Implants used for total knee replacement (TKR) in most Asian countries are not designed originally for the Asian population, and studies have shown anthropometric differences with respect to TKR among various ethnic groups. For this reason, implants designed for a specific population may not provide an anatomic fit when used in other populations. To avoid the consequences associated with such a misfit, the concept of ethnic-specific implant design is being introduced. In this study, the knee anthropometry of the Indian and Arabian patients was compared. They were operated with implants which were not ethnic-specific designs. Since the consequences associated with implant misfit apply equally to both the Indian and Arabian population, it is essential to compare the knee anthropometry of these two populations. Anthropometric measurements of the distal femur and proximal tibia of the Indian and Arabian knees were obtained intraoperatively using a Vernier caliper. Their respective aspect ratios (ARs) were calculated and statistically compared. It was found that the ARs of both tibia and femur of Indian and Arabian population did not show any statistical difference. There was no statistical difference between Indian and Arabian males (p = 0.345) and between Indian and Arabian females (p = 0.8210). However, a statistical difference in tibial AR (p-value = 0.049) and femoral AR (p-value = 0.003) was found significant when a comparison was made between the knees of Indian males and Indian females in the study. The above results suggested that TKR implants designed anatomically to suit the Indian population can also suit the Arabian population and vice versa. The obtained data can help implant designers to come up with ethnic-specific TKR implants.
The aesthetic appearance of the thumb hasn't been analysed to a similar extent as thumb function which would aid during reconstructive surgeries of the thumb and first web space and analyse its outcome. The purpose of this study is to determine the relative length, girth, nail width of thumb with respect to the index finger and intermetacarpal distance. Measurement of the 1 st web space arc radius has been done to tackle the problem of webbing which is not addressed by IMD and palmar abduction angles. A total of 482 hands in 241 subjects were studied to measure the relative length of the thumb with respect to the index finger, the relative nail width of thumb with respect to index finger, the relative girth of IP joint of thumb with respect to PIP joint of index finger and Intermetacarpal distance was calculated. The 1 st web space arc radius was calculated by the "best arc fit" with the thumb in maximum radial abduction using a radius gauge. The data collected was analysed by age, gender, laterality of the hand and the height and weight of the child. Hands of subjects of which with a mean age of years were analysed. The relative Thumb length, girth and nail width remained independent of age. It has been observed that the reliability of the measurements between the right and left web space arc radius measurement is significant . The provided would help reconstructive surgeons analyse aesthetic outcomes of reconstructive surgeries intraoperatively and post operatively. A correlation between the 1 st web space arc radius of right and left hands would help predict the expected post-operative outcome.
anterior cord syndrome. We present a case of traumatic unstable C2 flexion tear drop fracture without neurological deficit. We have treated the patient successfully with anterior cervical plating and tricortical bone grafting after removal of tear drop fragment and discectomy. This patient was mobilized on next day after surgery and neck mobilization started after 3 weeks. The patient in our study was followed up for 6 years and found to have no sequlae related to the injury. Unstable tear drop fracture needs to be fixed irrespective of the presence or absence of neurological deficit. Open reduction internal fixation with low profile plate and tricortical bone graft, shaped to fit the defect and disc space, through high anterior retropharyngeal approach is a promising treatment for unstable tear drop fractures. Key words: INTRODUCTIONTear drop fractures are rare injuries occurring in upper and lower cervical region. It occurs most often at C5 vertebrae followed by C6 and C4, sometimes involving the nearby vertebrae [1] . The reason for this is that normal cervical spine has a lordotic angle and the stress is more on C5 during flexion of the neck [2] . In the upper cervical region, axis vertebrae fracture is the most commonly reported and the incidence come to nearly 3% of cervical spine injuries [3] . Like any other tear drop fractures C2 tear drop fractures are also caused by flexion and hyper extension injuries. Management of the tear drop fractures are based on the stability of the cervical segment. The spectrum of management varies from conservative to surgical including immobilization, traction, corpectomy with fusion,
Background: Primary parathyroid adenoma is a diagnostic challenge especially in asymp-tomatic patients. We report a late diagnosed case of primary parathyroid adenoma in a patient who underwent bilateral total knee replacement. Case Presentation: A 65 year old female patient underwent bilateral Total Knee Arthroplasty (TKA) for tri-compartmental osteoarthritis. Since intra-operatively the bone was extremely soft, a metabolic workup was done. Serum calcium and parathyroid hormone was extremely high and phosphorus was low immediate post-total knee replacement. The DEXA scan of hip, spine, distal radius showed density less than -2.5 SD. Ultrasound scan and nuclear imaging was suggestive of parathyroid adenoma. Patient underwent focused parathyroidectomy of right inferior parathyroid after 1 month. Post parathyroidectomy, PTH, serum calcium and phosphorus levels reverted back to normal. At six months follow up after bilateral TKA, patient is walking without any symptoms. Conclusion: Delayed diagnosis of parathyroid adenoma, especially in arthroplasty surgeries, leads to intra-operative complications, but it can be avoided. Proper metabolic workup of all the arthroplasty cases and a multi-disciplinary approach is necessary.
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