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Aim Osteoporosis is a common metabolic bone disease accounting for low back pain (LBP). It is diagnosed by dual-energy X-ray absorptiometry (DXA). Magnetic resonance imaging (MRI), a routine investigation for LBP, is also sensitive to detect fat fraction (FF) of the vertebral body that increases with increasing age. This study aimed to correlate vertebral marrow FF using MRI and bone mineral density (BMD).

Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions.

Introduction: Conventional magnetic resonance imaging findings frequently do not correlate with the symptoms of lumbar disc herniation (LDH). Diffusion-weighted imaging can reveal important details about the microstructure of tissues. This study assessed the role of diffusion-weighted imaging (DTI) in LDH with radiculopathy and explored the relationship between DTI values and clinical scores. Methods: Forty-five patients with LDH with radiculopathy were evaluated via DTI at the intraspinal (IS), intraforaminal (IF), and extraforaminal (EF) levels. A visual analog scale (VAS) was used for low back and leg pain. The Japanese Orthopaedic Association (JOA) scoring system, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were used for functional evaluation. Results: There was a statistically significantly (p

Purpose The coronavirus disease 2019 (COVID-19) pandemic has adversely impacted medical education worldwide. However, its impact on the postgraduate medical thesis and dissertation work is still not evaluated. Through this study, we planned to find out the problems brought by the pandemic and likely alternatives and possible solutions to thrust the academic competence of postgraduate students. Methods After obtaining institutional ethics committee approval, we sent a 13-item questionnaire to postgraduate medical students in India via various social media online platforms. Data on the impact of the COVID-19 pandemic on thesis work and alternatives/solutions to improve the research competence were collected on a Likert scale and analyzed. Results We received a total of 398 responses out of which 377 entries were included for final analysis. The majority of participants (88%) reportedly had an adverse impact on the thesis work and out of 25% of the participants who recently submitted their around 45% had to do so without achieving the estimated sample size. The 6-month departmental review for thesis progress was seen in merely 28% of participants. Possible alternatives suggested were the maintenance of log books, task-based assessment of research methodology, departmental audits, and systematic reviews. Solutions suggested for improving the research competence of students were a compulsory research methodology curriculum, a biostatistics department in each institution, permission to conduct thesis work beyond submission time, exclusive time for research work, and financial incentives. Conclusion Modification in the research aspect of the current postgraduate medical education is the need of the hour and the pandemic has enlightened us regarding the current weaknesses.

Abstract Background Limb length alteration following total knee arthroplasty (TKA) has been under-reported. Few studies have shown a significant association between limb length discrepancy (LLD) and poor functional outcome. This prospective study evaluated the impact of radiographic and perceived LLD on functional outcome in TKA. The variables affecting LLD were also evaluated. Methods The preoperative and postoperative limb lengths of TKA patients (112 knees, 81 patients, KL grade ≥ 3) were measured in full-length digital radiographs. The Hip-Knee-Ankle (HKA) angles were also measured. The functional outcome (Western Ontario and McMaster Universities Arthritis Index) and perception about LLD were evaluated after six months. Results The mean preoperative radiographic LLD in the unilateral and bilateral TKA groups was 0.75 cm ± 0.60 cm and 0.58 cm ± 0.52 cm (P = 0.197), respectively. Similarly, postoperative LLD was 0.76 cm ± 0.85 cm in the unilateral group and was 0.59 cm ± 0.92 cm (P = 0.402) in the bilateral group. Only 19.7% of patients had postoperative radiographic LLD of ≥ 10 mm, and 80.2% of patients had LLD of

Background: “Cervical spondylosis” (CS) is a collective term used for non-specific neck pain post 30 age group. Management of CS is mainly non-surgical, particularly in mild to moderate severity that includes the oral anti-inflammatory drugs, exercises, manipulation, mobilization, or combination of these. Objective: The objective of the study is to assess the possible benefit of a selected group of asana in a group of patients over a short time frame and assess their functional outcome. Materials and methods: An observational study of cohort of patients having mild to moderate CS, who visited the AYUSH department between May 2016 and November 2016 were included. “Selected group of Asana (SGOA)” was practiced for 30 min supervised and then home-based for a period of 8 weeks with usual standard treatment. Patients followed up fortnightly, and their degree of severity & disability assessed. Results: Thirty patients with 19 males and 11 females having ages mean ± SD 45.61 ± 8.3 and 44.18 ± 9.78 having NDI score of mean ± SD 17.83 ± 4.749 at baseline (0 weeks) were included. Patients showed an improvement in NDI score to finally 7.40 ± 3.180, p-value = 0.0001. This improvement was also noted at various time intervals (p-value = 0.0001 each time), as seen in the post hoc analysis. Conclusion: Yogic practices “Specific Group of Asana” done for eight weeks on a home-based program could be useful in reducing pain and disability in people suffering from CS of mild to a moderate degree. However, more extensive, comparative, and multi-centric trials are required for establishing this as a treatment modality.

Background: The incidence of road traffic accidents (RTA) is increasing every day, especially in developing nations. Amongst various attributable factors, the menace of the stray animals remains one of the most underrecognized factors leading to animal-vehicle collision (AVC). Objectives: Our prospective cross-sectional study aims to survey the incidence of RTA attributable to stray animals and record the pattern of injuries along with other epidemiological parameters. Methods: The present study was conducted at a tertiary care trauma centre located in a major city of eastern India, between June 2019 and March 2020. Variables like demographic details, type of vehicle and injury with severity score, use of safety gear including types of stray animals were collected and analysed. Results: A total of 185 patients had suffered RTA due to AVC during the study period. The median age of occurrence was 29.0 years. The evening was the most frequent time of accidents (4 PM to 8 PM) with two-wheelers affected in 92% of cases. Stray dogs account for 69% of cases followed by cattle 21% cases. 41% of all RTA victims had polytrauma. Patients with RTA due to impact with ox were found to have higher injury severity score (ISS). The ISS comparison between two-wheeler drivers with and without helmet and influence of alcohol were statistically significant (P

Proximal fibular tumors are treated by en bloc excision and lateral collateral ligament (LCL) repair. Intraoperative injury to the popliteal artery or its trifurcation, common peroneal nerve, and LCL can occur. Three cases of giant cell tumor and one case of exostosis of proximal fibula were analyzed. Apart from routine tests, preoperative computed tomography angiography (CTA) was done in two cases. Vascular injury was seen in two cases where CTA was not done, while in others, it was safe. Foot drop was seen in one case due to peroneal nerve resection. None of the patients developed varus instability even without LCL repair. Authors suggest preoperative CTA in all tumors of proximal fibula for preoperative planning, counseling of patients, vascular consultation, and to prevent complications.

Purpose: To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster. Methods: A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated. Results: Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7–53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14–28), 7.84 (7.841–7.841), and 97.4 (91.6–98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure. Conclusion: In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.

Background: The available treatments for frozen shoulder yield variable results. Physical therapy and analgesics are considered as the first-line treatment for this disorder, but the effects are not uniform. There is some evidence to support that alternative medicine may have a role in its management. Objective(s): This study was designed to examine the short-term effects of yoga therapy in patients with frozen shoulder of mild to moderate severity. Materials and methods: A prospective randomized controlled trial was conducted on patients with frozen shoulder between 30 and 60 years of age. They were divided into two groups: yoga (Y) and control (NY). A set of Asana exercises called “Standing Group of Asana” was practiced by the yoga group in addition to the conventional therapy as received by the control group. The patients were reviewed at 1, 2 and 4 weeks. The pain and functional assessment were done at baseline and at each review using the Shoulder Pain and Disability Index (SPADI). Results: There were 16 male and 20 female participants in the Y group, and 15 males and 21 females in the NY group. There was no statistically significant difference in age, sex, and pre-treatment SPADI score between the groups. At the end of the four weeks, the SPADI pain scores in the Y and NY group were 20.47 and 20.14, respectively (p = 0.666). The SPADI disability scores in the Y and NY group were 20.4 and 19.7, respectively (p = 0.599). Overall SPADI scores were 40.67 and 40.03 in the Y and NY group, respectively (p = 0.736). Both groups had a significant reduction in SPADI pain and disability scores. However, there was no significant difference between the groups in terms of SPADI scores. Conclusion: The effect of the Standing Group of Asana has no added advantage relative to standard frozen shoulder treatment when practiced for one month.

Context: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. Aims: To find out the early impact of “THE MOTOR VEHICLES (AMENDMENT) ACT, 2019”. Settings and Design: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. Methods and Materials: Patients studied in two groups – One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). Conclusions: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity

Context: Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement. Aims: To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India. Settings and Design: A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department. Methods and Material: Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15). Conclusions: The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.

Purpose The spotter’s (objectively structured practical examination) is an assessment tool which is widely used to test the practical knowledge of anatomy extensively. In Indian context it is used as an inclusive model in the gross anatomy practical examination and the marks allotted to it varies. The traditional spotter examination often has been blamed for only incorporating the initial levels of revised Bloom’s taxonomy. This study retrospectively analysed the pre-professional spotter’s examination score and tested its efficacy in terms of reliability, internal consistency, validity, educational impact, and resource intensiveness. Methods The summative data of student’s score on four different days of unrepeated spotter’s examination and final theory examination score was collected and tabulated. These four group of students acted as independent cohorts. The difficulty index (DI), point biserial correlation (PBC), Cronbach α (CA) and descriptive statistics of each cohort were calculated. Revised bloom taxonomy rating was applied to spotter’s. Results We found heterogenous distribution of spotter’s in each cohort according to DI. The PBCs and CA of each cohort were acceptable. The majority of spotter’s tested the cognitive and comprehension domain of revised bloom’s taxonomy. There was nonsignificant difference between mean scores of cohorts but we found low positive significant correlation between theory and spotter’s score. Conclusion We concluded that the construct of spotter’s was reliable, internally consistent, had fair validity, variable educational impact, and sustainable resource intensiveness. We propose urgent redesigning of spotter’s to include higher level of taxonomy to comply with emerging curricular changes.

Purpose: Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup. Methods: We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate. Results: Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3. Conclusion: 135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results. Keywords: Femoral neck fractures, Osteotomy, Bone plates, Bone screws

Ipsilateral hip and knee dislocation (double blow) occurring simultaneously during trauma are rare occurrences that are associated with secondary complications. These are high energy injuries that warrant acute emergency management more so if associated with vascular compromise. We encountered a poly trauma patient having a combined right anterior hip and ipsilateral knee dislocation with vascular occlusion at popliteus level apart from associated segmental radius fracture of the left upper limb. This young patient presented after 22 h being referred form elsewhere making the situation critical to the surgical team. An attempted thrombolysis was done but as gangrenous changes started, we ended up in a below knee amputation. This case highlights a typical scenario in a developing country where facilities involving super specialty services are scarce and even patients are complacent about need for emergent referral. All this adds to surgical dilemma as guidelines are unclear for the best treatment.

Introduction: Venous air embolism is a catastrophic complication that can result in sudden cardiac arrest and death. Massive air embolism has been reported with central venous catheter through the internal jugular and subclavian veins. Though external jugular vein is a potential site of an air embolism to cardiac chambers and subsequently to vital organs such as brain, heart and lungs but has not been reported yet in literature. Case presentation: We are reporting a case of sudden pulmonary air embolism in a patient through the open hub of an intravenous cannula, vigilant monitoring and timely action saved the patient from a catastrophic outcome. Conclusion: We recommend vigilant monitoring and adequate precaution in patients with external jugular venous cannulation in the operation theater, intensive care unit or wards to prevent iatrogenic complications. Keywords: Air embolism, External jugular vein, Intravenous cannula, Vigilance

Bifid rib presents usually as an isolated and asymptomatic finding on x-rays and cadaveric dissections. This may be due to atypical process of segmentation of developing somites. Sometimes it may occur with other malformations. Aim of the case report presented here was to give a description of the characteristics of bifid rib and to look for any associated abnormalities. During routine dissection, bifid rib was found in thoraco-abdominal region of a male cadaver. The dimensions of the bifid rib were measured with digital vernier calliper of resolution 0.01mm and photographed using a digital camera. Survey of other regions of the cadaver was done by dissection. Bifurcation of anterior part of right third rib enclosing an additional intercostal space was found. Follow-up dissection in other regions of the cadaver revealed characteristics of Crohn-s disease of jejunum, ileum, and transverse colon and signs of dysmorphism of both the kidneys. The knowledge of such variations will be of use to the clinicians, radiologist and anatomist to investigate any incidental bifid rib finding.

Study DesignData of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively.PurposeTo report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results.Overview of LiteratureSingle stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported.MethodsTwenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared.ResultsAverage number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p

A 42-year-old migratory laborer presented to the emergency department with an alleged history of being hit by a bull on his right forearm and a subsequent fall.

Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA) at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture in chronically dislocated prosthesis, done for fracture neck of femur is a rare clinical entity. Increased stress transfers due to dislocation compounded with osteoporosis makes the shaft vulnerable to fracture even with low velocity injury as in our case. Though fixation of fracture shaft femur is clear and straightforward; management of neglected prosthesis dislocation have to be guided by patient’s level of expectations and subjective contentment to adaptation to the altered hip state which influence the overall functional outcome. Keywords: Neglected dislocation, ipsilateral femoral fracture, hip arthroplasty.