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Mathur B, Sakthivel M, Annamalai S, Muthu S, Sameer M. Delay in Time to Diagnosis of Idiopathic Transient Osteoporosis of the Hip with Radiographs: Diagnostic Insights from a Series of 10 Cases. J Orthop Case Rep 2024; 14:93-98. [PMID: 38420254 PMCID: PMC10898693 DOI: 10.13107/jocr.2024.v14.i02.4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/27/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Transient osteoporosis of the hip (TOH) is a poorly recognized self-limiting clinical entity. Due to a lack of awareness among the clinicians, the condition is often misdiagnosed leading to inappropriate treatment, thereby lengthening the time to diagnosis (TTD). In this study, we analyze the delay in TTD of TOH using plain radiographs and present the optimal management strategy. Case Report We retrospectively collected the data of patients who were diagnosed with TOH from March 2017 to March 2022. A total of 10 patients with a mean age of 43.7 years (range 33-56 years) were included in the study. The mean time to presentation from the onset of symptoms was 4 weeks (range 2-8 weeks) Radiologic evaluation with radiographs was sensitive in only 8 patients with osteopenia, whereas magnetic resonance imaging (MRI) was sensitive in all the patients and aided in early diagnosis of TOH. Radiographic evaluation alone leads to a mean delay in TTD of 1.6 weeks (range 0-8 weeks) in our study. All the patients were treated conservatively without any major complications. Conclusion Plain radiographs were not sensitive in the early detection of TOH and increased the TTD by 1.6 weeks, however, MRI imaging was found to be highly sensitive and specific in diagnosing TOH.
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Affiliation(s)
- Bhavya Mathur
- Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Manoharan Sakthivel
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Saravanan Annamalai
- Department of Orthopaedics, Thiruvallur Medical College, Thiruvallur, Tamil Nadu, India
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - Mohamed Sameer
- Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Narayan MS, Sameer M, Viburajah V. Hip Fracture in a Patient with Overlap Syndrome - Conundrums Involved in the Management - A Case Report. J Orthop Case Rep 2023; 13:106-111. [PMID: 38025370 PMCID: PMC10664231 DOI: 10.13107/jocr.2023.v13.i11.4024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition producing symptoms of varying severity depending on the extent and progression of the disease pathology most importantly respiratory insufficiency and pulmonary complications. Myasthenia gravis (MG) on the other hand is an autoimmune condition due to the pathology involving failure of neuromuscular transmission causing muscle weakness exacerbated by activity and involvement of the respiratory muscles leading to respiratory failure. Overlap syndrome is a condition wherein both motor neuron disease (MND) and MG are present in the same patient. The safety of using muscle-relaxing agents in patients with MG undergoing major surgical procedures has so far been assessed as insufficient. There have been many concerns regarding anesthetic management in relation to complications with respiratory function in patients with ALS, with regional anesthesia being considered slightly safer. Case Report An 81-year-old female presented with a closed injury to her left hip, and she was diagnosed to have a left neck of femur fracture. She was also a known case of bulbar MND with an overlap syndrome of MG. She was hypertensive and controlled with regular medication. She was planned for a left hip bipolar arthroplasty. Anesthetic requirements and management of these patients require a high degree of expertise and anesthesia in patients undergoing surgery is prone to more complications and mortality. In addition, as the patient had an overlap of both MG and MND, more meticulous assessment and management strategies were necessary. Conclusion The importance and purpose of this study are to highlight a case of overlap syndrome of MND and MG patients who sustained a left neck femur fracture and underwent bipolar arthroplasty highlighting the anesthetic considerations in the patient for the procedure. We concluded that the choice of mode of anesthesia needs to be individualized based on each patient's requirements after careful analysis of the risk-benefit ratio of general versus regional. Regional anesthesia was successfully administered for this patient.
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Affiliation(s)
- M Sriman Narayan
- Department of Orthopedics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Mohamed Sameer
- Department of Orthopedics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Vidarshna Viburajah
- Department of Anaesthesia, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Sameer M, Muthu S, Vijayakumar PC. Enhanced Recovery After Surgery (ERAS) Protocol in Geriatric Hip Fractures: An Observational Study. Cureus 2023; 15:e42073. [PMID: 37602104 PMCID: PMC10434293 DOI: 10.7759/cureus.42073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Geriatric hip fractures are the new global pandemic. It is predicted to reach 7.3-21.3 million cases worldwide by 2050. Even with optimal care, geriatric patients suffer a higher morbidity and mortality rate when compared with the general population and often demand expensive hospital aftercare. This study aims to assess the implications of the successful adoption of the enhanced recovery after surgery (ERAS) protocol in the management of geriatric hip fractures in an Indian facility. METHODS This is a retrospective study conducted in a tertiary care hospital in India and reported following REporting of studies Conducted using the Observational Routinely collected health Data (RECORD) guidelines. We included all geriatric patients over 60 years of age who were admitted with hip fractures for surgical management between January 2021 and January 2023. The individual perioperative components of the ERAS protocol focus on key areas such as preoperative nutritional support, effective multimodal analgesia with optimal pain control, fluid management, and early postoperative mobilization. RESULTS Thirty-eight geriatric patients with a mean age of 77.5 (± 9.6) years were included for analysis. Twenty-three patients sustained intertrochanteric fractures and underwent fixation with proximal femur nailing and the remaining had 15 sustained neck or femur fractures of which 11 underwent hemiarthroplasty surgery and the remaining four underwent a total hip replacement. The mean time to surgery was 2 (± 0.2) days. Eighty-two percent (n=31) of the patients were mobilized with a walking frame within a day after surgery and were followed up after discharge with home physiotherapy. The mean time to ambulation was 2 (± 0.62) days. The mean length of stay was 4 (± 1.6) days. We had a 30-day readmission rate of 5.2% (n=2) and a 30-day mortality rate of 5.2% (n=2). The one-year mortality rate was 13% (n=5). CONCLUSION Management of geriatric hip fractures requires exceptional interdisciplinary coordination and carefully planned strategies to optimize patient care. With the implementation of the ERAS protocol, we could perceive clinical benefits in terms of early recovery and short length of hospital stay in patients with hip fractures. Further comparative studies are required, which can determine the relative importance of individual measures in the ERAS protocol and understand their longer-term outcomes in hip fracture surgeries.
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Affiliation(s)
- Mohamed Sameer
- Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sathish Muthu
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, IND
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, IND
- Department of Orthopaedics, Government Medical College, Dindigul, IND
| | - P C Vijayakumar
- Department of Anaesthesiology, Sooriya Hospital, Chennai, IND
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Amirthalingam S, Sameer M, Harshavardhan JKG. A Wrong Punch and a Rare Fracture! - A Case Report of Isolated Fourth and Fifth Metacarpal Base Fracture. J Orthop Case Rep 2022; 12:110-113. [PMID: 37013244 PMCID: PMC10066685 DOI: 10.13107/jocr.2022.v12.i11.3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/26/2022] [Indexed: 02/12/2023] Open
Abstract
Introduction Isolated displaced fourth and fifth metacarpal base fracture without a carpometacarpal joint subluxation or carpal bone fracture by a punch injury is extremely rare. The site of the fracture in the metacarpal is determined by the type and direction of punch. These fractures usually occur as a result of misdirected blow or wrong punch on a hard surface with a clenched fist. To best of our knowledge, there are only few published case reports. The difficulties in management and biomechanics of such fractures with 10 months follow-up are discussed in this case report. Case Report A 37-year-old male right hand dominant person presented with pain and swelling of the right hand after punching a wall. The difficulties in reduction and fixation of such fracture, the functional and radiological outcome of minimally open Kirschner wires fixation of this type of fracture with 10-month follow-up and the fracture biomechanics has been discussed in this case report. Conclusion Clenched fist injury not always means a boxer fracture. This kind of rare fracture is also a possibility and should kept as a differential diagnosis. These fractures are easily misinterpreted by a beginner. Meticulous reduction techniques and fixation will yield better results.
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Affiliation(s)
- Sivabalaganesh Amirthalingam
- Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohamed Sameer
- Department of Orthopaedics Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - J K Giriraj Harshavardhan
- Pediatric Orthopaedics Fellowship, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Amirthalingam S, Suriyakumar S, Harshavardhan JKG, Sameer M. Neglected Acromion Fracture Causing Chronic Post-traumatic Shoulder Pain - A Case Report. J Orthop Case Rep 2022; 12:39-43. [PMID: 36874898 PMCID: PMC9983393 DOI: 10.13107/jocr.2022.v12.i10.3358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/10/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Patient presented with persistent shoulder pain 8 months following an injury which was diagnosed to be an old non-united missed acromion fracture. The difficulties in diagnosing such fracture, the functional and radiological outcome of surgical fixation of this type of missed acromion fracture with 6-month follow-up has been discussed in this case report. Case Report We report a case of 48-year-old male who presented to us with chronic shoulder pain following an injury which was later diagnosed to be a missed non-united acromion fracture. Conclusion Acromion fractures are commonly missed. Non-united acromion fractures can cause significant chronic post-traumatic shoulder pain. Reduction and internal fixation can alleviate the pain with a good functional result.
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Affiliation(s)
- Sivabalaganesh Amirthalingam
- Department of Orthopaedic, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sundar Suriyakumar
- Department of Orthopaedic, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - J K Giriraj Harshavardhan
- Department of Orthopaedic, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohamed Sameer
- Department of Orthopaedic, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Deep K, Prabhakara A, Mohan D, Mahajan V, Sameer M. Orientation of Transverse Acetabular Ligament With Reference to Anterior Pelvic Plane. Arthroplast Today 2021; 7:1-6. [PMID: 33521189 PMCID: PMC7818603 DOI: 10.1016/j.artd.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background Transverse acetabular ligament (TAL) is a 3-dimensional structure which cannot be defined by a single plane. Therefore, we aimed at describing the orientation of different parts of TAL with respect to anterior pelvic plane (APP) and correlate it with gender, body mass index (BMI), and Lewinnek’s safe zone. Methods A total of 109 consecutive patients undergoing imageless navigated THA were prospectively studied. Computer navigation was used as the measurement tool. APP was registered for navigation. After excision of osteophytes, a trial component matching the size of unreamed acetabular cavity was aligned with acetabular rim, outer and inner margins, and middle of TAL to record cup orientation with computer tracker. Results Ninety-nine patients (41 males and 58 females, mean BMI of 28.8kg/m2) were studied after applying exclusion criteria. Mean acetabular inclination was 55.15°, 53.00°, 47.70°, and 42.60° respectively, for acetabular rim, outer, middle, and inner margins of the TAL. Corresponding mean acetabular anteversion was 6.63°, 7.41°, 11.23° and 14.90°respectively. Overall, 17.17%, 28.28%, 47.47% and 71.71% of cup orientation corresponding to acetabular rim, outer, middle, and inner margin of TAL respectively, were within Lewinnek’s safe zone. No association was established between BMI and acetabular orientation. Males had overall lesser anteversion than females. Conclusion We describe orientation of outer, middle, and inner margins of TAL, as reference planes for TAL, in relation to APP. The anteversion differs significantly with gender. A knowledge about these will assist surgeon in component placement during THA, with inner margin of TAL providing the best chance of orientation out of the studied landmarks.
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Affiliation(s)
- Kamal Deep
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Anjan Prabhakara
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
- Corresponding author. Golden Jubilee National Hospital, Agamemnon Street, G81 4DY, Glasgow, UK. Tel.: +44 7311195584.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vivek Mahajan
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Mohamed Sameer
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
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Sameer M, Bassetty KC, Singaravadivelu V. Fixation Of Tibial Pilon Fractures Based On Column Concept :A Prospective Study. Acta Orthop Belg 2017; 83:568-573. [PMID: 30423663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Distal tibia fractures are complex injuries with high complication rates. Limited soft tissue, poor vascularity and complexity of fracture pattern impose limitations for traditional plating techniques. Better understanding of fracture patterns using 3D-CT reconstruction, optimum pre-op planning and availability of anatomical locking plates have certainly improved the outcome in these fractures. We report the functional and radiological outcome in 12 patients of complex tibial pilon fractures, who were treated on the basis of the novel column concept.
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Mahmud A, Balghaith M, Ayoub K, Khan F, Sameer M, Thanoon B, Thawyee A, Al-Shabeeb A, Ghamdi A. P2111Age and gender related differences in invasive central pulsatile heamodynamics versus. non-invasive brachial pressures in a large arab population. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mohambourame A, Sameer M, Hemanth Kumar VR, Ramamirtham M. Submental intubation with intubating laryngeal mask airway as conduit: An airway option for oral submucous fibrosis release. Anesth Essays Res 2015; 9:95-7. [PMID: 25886429 PMCID: PMC4383123 DOI: 10.4103/0259-1162.150137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The main anesthetic concern with oral submucous fibrosis is progressive restriction of mouth opening due to fibrosis producing difficult airway. Securing airway by nasotracheal intubation and tracheostomy are associated with potential complications. Flexible fiberoscope is not available in all the institutes. Submental intubation using intubating laryngeal mask airway is an acceptable alternative technique in such situations. It also provides an unobstructed surgical field.
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Affiliation(s)
- Aruloli Mohambourame
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Mohamed Sameer
- Department of Anaesthesiology, Government Medical College Hospital, Thanjavur, Tamil Nadu, India
| | - V R Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Muthukumaran Ramamirtham
- Department of Anaesthesiology, Government Medical College Hospital, Thanjavur, Tamil Nadu, India
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Natarajan M, Sameer M, Kunal D, Balasubramanian N. Custom-made endoprosthetic total humerus reconstruction for musculoskeletal tumours. Int Orthop 2011; 36:125-9. [PMID: 21796334 DOI: 10.1007/s00264-011-1316-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 06/24/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE We analysed 11 patients with malignant musculoskeletal tumours of the humerus who underwent limb salvage surgery with total humeral custom endoprosthesis from 1990 to 2009. METHODS There were six male and five female patients, with a mean age of 17 years. The most common diagnosis was osteosarcoma. The average follow-up period was 66 months, with the maximum being 180 months. Functional and oncological outcomes were analysed. RESULTS The one and five year cumulative survival (Kaplan-Meier method) rates were 90.9% and 77.9 %. The average Musculoskeletal Tumour Society Score (MSTS) was 80%. Two patients died due to metastasis. One patient had a forequarter amputation for local recurrence. The procedure provides fast recovery and relatively good restoration of elbow function, whereas active shoulder movements remain limited CONCLUSION Total humeral custom endoprosthetic replacement represents a viable treatment option in indicated patients, providing reliable and reasonable function of the upper limb, with a low complication rate.
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