Orthopaedic Journal of M. P. Chapter https://ojmpc.com/index.php/ojmpc <h4>E-ISSN: 2320-6993</h4> <p>Orthopaedic Journal of M P Chapter is official publication of M P Chpater of Indian Orthopaedic Association. Orthopaedic Journal of M P Chapter started in 1980 with Dr. P. K. Rai as first editor. Subsequently Dr. H.K.T. Raza, Dr. Alok C Agrawal, Dr. Sunil Rajan, Dr. A. Mukherjee, Dr. Alok C Agrawal and then again Dr. Ashish Gohiya were elected as editor. Currently Dr. Saurabh Jain is editor of this journal. in year 2013 this journal got ISSN in year 2014 it was indexed with Index Copernicus with IC value of 37.91 for 2016 and Index Copernicus with IC value of 71.64 for 2017. Currently this journal has both print and online versions and it is an open access journal, it is peer revied and there is no processing fee for authors.</p> M P Chpater of Indian Orthopaedic Association en-US Orthopaedic Journal of M. P. Chapter 2320-6993 A life to live beyond orthopaedics https://ojmpc.com/index.php/ojmpc/article/view/96 <p>Why we have chosen Orthopaedics for ourselves? There can many personalized reasons for the above, but the commoner are – its lucrative, paying, satisfying, early practice settlement, definitive and terminal branch. There are hardly any females in the branch; hence branch is totally all boys party without any inhibitions. They have all sorts of fun and enjoyment. Orthopods live life king size.</p> <p>The various modes of leisure for orthopods are party, exercise/ physical activity followed by travelling, food and wine, whereas less common in them are music and arts (photography, painting, sculpture). Party with friends, colleagues or family members is most common form of enjoyment for orthopods and most of orthopaedicans are party animals having regular parties. On an average orthopods do party or attend functions about one per week. These parties are full with boozing and smoking and almost more than 80 % of the surgeons are drinkers in these parties having average more than two drinks per day and only 20% of orthopaedic surgeons are non-drinkers. About 30 % of the orthopaedians are smokers, among which 20 % are chain smokers.Many of the academics conferences, short table gatherings and group discussion held over the dinner for orthopaedic surgeons arranged by the pharmaceuticals are for alcohol only. Many of the academic meetings attended by the members outside the hometown are not for academic content, but only for the food, alcohol, banquet or adult entertainment, outside the hometown they are away from inhibitions. These gatherings between the orthopod surgeons is always with adult jokes and abusive slangs which is commonly done over smoke and booze.The average happiness rating for an orthopaedician is 3.96 out of 5.</p> <p>Orthopaedic surgery, as a branch is rewarding profession, but it is a very demanding also. Orthopaedics is a hectic, intense and stressful branch. It needs high learning curve in lesser time and lot of physical effort. Being an emergency branch, emergency duties can be day and night and you need to attend, manage and sometimes may have to operate also in odd hours, which when started, there is no warranty when will end.The load, burden, malpractice and negligence allegations are increasing day by day, thus it is increasing the practice risk and now there is very less margin of error.This time commitment can negatively impact family time and adversely affect work life balance. It is common for Orthopods in the bedroom, having sleepless night thinking that how could that screw go out during the surgery. We can commonly see orthopaedicians using derogative language and abusive words in operation theatres and hospitals among themselves and to patients even. Being all boys party, there is lack of softness and politeness of the behaviour of many of the orthopaedicians as well. Further the cut throat competition and decline in ethical values have lead to envy among themselves and with others. These have made the life of an orthopaedician difficult and stressful and also affected their family-life, with equal increase in rate of remarriage and divorce.</p> <p>This stressful and demanding life among us has lead us to seek measures to overcome stress. We seek pleasures for deal with this intense and hectic life of orthopaedics surgeon.We seek this escapism in smoking and boozing, which at times and for few of us is over the acceptable limit. The competition between the minded maniacs for smoking and drinking crosses the barriers and it has made many of our friends addicted even.This along with stressful life, sedentary habits and medical comorbidities like hypertension and diabetes has made us vulnerable for serious problems. In recent time, we have lost eminent orthopods for the unknown reasons, the damages of which cannot be repent. Many of our orthopaedic surgeons are still dealing with some serious chronic morbidities and terminal illnesses, most of which could be prevented.</p> <p>What needs to be done, is balance between the professional and personal life.In professional life we needsfocus on limitations of our body as well as mind. Rather than treating ourselves as machine consider ourselves human. Professionally, strict to the duties towards patient by beingunderstanding, honest, polite, competent, ethical and committed and have empathy towards patients. Towards our peer members we need to be respectful and should not be involved in medical jousting and entice. We should keep ourself updated and should not be overburdened and exhaustive. Admit your limitations and overcome the shortenings.In personal life we needto take time for leisure, family and friend and not the least for ourselves. Keep yourself simple and low maintained. Keep time for your hobby like traveling, shopping, singing, painting, playing or music etc. Nurture your relations with family and friends. Take care of your health with balanced diet and light exercise.<br>As it is rightly said Orthopedic surgeons are “strong as an ox and twice as smart”, but we as an orthopaedic surgeon should strive for a balanced life to care for ourselves and our families as well as profession. We want work satisfaction and healing touch for our patients. At the same time we owe responsibility to family. Its a bitter truth that only family will be with you in all your difficult times. Neglecting family life for excelling professionally does happen in lives of many of us. No one will remember you for working day in and day night or working on weekends when others are enjoying. Its imperative to strike a critical balance between work and family life. Mobile phone is again a big stress for a doctor. Patients in India feel it their right to call a doctors mobile at any time for petty issues. Many of us don’t switch off mobiles even on vacations for the fear of loosing patients. Another area is Professional jousting. At times we get complications from other colleague and patients and their relatives try to make us talk about the previous orthopods alleged mistakes. Many times we receive x rays on Whats app seeking opinions from patients. We need to be very careful on such situations as today litigations against doctors are on a rise. If we talk something loose about any colleague, some or the other day it is bound to backfire on us. Finally we want to be happy and healthy, caring and competent and good travel companions for people through the journey we call life, which can be done by none other than we ourselves.</p> Saurabh Jain Copyright (c) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-10 2020-03-10 26 1 1 2 Current Concepts In Diagnosis & Management Of Osteoarticular Tuberculosis https://ojmpc.com/index.php/ojmpc/article/view/97 <p>Tuberculosis is common worldwide and in endemic in India. Musculoskeletal tuberculosis, involving spine and other joints is seen in 1% to 3% of patients with tuberculosis. The disease has varied clinical presentation &amp; lack of charateristic radiographic findings leading to delayed diagnosis and treatment. Early confirmed diagnosis &amp; proper medical treatment are essential for control of the disease. This review article based on the recent literature review discuss the clinical presentation, diagnosis and management of osteoarticular tuberculosis.</p> Dhammi IK Kumar S Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 3 13 Trochanteric support plate with Dynamic Hip Screw, is this combination a feasible option in unstable trochanteric fractures? https://ojmpc.com/index.php/ojmpc/article/view/98 <p>Background: Dynamic Hip Screw (DHS) is the gold standard for stable trochanteric fractures and Proximal Intramedullary nail (IMN) is beneficial in treating intertrochanteric femur fractures with comminution and loss of lateral buttress. DHS augmented with trochanteric support plate can buttress the broken lateral trochanteric wall. Thus we conducted this study is to evaluate the role of the trochanteric support plate (TSP) with DHS in unstable trochanteric fractures.</p> <p>Materials &amp; Methods: 25 patients presenting with unstable trochanteric fractures treated with TSP with DHS were evaluated for intraoperative blood loss and duration of surgery. Functional outcome was assessed as per the Kyle's Criteria, Harris Hip Score, and ambulatory outcome.</p> <p>Results: 21 patients with mean age of 67.14 years were available for study. The mean duration of surgery and blood loss was 100.5 minutes and 312 ml, respectively. All fractures, except 1 united. Nonunion occurred in 1 case due to screw cut out. Af final followup, all patients had excellent to good harris hip score and 91% had excellent Kyle’s criteria, while 9% had good Kyle’s criteria.</p> <p>Conclusion: The DHS with trochanteric support plate is an acceptable alternate device for managing unstable intertrochanteric fractures with broken lateral wall. It’s an easy, low cost, easily available and less demanding surgical procedure giving excellent results.</p> Agrawal Y Pathak A Gaur S Tiwari A Verma R Aher D Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 14 18 Is It Worthy To Replace Hip Than To Go For Intramedullary Osteosynthesis In Unstable Intertrochantric Fractures In Elderly- A Prospective Comparative Study https://ojmpc.com/index.php/ojmpc/article/view/99 <p>Background: Internal fixation for the management of unstable intertrochantric femoral fractures in elderly is difficult and less successful due to communition and poor bone stock. Arthroplasty for unstable intertrochantric fracture in elderly has produced promising results as per literature. So, we conducted this study to compare the results of intramedullary devices with cemented bipolar hemiarthroplasty in unstable osteoporotic intertrochanteric fractures in elderly patients.</p> <p>Material &amp; methods: 51 patients, 65 years or older with unstable osteoporotic intertrochanteric femoral fractures were treated with internal fixation or hemiarthroplasty. Intraoperative parameters and functional outcome as per Harris Hip Score were compared.</p> <p>Results: Average age of patients for intramedullary fixation and arthroplasty was 73 ± 6 years and 75 ± 6.5 years respectively. Average delay in surgery for group A (PFN) and group B (hemiarthroplasty) was 5.7 days and 6.56 days, mean duration of surgery was 75 min (range 45 to 125) and 95 min (range 70 to 132), mean blood loss was 180ml (range 150 to 280) and 270 ml (range 250 to 420) respectively. Harris hip score at one year were better in arthroplasty group but almost comparable at two year.</p> <p>Conclusion: Primary arthroplasty provides a stable, painless and reasonably functional joint, which provided early mobility and rehabilitation and hence is a better way of managing an osteoporotic unstable intertrochanteric fracture in elders especially. However, overall long term functional outcomes are almost similar for two groups.</p> Sabir AB Mohan R Faizan M Jilani LZ Ahmed S Shaan ZH Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 19 23 Comparative Study between Minimally Invasive Percutaneous Plate Osteosynthesis and Open Reduction Internal Fixation For Management Of Proximal Humerus Fracture https://ojmpc.com/index.php/ojmpc/article/view/100 <p>Background: Fractures of the proximal humerus comprise nearly 4% of all fractures and 26% of fracture of humerus. Surgical options ranges from open reduction internal fixation (ORIF), intramedullary device fixation, external fixation to hemi arthroplasty. We compared the clinical and radiological outcomes of minimal invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in patients with proximal humerus fractures.</p> <p>Material &amp; Methods: This prospective study included 24 patients with 2 part and 3 part proximal humerus fracture treated with ORIF or MIPO technique, with 12 patients in each group. A matched pair analysis was performed and patients were followed up for 3 months, 6 months and 12 months both radiographically and clinically using Constant and Murley score.</p> <p>Results: The average of patients was 47.2 years. Average blood loss and mean duration of surgery was 287.50 ml and 102.9 mins, in ORIF group and 198.33 ml and 93.75 mins in MIPO group. The mean Constant Murley Score at 12 months in the MIPO group was 77.00, while in the ORIF group it was 72.33. MIPO group experienced significantly less pain, higher satisfaction in activities of daily living, and greater range of motion. In the MIPO group, only one patient had infection whereas in ORIF group three patients, had complications with one each having infection, varus collapse and malunion</p> <p>Conclusion: The use of MIPO with a locking compression plate in the management of proximal humerus fractures is a safe and superior option compared to ORIF.</p> Choudhari P Verma A Jain N Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 24 29 Evaluation Of Cast Index In Predicting The Outcome Of Pediatric Forearm Fractures https://ojmpc.com/index.php/ojmpc/article/view/101 <p>Background: Pediatric forearm fractures of radius ulna account for 40% of all pediatric fracture. Closed reduction followed by application of well molded plaster cast is the standard treatment for these fractures, which can be complicated by re-displacement inside the cast, which further needs re-manipulation or surgery. We assessed the rate if re-displacement in paediatric forearm fractures treated by cast by calculating the cast index.</p> <p>Material &amp; Methods: 30 patients with fractures of both radius ulna were treated with close reduction and cast application and Cast Index was calculated in immediate post reduction and subsequent radiographs at 2, 4 and 6 weeks. These were evaluated for re-displacement and their relation with cast index.</p> <p>Results: The mean CI was found to be 0.858. Three patients had re-displacement which required re-manipulation, the mean CI in these re-displacement group was 0.92. Mean CI was found to be higher in proximal third fractures however it did not correspond to increased incidence of re-displacement.</p> <p>Conclusion: Our study provides sufficient association of cast index in predicting the outcome of pediatric forearm fractures. Higher CI in proximal third fracture didn’t correspond to increased incidence of re-displacement.</p> Ajmera A Jain S Jain M Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 30 33 External Fixator As A Definitive Treatment For Tibial Diaphyseal Fractures https://ojmpc.com/index.php/ojmpc/article/view/102 <p>Background: Precarious blood supply, subcutaneous nature and lack of soft-tissue cover of the shaft of the tibia make these fractures vulnerable to open fractures with high rate of nonunion and infection. External fixators have been used to treat these open tibial fractures as temporary mode of fixation. We evaluated the role of external fixator as a definitive treatment for tibial diaphyseal fractures.</p> <p>Materials &amp; methods: 57 patients with open tibial diaphyseal fracture with various degree of soft tissues injuries, treated with external fixator as definitive fixation were included in the study. The outcome, rate of union and complications were assessed.</p> <p>Results: 57 patients with mean age 34.4 (range 18 to 59 years) were included. 45 were male while 12 were females. Mean duration of trauma to surgery interval 26.5 hrs. Mean time for dynamization was 7.44 weeks. 50 patients had union with mean time of union 22.4 weeks, while 7 patients had nonunion. 13 patients had pin tract infection, out of which 7 infections healed by oral antibiotics while 6 patients eventually had pin loosening requiring change of pin under local anaesthesia. One patient had malunion.</p> <p>Conclusion: External fixator is a very useful method for treatment of open tibial diaphyseal fractures which eliminates the need of second surgery and allows bone and soft tissue healing without increasing morbidity when applied properly.</p> Jain S Patel P Gupta S Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 34 39 Giant cell tumor of proximal radius: A rare case report and review of literature https://ojmpc.com/index.php/ojmpc/article/view/103 <p>Case report: Giant-cell tumor (GCT) of the bone is benign bone tumor which usually arises from the epiphysis of long bones. Distal femur and proximal tibia are the most common sites of this tumor. The proximal radius is extremely rare site of this particular tumor. We present a rare case of Giant cell tumor of proximal radius in a twenty-one year old girl, for which wide margin resection was performed successfully with no recurrence, complications or disability seen at one year follow up.</p> Jain T Bharadwaj L Tiwari A Verma R Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 40 44 Tarlov Cyst: A Case Report https://ojmpc.com/index.php/ojmpc/article/view/104 <p>Case Report: Tarlov cyst is rare perineural cyst, which may be symptomatic and present with with low back pain, sciatica, coccydynia or cauda equina syndrome. Symptomatic tarlov cyst needs to be removed surgically. We present such a rare case of symptomatic sacral cystic mass (tarlov cyst) presenting with severe lower back pain for months which was successfully treated by sacral laminotomy and cyst excision. The aim of reporting this case was to create awareness among the surgeons regarding this rare entity and to include it in differential diagnosis of chronic low back pain.</p> Verma A Jain S Jain M Mundra A Copyright (c) 2020 https://creativecommons.org/licenses/by-nc/4.0 2020-03-31 2020-03-31 26 1 45 48