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Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were (‘stenosing tenosynovitis’ OR ‘trigger finger’) AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40–0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08–0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic)

Background and aims Coronavirus pandemic is currently a global public health emergency with no definitive treatment guidelines. We conducted a systematic review and meta-analysis of the literature evaluating the efficacy of hydroxychloroquine and its related formulations in COVID-19 patients. Methods A systematic search of PubMed, Scopus, MedRxiv data and Cochrane Central Register of Clinical Trials for published articles that reported the outcomes of COVID-19 patients treated with hydroxychloroquine or its compounds was done. We identified 1071 published studies and 7 studies were included in the analysis. Results The study population consisted of a total of 4984 patients, of which 1721 (34.5%) received hydroxychloroquine or its congeners (HCQ group) while 3091 (62.01%) received standard of care or had included antiviral medication (control group). The pooled estimate of successful treatment in the hydroxychloroquine group and the control group was 77.45% and 77.87% respectively, which indicated similar clinical outcomes in patients treated with hydroxychloroquine compared to the control group. The odds ratio of a favourable outcome with hydroxychloroquine was 1.11 (95 CI 0.72 to 1.69) (p = 0.20). The pooled risk difference of favourable outcome with hydroxychloroquine versus control group was 0.00 (95 CI -0.03 to 0.03) which was statistically not significant (p = 0.10). Conclusions: The present evidence shows no benefit of hydroxychloroquine in patients affected by mild to moderate COVID-19 disease. However, now several trials on HCQ are ongoing and hopefully more data will be available soon. Hence, the management of COVID-19 is set to change for better in the future., Highlights • This meta-analysis includes only randomised controlled trials, with systematic review of recently published data. • Hydroxychloroquine has no benefit in treatment of mild to moderate COVID-19 disease. • Large size multi-centre studies are required for further evaluation.

Background and aimsbackground Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19. Methods PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were “coronavirus” and “clinical characteristics” with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis. Results There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1–4). Conclusions Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients., Highlights • COVID-19 in cancer patients is associated with higher morbidity. • Patient with Comorbidities are likely to have higher risk of severe events. • Cancer has a significant impact on ICU admission rate.

Intertrochanteric fractures constitute around 50% of the hip fractures and half of which are unstable. In this study, we aim to determine the tip apex distance as a predictor of failure in patients with peri-trochanteric fractures treated with PFN-A. A total of 50 patients with peri-trochanteric fractures were enrolled in the study, who underwent surgical xation with PFNA and were followed up at 6 weeks, 3months and 6 months. Position of helical blade and TAD were calculated on the post operative radiographs. The mean TAD in our study was 22.5+6.7 mm, with 66% patients having a TAD

The Shepherd's crook deformity of the proximal femur is a characteristic radiologic feature of fibrous dysplasia. It may be limited to a single bone, which is called monostotic, or may be polyostotic involving multiple bones as seen in McCune-Albright Syndrome. We report a case of a 19-year-old male patient who presented to us with pain in the right hip for one year. He had dysmorphic facies and multiple cafe-au-lait spots over the back, which were suggestive of McCune-Albright Syndrome. The radiographs of the hip showed varus deformity of the proximal femur. A lateral closing wedge osteotomy was done and the defect was filled with morselised femoral head allografts and fibular strut allografts. At the 14-month follow-up, the patient remained functionally active without any symptoms. The use of morselised femoral head allograft combined with strut fibular allograft ensures both stability and improved biology at the site of the lesion without any donor site morbidity.

BACKGROUND: The purpose of this study was to evaluate the flexion-gap of the native knees in the normal population and to assess any gender-specific variations in the flexion gap of the knees. METHODS: A total of 50 normal asymptomatic volunteers with normal knee radiographs were selected for MRI of the knee. The left knee was scanned in an open MRI using a T1-weighted sequence. Imaging was performed in neutral, passive varus and valgus stress at 90° of knee flexion by placing custom-made blocks on a special board consecutively below the distal part of the leg. RESULTS: The study population consisted of 26 males and 24 females with a mean age of 25.77 years. Under varus stress, the mean lateral flexion gap increased to 9.28 ± 1.53 mm and under valgus stress, the mean medial flexion gap increased to 2.75 ± 1.22 mm from neutral. The increase in the flexion gap on the lateral side was 5.28 ± 1.79 mm, which was significantly higher compared to that on the medial side. In gender-specific analysis, the mean lateral flexion gap was 10.21 mm in females and 8.46 mm in males under varus stress. CONCLUSION: The findings of the study indicate that the lateral soft tissues are more lax compared to the medial soft tissue structures and this laxity is higher in females as compared to males. The study provides evidence of the existing physiological variations of these soft tissue structures resulting in a trapezoidal flexion gap in the native knees rather than the recommended rectangular gap.

Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. It is usually associated with other injuries around the knee joint and hence is often missed. We conducted a comprehensive systematic review of papers published in the English language using PubMed, Web of Science, Scopus, and the Cochrane Database, which reported Hoffa's fracture associated with other injuries around the knee joint. We selected 11 eligible papers for final analysis and review. These papers had 12 patients with Hoffa's fracture, with associated injuries around the knee joint. The associated injuries with Hoffa's fracture were in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. The management principles for Hoffa's fracture with associated injuries around the knee joint are: having a high clinical index of suspicion for these injuries, obtaining all trauma series radiographs and computed tomography of the knee, achieving complete articular incongruity, and restoring the functions of the knee joint.

Background: We conducted a systematic review and meta-analysis to evaluate whether the presence of cancer in patients with COVID-19 has effect on ICU admission

Focus on uncommon symptoms of COVID-19: Potential reason for spread of infection.

Introduction: Proximal Fibular Osteotomy (PFO) is removing 1-1.5 cm of FIBULA, 7 to 10 cm below its head, which provides symptomatic relief from pain of medial compartment Osteoarthritis (OA) knee. It is a procedure wherein we remove Proximal part of fibula to stop mechanical axis of knee going into further varus and hence putting a stop to progression of disease. The aim of the study was to observe and study the resultsin patients of isolated medial compartment Osteoarthritis of Knee,treated by Proximal Fibular Osteotomy. Material and Method: The study was conducted on 36 patients amounting to 50 knee joints (male and female between the age of 50-70 years) with medial compartment OA Knee. Patients were followed up till 6 months. Medial and lateral joint space along-with visual analogue score for pain were recorded preoperative, immediate post-operative and at final follow up. Result: Significant improvement in mean visual analogue pain score (VAS), from 7.32 + 0.98 preoperative to 2.72 + 1.20 at the final follow up was observed (p-value

Introduction: Sciatica is one of the most excruciating type of pain resulting due to irritation of the sciatic nerve in the lower back. Pain radiates along the distribution of the sciatic nerve in the lower limb. Lumbar disc herniation is commonly implicated as a cause of sciatica. Treatment options include initial conservative approach with epidural injection and analgesics and in patients with no relief decompression surgery performed. The short-term efficacy of the epidural injections is well established but the long-term outcome remains controversial. Even, spinal decompression surgeries have shown significant relief of symptoms at short term but in long term remain doubtful. This study attempts to compare both these treatment options in people with disabling chronic sciatic pain. Materials and Method: This prospective randomized controlled trial conducted on 25 patients for duration of 1 year with sciatica symptoms lasting for more than 6 weeks. Complete history and examination with imaging studies was carried out with pain assessment done by using a Roland Disability Questionnaire (RDQ) and Visual Analogue Scale (VAS). Follow up Assessment of the patient’s were done at regular interval of 0, 2, 4, 12, 26, 52 weeks post intervention. Results: Of the 25 patients 12 were assigned randomly to early surgery group and 13 to epidural injection group. Immediate post-op and follow up assessment showed significant improvement in pain and disability scores for patients randomized to early surgery group with a significant difference between areas under the curve. The short-term benefit of early surgery was no longer significant by 6 months and by the end of 1 year outcomes were similar between the two groups. Conclusion: Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year in patients of both groups.