emphasis on function and complications.Materials and Methods: 29 patients with displaced 3 and 4 part proximal humerus fractures were treated using the principles of second-generation proximal humerus locked plating. Fixed angle locked plating (PHILOS) using the anterolateral deltoid spilt approach augmented with traction cuff sutures was performed. Minimum of 7 locking head screws including 2 calcar screws were used. In cases with a comminuted medial calcar, an endosteal fibular strut was used. Subchondral metaphyseal bone voids were filled with injectable calcium phosphate cement. Radiological outcome (union, head - shaft angle, tuberosity reduction), functional outcome assessment (Constant and ASES scores) and complications (loss of reduction, nonunion and osteonecrosis) were assessed.Results: The fracture united in 24 of the 26 patients available for follow up at a mean of 27 months (12-40 months). 3 patients developed complications that required arthroplasty (fixation failure in 2 patients and osteonecrosis in 1 patient). Follow up age adjusted Constant (63.1±11.9) and ASES scores (62.58±7.5) showed the extent of functional improvement post surgery. Patients with fractures having a non-comminuted medial calcar and valgus displacement of the humeral head had better functional scores and fewer complications.Conclusion: Osteosynthesis with second generation locked plating techniques provide satisfactory outcome in very elderly patients with complex proximal humerus fractures with minimal complications. [ABSTRACT FROM AUTHOR]

Background: The technique of intralaminar screw placement for achieving axis (C2) fixation has been recently described. The purpose of the study was to provide the morphometric and radiological measurements in Indian population and to determine the feasibility of safe translaminar screw placement in this population. To the best of our knowledge there is no study (cadaveric or radiological) done in Indian population to detect suitability of axis bone for laminar screw fixation. Material and Methods: 38 dry axis vertebrae from adult South Indian population were subjected to morphometric measurement and CT scan analysis. Height of posterior arch, midlaminar width(bilateral) in upper 1/3rd, middle 1/3rd and lower 1/3rd were measured using high precision Vernier Calipers. Each vertebra was subjected to a spiral CT scan (Philips brilliance 16 slice) thin 0.5 mm slices were taken and reconstruction was done in coronal and sagittal plane. Analysis was done on a CT work station. Using axial slices, sagittal cuts were reconstructed in plane perpendicular to the lamina at the mid laminar point and upper-middle and lower 1/3rd width of the lamina measured. Height of the posterior arch was measured in the sagittal plane. Intralaminar angle was measured bilaterally. Results: Middle 1/3rd lamina was the thickest portion (mean 5.17 mm +/-1.42 mm). A total of 32 (84.2%) specimen were having midlaminar width in both lamina greater than 4 mm, however only 27 (71 %) out of them had spinous process more than 9 mm. CT scan measurement in middle and lower 1/3rd lamina was found to be strongly correlated with the direct measurement. Conclusion: There is high variability in the thickness of the C2 lamina. As compared to western population, the axis bones used in the present study had smaller profiles. Hence the safety margin for translaminar screw insertion is low. [ABSTRACT FROM AUTHOR]

Background: The integrity of the lateral wall has been reported to be an important factor determining fracture stability in an intertrochanteric fracture. Iatrogenic the lateral wall fracture (ILWF) has been reported while reaming for the lag screw and the barrel of the dynamic hip screw (DHS). This study aimed to identify the predictors of iatrogenic lateral wall fractures (ILWF) while using the DHS, which will help to improve the pre-operative planning and avoid their incidence. Materials and methods: A total of 120 adult patients with intertrochanteric fracture femur treated with the DHS were included in this prospective series. Pre-operatively, the parameters noted were the demographic data, quality of bone using Singh's index, fracture classification using AO/OTA and modified Evan's system. The incidence of ILWF was recorded immediately after the fixation with the DHS. The two groups, i.e. one with ILWF and other without ILWF, were compared. Results: The mean age of 46 females and 74 men in the study was 61 years. Among 120 patients, 87 (72.5 %) patients had a posterior sag that had to be corrected while passing the guide wire and while reaming the neck of femur. The incidence of ILWF was 23.33 %. The incidence of osteoporosis in patients with unstable fracture was 66.67 %. 1.7 % patients with a stable AO/OTA A1 fracture had ILWF, as compared to 50 % of patients with type A2.2 and type A2.3 who sustained an ILWF ( p < 0.0001). None of the patients with a 2-part fracture on modified Evan's classification had ILWF, while 53.84 % with a 4-part fracture had ILWF ( p < 0.01). Conclusion: There is a high risk of ILWF using the DHS in unstable intertrochanteric fractures (AO type A2.2 and A2.3 or 4-part fracture patterns). Level of evidence: IV (case series). [ABSTRACT FROM AUTHOR]

Purpose: As Indian spine surgeons, we have to choose between 'foreign implants' and 'Indian implants'. An Indian four pedicle screw rod construct costs 330 US dollars (one-third that of a similar foreign construct). About 60% of patients cannot afford expensive foreign implants. There is little written data evaluating how these Indian implants fare. The purpose of our study was to evaluate implant failure rate with Indian implants and compare it to foreign implants. Methods: We analysed results of 1,572 titanium pedicle screws used in 239 patients with a minimum 1-year follow-up. Patients were divided into Indian and foreign implant groups. Radiological failures were classified as (1) surgery and disease failure, (2) bone failure and (3) implant failure. The null hypothesis was that there is no difference between implant failure rate for Indian and foreign implants. Results: A total of 128 (53.56%) of patients could not afford foreign implants. We used 679 foreign and 893 Indian pedicle screws. In foreign implant group, there was a single incident of implant failure (0.15%). In Indian implant group, there were five such incidents (0.56%). Conclusions: (1) Rate of failure for 'low cost' Indian implants is very low (approximately 1 implant complication for every 200 screws). (2) There is no statistically significant difference in failure rates for Indian implants and foreign implants ( P-value = 0.2438). We recommend that Indian implants are a safe and viable option to make spine surgery cost effective in the Indian scenario. [ABSTRACT FROM AUTHOR]

Background: The key to the safe and effective use of thoracic pedicle screws in the deformed spine is to thoroughly understand pedicle anatomy. There are a few studies related to pedicle anatomy in the Indian population and no pedicle morphometric studies in scoliosis patients. The present study aims to highlight the differential features of pedicle morphometry, including pedicle width, transverse pedicle angle and the depth to anterior cortex on the concave and convex side, in a group of Indian patients with adolescent idiopathic scoliosis and compare this to that of a western population. Materials and Methods: This is a prospective study of 24 patients with adolescent idiopathic scoliosis. The average age is 14.6 years (12.3-18.3 years) of which 14 were females and 10 were males. All the patients underwent CT scan using Siemens 4th generation scanner. The scans were analyzed by measuring the transverse pedicle width, transverse pedicle angle and the chord length; all the measurements being made both on the convex as well as the concave pedicle. Statistical analysis was performed with unpaired 't' test. Results: A total of 1295 measurements were performed from 24 patients and an average of 215 pedicles were assessed for each set of the measurements made. The transverse pedicle width was consistently found to be smaller on concave side in comparison with the convex side at all levels except at T1. The transverse pedicle angle was greater on the concave side at all levels as compared to the convex side, though there was wide individual variation. The depth to anterior cortex was lesser on convex side in comparison to the concave side except at T1. Conclusions: The concave pedicle is much thinner and directed more medially than the convex side, especially at the apical region of the scoliotic curve. The pedicle anatomy in scoliosis patients shows very high individual variations and a careful study of pre-operative CT scans is essential for planning proper pedicle screw placement. Slightly longer screws can be accommodated on the concave side as compared to the convex side, though the difference in the chord length is not statistically significant at most levels. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term follow-up. In this study we review a single surgical team's series of 235 surgically treated cases of AIS with a follow-up from two to six years. Materials and Methods: Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups. Results: The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards. Conclusion: The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment. [ABSTRACT FROM AUTHOR]

Background: We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures. Materials and Methods: One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study. Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union. Results: The follow-up period averaged 15 months (range, 6.26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury. Conclusion: Unreamed distally locked dynamic tibial nailing (modified Kuntscher nail/Daga nail) can produce excellent clinical results for diaphyseal tibial fractures. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve. [ABSTRACT FROM AUTHOR]

Establishing identity from skeletal remains is a challenging task for forensic experts. Identification in such cases can be achieved by dental records, post-mortem radiography and DNA profiling. However, these methods require additional data for comparisons. Positive identification can also be achieved using implanted medical devices. This is a rapid and inexpensive method, as long as a central database is maintained for effective tracking of such devices. We present a case report in which identity was established from skeletal remains using information furnished on the implanted metallic dynamic hip screw and side plate. This case report discusses the legal scenario in India and globally with regard to medical devices and their utility for forensic application. It emphasises the need for legal provision relating to medical devices in India, which would compel the manufacturer to use unique identification numbers for each medical device and to maintain a person-specific database.

Introduction: Infrazygomatic crest (IZC) dimension is an important factor in the safety and stability of bone screws. The dimension is known to vary according to the dimensions of the maxillary sinus, which in turn depends on the vertical facial skeletal pattern., Objective: The objective of the study was to compare the infrazygomatic crest thickness (IZC) above the mesiobuccal root of the first and second maxillary molar in different vertical skeletal patterns., Materials and Methods: This was a retrospective study conducted in Saveetha Dental College, Chennai. Cone beam computed tomography (CBCT) and lateral cephalograms of 36 subjects were collected and divided into 3 groups (12 subjects in each group) depending on their vertical skeletal pattern, namely normal, low and high angle. Vertical skeletal pattern was assessed using lateral cephalogram whereas IZC thickness was measured using CBCT. Mann Whitney U test was done to compare the bone thickness in the right and left sides and also to compare the same above the mesiobuccal root of the first and second molar. Kruskal Wallis and post hoc tests were done to compare bone thickness among the three groups. P-value was set at 0.05 for all the analysis., Results: Significant difference in IZC bone thickness above the first molar region was noted between high angle and average angle groups (P-value 0.001) and high angle and low angle (P-value 0.001). Above the second molar region, a significant difference was seen between high angle and average angle groups (P-value 0.001). Significant difference in bone thickness was also observed among the first molar and second molar region in all the three groups (P-value<0.05)., Conclusion: IZC thickness was the least in high-angle subjects. Clinically, it is desirable to place the IZC screw above the mesiobuccal root of the maxillary second molar especially in high-angle subjects., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Infrazygomatic crest miniscrews are an important advancement in the field of orthodontics for anchorage reinforcement. The size of the miniscrews and the site of placement depend on the bone thickness in the infazygomatic crest area. The bone morphology and the thickness vary among different ethnicities of population., Objectives: To assess the bone thickness in the infrazygomatic crest area around the distobuccal root of the maxillary first molar using cone beam computed tomography and determine the best possible site and angulation for the placement of the miniscrew. Therefore, to determine the size of the implant that will suit the Dravidian population., Methods: The infrazygomatic crest bone thickness was evaluated on 10 patients using cone beam computed tomography. The measurements were made along the distobuccal root of maxillary first molar at different angulations ranging from 75° to 40° to the occlusal surface of the molar., Results: The infrazygomatic crest bone thickness was of 4.5mm to 9mm for the Dravidian population, when measured at an angle of 40° to 75° to the maxillary first molar occlusal plane and of 11 to 17mm above the occlusal plane. Student t-test (confidence interval 95%) was done to determine gender variation and compare the bone thickness of right and left side. ANOVA and post-hoc test were done to find the statistical difference between the bone thickness measured at different insertion angles., Conclusions: The best possible site for miniscrew insertion is 12 to 17mm above the occlusal plane at an angle of 65° to 70°, with no injury to the adjacent anatomical structures, no mucosal irritation and adequate stability for the miniscrew. The ideal infrazygomatic crest screw length for Dravidian population is 9 to 11mm., (Copyright © 2019 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Accurate and detailed measurements of spinal canal diameter (SCD) and transverse foraminal morphometry are essential for understanding spinal column-related diseases and for surgical planning, especially for transpedicular screw fixation. This is especially because lateral cervical radiographs do not provide accurate measurements., Aim:: This study was conducted to measure the dimensions of the transverse foramen sagittal and transverse diameters (SFD, TFD), SCD, and the distance of spinal canal from the transverse foramina (dSC-TF) at C1-C7 level in the Indian population., Materials and Methods:: The study population comprised 84 male and 42 female subjects. The mean age of the study group was 44.63 years (range, 19-81 years). A retrospective study was conducted, and data were collected and analyzed for patients who underwent cervical spine computed tomography (CT) imaging for various reasons., Results: One hundred and twenty-six patients were included in the study. Detailed readings were taken at all levels from C1-C7 for SCD, SFD, TFD, and dSc-TF. Values for male and female subjects were separately calculated and compared. For both the groups, the widest SCD were measured at the C1 level and the narrowest SCD at the C4 level. The narrowest SFD was measured at C7 for both male and female subjects on the right and left sides. The widest SFD was measured at C1 both for male and female subjects on the right and left side. The narrowest TFD on the left side was measured at C7 for male and at C1 for female subjects. The narrowest mean distance of dSC-TF was found to be at C4 for both male and female subjects on both left and right side., Conclusion: The computed tomographic (CT) imaging is better than conventional radiographs for the preoperative evaluation of cervical spine and for better understanding cervical spine morphometry. Care must be taken during transpedicular screw fixation, especially in female subjects, more so at the C2, C4, and C6 levels due to a decrease in the distance of dSC-TF., Competing Interests: There are no conflicts of interest

Background: Cervical transpedicular screw fixation is safe and is probably going to be the gold standard for cervical spine fixation. However, cervical transpedicular screw use in the Asian population can be limited as the transverse diameter in this group of patients may not be adequate to accommodate the 3.5-mm pedicular screw thus injuring the vital structures located in the close proximity of the pedicles. Thus lateral mass fixation remains the mainstay of treatment. The present study evaluated the transverse cervical pedicle diameter of C2-C7 vertebrae in a pilot study in 27 Indian subjects using computed tomography (CT) imaging and evaluated the feasibility of transpedicular screw fixation in them., Aims: To evaluate the feasibility of transpedicular screw fixation in the Indian population., Settings and Design: The cervical pedicle diameter size differs between the Asian and non-Asian population. The authors studied the transverse pedicle diameter of the C2-C7 of the cervical spine in the Indian population using CT measurements. This cross-sectional study was carried out at a tertiary care centre for a period of four months from October 2010 to December 2010., Material and Methods: Measurements of cervical pedicles in the subjects were performed on the CT workstation from the CT images taken at 2.5-mm interval. The transverse pedicle diameter was defined as the outermost diameter of the pedicle, taken perpendicular to the axis of the pedicle at the narrowest point and measured in millimeters±0.1 mm., Statistical Analysis: Descriptive statistics was used to represent percentage of transverse diameter of cervical pedicles less than 5 mm in male and female subjects at C2-C7 levels. Since there is no previous study done in India, we initiated the study with sample size of 27 as a pilot study. The statistical analysis was performed using SPSS software., Results: The mean transverse diameters of the cervical pedicles of C2, C3, C4, C5, C6 and C7 in males were 5.3, 5.3, 5.3, 5.6, 5.6 and 6.1 mm respectively and ranged between 5.3 to 6.1 mm. The mean transverse diameters of the cervical pedicles of C2, C3, C4, C5, C6 and C7 in females were 5.1, 4.6, 4.7, 4.7, 5.3 and 5.6 mm respectively and ranged between 4.6 to 5.6 mm. Between 2.1% and 55.7% of pedicles in our male population and between 5.5% and 74.3% pedicles in our female population was smaller than 5.0 mm in transverse diameter and thus cannot have fixation with a 3.5 mm screw using this technique., Conclusions: We found that the transverse pedicle diameter of cervical pedicles in the Indian subjects is smaller compared to the Western population. Although transpedicular screw fixation has stronger pullout strength compared to lateral mass fixation, its use must be considered carefully and individually. Preoperative CT evaluation is a must before transpedicular fixation in the cervical spine, especially in the Indian female population. As an option 2.7-mm screws can be devised for the Indian population giving a wider safety margin.

This study describes a 2- to 13-year follow-up of a novel technique for osteosynthesis of neglected femoral neck fractures and nonunions that combines internal fixation with the benefits of fibular grafting and valgus angulation osteotomy. Twenty-three patients were treated by the "3-in-1" surgery, which consisted of osteosynthesis with a dynamic hip screw, nonvascularized fibular grafting, and valgus osteotomy, between January 1996 and June 2009. Union was achieved in all patients at an average of 5.4 months. The average shortening was 0.9 cm. Although avascular necrosis was seen in 4 patients, 2 of them still had good functional scores. Excellent and good hip functional scores were seen in 18 patients. Well-executed surgeries combining biomechanics and biology can ensure union in neglected femoral neck fractures and nonunions provided an adequate length of the neck and proximal fragment is present and there is no subchondral collapse.

Purpose: The use of titanium mesh in communited mandibular fractures has been substantially documented. However, the use of stainless steel mesh for routine fixation in mandibular fractures has not been widely reported. The aim of the present study was to evaluate the efficacy of stainless steel mesh for routine osteosynthesis of mandibular fractures., Materials and Methods: A total of 252 patients who had been diagnosed with 287 single or multiple mandibular fractures at Guru Nanak Institute of Dental Science and Research from 2002 to 2009 were selected for the present study. Those with condylar fractures and other maxillofacial injuries were excluded from the study. The patients were evaluated preoperatively, intraoperatively, and postoperatively at 1 day, 6 weeks, and 3 and 6 months. The local complications, occlusion (for static function), and chewing (for dynamic function) were evaluated postoperatively., Results: The intraoperative time taken for implant fixation (from site exposure to fixation of the last screw) was 32 minutes. Of the 252 patients, 40 (15.8%) had local complications and 24 patients required implant removal. Of the 252 patients, 82% had bilaterally satisfactory occlusion according to the surgeon at 6 months postoperatively. Discomfort in chewing unilaterally or bilaterally was reported by 17% of the patients., Conclusion: The results of our study have shown that stainless steel mesh has acceptable complication rates and the ability to maintain occlusion and chewing postoperatively compared with the present standards of care of mandibular fractures using miniplates. The lower cost and versatile placement of screws were the principal advantages. However, placement near the mental foramen with an extraoral approach for certain sites is the primary disadvantage., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Thirty-six patients of type C intercondylar fractures of lower end of humerus who visited JN Medical College, Aligarh between January, 2001 and January, 2003 were included in the study. All patients were treated surgically by open reduction and internal fixation with 4mm cancellous screws, reconstruction plates, one-third tubular plates. Early physiotherapy was started and the results graded using Krishnamoorthy criteria.

Study Design: A retrospective study of all patients who underwent spinal fusion between 1986 to 1989 with inexpensive, locally made unconventional pedicle spinal instrumentation systems was undertaken. Implants were made with passivated 316L stainless steel, and a single level of instrumentation cost +f430., Objectives: To demonstrate that simple, cheap pedicle instrumentation systems are as effective as the conventionally available expensive systems, provided proper anterior column support is maintained., Methods: Ninety out of 102 patients were available for review. Average follow-up was 41 months (range, 22 to 60 months). Implant failures, screw placement, fusion rates, infection, neurologic deficit due to the implant, patient satisfaction, and the benefit of anterior column grafting with the unconventional pedicle spinal instrumentation systems in the long term were evaluated., Results: Forty-four out of 467 screws failed (9%) in 16 patients, seven of whom were symptomatic. There were no plate failures. On comparing burst fractures with (n = 12) and without (n = 10) anterior column grafting, the latter group had a significant increase in implant failures, loss of sagittal alignment, and the time required to fusion. Overall, fusion occurred within 6.5 months., Conclusions: Anterior column reconstruction in anterior column deficient spines will re-create the normal biomechanics and significantly reduce the incidence of implant failures and loss of sagittal alignment with these systems. Pedicle screw failure in itself is not necessarily associated with a bad result. These inexpensive, locally made unconventional systems, with the proper understanding of biomechanics and creation of appropriate load-sharing constructs, are as good as the conventional systems available today.