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Sharma S, Jindal K, Patel S, Prabhkar S, Prakash M, Rammelt S, Dhillon M. Parameters That Can Be Used to Quantify Reduction Accuracy in Talar Neck Fractures and Malunions: A PRISMA-Compliant Scoping Review and Meta-Analysis. Cureus 2024; 16:e58161. [PMID: 38741879 PMCID: PMC11089339 DOI: 10.7759/cureus.58161] [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] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Understanding the three-dimensional anatomy of the talar neck is essential in assessing the accuracy of reduction in talar neck fractures as well as for planning surgical correction for talar malunions. However, the geometrical parameters that describe this anatomy are sparsely reported in the orthopedics literature. We aimed to identify from the existing literature, geometrical parameters that describe the anatomy of the talar neck, determine how these are measured, and their normative values. A scoping literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. The primary searches were conducted on the PubMed, Embase, and Scopus databases. Any original research study looking at the human talus neck geometry was included. Parameters that described the anatomy of the talar neck were identified, and pooled estimates were determined by the random-effects meta-analysis model. Heterogeneity was assessed by the I2 test and leave-one-out meta-analysis. Subgroup analysis was done to compare the values of parameters between the Asian and Non-Asian populations. The risk of bias was assessed by the National Institutes of Health (NIH) Case Series Tool. The combined searches yielded 6326 results, of which 21 studies were included in the review and 15 in six different sets of metanalysis. The majority of the studies (n=19, 90.5%) evaluated adult tali, and only two (9.5%) evaluated pediatric tali. In most of the studies (n=13, 61.9%), talus neck geometry was evaluated on dry bones or anatomical specimens; evaluation by imaging techniques (radiographs, CT, MRI, and radiostereometric analysis) was used in eight studies, (39.1%). A total of eight different geometrical parameters (neck length, height, width, declination angle, inclination angle, torsion angle, circumference, and cross-sectional area) were identified. Except for talar torsion, variability was noted in methods of measurement of all other parameters. Subgroup analysis revealed that Asians had a higher neck height as compared to non-Asians; other parameters were not significantly different. Although the literature reports geometrical parameters to assess the talar geometry, the methods of measurement of these parameters are variable. Most of the available literature describes measurement techniques on cadaveric tali, and there is no literature on how these parameters should be measured on conventional CT or MRI slices. Further research needs to focus on the standardization of measurement techniques for these parameters on conventional CT and/or MRI scans.
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Affiliation(s)
- Siddhartha Sharma
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Karan Jindal
- Orthopedics, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, IND
| | - Sandeep Patel
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Sharad Prabhkar
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Mahesh Prakash
- Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Stefan Rammelt
- Orthopedics, Accident, and Plastic Surgery, UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, University Hospital Carl Gustav Carus, Dresden, DEU
| | - Mandeep Dhillon
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
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Dhillon M, Kobashigawa J, Patel N, Kittleson M, Zhang X, Patel J. Does Bortezomib Have an Effect on Pre-Transplant Desensitization Therapy or Benefit Post-Heart Transplant Outcomes for Highly Sensitized Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.122] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kumar D, Ghosh A, Jindal K, Berwal P, Sharma S, Dhillon M. Antegrade vs retrograde intramedullary nailing in humerus shaft fractures: A systematic review and meta-analysis. J Orthop 2022; 34:391-397. [PMID: 36281312 PMCID: PMC9587345 DOI: 10.1016/j.jor.2022.10.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction Plate osteosynthesis, external fixators and intramedullary nails are the commonly used devices for fixation of humerus shaft fractures. Humerus nails are gradually coming into popular use. Both antegrade and retrograde nails are used for this, however no evidence clearly states the benefits of one over the other. Thus, the purpose of this study was to evaluate the available evidence comparing the complications and outcomes of antegrade versus retrograde nails. Patients and methods We followed the Preferred Reporting Items for Meta-analyses Statement (PRISMA) guidelines. All studies in any language comparing the use of antegrade and retrograde nailing for humerus fractures, with a minimum follow up of 12 months were included. The primary outcome measures were complications and time to union. Results Seven studies including 384 patients (200 antegrade, 184 retrograde) were analyzed. A significantly lower complication rate was observed with retrograde nails (OR 1.77, p = 0.04, 95% CI 1.02,3.06; p = 0.04). Antegrade nails were associated with shorter operative time (MD -13.69, p > 0.00001). There was no significant difference in time to union and intra-operative blood loss between the two techniques. Conclusion Retrograde nails have a significantly lower complication rate. However, the surgeon's experience with these devices and the location of the fracture are the primary considerations when choosing either implant. Loe Level IV.
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Affiliation(s)
- Deepak Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Akash Ghosh
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Karan Jindal
- Department of Orthopaedics, AIMSR, Mohali, India
| | - Prerana Berwal
- Department of Physical and Rehabilitative Medicine, PGIMER, Chandigarh, India
| | - Shivam Sharma
- Department of Physical and Rehabilitative Medicine, PGIMER, Chandigarh, India
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Dhillon M, Patel J, Kittleson M, Chang D, Patel N, Singer-Englar T, Hamilton M, Czer L, Megna D, Kobashigawa J. Experience with Eculizumab in Highly Sensitized Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.213] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thoele K, Yu M, Dhillon M, Comer RS, Maxey HL, Newhouse R, Oruche UM. Development and assessment of the usability of a web-based referral to treatment tool for persons with substance use disorders. BMC Med Inform Decis Mak 2021; 21:260. [PMID: 34496855 PMCID: PMC8425151 DOI: 10.1186/s12911-021-01620-9] [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] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hospitalized people with unhealthy substance use should be referred to treatment. Although inpatient referral resources are often available, clinicians report that outpatient referral networks are not well-established. The purpose of this manuscript is to describe the development and usability testing of a web-based Referral to Treatment Tool (RTT © 2020 Trustees of Indiana University, all rights reserved) designed to identify treatment centers for people with unhealthy substance use. Results The RTT was conceptualized, developed, and then populated with public use and local survey data of treatment centers from 14 market ZIP codes of hospitals participating in an SBIRT implementation study. The tool underwent initial heuristic testing, followed by usability testing at three hospitals within a large healthcare system in the Midwest region of the United States. Administrative (n = 6) and provider (n = 12) users of the RTT completed a list of tasks and provided feedback through Think-Aloud Tests, the System Usability Scale, and in-person interviews. Patients (n = 4) assessed multiple versions of a take-home printout of referral sites that met their specifications and completed in-person interviews to provide feedback. Each administrative task was completed in less than 3 min, and providers took an average of 4 min and 3 s to identify appropriate referral sites for a patient and print a referral list for the patient. The mean System Usability Scale score (M = 77.22, SD = 15.57, p = 0.03) was significantly higher than the passable score of 70, indicating favorable perceptions of the usability of the RTT. Administrative and provider users felt that the RTT was useful and easy to use, but the settings and search features could be refined. Patients indicated that the printouts contained useful information and that it was helpful to include multiple referral sites on the printout. Conclusion The web-based referral tool has the potential to facilitate voluntary outpatient referral to treatment for patients with unhealthy substance use. The RTT can be customized for a variety of health care settings and patient needs. Additional revisions based on usability testing results are needed to prepare for a broader multi-site clinical evaluation. Trial Registration Not applicable.
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Affiliation(s)
- Kelli Thoele
- Robert Wood Johnson Future of Nursing Scholar, Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Mengmeng Yu
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Mandeep Dhillon
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Robert Skipworth Comer
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Hannah L Maxey
- Indiana University School of Medicine, 1110 West Michigan St., Suite 200, Indianapolis, IN, 46202, USA
| | - Robin Newhouse
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Ukamaka M Oruche
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
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Hafiz N, Hyun K, Tu Q, Knight A, Hespe C, Dhillon M, Frick C, Usherwood T, Redfern J. Do Quality Improvement Workshops Improve Health Professionals’ Knowledge on Implementing Change for Patients With Coronary Heart Disease in Primary Care? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.408] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharma S, Mahajan A, Mittal A, Gohil R, Sachdeva S, Khan S, Dhillon M. Epigenetic and transcriptional regulation of osteoclastogenesis in the pathogenesis of skeletal diseases: A systematic review. Bone 2020; 138:115507. [PMID: 32610074 DOI: 10.1016/j.bone.2020.115507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To identify epigenetic and transcriptional factors controlling osteoclastogenesis (OCG), that have been shown to play a role in the pathogenesis of skeletal diseases. METHODS A systematic review was conducted in accordance with the PRISMA guidelines. The PubMed and EMBASE databases were searched up to 30th April 2020; references of included articles and pertinent review articles were also screened to identify eligible studies. Studies were included if they described epigenetic and/or transcriptional regulation of OCG in a specific skeletal disorder, and quantified alterations in OCG by any well-described experimental method. Risk of bias was assessed by a previously described modification of the CAMARADES tool. RESULTS The combined searches yielded 2265 records. Out of these, 24 studies investigating 12 different skeletal disorders were included in the review. Osteoporosis, followed by osteopetrosis, was the most commonly evaluated disorder. A total of 22 different epigenetic and transcriptional regulators of OCG were identified; key epigenetic regulators included DNA methylation, histone methylation, histone acetylation, miRNAs and lncRNAs. In majority of the disorders, dysregulated OCG was noted to occur at the stage of formation of committed osteoclast from preosteoclast. Dysregulation the stage of formation of the preosteoclast from late monocyte was noted in rheumatoid arthritis and fracture, whereas dysregulation at stage of formation of late monocyte from early monocyte was noted in osteopetrosis and spondyloarthritis. Quality assessment revealed a high risk of bias in domains pertaining to randomization, allocation concealment, blinding of outcome assessors and determination of sample size. CONCLUSIONS A variety of epigenetic and transcriptional factors can result in dysregulated osteoclastogenesis in different skeletal disorders. Dysregulation can occur at any stage; however, the formation of committed osteoclasts from preosteoclasts is the most common target. Although the published literature on this subject seems promising, the overall strength of evidence is limited by the small number of studies evaluating individual skeletal disorders, and also by deficiencies in key aspects of study design.
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Affiliation(s)
- Siddhartha Sharma
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mahajan
- Department of Biophysics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Mittal
- Department of Translational and Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India..
| | - Riddhi Gohil
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunny Sachdeva
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shahnawaz Khan
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jaiswal NK, Kumar V, Puvanesarajah V, Dagar A, Prakash M, Dhillon M, Dhatt SS. Necessity of Direct Decompression for Thoracolumbar Junction Burst Fractures with Neurological Compromise. World Neurosurg 2020; 142:e413-e419. [PMID: 32688041 DOI: 10.1016/j.wneu.2020.07.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical management of burst fractures is controversial, with many different operative options. From a posterior approach, decompression of the spinal cord can be performed through both indirect and direct methods, the former relying on ligamentotaxis. It is unclear whether indirect decompression with ligamentotaxis is as effective as direct decompression. METHODS Prospective, randomized controlled data were retrospectively analyzed to include only burst fractures of the thoracolumbar junction. Patients were treated with either direct decompression, involving wide posterior decompression in addition to operative stabilization, or indirect decompression, where decompression was performed solely through ligamentotaxis. Patients were followed up at 6 months with clinical assessment and imaging. Additional clinical assessment was performed at 1 year. For all analyses, P < 0.05 was significant. RESULTS The study included 46 patients, with 18 patients in the direct decompression subgroup and 28 patients in the indirect decompression subgroup. The average age of the full cohort was 35.1 ± 13.1 years (range, 16-60 years). Most patients had L1 fractures (21/46; 46%), with an AOSpine classification type A4 fracture morphology (17/46; 37%), and were American Spinal Injury Association grade B (18/46; 39%). Both treatments resulted in similar increases in canal diameter and decreases in dural sac compromise (P > 0.5) at 6-month follow-up. Both treatments resulted in similar grades of neurological improvement (P = 0.575) at 1 year. CONCLUSIONS There were no significant differences in clinical and imaging outcomes when comparing direct decompression with ligamentotaxis. Ligamentotaxis alone may be effective in carefully selected cases.
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Affiliation(s)
- Nitin K Jaiswal
- Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ashish Dagar
- Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Dhillon
- Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarvdeep S Dhatt
- Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
A patient suffered significant bleeding during an attempt at percutaneous dilatational tracheostomy due to an aberrant anterior jugular vein. Bleeding was controlled with pressure temporarily, but quickly returned necessitating conversion to an open technique. We present an algorithm for the management of significant peri-procedural bleeding during this procedure.
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Affiliation(s)
- C Kaye
- Aberdeen Royal Infirmary, UK
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Abstract
The anterior end of calcaneum fractures can present as inversion injuries, stress fractures or as a part of displaced intraarticular calcaneum fracture. Rarely, these may occur due to abduction injury from a laterally directed force that crushes the anterior calcaneum instead of the cuboid, and has associated medial column injuries which are unrecognized. Compression fractures of the anterior calcaneum are actually lateral column shortening injuries with poor outcomes in the few published reports. We describe three patients with compression fractures of the anterior end of calcaneum resulting from foot abduction injury which were managed by reduction and column length restoration via distraction by external fixator. All three fractures showed good to excellent outcomes using the American Orthopedic Foot and Ankle Society midfoot score at followup >1 year. Awareness of this injury pattern is important, and appropriate measures to reduce and maintain the fracture reduction are needed to avoid long term disability.
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Affiliation(s)
| | - Ankit Khurana
- Department of Orthopaedics, AIIMS, New Delhi, India,Address for correspondence: Dr. Ankit Khurana, Department of Orthopaedics, AIIMS, New Delhi, India. E-mail:
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Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The objectives of this study were (1) to determine the characteristics of patients sustaining spinal trauma in India and (2) to explore the association between patient or injury characteristics and outcomes after spinal trauma. METHODS In affiliation with the ongoing INternational ORthopaedic MUlticentre Study (INORMUS), 192 patients with spinal injuries were recruited during an 8-week period (November 2011 to June 2012) from 14 hospitals in India and followed for 30-days. The primary outcome was a composite of mortality, complications, and reoperation. This was regressed on a set of 13 predictors in a multiple logistic regression model. RESULTS Most patients were middle-aged (mean age = 51.0 years; median age = 55.5 years; range = 18.0 to 72.0 years), male (60.4%), injured from falls (72.4%), and treated in a private setting (59.9%). Fractures in the lumbar region (51.0%) were most common, followed by thoracic (30.7%) and cervical (18.2%). More than 1 in 5 (21.6%) patients experienced a treatment delay greater than 24 hours, and 36.5% arrived by ambulance. Thirty-day mortality and complication rates were 2.6% and 10.0%, respectively. Care in the public hospital system (odds ratio [OR] = 6.7, 95% CI = 1.1-41.6), chest injury (OR = 11.1, 95% CI = 1.8-66.9), and surgical intervention (OR = 4.8, 95% CI = 1.2-19.6) were independent predictors of major complications. CONCLUSIONS Treatment in the public health care system, increased severity of injury, and surgical intervention were associated with increased risk of major complications following spinal trauma. The need for a large-scale, prospective, multicenter study taking into account spinal stability and neurologic status is feasible and warranted.
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Affiliation(s)
- Ilyas S. Aleem
- McMaster University, Hamilton, Ontario, Canada,University of Michigan Health System, Ann Arbor, MI, USA,Ilyas Aleem, Department of Orthopaedic Surgery, University of Michigan Health System, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
| | | | - Brian Drew
- McMaster University, Hamilton, Ontario, Canada
| | | | - Vijay Shetty
- Dr L. H. Hiranandani Hospital, Powai, Mumbai, India
| | - Mandeep Dhillon
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Orchard JW, Ranson C, Olivier B, Dhillon M, Gray J, Langley B, Mansingh A, Moore IS, Murphy I, Patricios J, Alwar T, Clark CJ, Harrop B, Khan HI, Kountouris A, Macphail M, Mount S, Mupotaringa A, Newman D, O'Reilly K, Peirce N, Saleem S, Shackel D, Stretch R, Finch CF. International consensus statement on injury surveillance in cricket: a 2016 update. Br J Sports Med 2016; 50:1245-1251. [PMID: 27281775 DOI: 10.1136/bjsports-2016-096125] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 05/12/2016] [Indexed: 11/04/2022]
Abstract
Cricket was the first sport to publish recommended methods for injury surveillance in 2005. Since then, there have been changes to the nature of both cricket and injury surveillance. Researchers representing the major cricket playing nations met to propose changes to the previous recommendations, with an agreed voting block of 14. It was decided that 10 of 14 votes (70%) were required to add a new definition element and 11 of 14 (80%) were required to amend a previous definition. In addition to the previously agreed 'Match time-loss' injury, definitions of 'General time-loss', 'Medical presentation', 'Player-reported' and 'Imaging-abnormality' injuries are now provided. Further, new injury incidence units of match injuries per 1000 player days, and annual injuries per 100 players per year are recommended. There was a shift towards recommending a greater number of possible definitions, due to differing contexts and foci of cricket research (eg, professional vs amateur; injury surveillance systems vs specific injury category studies). It is recommended that researchers use and report as many of the definitions as possible to assist both comparisons between studies within cricket and with those from other sports.
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Sydney, Australia Cricket Australia, National Cricket Centre, Brisbane, Australia
| | - Craig Ranson
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Benita Olivier
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Mandeep Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Janine Gray
- Cricket South Africa, Cape Town, South Africa Exercise Science Camp, Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Ben Langley
- England and Wales Cricket Board, National Cricket Performance Centre, Loughborough, UK
| | - Akshai Mansingh
- Sports Medicine, University of the West Indies, Kingston, Jamaica
| | - Isabel S Moore
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Ian Murphy
- New Zealand Cricket, High Performance Centre, Lincoln, New Zealand
| | - Jon Patricios
- Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Johannesburg, South Africa Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Brett Harrop
- Bangladesh Cricket Board, Sher-e- Bangla National Cricket Stadium, Dhaka, Bangladesh
| | - Hussain I Khan
- Sports Medicine Department, National Cricket Academy, Pakistan Cricket Board, Lahore, Pakistan
| | - Alex Kountouris
- Cricket Australia, National Cricket Centre, Brisbane, Australia
| | - Mairi Macphail
- National Cricket Academy, Cricket Scotland, Edinburgh, UK
| | | | | | - David Newman
- England and Wales Cricket Board, National Cricket Performance Centre, Loughborough, UK
| | | | - Nicholas Peirce
- England and Wales Cricket Board, National Cricket Performance Centre, Loughborough, UK Nottingham University Hospitals Trust, Centre for Sports Medicine, Nottingham, UK
| | - Sohail Saleem
- Sports Medicine Department, National Cricket Academy, Pakistan Cricket Board, Lahore, Pakistan
| | - Dayle Shackel
- New Zealand Cricket, High Performance Centre, Lincoln, New Zealand
| | - Richard Stretch
- Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Victoria, Australia
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Murray S, Siddiqui A, Dhillon M, Lowe T, Greenstein A. Mandibular peripheral ameloblastoma – a rare clinical entity. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.101] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Foote CJ, Mundi R, Sancheti P, Gopalan H, Kotwal P, Shetty V, Dhillon M, Devereaux P, Thabane L, Aleem I, Ivers RQ, Bhandari M. Musculoskeletal trauma and all-cause mortality in India: a multicentre prospective cohort study. Lancet 2015; 385 Suppl 2:S30. [PMID: 26313078 DOI: 10.1016/s0140-6736(15)60825-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is little data in low-income and middle-income countries (LMICs) quantifying the burden of fractures and describing current practices. The aim of the study was describe the severity of musculoskeletal injuries in LMICS and identify modifiable factors that predict subsequent early all-cause mortality. METHODS We did a multicentre, prospective, observational study of patients who presented to 14 hospitals across India for musculoskeletal trauma (fractures or dislocations). Patients were recruited during an 8-week period, between November, 2011, and June, 2012, and were followed for 30-days or hospital discharge, whichever occurred first. Primary outcome was all-cause mortality with secondary outcomes of reoperation and infection. Logistic regression analyses were conducted to identify factors associated with all-cause mortality. FINDINGS We enrolled 4822 patients, but restricted analyses to 4612 (96%) patients who had complete follow-up. The majority (56·2% younger than 40 years old) of trauma patients were young (mean age 40·9 years [SD 16·9]) and 3148 (68%) were men. 2344 (518%) patients sustained trauma as a result of a road traffic accident. The most common musculoskeletal injury was a fracture (4514 [98%]) and 707 patients (15%) incurred an open fracture. Less than a third of musculoskeletal trauma patients (1374 [29%]) were transported to hospital by ambulance, and one in six patients (18%) arrived at the hospital later than 24 h after sustaining their injury. Over a third (239 [35%] of 707) of open fractures were definitively stabilised later than 24 h. 30-day mortality was 1·7% (95% CI 1·4-2·2) for all patients and 2·1% (95% CI 1·5-2·7) among road traffic victims (p=0·005). Musculoskeletal trauma severity including the number of fractures (3·1 [95% CI 2·4-3·9]) and presence of an open fracture (2·1 [95% CI 1·2-3·4]) significantly increased the odds of all-cause mortality. INTERPRETATION Musculoskeletal trauma severity, particularly road related, is a key predictor of subsequent mortality. Improvement in road safety policies, and improvements in access to emergency medical services and timely orthopaedic care are critical to mitigate the burden of injury worldwide. FUNDING Regional Medical Associates, AO International, Hamilton Health Sciences Trauma Fund.
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Affiliation(s)
| | - Raman Mundi
- Centre for Evidence-based Orthopaedics, Hamilton, ON USA
| | - Parag Sancheti
- Sancheti Hospital, Shivajinagar, Pune, Maharashtra, India
| | | | - Prakash Kotwal
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vijay Shetty
- Dr L H Hiranandani Hospital, Powai, Mumbai, India
| | | | - Philip Devereaux
- McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | | | - Ilyas Aleem
- McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Rebecca Q Ivers
- The George Institute for Global Health, University of Sydney, NSW, Australia
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Behera P, Dhillon M, Aggarwal S, Marwaha N, Prakash M. Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg (Hong Kong) 2015; 23:6-10. [PMID: 25920634 DOI: 10.1177/230949901502300102] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare a single leukocyte-poor (type-4B) platelet-rich plasma (PRP) injection versus bupivacaine injection for recalcitrant lateral epicondylar tendinopathy (LET). METHODS 25 patients aged 27 to 50 years with painful and recalcitrant LET of the humerus were randomised to receive leukocyte-poor (type-4B) PRP (n=15) or bupivacaine (n=10) injection. Outcome measures included visual analogue scale (VAS) for pain, modified Mayo clinic performance index for elbow (MMCPIE) for elbow function, and Nirschl score for activity-related pain at 1, 3, 6, and 12 months by a single assessor. RESULTS At baseline, the PRP and bupivacaine groups were comparable in terms of age, sex, duration of symptoms, VAS for pain, MMCPIE score, and Nirschl score. After one month, the percentage of improvement was less in the PRP than bupivacaine group in terms of the VAS for pain (17.7% vs. 26.5%), MMCPIE score (24.0% vs. 27.6%), and Nirschl score (20.7% vs. 31.1%). Nonetheless, improvement in the respective scores was greater in the PRP than bupivacaine group after 3 months (42.5% vs. 30.9%, 34.1% vs. 27.2%, and 50.7% vs. 39.6%), 6 months (67.3% vs. 20.1%, 40.6% vs. 16.3%, and 71.4% vs. 31.1%), and one year (83.2% vs. 45.6%, 47.0% vs. 21.7%, and 76.6% vs. 56.3%). The differences in scores between groups were significant at 6 months and one year only (p<0.001). CONCLUSION Leukocyte-poor (type-4) PRP injection for recalcitrant LET enabled good improvement in pain and function.
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Affiliation(s)
- Prateek Behera
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Behera P, Chouhan DK, Prakash M, Dhillon M. Proposed Methods for Real-Time Measurement of Posterior Condylar Angle during TKA. Knee Surg Relat Res 2014; 26:230-5. [PMID: 25505705 PMCID: PMC4258490 DOI: 10.5792/ksrr.2014.26.4.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/19/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Conventional instruments are known to result in high numbers of outliers in restoring femoral component rotation primarily due to fixed degree of external rotation resection relative to the posterior condylar line (PCL). Outliers can be reduced by determining the patient specific posterior condylar angle (PCA) preoperatively or intraoperatively. There is a paucity of methods that can be used during surgery for determining the PCA. We propose two simple, real-time methods to determine the PCA and hence to measure the axial anatomical variation during surgery. Materials and Methods The study was conducted using axial computed tomography (CT) scans of the knees of 26 patients. The commercial software K-PACS and our proposed two methods (trigonometric and protractor) were used to measure the angle between the transepicondylar axis and PCL, i.e., PCA. Statistical comparison between the mean angles obtained by K-PACS and our methods were done. Results The three methods resulted in similar PCAs. The mean PCA measured by the three methods were similar. The mean PCA value measured by the K-PACS, trigonometric method and protractor method was 6.27° (range, 0° to 12°), 6.23° (range, 0° to 11.11°) and 6.31° (range, 0° to 12°), respectively. There were significant correlations between the K-PACS measured PCA and trigonometrically or protractor measured PCA. Conclusions Our novel, simple, easily reproducible, real-time and radiation-free PCA measurement methods obviate the need for preoperative CT scan for identification of patient specific PCA.
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Affiliation(s)
- Prateek Behera
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra Kumar Chouhan
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg 2014; 20:10-3. [PMID: 24480492 DOI: 10.1016/j.fas.2013.08.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/04/2013] [Accepted: 08/08/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis. METHODS We undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients. RESULTS We studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection. CONCLUSION The use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis. STUDY DESIGN Cohort study. LEVEL OF CLINICAL EVIDENCE Level 3.
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Affiliation(s)
- Vijay D Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr L. H. Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai 400076, India.
| | - Mandeep Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Chintan Hegde
- Hiranandani Orthopaedic Medical Education (HOME), Dr L. H. Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai 400076, India
| | - Prajyot Jagtap
- Hiranandani Orthopaedic Medical Education (HOME), Dr L. H. Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai 400076, India
| | - Suvin Shetty
- Department of Pathology, Dr L. H. Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai 400076, India
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Abstract
Deep venous thrombosis (DVT) is uncommonly seen in children and adolescents. A distal femoral osteochondroma causing isolated lower limb DVT is even rarer and to our knowledge only four such cases have been reported in the literature. We report a case of a solitary distal femoral osteochondroma in a 15-year-old adolescent presenting as isolated DVT. We highlight the potential of coexistence of DVT and osteochondroma in young patients. We also emphasize the importance of timely diagnosis and outline the plan of management when faced with such a rare condition.
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Affiliation(s)
| | - Vishal Kumar
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Vikas Bachhal
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Kamal Bali
- Department of Orthopedics, PGIMER, Chandigarh, India
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Affiliation(s)
- Devendra Kumar Chouhan
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Bachhal V, Jindal N, Saini G, Sament R, Kumar V, Chouhan D, Dhillon M. Erratum to: A new method of measuring acetabular cup anteversion on simulated radiographs. Int Orthop 2012; 36:2601-2601. [PMCID: PMC3508058 DOI: 10.1007/s00264-012-1705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Vikas Bachhal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Nipun Jindal
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, 160030 India
| | - Gaurav Saini
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Radheshyam Sament
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Devendra Chouhan
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Mandeep Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Dhillon M, Akkina N, Prabhakar S, Bali K. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee 2012; 19:769-72. [PMID: 22424688 DOI: 10.1016/j.knee.2012.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is paucity of literature regarding the outcomes of ACL reconstruction in ACL deficient knees with concomitant Type A and Type B PLC injuries. MATERIALS AND METHODS A total of 102 patients undergoing isolated ACL reconstruction for an ACL injury were evaluated prospectively in this study. The patients with divided into three groups: group A with isolated ACL injury, group B1 with concomitant Type A PLC injury and group B2 with concomitant Type B PLC injury. The associated PLC injury in all these patients was managed conservatively. Outcome assessment was based on IKDC scores measured preoperatively and at last follow up visits. RESULTS The mean age of the patients was 25.33 years (16-38 years) with 95 males and seven females. The average follow up was almost 2.5 years (13-46 months). Group A had 88 patients while groups B1 and B2 had six and eight patients respectively. The preoperative IKDC scores were comparable for all the groups. The follow up IKDC scores were similar (statistically insignificant, p value: 0.421) for group A and group B1. Group B2 had poorer follow up IKDC scores as compared to group A and this result was found to be statistically significant (p value: 0.0001). CONCLUSION Conservative management of a concomitant Type B PLC injury adversely affects the outcomes of ACL reconstruction in these patients. Type A PLC injuries, on the other, do well without surgery and can be left as such even when associated with a concomitant ACL tear. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Mandeep Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh- 160 012, India
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Bachhal V, Jindal N, Saini G, Sament R, Kumar V, Chouhan D, Dhillon M. A new method of measuring acetabular cup anteversion on simulated radiographs. Int Orthop 2012; 36:1813-8. [PMID: 22648556 DOI: 10.1007/s00264-012-1583-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 05/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Optimal positioning of acetabular components is crucial for maintaining stability of THA. Postoperative assessment of acetabular anteversion is a vital but difficult task. Various methods have been devised with good results for measuring anteversion on plain radiographs but these methods are either too complicated or require special objects like scientific calculators, special protectors, tables, etc. A new simplified method of measuring anteversion on plain radiographs was created based on basic geometry. METHODS Anteversion of acetabular components was estimated on computer generated images of the acetabular cup by our method and compared with two previously established methods of Liaw and Pradhan. Measurement was done at 400 different positions of acetabular cup and compared with actual values. Another analysis was done after adding the femoral head to the acetabular component, thus obscuring some of the acetabular rim. RESULTS Mean and standard deviation of error for our method was 0.77° ± 0.75° as compared to 0.93° ± 0.86° and 0.72° ± 0.68° for the methods of Liaw and Pardhan, respectively, with no significant differences from actual values. Maximal errors for our method, Liaw's and Pradhan's method were 3°, 4°, and 2.91°, respectively. On analysis, after the adding femoral head, there was a significant error of measurement with Liaw's method, while our method as well as Pardhan's remained accurate. All methods showed high inter- and intraobserver reliability. CONCLUSION Our new simplified method of measuring acetabular anteversion on plain radiographs is acceptable in comparision to other established methods and requires only routinely used goniometer and calliper.
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Affiliation(s)
- Vikas Bachhal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Bachhal V, Rangdal S, Saini G, Dhillon M. Comments on Reito et al.: Assessment of inter- and intra-observer reliability in the determination of radiographic version and inclination of the cup in metal-on-metal hip resurfacing. Int Orthop 2012; 36:1535-7. [PMID: 22584620 DOI: 10.1007/s00264-012-1566-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Dhillon M, Bachhal V, Chouhan D, Kumar V. Comment on: Markmiller M, Weiss T, Kreuz P, Rüter A, Konrad G. Partial weightbearing is not necessary after cementless total hip arthroplasty. Int Orthop. 2011 Aug;35(8):1139-43. Int Orthop 2011; 36:895; author reply 897. [PMID: 22139196 DOI: 10.1007/s00264-011-1415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/03/2011] [Indexed: 11/29/2022]
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Dhatt S, Tahasildar N, Tripathy SK, Bahadur R, Dhillon M. Outcome of spinal decompression in Cauda Equina syndrome presenting late in developing countries: case series of 50 cases. Eur Spine J 2011; 20:2235-9. [PMID: 21594752 PMCID: PMC3229723 DOI: 10.1007/s00586-011-1840-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/10/2011] [Accepted: 05/06/2011] [Indexed: 02/08/2023]
Abstract
The purpose of this study is to find the clinical outcome of decompression of Cauda Equina presenting late in the course of disease. There were 33 males and 17 females with average age of 48 years, ranging from 25 to 85 years. All patients presented to us with a fully developed Cauda Equina syndrome (CES). All of them presented late with mean delay of 12.2 days. Time interval between bladder and bowel dysfunction and admission to hospital varied from 1 to 35 days. The average follow-up was 34.5 months, ranging from 12 to 60 months. There was no statistically significant difference in time of delay in surgery between the recovered and non-recovered group as tested by Student's t test. But there was a statistically significant positive correlation between duration taken for total recovery and delay in surgery. Anal wink as a predictor of bladder and bowel recovery also showed statistical significance, as patients with an absence had a poorer prognosis for bladder recovery. The result of surgery in CES is not as dramatic and fast as seen after routine disc surgery. Some improvement can be expected with decompression even in those patients presenting late and results are not universally poor as previously thought. The treating physicians of such patients should be aware that the recovery in this group of patients can take an exceptionally long time and hence should involve in constant reassurance and rehabilitation of the patient. Presence of anal wink is a very good predictor of bladder and bowel recovery.
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Affiliation(s)
- Sarvdeep Dhatt
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
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Affiliation(s)
| | | | - Mohit Bhandari
- McMaster University, Canada,Address for correspondence: Dr. Mohit Bhandari, 2309 Hoover Court, Hamilton, L7P 4V2, Ontario, Canada. E-mail:
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Dhillon M, Dhariwal D. P79 Acute haemorrhagic oedema of infancy: a case report. Br J Oral Maxillofac Surg 2010. [DOI: 10.1016/s0266-4356(10)60170-2] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dhatt S, Kumar S, Arora N, Dhillon M, Tripathy SK. Migration of anterior spinal rod from the dorsolumbar spine to the knee: an unusual complication of spinal instrumentation. Spine (Phila Pa 1976) 2010; 35:E270-2. [PMID: 20228697 DOI: 10.1097/brs.0b013e3181c5d4da] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A retrospective case report. OBJECTIVE The objective of the present article is to report an unusual complication of spinal instrumentation. SUMMARY OF BACKGROUND DATA Migration of spinal implants to distant site is quite unusual, and literature till date has only 2 case reports. For the first time, we are reporting a case of anterior spinal rod migration from the dorsolumbar spine to the knee joint in a young male patient after 4 years of its fixation following spinal injury. METHODS A 38-year-old man presented with pain, swelling, and restriction of movement of left knee joint. On clinical examination, a hard movable rod was palpable which was suspected to be a metallic foreign body initially. The detailed history of the patient revealed anterior spinal fixation following posttraumatic injury of L1 vertebra 4 years back. Radiograph showed a metallic rod lying around the knee joint with absence of anterior rod of dorsolumbar spine. The suspicion of migration of the rod was confirmed by surgical exploration. RESULTS After 1 week of removal of the rod, patient became totally asymptomatic with normal full range of movement of the knee joint. CONCLUSION Though rare, migration of implants from the spine to the distant sites is always a possibility and may have severe complications too. We stress the need of long-term follow-up with clinical examination and radiographs to prevent missing such a complication.
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Affiliation(s)
- Sarvdeep Dhatt
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Odumenya M, Costa ML, Parsons N, Achten J, Dhillon M, Krikler SJ. The Avon patellofemoral joint replacement: Five-year results from an independent centre. ACTA ACUST UNITED AC 2010; 92:56-60. [PMID: 20044679 DOI: 10.1302/0301-620x.92b1.23135] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Between May 1998 and May 2007 we carried out 50 Avon patellofemoral joint replacements in 32 patients with isolated patellofemoral osteoarthritis. There were no revisions in the first five years, giving a cumulative survival of 100% for those with a minimum follow-up of five years. The mean follow-up was 5.3 years (2.1 to 10.2). The median Oxford knee score was 30.5 (interquartile range 22.25 to 42.25). In patients with bilateral replacements the median Euroqol General health score was 50 which was significantly lower than that of 75 in those with a unilateral replacement (p = 0.047). The main complication was progression of disease, which was identified radiologically in 11 knees (22%). This highlights the need for accurate selection of patients. Our findings suggest that the Avon prosthesis survives well and gives a satisfactory functional outcome in the medium term.
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Affiliation(s)
- M Odumenya
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England.
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Prakash SMR, Dhillon M, Raju MS, Malik U. Intraosseous Polymorphous Low Grade Adenocarcinoma of the Mandible: Report of a Rare Case. J Indian Acad Oral Med Radiol 2010. [DOI: 10.4103/0972-1363.166913] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Affiliation(s)
- M. Dhillon
- Punjab Agricultural University, Department of Botany Ludhiana, India
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Dhillon M, Davies AM, Benham J, Evans N, Mangham DC, Grimer RJ. Calcific myonecrosis: a report of ten new cases with an emphasis on MR imaging. Eur Radiol 2004; 14:1974-9. [PMID: 15480695 DOI: 10.1007/s00330-004-2368-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 04/05/2004] [Accepted: 04/26/2004] [Indexed: 11/29/2022]
Abstract
The aim of this study is to report the typical radiographic and MR imaging features of calcific myonecrosis, which help to distinguish this rare entity from other causes of a calcifying calf mass. Ten patients with a final diagnosis of calcific myonecrosis were referred to a specialist orthopaedic oncology service in a 5-year period with the presumptive diagnosis of malignancy based on recent clinical presentation and imaging findings. Radiographs were available for retrospective review in all ten cases and MR imaging in six. All patients presented with a slow-growing painless calf mass. All gave a history of major trauma to the lower leg many years before, but in only two cases did the referring clinician query whether trauma might be a contributory factor. Radiographs showed well-defined fusiform mineralised masses up to 25 cm in length arising within the calf. The calcification was consistently peripheral and plaque-like. Ossification was not present. MR imaging showed the anterior compartment to be involved in four cases and all compartments in two. T1- and T2-weighted images showed peripheral low signal intensity, more prominent on the T2-weighted images, because of the peripheral mineralization. The contents of the masses were variable on T1-weighted images depending on the differing amounts of blood breakdown products and were heterogeneous on T2-weighted images. The latter may be explained by a combination of the mineralisation and T2 shortening due to blood breakdown products. A gadolinium chelate, administered in two cases, failed to show any appreciable enhancement. Calcific myonecrosis has characteristic clinical, radiographic and MR features that should make the condition easy to recognise. Despite its rarity, it should be included in the differential diagnosis of focal mineralisation of the calf.
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Affiliation(s)
- M Dhillon
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Abstract
Previous work has shown that a 25-30% citric acid solution was the most effective concentration with which to demineralize dentin. The purpose of this investigation was to study the topography, using a scanning electron microscope, of root surfaces treated with a 30% citric acid solution using various application pressures. 20 freshly extracted human teeth were collected and stored in physiologic saline at room temperature. 3 root specimens, approximately 3x5x5 mm in size, were prepared from the coronal periodontally healthy area of each tooth. 30 specimens were root planed to expose dentin (dentin group) while the remaining 30 specimens were lightly scaled to remove periodontal soft tissue (cementum group). A freshly made 30% citric acid (CA) solution, (pH = 1.60), was applied to each of the experimental areas. Cotton pellets soaked in the citric acid solution were either placed (CAP), lightly rubbed (CAR) or heavily burnished (CAB) on the prepared root surface for 3 min. Pellets were resoaked every 30 s. The root sections were rinsed, fixed in glutaraldehyde, dehydrated in graded ethanol, critically point dried in liquid CO2 and sputter coated in gold. The treated surfaces were assessed for fibril tufting using scanning electron microscopy. Assessment was made of: (i) the % of surface area tufted; (ii) tufting depth (0-3); (iii) tufting density (1-3). Results of the study showed significantly more tufted surface area and greater tufting depth on both dentin and cementum for CAR and CAB compared to CAP. CAP produced a flat/mat fibril surface with no evidence of tufting.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J D Sterrett
- Department of Periodontology, Medical College of Georgia, Augusta 30912-1220, USA
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Nagi ON, Panikkar KV, Dhillon M. The versatility of the contoured AO plate as a mode of fixation for proximal femoral fractures. Contemp Orthop 1994; 28:428-34. [PMID: 10147143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Proximal femoral fractures, especially in young adults, usually are high-energy injuries associated with severe comminution. Presently available fixation devices such as the blade plate and DHS are difficult to apply in comminuted cases, their application requires the use of an image intensifier, and their versatility is limited. This report describes the use of the AO plate molded according to the proximal femoral anatomy in 21 cases (seven subtrochanteric and 14 trochanteric fractures) in which high-energy injuries were sustained. Eleven cases were primarily bone grafted. Postoperative mobilization was started by an average of 5.4 weeks. All cases united by an average of 3.2 months. There were six excellent, ten good, three fair, and one poor result (one patient died). This method was found to be superior to conventional devices as it offers more versatility in placement of screws and plate contouring. The inventory of implants is also reduced, and there is no need for specialized instruments, a significant factor in Third World countries.
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Affiliation(s)
- O N Nagi
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Phospholipase A2 (PLA2), the major bee-venom allergen, was purified by gel filtration, inactivated by denaturing, and carboxymethylating its cysteine residues. Peripheral blood mononuclear cells from an individual (HLA-DR2 [15], Dw52, DQ1 and DQ3) allergic to bee stings were used to generate cell lines specific for PLA2 and a control antigen, tetanus toxoid. These lines were 90% CD3+, 64% CD4+ and 20% CD8+ by fluorocytometry analysis. T-lymphocyte epitope mapping done with 12 overlapping synthetic peptides of PLA2 revealed two immunodominant epitopes. These epitopes correspond to amino acid sequences 50 to 69 and 83 to 97 of PLA2. Cytokine interleukin-4 and Interferon-gamma secretion was studied from PLA2- and tetanus toxoid-specific cell lines. Interleukin-4 secretion was common to both cell lines but only tetanus-toxoid cell lines secreted interferon-gamma. No interferon-gamma was found to be secreted by PLA2-specific cell line in response to stimulation by PLA2 or the two immunodominant peptides.
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Affiliation(s)
- M Dhillon
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Dhillon M. Current status of mold immunotherapy. Ann Allergy 1991; 66:385-92. [PMID: 2035901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is evidence to suggest that molds can cause IgE-mediated upper respiratory tract disorders and immunotherapy is efficacious in a select group. The environmental sampling studies show a remarkably small numbers of molds accounting for a majority of the mold load in various diverse locations. These are Cladosporium, Basidiospores, Aspergillus, and Alternaria-Penicillin families. Basidiospores have been underreported in the older studies because of difficulties in their identification. Whether the absolute mold level is the most important factor leading to IgE formation and induction of upper respiratory tract symptoms is uncertain. Certainly, the majority of the studies are based on the assumption that the absolute level of mold in the environment is the most important factor leading to the development of symptoms, but this is not based on strong evidence. A major problem in the majority of the studies is a lack of standardization of extracts which may lead to false negatives on skin testing and thus produce variable data in population evaluations comparing the prevalence of mold to its ability to induce IgE production and symptoms. The best current trials to document the efficacy of mold immunotherapy have been with the standardized Cladosporium extract. Unfortunately, these results cannot be extrapolated to the commercially available mold extracts available in the United States either for immunotherapy or for skin testing. These extracts are highly variable in their potency, prone to high false negative rates, and at best serve as poor skin testing reagents and possibly even worse immunotherapy reagents. Adequately standardized mold reagents are urgently needed to determine whether the Cladosporium data can be extrapolated to them in any meaningful way.
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Affiliation(s)
- M Dhillon
- Queen's University Kingston, Ontario, Canada
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Strober S, Dhillon M, Schubert M, Holm B, Engleman E, Benike C, Hoppe R, Sibley R, Myburgh JA, Collins G. Acquired immune tolerance to cadaveric renal allografts. A study of three patients treated with total lymphoid irradiation. N Engl J Med 1989; 321:28-33. [PMID: 2525231 DOI: 10.1056/nejm198907063210106] [Citation(s) in RCA: 157] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S Strober
- Department of Medicine, Stanford University School of Medicine, Calif 94305
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Dhillon M, Davis H. Socialization, locus of control, and dogmatism as related to counsellors' office settings. Psychol Rep 1985; 56:328-30. [PMID: 3983321 DOI: 10.2466/pr0.1985.56.1.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Psychologists and social workers in geographically decentralized and sometimes isolated settings must often work autonomously and make independent decisions. It was predicted that staff who choose to work in these settings would be more internally directed and more dogmatic than staff who worked in a centralized office. Decentralized staff were also hypothesized to want less control by others and less social inclusion. On Rotter's (1966) Internal-External Scale, Rokeach's (1959) Dogmatism Scale and Shurz's FIRO-B measures for 29 social workers and psychologists there were differences on the FIRO-B but not in internality or dogmatism. The results are discussed in terms of the sample's characteristics and the implications for the decentralization of counselling services.
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