Background:Autologous cancellous bone is the most effective biological graft material. However, harvest of autologous bone is associated with significant morbidity. Since porous hydroxyapatite and beta-tricalcium phosphate are biodegradable materials and can be replaced by bone tissue, but it lacks osteogenic property. We conducted a study to assess their use as a scaffold and combine them with bone marrow aspirate for bone regeneration using its osteogenic property for posterolateral spinal fusion on one side and autologous bone graft on the other side and compare them radiologically in terms of graft incorporation and fusion.Materials and Methods:Thirty patients with unstable dorsal and lumbar spinal injuries who needed posterior stabilization and fusion were evaluated in this prospective study from October 2005 to March 2008. The posterior stabilization was done using pedicle screw and rod assembly, and fusion was done using hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute over one side of spine and autologous bone graft obtained from iliac crest over other side of spine. The patients were followed up to a minimum of 12 months. Serial radiographs were done at an interval of 3, 6, and 12 months and CT scan was done at one year follow-up. Graft incorporation and fusion were assessed at each follow-up. The study was subjected to statistical analysis using chi-square and kappa test to assess graft incorporation and fusion.Results:At the end of the study, radiological graft incorporation and fusion was evident in all the patients on the bone graft substitute side and in 29 patients on the autologous bone graft side of the spine (P > 0.05). One patient showed lucency and breakage of distal pedicle screw in autologous bone graft side. The interobserver agreement (kappa) had an average of 0.72 for graft incorporation, 0.75 for fusion on radiographs, and 0.88 for the CT scan findings.Conclusion:Hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate seems to be a promising alternative to conventional autologous iliac bone graft for posterolateral spinal fusion.

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Introduction: Neglected Monteggia fracture dislocation in children leads to significant restriction of daily activities by causing decreased range of motion at elbow, stiffness, deformity, and neurological compromise. Various treatment strategies have been described in the literature and one of them is ulnar osteotomy combined with reduction of radial head and annular ligament reconstruction. Aim: The aim of this study was to evaluate the results of step-cut osteotomy without the use of bone grafting with reconstruction of annular ligament in the management of neglected Monteggia fracture dislocation in children. Materials and Methods: A retrospective study was conducted in six patients with neglected Monteggia fracture dislocation with a mean age of 8.83 years. The median interval between the original injury and the corrective surgery for 6 patients was 4.4 months (range 1–12 months). All children underwent step-cut osteotomy of ulna, open reduction of radial head, and annular ligament reconstruction. Mayo Elbow Performance Index (MEPI) score was used for evaluation. Results: The ulnar osteotomies healed uneventfully without the need for a bone graft. Elbow range of motion improved post-op along with improved elbow functioning as indicated by raised MEPI score. The MEPI score was excellent in 5 cases and fair in 1 case. Conclusion: Step-cut osteotomy alone without the use of bone grafting and reinforcement with annular ligament repair is a simple yet effective technique for treating neglected Monteggia fracture dislocation.

Aims:To assess the effect of zoledronic acid (ZOL) on fracture healing in osteoporotic patients with intertrochanteric fracture based on radiological evaluation and to study the correlations between severity of osteoporosis, age, gender, and time taken to fracture union.Settings and Design:An open label study was conducted on 43 patients at a tertiary care center.Subjects and Methods:The osteoporosis status of all the included patients was documented using a double-energy X-ray absorptiometry scan. A single dose of injection ZOL 5 mg was administered intravenously to all the patients after fixation during their hospital stay. Follow-up of the patients was done at 1, 3, and 6 months after surgery until union was seen radiologically.Statistical Analysis Used:Data were entered into Microsoft Office Excel version 2007, and interpretation and analysis of obtained data were done using summary statistics. Pearson correlation between age, gender, bone mineral density (BMD), and time taken to fracture union was done using the IBM SPSS Version 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.).Results:The average age of the patients included in the study was 71.27 ± 11.48 and the average BMD was -4.58±1.42. All the fractures united by the 6th month of follow-up, which was similar to the union rate in comparison with the literature. The correlations between the gender, BMD, age, and time to union were calculated, and all the r values obtained showed very low correlation and the P values in all the variables were not significant.Conclusion:The bisphosphonate therapy did not adversely affect radiologically determined fracture union, and no correlations between severity of osteoporosis, age, gender, and time taken to fracture union were found to be significant.

A clear cell hidradenoma is a rare dermal tumor, which is believed to originate from the apical portion of the sweat glands. The usual size reported is 5–30 mm. It is generally found in the head, face, and upper extremity regions. This lesion has not been reported to be large enough to impinge a joint range of motion. Hence, its description in the orthopedic literature is extremely rare. We present a giant benign nodular hidradenoma presenting as painful restriction of the right shoulder joint in a 35-year-old male.

Statistically the pertrochanteric fracture configuration as per AO Classification does not correlate with the osteoporosis severity of the patient.

Background:New and expensive technology such as three-dimensional computer assisted surgery is being used for pedicle screw fixation in dorsolumbar spine. Their availability, expenses and amount of radiation exposure are issues in a developing country. On the contrary, freehand technique of pedicle screw placement utilizes anatomic landmarks and tactile palpation without fluoroscopy or navigation to place pedicle screws. The purpose of this study was to analyze and compare the accuracy of freehand and image-assisted technique to place pedicle screws in the dorsolumbar spine of cadavers by an experienced surgeon and a resident. Evaluation was done using dissection of pedicle and computed tomography (CT) imaging.Materials and Methods:Ten cadaveric dorsolumbar spines were exposed by a posterior approach. Titanium pedicle screws were inserted from D5 to L5 vertebrae by freehand and image-assisted technique on either side by an experienced surgeon and a resident. CT was obtained. A blinded radiologist reviewed the imaging. The spines were then dissected to do a macroscopic examination. Screws, having evidence of cortical perforation of more than 2 mm on CT, were considered to be a significant breach.Results:A total of 260 pedicle screws were placed. The surgeon and the resident placed 130 screws each. Out of 130 screws, both of them placed 65 screws each by freehand and image- assisted technique each. The resident had a rate of 7.69% significant medial and 10.76% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 9.23% significant lateral breach. The expert surgeon had a rate of 6.15% significant medial and 1.53% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 6.15% significant lateral breach on CT evaluation.Conclusion:Freehand technique is as good as the image-assisted technique. Under appropriate supervision, residents can safely learn to place freehand pedicle screws with an acceptable violation rate.

Abstract:Introduction: Osteoarthritis of the knee is a common orthopaedic condition. Medial compartment osteoarthritis results from undue stress on the medial compartment of the knee joint following varus deformity. High tibial osteotomy (HTO) has been a long-standing treatment for osteoarthritis of the medial compartment of the knee. Although knee replacement has gained wide popularity for its treatment, still HTO is a good and cost effective procedure for young patients having good range of motion and uni-compartmental involvement. Objective: To evaluate the results of HTO in medial compartment osteoarthritis. Methods and Material: This study was conducted in a tertiary care teaching hospital of North India over a period of 3 years. The patients with disabling knee pain due to medial compartment osteoarthrosis with genu varus deformity refractory to conservative treatment were treated by High Tibial Osteotomy. Results: Overall 40 patients with medial compartmental osteoarthritis were treated with HTO. Patients were evaluated for the severity of pain as per Visual Analogue Score (VAS). There was satisfactory pain reduction (up to 80%) in most of the patients. Conclusions: HTO is a good procedure for young patients with good range of motion and changes confined to one compartment only.