Compare the Combined Diagnostic Accuracy of Transient Elastography and Visual Liver Score in Assessing Non-Alcoholic Fatty Liver Disease (NAFLD) and Compare it with Liver Biopsy in Morbidly Obese Patients Undergoing Bariatric Surgery: An Observational Study

INTRODUCTION

A liver biopsy is the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Here, we combine preoperative transient elastography (TE) and intraoperative standardized visual liver score (VLS) which is compared with intraoperative liver biopsy for prediction of NAFLD and NASH in patients undergoing bariatric surgery.

AIM

Evaluate the combined diagnostic accuracy of TE and VLS in assessing NAFLD or NASH and compare it with liver biopsy in patients undergoing bariatric surgery.

METHODS

In a prospective cohort of 70 morbidly obese undergoing bariatric surgery, preoperative TE and intraoperative VLS were calculated. Findings of TE and VLS were compared with histology from intraoperative liver biopsy.

RESULTS

Histologically, 44 (62.85%) had NAFLD (≥ S1). Significant steatosis was seen in 20 (28.57%) while significant fibrosis was visible in 18 (25.71%). Area Under the Receiver Operating Characteristics (AUROC) TE for diagnosis of NAFLD was excellent (0.844, p = 0.001). At the optimal cutoff of 8.1, the positive predictive value (PPV) was 92.9%, and diagnostic accuracy was 90.6%. VLS had a sensitivity of 90.9% for NAFLD. The combined sensitivity of TE + VLS was 95.5% for ruling out NAFLD. Fourteen (20%) had NASH. VLS had a diagnostic accuracy of 97% in identifying NASH in comparison to TE. AUROC-VLS was 0.987, p ≤ 0.001, and a sensitivity of 100%. The overall sensitivity of combined TE and VLS was 100% with a negative predictive value (NPV) of 100%.

CONCLUSION

TE when combined with intraoperative VLS is comparable to liver biopsy and can be used for the diagnosis of NAFLD and NASH in patients undergoing bariatric surgery.

Synergistic effect of a Bi2Zr2O7 and hydroxyapatite composite: organic pollutant remediation, antibacterial and electrochemical sensing applications

Global concern regarding the energy crisis and environmental pollution is increasing. The fabrication of efficient catalysts remains a long-term goal. Recently, green synthesis methods for catalyst fabrication have attracted the scientific community. Herein, a simple approach to synthesize bismuth zirconate-hydroxyapatite (BZO-HA) nanocomposites using Mentha spicata (mint) leaves as a reducing agent via a combustion method has been reported. The use of a green reducing agent provided economic attributes to this work. Among the prepared samples, the BZO-HA (20%) composite exhibited superior photocatalytic activity. The photodegradation efficiency of the composite reached 90.3% and 98.4% for methylene blue (MB) and rose Bengal (RB) dyes, respectively. The results showed the excellent optical performance of the prepared composites. The constructed sensor (BZO-HA 20%) for the very first time showed outstanding selectivity and performance towards sensing lead nitrate and dextrose compared to bare bismuth zirconate (BZO) and hydroxyapatite (HA). A three-electrode system using 0.1 M KCl was used for the study. The synthesized composite BZO-HA (20%) can sense lead nitrate and dextrose over the concentration range of 1-5 mM in the potential range from -1.0 V to +1.0 V. The BZO-HA composite was also investigated against Gram-negative (S. typhi) and Gram-positive (S. aureus) bacteria for antibacterial activity studies. Enhanced antibacterial activity was observed compared to bare BZO and HA catalysts. Thus, the prepared BZO-HA nanocomposite exhibited multifunctional applications.

Randomized single blind trial to compare the short term post-operative outcome and cost analysis of laparoscopic versus ultrasound guided transversus abdominis plane block in patients undergoing bariatric surgery

INTRODUCTION

Laparoscopic Bariatric surgery despite being minimally invasive can cause moderate to severe pain in the immediate postoperative period. Adequate pain management remains a major challenge. Transversus Abdominis Plane (TAP) block is a regional anesthesia technique which blocks the sensory nerve supply of anterior-lateral abdominal wall.

AIMS AND OBJECTIVES

Primary: evaluate Laparoscopic versus ultrasound (USG)-guided TAP block on immediate post-operative analgesia after undergoing laparoscopic bariatric surgery. Secondary: compare cost effectiveness of Laparoscopic versus ultrasound-guided TAP block after undergoing bariatric surgery.

MATERIALS AND METHODS

Randomized Single blind study undertaken after sample size was calculated by (N) = 2(Zα + Z1-β)2σ2/δ2 which proposed 60 patients in each group. Block randomization was done after excluding redo/revision surgeries and patients were alloted Group I: Laparoscopic-guided TAP block & Group II: USG-guided TAP block. In both groups, Bilaterally, 20 ml (0.25%) bupivacaine was injected immediately after completion of bariatric surgery. SPSS v23 (IBM Corp.) was used for analysis.

RESULTS

Group I (N = 61 53F/8 M) & Group II (N = 60 42F/18 M) were demographically comparable. Group I (3.58 ± 0.67) had significantly lower procedure time compared to Group II (12.47 ± 1.61) (p-Value < 0.001). First rescue analgesia was administered at 7.07 ± 2.61 h in Group I vs 7.21 ± 2.39 h in Group II (p-Value 0.659). In first 24 h rescue analgesic dose requirement in Group I was 1.29 ± 0.53 vs 1.39 ± 0.50 in Group II (p-Value 0.487). VAS scores during rest and movement till 24 h post-operative were statistically similar. Procedural cost was more in group II.

CONCLUSION

Laparoscopic-guided TAP block is a safe and cost-effective approach for postoperative pain management after bariatric surgery and provides similar comparable analgesic effect as the USG-TAP block. Laparoscopic TAP is a surgeon delivered, easy to administer and significantly less time-consuming procedure which is feasible even when an ultrasound machine is not available.

K Wires or Cannulated Screws for Fixation of Lateral Condyle Fractures in Children: A Systematic Review of Comparative Studies

Introduction

Lateral condyle fractures in children have been typically been treated operatively using Kirschner wires (K wire) or cannulated screws (CCS); however, a definitive choice of implant remains a matter of debate. This systematic review aims to determine if union and functional outcomes of these fractures are better with screw fixation.

Methodology

A search of PubMed, Medline, Cochrane, and Google scholar was performed in March 2021. The results were screened by title and abstract, and relevance and a quality assessment of the data were performed for the articles meeting the inclusion criteria. Articles comparing radiological and functional outcomes of lateral condyle fractures treated with K wires or screws were included for examination. Articles were excluded if they did not compare outcomes of K wires and CCS together, or were in a language other than English, technical notes, case reports, and articles, which describe the use of fixation methods other than K wire or CCS as well as biomechanical studies were also excluded. Risk of bias and quality assessment of included articles were also done.

Results

Seven clinical studies were included. 44.4% (n = 4) were retrospective review of records with level III evidence (77.7%, n = 7). Only two included articles had good-quality assessment scores. Union was reported in 85.7% % in K wire group and 99.6% in CCS group. Functional outcomes were not statistically significant between the two groups.

Conclusion

Using screws to fix lateral condyle provides better union; however, there is no difference in the functional outcomes and complication rate between the two. Using screws or buried K wires adds the burden of an additional procedure for removal.

Influence of Ag on the Structural, Electrochemical, Antibacterial, and Photocatalytic Performance of the (CuO-Cu2O)Cu Nanocomposite

The cost-effective novel Ag-doped (1-7%) (CuO-Cu₂O)Cu (C3) heterostructured nanocomposites are successfully synthesized by the facile solution combustion process using the Leucas aspera extract as a green fuel. The structural properties of fabricated nanocomposites were well-characterized by specific spectral techniques for enhanced electrochemical sensor detection, antibacterial activities, and sunlight-driven photocatalytic dye decoloration studies. The existence of Ag⁺ ions has been confirmed by the appearance of two peaks of Ag 3d_5/2 (367.9 eV) and Ag 3d_3/2 (373.9 eV), with the chemical binding nature and exchange of the Ag⁺ state in the nanocomposite lattice as revealed by X-ray photoelectron spectroscopy analysis. The energy band gap value of the doped nanocomposite decreases from 2.2 to 1.8 eV, as measured by the UV-visible absorption spectral technique, hindering the recombination of electron-holes pairs by trapping e^- and h⁺. This result supports that the C3Ag5 nanocomposite has a great potential as a sunlight photocatalyst toward the Alizarin Red (AR) dye, for which an excellent degradation activity of 98% at 180 min was achieved compared to that of the host nanocomposite (78% at 180 min). The variation of redox peak potentials of the prepared graphite nanocomposite working electrode is an effective tool for paracetamol sensing activity in 0.1 M KCl using electrochemical spectral studies. In addition, the antibacterial activities of the C3Ag5 nanocomposite against Escherichia coli and Staphylococcus aureus were successfully studied. The C3Ag5 nanocomposite exhibited a better performance than C3. The increase in activity is attributed to the presence of Ag as a dopant.

P-094 LAPAROSCOPIC VS OPEN VENTRAL HERNIA REPAIR: AN OBSERVATIONAL SINGLE CENTRE STUDY

Background

Various surgical techniques are practised to provide best possible outcome for ventral hernia patients. This study was conducted to understand the patient's perspective regarding the choice and outcome of treatment.

Aim

To determine the level of satisfaction 1 month after ventral hernia repair. To analysed various factors which affects the patient's decision regarding the choice of surgery. To compare post operative outcomes between laparoscopic and open ventral hernia repair.

Material & Methods

An observational study was conducted between January 2020 and December 2021. Total 70 patients with ventral hernia were included. Relevant data was collected and analysed using SPSS version 28.

Results

39 patients underwent open repair and 31 patients underwent laparoscopic repair. 40% patients thought that their choice is better than the other option. 18.5% patients who preferred laparoscopic surgery were scared of big incision and 5% patients opted for open surgery because of unaffordability of mesh. 11.4% patient's decision was affected by the advice from other doctors whom they may have consulted before, 2.8% patients took advise from friends and family. Almost 20% patients left the decision on the treating team. The incidence of complications was significantly less in laparoscopic repair. However, there was no significant difference in the postoperative pain, duration of hospital stay, return to activity and satisfaction at discharge. level of satisfaction at 1 month was significantly higher in the laparoscopic group compared to open group.

Conclusion

laparoscopic ventral hernia repairs should be preferred in view of fewer complications and higher satisfaction.

Resection of a large Solid Pseudopapillary Neoplasm of the Pancreas: A multidisciplinary feat and review of literature

Solid pseudopapillary neoplasm (SPN) is an extremely rare tumor with low malignant potential which is generally located in the tail of the pancreas. The prevalence of SPN has increased with the recent advancement in radiological imaging. CECT abdomen and Endoscopic ultrasound-FNA are excellent modalities in preoperative diagnosis. Surgery is the main treatment modality of choice and a successful R0 resection is curative. We present a case of solid pseudopapillary neoplasm and included a summary of the current literature to provide a reference for the management of this rare clinical entity.

Mucous patch of secondary syphilis masquerading as leukokeratosis: An atypical presentation

Syphilis is known to inflict human being since long. It has varied clinical presentations. Atypical presentations are not uncommon and may jeopardize the clinical acumen of experienced clinician. Here, we are reporting a case of syphilis presenting as a sole manifestation in oral cavity.

Comparative evaluation and analysis of outcomes in non-idiopathic and idiopathic clubfeet with Ponseti method at a tertiary care centre of a developing country

BACKGROUND

Idiopathic clubfoot (congenital talipes equinovarus, CTEV) is being managed worldwide by Ponseti method with high success rates, while for non-idiopathic clubfoot surgical interventions is being widely used with variable results. This study evaluated the effectiveness of Ponseti method in non-idiopathic clubfoot and compared the results with idiopathic clubfoot.

METHODS

The paper evaluated the epidemiological incidence and demographic profile of non-idiopathic clubfoot in a tertiary centre of developing country. A total of 108 subjects with 85 having idiopathic (group I;125 feet) and 23 having non-idiopathic variety (group II;34 feet) were managed with Ponseti method and were followed for a mean duration of 38.33 (12-62) and 36.27 months (12-58) in group I and II respectively. The most common associations were meningomyelocele (MMC/spina bifida,5), arthrogryposis multiplex congenita (AMC,4), developmental dysplasia of hip (DDH,3) and Down's syndrome and amniotic band syndrome (2 each).

RESULTS

Primary correction was achieved in both the groups in 98% and 87% in group I and II respectively, while recurrences of at least one deformity was observed in 11 (9%) and 12 (40%) feet in group I and II respectively. Favourable outcomes were noticed in 22 (65%) feet in non-idiopathic group and 12 feet (35%) underwent extensive soft tissue release as compared to 3 feet (2.4%) in idiopathic variety.

CONCLUSION

Deformities improved significantly in non-idiopathic clubfeet with Ponseti methods although complete correction was not possible. Extensive surgical interventions were reduced in up to 35% feet in non-idiopathic variety and hence, it is recommended as primary treatment for all variety of clubfeet, irrespective of their etiology.

Distal Locked versus Unlocked Intramedullary Nailing in Intertrochanteric Fracture; A Systematic Review and Meta-Analysis of Randomized and Non-Randomized Trials

Objective:

To compare the outcome of distal locked and unlocked intramedullary nailing in patients with intertrochanteric fractures through systematic review and meta-analysis of randomized and non-randomized clinical trials.

Methods:

Randomized or non-randomized controlled studies comparing the effects of unlocked and locked nails for treatment of intertrochanteric fractures were searched using the search strategy of Cochrane collaboration up to April 2019. Four eligible studies involving 691 patients were included. Their methodological quality was assessed, and data were extracted independently for meta-analysis.

Results:

The results showed that the unlocked group has significantly less operative time (MD: -8.08; 95%CI -11.36 to -4.79; P< 0.00001), fluoroscopy time (MD: -7.09, 95%CI -7.09 to -4.79; p<0.00001), length of incision (MD: -2.50, 95%CI 2.85 to -2.14; p< 0.00001) than the locked group. The complication rate was significantly higher in the locking group (OR: 0.55, 95%CI 0.26 to 1.15; p=0.03). No significant differences were found in the Harris hip score between the two groups (MD: 0.68, 95% CI -0.83 to 2.19, p<0.08).

Conclusion:

The present meta-analysis suggests that intramedullary nailing without distal locking is reliable and acceptable option for treating intertrochanteric fracture. The advantages are reduced operative time, decreased fluoroscopy time, smaller size of incision and decreased complication rate. However, owing to the low-quality evidence currently available, additional high quality Randomized controlled trials are needed to confirm these findings.

Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis

Objective

To find out which surgical approach, optimize the functional outcomes and reduce the risk of complications in terrible triad of elbow".

Methods

Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had terrible triad of elbow (TTIE) that compared lateral approach (LA) with combined lateral and anteromedial approach (CML), and were published in English. Outcomes of interest were functional outcomes, complications, and operative time.

Results

Four studies, involving 470 patients were included in the systematic review. Mean follow up after surgery was typically 24 to 30 months. We found significant more range of motion (ROM) of elbow in CML as compared to LA group (MD: -14.21, 95% CI: -21.13 to-7.29, p<0.00001). There was significant more forearm rotation in CML as compared to LA group (MD: -18.88, 95% CI: -32.35 to -5.40, p<0.00001). Mayo elbow performance score (MEPS) was significantly more in CML (MD: -3.31, 95% CI: -7.23 to 0.62, p=0.00001). Blood loss, operative time, VAS and complications were more in CML group; however, the difference was not significant. The heterogeneity of the study and synthesizing retrospective data were the primary limitations.

Conclusion

Our analysis demonstrated that combined lateral and medial approach had significantly more elbow ROM and forearm rotation. The combined approach also had significantly more MEPS. However, using combined approach significantly increased the operative time.

Delayed femoral artey thrombosis after hemi arthroplasty of hip- a case report

Vascular complications following hip-arthroplasty (HA) are rare. Delayed vascular complications are exceptional with handful of reports. We report a case of femoral artery thrombosis following hemi arthroplasty with delayed presentation after a bone fragment left in situ penetrated and injured the vessel. This report is a revelation for surgeons who need to be extremely careful while operating as well as be vigilant with patients in their follow up and should assess for vascular status at each visit.

Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review

INTRODUCTION

Subcutaneous screw rod system which is popularly known as Pelvic internal fixator (INFIX) has emerged as an alternative to external fixators in management of unstable pelvic injuries. INFIX has shown various advantages over external fixation such as reduced infection rate and patient morbidity. However, it has its own set of complications such as lateral femoral cutaneous nerve injury, heterotopic ossification, femoral nerve palsy etc. We intended to conduct a systematic review of the current literature to assess outcomes and complications with INFIX technique of fixation.

METHODS

A comprehensive search of literature was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and online database of EMBASE, PubMed, Medline and Scopus was searched for all studies in English language till March 2020. Included studies were reviewed for demographic data, fracture type/classification, radiological outcome and functional outcomes. The inclusion criteria were: 1. Studies in English language 2. Clinical studies reporting use of INFIX technique in pelvis fracture where clinical and radiological outcomes were reported.

RESULTS

Twenty-two studies fulfilling inclusion and exclusion criteria were included in this systematic review with total of 619 patients. Radiographic parameters and outcome measures were infrequently reported. Fixation with INFIX in these fractures leads to 87% excellent to good radiological results and 84% excellent to good functional results. Complications include lateral femoral cutaneous nerve irritation (25.3%), heterotopic ossification (24.7%), infection (3%), and femoral nerve palsy (1.6%); which is likely related to placing the bar and screws too deep.

CONCLUSION

This analysis supports the use of INFIX in management of unstable pelvis fractures where anterior fixation is required.

Thermal assisted alkaline pretreatment of rice husk for enhanced biomass deconstruction and enzymatic saccharification: Physico-chemical and structural characterization

Thermal assisted alkaline pretreatment (TAAP) of rice husk (RH) was investigated to facilitate enzymatic saccharification by enhancing the enzyme accessibility to cellulosic components. Statistically guided experiments based on the Box-Behnken design involving four factors viz. biomass loading, particle size, NaOH loading and reaction time was considered for optimization. The maximum sugar yield of 371 mg g^-1 biomass was obtained at optimized pretreatment condition [biomass loading (10% w/w), particle size (0.25-0.625 mm), NaOH loading (2% w/w), and reaction time (40 min)]. The TAAP of RH resulted in the efficient removal of lignin (14.9-54% (w/w)) with low hemicellulose solubilization [10.7-33.1% (w/w)] and with a simultaneous increase in cellulose concentration [32.65-51.65% (w/w)]. The SEM analysis indicated increased porosity and biomass disruption during TAAP. The FTIR analysis showed progressive removal of noncellulosic constituents, and XRD analysis revealed an increase in cellulose crystallinity post-TAAP indicating the effectiveness of pretreatment.

Operative versus Non operative treatment of displaced intraarticular fracture of calcaneum: a meta-analysis of randomized controlled trials

Various studies comparing operative and non-operative intervention for displaced intrarticular calcaneal fractures have reported conflicting findings in the past. The objective of this meta-analysis was to compare the efficacy and safety of open reduction and internal fixation (ORIF) vis-a-vis conservative management. Relevant randomized controlled trials (RCTs) comparing operative and non-operative intervention for displaced intraarticular calcaneal fractures were assessed and included in this meta-analysis. Data was extracted independently and methodological quality was further assessed. The inclusion criteria of this meta-analysis were: randomized controlled trials comparing operative with non-operative intervention for displaced intra-articular fractures of calcaneum and reporting atleast one of the main outcomes as failure to resume pre-injury work, residual pain and other complications. Eight randomized controlled trials fulfilled the criteria for this meta-analysis. Pooled results showed that patients managed conservatively failed to resume pre-injury work (RR 0.60, 95% CI = 0.37-0.98, P = 0.04). However operative intervention was associated with more complications (RR 1.74, 95% CI = 1.28 to 2.37, P = 0.0005). There was no statistically significant difference in residual pain (RR 0.73 95% CI = 0.40-1.36, P = 0.33) and reoperation (RR = 0.75, 95% CI = 0.48-1.16, P = 0.20) between the two groups. Surgery can benefit patients with calcaneal fracture and increases their likelihood to resume pre-injury work. However, the complication rates are significantly higher in the operative group. Since the included trials have used different scores to measure patient outcomes, hence little effective data could.

Knee replacement in chronic post-traumatic cases

Post-traumatic knee arthritis is a challenging condition. Prosthetic surgery is demanding and the risk of complications is relatively high.

Planning is an essential element of this surgery; correct diagnosis (to exclude latent infection) and adequate considerations regarding approach, axis, bone loss, choice of implant and level of constraint are indispensable.

There are two main categories of post-traumatic arthritis: extra-articular deformities and articular deformities.

Use of an algorithms can support the surgeon’s choice of implant.

Correct implant positioning and limb alignment restoration is associated with very good results, similar to those achieved with standard total knee arthroplasty.

Cite this article: Benazzo F, Rossi SMP, Combi A, Meena S, Ghiara M. Knee replacement in chronic post-traumatic cases. EFORT Open Rev 2016:1:211-218. DOI: 10.1302/2058-5241.1.000025.

Modified Stoppa Approach versus Ilioinguinal Approach for Anterior Acetabular Fractures; A Systematic Review and Meta-Analysis

INTRODUCTION

Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss.

METHODS

Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs.

RESULT

Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37), p=0. 90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91), p=0.73 (I2= 0%). The operative time was significantly shorter with modified Stoppa approach (MD = -48.79 (-80.29 to -17.30), p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15), p=0. 56, I2=0%) and blood loss (MD= -212.89 (-476.27 to 50.49) p=0. 06, I2=71%).

CONCLUSION

Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results.

Topical versus intravenous tranexamic acid in total knee arthroplasty

PURPOSE

The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route.

METHODS

The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included.

RESULTS

Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration.

CONCLUSION

Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications.

Review Article: Operative versus nonoperative treatment for displaced intraarticular calcaneal fracture: a meta-analysis of randomised controlled trials

We reviewed 8 randomised controlled trials that compared operative and non-operative treatment for displaced intra-articular calcaneal fractures. Patients with operative treatment were more likely to resume pre-injury work (relative risk [RR]=0.60, p=0.04), had fewer problems when wearing shoes (RR=0.42, p=0.0004), and had a higher physical component summary score of SF-36 (difference in means=6.75, p<0.0001) but a higher complication rate (RR=1.74, p=0.0005).

Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter syndrome

Reactive arthritis or Reiter's syndrome characteristically affects the joint of the lower limb in an asymmetrical pattern. Usually it does not affect the axial skeleton or upper limbs. Although cases of atraumatic atlantoaxial subluxations have been reported, no case of spontaneous sternoclavicular dislocation in Reiter's syndrome has been reported. This paper describes a case of a 26 year old male patient who developed a spontaneous posterior sternoclavicular joint dislocation. No attempt of reduction was made and the patient was managed conservatively with good results.

Anterior dislocation of shoulder in eclampsia: a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia. This is an unusual mechanism of injury, but similar to other uncontrolled muscular contractions caused by electroconvulsive therapy, etc. To the best of our knowledge only one such case has been reported in the English literature. Closed reduction under general anaesthesia was successfully achieved. High suspicion in patients complaining of pain over shoulder joint is necessary for early diagnosis of this condition.

Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years

BACKGROUND

Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction.

PURPOSE

To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population.

METHODS

We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores.

RESULTS

At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively.

CONCLUSION

Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

Validation of the Ottawa Ankle Rules in Indian Scenario

Background:

Ankle injuries are one of the most common presentations in emergency department. Ottawa Ankle Rules (OARs) have been used to predict the requirement of radiographs.

Objectives:

This study aimed to validate the OARs protocol for predicting ankle and midfoot fractures in Indian population.

Patients and Methods:

A prospective study was conducted in a teaching hospital in north India, during a period of nine months, including all patients who presented with complaints in the ankle region and evolution of less than 48 hours. The study excluded patients with multiple trauma and Glasgow coma scale of less than 15. All patients underwent clinical evaluation, followed by radiographs depending upon the location of the complaints. Radiographic study results were evaluated by orthopedic surgeons who had not seen the patient.

Results:

We evaluated 140 patients (84 males and 60 females) with the mean age of 35.2 (range, 8 - 76 years). Of the 140 evaluable patients, 71 had positive criteria for radiological evaluation of which 43 presented with fracture, 69 had negative criteria for radiography with no fracture. The sensitivity of OARs to detect fractures was 100%. The implementation of the OARs appears to have the potential to reduce the number of radiographs for the assessment of these patients by about 51%.

Conclusions:

The implementations of OARs have the potential to reduce the number of X-ray graphics needed to assess these patients by about 51%. The results of this study demonstrate no false negatives and are in agreement with results from other similar studies. It encourages us to implement these criteria in our services urgently, with all the resulting socio-economic implications.

Hydrolysis of biomass using a reusable solid carbon acid catalyst and fermentation of the catalytic hydrolysate to ethanol

Solid acid catalysts can hydrolyze cellulose with lower reaction times and are easy to recover and reuse. A glycerol based carbon acid catalyst developed at CSIR-IICT performed well in acid catalysis reactions and hence this study was undertaken to evaluate the catalyst for hydrolysis of biomass (alkali pretreated or native rice straw). The catalyst could release 262 mg/g total reducing sugars (TRS) in 4h at 140 °C from alkali pretreated rice straw, and more importantly it released 147 mg/g TRS from native biomass. Reusability of the catalyst was also demonstrated. Catalytic hydrolysate was used as sugar source for fermentation to produce ethanol. Results indicate the solid acid catalyst as an interesting option for biomass hydrolysis.

Comparative study of complete subtalar release and Joshi's external stabilization system in the management of neglected and resistant idiopathic clubfoot

BACKGROUND

Various procedures have been used for the management of neglected and resistant clubfoot. The aim of our study was to assess the clinical and radiological correction by Joshi's external stabilization system (JESS fixator) and Simons subtalar release in resistant and neglected idiopathic congenital talipes equinovarus in children between the ages of 1 and 2 years.

METHODS

A total of 50 resistant and neglected clubfeet were randomly divided into two equal groups of 25 feet each. Group I was treated with JESS fixator and group II was treated with complete subtalar release as described by Simons. Assessment of correction achieved was done both clinically and radiologically. Functional outcome was assessed with Ponseti scale.

RESULTS

The change in clinical deformity and radiological correction of deformity were statistically significant within each group, but not significant when compared to each other. In group I excellent results were obtained in 17 (68%) and good in 8 (32%) of the feet. In group II, excellent results were found in 16 (64%) and good in 9 (36%) feet out of the 25 feet. Pin-site infections were seen in two cases in group I and serious skin problems occurred in two feet in group II.

CONCLUSION

We conclude that there were no statistical significant differences between the outcomes of the two techniques in this short-term follow-up of 2.4 years. Thus, functional distraction using JESS can be utilized as an alternative method in cases of neglected and resistant clubfoot.

An alternative instrument for making entry point for elastic intramedullary nail

Femoral shaft fractures are common in children and are increasingly being treated with elastic intramedullary nail. We outline an instrument we have used successfully to make an entry point for placement of elastic nail.