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Study Design Systematic Review and Meta-analysis Objectives This systematic review and meta-analysis is aimed to assess effectiveness, safety, clinical, functional and radiological outcome of either combined anteroposterior or posterior-only approach in the surgical management of active tubercular disease of paediatric thoracolumbar spine. Methods A systematic literature search through PubMed, Scopus, Web of Science and Cochrane Library database was performed. Data extraction was undertaken following methodological quality assessment. Results 9 out of the 182 publications identified, were included for analysis. A total of 247 patients were analysed. Two amongst the 9 studies were retrospective comparative studies evaluating posterior approach with combined anteroposterior approach and were considered for comparative meta-analysis. Blood loss and duration of surgery was significantly higher in the anteroposterior group, as compared to the posterior-only group. There was no significant difference between the 2 groups in terms of post-operative kyphosis angles, final kyphosis angles, number of complications, functional outcome and spinal fusion time. However, all the included studies were non-randomised and retrospective. Only 2 of them had a control group with a high heterogeneity amongst these 2 studies. Conclusion The inference from the studies included in this review suggests that equivalent results can be achieved with posterior-only approach for thoracolumbar tuberculosis in children as compared to anteroposterior approach, with much lower complexity, reduced blood loss and shorter surgical time. However, due to the high risk of bias and considerable heterogeneity among the studies included, we cannot conclude whether one approach is better than the other.

Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1–5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.

Background Patients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies. Methods A systematic search of electronic databases of PubMed, Scopus, and Web of Science pertaining to English literature was undertaken from 1945 to August 2020 to assess the results of THA in patients with poliomyelitis. Information was gathered about demographics, indication, clinical course, complications, functional outcome, survival, and need for any revision surgery in these patients. Results The literature search revealed 81 articles. Finally, after deduplication and manual selection, 16 relevant articles (128 hips) were included for evaluation. There is a paucity of literature evaluating THA in patients with poliomyelitis over the last 2 decades. The principal reason for arthroplasty was osteoarthritis of the hip in the ipsilateral (paralyzed) limb. A combination of cemented, uncemented, and hybrid implant fixation system was found to be used by surgeons. Addressing instability and perioperative management of limb length discrepancy were found to be challenging propositions. Conclusion THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.

INTRODUCTION: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. MATERIALS AND METHODS: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. RESULTS: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and nontrauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). CONCLUSION: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

Major trauma is one of the leading causes of morbidity and mortality in young adults. The impact of disability on the quality of life and functionality in this younger population is worrisome. This remains a major public health concern across the globe. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury to the first few days, usually because of traumatic brain injury or major exsanguination and subsequently due to shock or hypoxia. Worldwide adoption of comprehensive trauma systems and evolving models of trauma care including prehospital interventions have led improvements in trauma and critical care over the last few decades. Resuscitation and damage control orthopaedics are two key pillars in the management of polytrauma patient. Trauma-related coagulopathy can be an emerging complication during resuscitation of such patients which should be recognized early so appropriate corrective measures can be undertaken. We describe the evolving models of care in the management of polytrauma and trauma associated coagulopathy.

Background and aims COVID-19 disease appear to have been associated with significant mortality amongst doctors and health care workers globally. We explore the various risk factors associated with this occupational risk, especially focusing on India. This may elucidate lessons to protect these frontline workers during the COVID-19 pandemic. Methods We carried out a comprehensive review of the literature using suitable keywords such as ‘COVID-19’, ‘pandemics’, ‘physicians’ ‘mortality’ and ‘health personnel’ on the search engines of PubMed, SCOPUS, Google Scholar and ResearchGate in the month of July 2020 during the current COVID-19 pandemic and assessed mortality data. Results Mortality in health care professionals has been on the rise. The countries which faced the pandemic in the early months of 2020 have had a huge surge in mortality amongst doctors due to COVID-19. India continues to show a rising trend in COVID-19 cases, however although compared to the western world India has seen a comparatively favourable statistic. Male gender, elderly doctors and those belonging to Black, Asian, and Minority Ethnic (BAME) community seem to be predisposing factors in the western world. Conclusion COVID-19 has been associated with an increased mortality in doctors and health care workers. Until an effective cure/vaccine is developed, risk assessments at work, mitigating confounding factors, adequate supply of personal protective equipment (PPE) and enhanced protection against infection are necessary to protect health care professionals on the coronavirus frontline. Otherwise this occupational risk can lead to further untimely mortality and become another unintended consequence of the COVID-19 pandemic., Highlights • COVID-19 has been associated with increased mortality amongst doctors and health care workers. • Multifactorial reasons can be attributed for increased mortality seen in doctors during the COVID-19 pandemic. • Risk assessment, enhanced protection and infection prevention measures at work are necessary to protect doctors.

Digital image processing is a prominent tool which is used by radiologists to diagnose the complicated tumor. Magnetic resonance imaging, CT scans, X-rays, etc., are examined and analyzed by extracting the meaningful/accurate information from them. Diagnosing the brain tumor with accuracy is the most critical task. The survival of the infected patients can be increased if the tumor is detected earlier. In this research paper, an ensemble approach is proposed to classify the benign and malignant MRI of the brain. The total of 150 image slices from the Harvard Brain Atlas dataset is utilized in the ratio of 60:40 for training and testing the proposed method. Otsu’s segmentation has been applied to segment the tumor from the skull. Then, the hybrid features including shape, intensity, color and textural features of the MRI are extracted. Decision trees, k-nearest neighbor and support vector machine classifiers are applied separately on the feature set. Then, the stacking model is applied to combine the outcome/prediction of each classifier and gives the final result. The proposed methodology is validated on an open dataset and achieved 97.91% average accuracy, 88.89% precision and 94.44% sensitivity. When compared with other existing methodologies, better accuracy is achieved by this approach.

Background Concerns have been raised about the escalated mortality in patients of proximal femoral fractures (PPFs) with COVID-19. A meta-analysis to evaluate the mortality in patients with PPFs managed during the current COVID-19 pandemic was conducted. Methods A systematic review and meta-analysis of all published studies were conducted with a search on PubMed, Scopus, Web of Science, and Cochrane Library databases using appropriate keywords from January 01, 2020 to January 29, 2021. Results 35 relevant studies reporting 4255 patients with hip fracture in the current ongoing pandemic, out of which 692 patients were COVID-19 positive. Twenty studies reported mortality and other relevant statistics on hip fracture patients with and without COVID-19 (4123 hip fracture patients in the year 2020–21, out of which 560 had or were suspected of having COVID -19). A meta-analysis of mortality statistics in patients with and without COVID revealed increased odds of mortality among COVID patients [odds ratio (OR) 6.31, 95% confidence interval (CI) [5.09, 7.83] and meta-analysis on the subgroup of surgically treated patients also showed markedly increased mortality risk among those with COVID-19 (OR) 5.99, 95% CI [3.88,9.24]. Conclusion The mortality risk is markedly increased in hip fracture with concomitant COVID-19 as compared to those without it. This increased risk persisted in those managed surgically. It could be due to the inflammation induced by the fracture or surgery for fracture fixation, further exacerbating inflammation, leading to cytokine storm. It is imperative that such patients are informed regarding increased mortality risk during the consent and shared decision-making process.

Background COVID-19 has resulted in restriction of face to face consultations and mechanisms to access health care. Osteoporosis and fragility fractures forms a significant proportion of adult trauma and orthopaedic workload even during the pandemic. Aims We assess the challenges and strategies used in the management of osteoporosis and fragility fracture care during the COVID-19 pandemic. Methods We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 on developments and guidance during the current COVID-19 pandemic. Results Osteoporosis and fragility fractures management has been hampered by lock down and infection transmission strategies used to contain the COVID-19 pandemic. Access to diagnostic tests, treatment facilities with the need to use clinical and prediction tools to guide management Telemedicine has an evolving role. Conclusion Osteoporosis and fragility fractures in elderly individuals pose a real challenge for an appropriate diagnosis and management, during the COVID-19 pandemic. A clinical decision along with use of clinical prediction tools for osteoporosis should be used to direct treatment. Obligatory fractures such as hip fractures require operative intervention. Non-obligatory fractures such as distal radius fractures can be managed conservatively with use of telemedicine applications in monitoring both types of patients.

Purpose of the study The Coronavirus disease 2019 (COVID-19) pandemic has had profound effects on healthcare system including medical training and education in India. The study was aimed to evaluate the impact of COVID-19 on post-graduate teaching and learning amongst candidates pursuing higher qualification in orthopaedics, in the Delhi- National Capital Region in India. Design An online cross-sectional survey of 29 questions was circulated amongst post-graduate students pursuing higher orthopaedics degree to evaluate (i) Impact on PG teaching (ii) Impact on surgical training (iii) Impact on Dissertation (iv) Future implications on PG training programme (v) Mental wellbeing. Results 138 (77.5) PG trainees contributed in the survey, and 65.1% of them stated that no clinical classes are being held presently. The majority (94%) confirmed that COVID-19 has affected their surgical and clinical training. A large number (71.6%) had problems in completing their dissertations and 96% had concerns about mental health. Conclusion COVID-19 pandemic has severely disrupted the education and training of the Orthopaedic PG students, in Delhi-NCR region and perhaps elsewhere similarly too. The Government and Teaching organisations should take serious consideration of the plights of PGs and devise satisfactory mechanisms to overcome their problems and provide reasonable solutions also.

Background With restrictions on face to face clinical consultations in the COVID-19 pandemic and the challenges faced by health care systems in delivering patient care, alternative information technologies like telemedicine and smartphone are playing a key role. Aims We assess the role and applications of smartphone technology as an extension of telemedicine in provide continuity of care to our patients and surveillance during the current COVID-19 pandemic. Methods We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020. Results Through the published literature on this topic, we discuss role, common applications and its support in extended role of telemedicine technology in several aspects of current COVID-19 pandemic. Conclusion Smartphone technology on its own and as extension of telemedicine has significant applications in the current COVID-19 pandemic. As the smartphone technology further evolves with fifth generation cellular network expansion, it is going to play a key role in future of health medicine, patient referral, consultation, ergonomics and many other extended applications of health care., Highlights • Smartphone technologies avoid face to face consultations but deliver continuity of health care during this pandemic. • Smartphone technologies provide continuity of care by avoiding physical contact and maintaining social distancing. • Smartphone technologies will play a key role in future of health care delivery.

Synovial Fluid Eosinophilia (SFE) is a rare finding. Minor SFE is defined as 10% eosinophils of the total leucocyte count in SF. The aetiology and pathophysiology of eosinophilic synovitis is unclear. Most commonly affected joints are Knees; however ankle, elbow and metatarso-phalangeal joint involvement is also being reported. A 10-year-old girl reported with history of pain, swelling and difficulty in bending left knee since five days. On the basis of investigations such as blood investigations including complete blood count, Rheumatoid factor, filarial card test etc., radiographs of knee and arthrocentesis of knee, she was diagnosed as Eosinophilic Synovitis of Knee with peripheral eosinophilia without any known cause. She was treated with Ibuprofen 200 mg BD for 10 days and was relieved of her complaints. After one and half year of follow-up, there were no episodes of recurrent pain or swelling and patient was doing well.

Poliomyelitis is on the verge of eradication. But the survivors of polio are still living with its consequences in different parts of the world and so will continue to be seen for almost a century. Fractures in the polio-affected limb are a common entity in these patients and are difficult to manage using the common fracture management protocols. This article gives a comprehensive review of the challenges faced in fixation of fractures in polio affected limbs and possible solutions to overcome them. Knowledge of treating these fractures is important to a trauma surgeon as such scenarios are not uncommon in daily practice.

Fracture of isolated spinous processes at multiple levels is a rare injury. Herein, we present a 45-year-old male with cervical pain and swelling following a road traffic accident. Computerized tomography and magnetic resonance imaging revealed fractures of spinous process from C7 to D6 vertebra. The patient was managed with rest, analgesics and immobilization. At the 1-year follow-up, the patient is doing well without any neurological problem.

Osteochondroma of the spine is rare. It may present in solitary or multiple form (hereditary multiple exostoses). Herein, we report a case of an 18-year-old male who was diagnosed with thoracic osteochondroma, originating from the D4 vertebra with intraspinal extension and spinal cord compression in hereditary multiple exostosis. The patient was managed with surgery. Complete tumour excision was done to relieve cord compression and recurrence. Postoperatively the patient’s symptoms were improved. At 2.5 year follow-up patient is doing well without any recurrence.