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Background: Adequate research is not reported so far to underline the influence of commonly used polycentric knee joints on gait performance of subjects with trans-femoral amputation. Objective: The intent of this investigation is to analyze prosthetic gait of unilateral traumatic trans-femoral amputees with polycentric four-bar linkage knee and compare it with normal subjects for evaluating any asymmetry in gait performance. Methods: Objective three-dimensional gait analysis of 15 subjects [mean (age): 36.4 (10.7) years] were performed in gait lab through force plate and optoelectronic devices to measure temporal-spatial parameters, kinematic and kinetic performances. Gait patterns of amputees were compared with those of 15 individuals with normal gait to analyze distinct functionalities of existing polycentric knee. Results: Asymmetry in gait was observed between amputees and normal subjects for all variables concerned ([Formula: see text]). Amputee gait was with significantly lesser velocity, cadence with shorter step and stride length. There was significantly less hip, knee and pelvic motions, however, pelvic obliquity and rotation did not show significant difference from the normal subjects. The vertical component of the ground reaction force differed significantly between prosthetic and intact limb [49.7 (8.5)% and 90.4 (7.4)% body weight] and also from normal subjects [107.5 (2.4)% body weight] during stance ([Formula: see text]). Interpretation and Conclusion: This difference may be attributed to nonproportionate loading of limbs and mechanical adaptations for counteracting deficiencies of prosthetic side. This study will help to explain gait asymmetry in trans-femoral amputees and to identify underlying mechanisms to enhance the quality of the existing design of prosthetic knee through optimizing design parameters and utilizing appropriate materials.

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There is no consensus on the timing for early surgery in spinal cord injury (SCI). On Pubmed, we found no primary research article from India evaluating the effects of timing of surgery on outcomes in SCI patients. This single-centre prospective observational study was done to evaluate the outcome of surgical decompression done > 72 h after traumatic incomplete SCI and assess prognosis over 6 and 12 months. Patients, with history of traumatic incomplete SCI of < 6-month duration and below C5 vertebra level, who had had late surgery (> 72 h after the injury) elsewhere were enrolled. A complete and standard neurological examination was done at presentation. Neurological and functional recovery was assessed at 6 and 12 months. Forty-two patients fulfilling the inclusion criteria were followed up of at least 12 months. At baseline, 31 had ASIA B and 11 had ASIA C grade. By 6 months, 4 patients improved by 1 ASIA grade. By 12 months, 14 patients improved by 1 grade and two by 2 grades. Mean motor recovery and overall functional recovery were significant (p = 0.03 and p < 0.001 respectively). Patients with lumbar injuries had significantly better overall functional recovery at both 6 (p = 0.006) and 12 months (p < 0.001). ASIA C group recovered significantly better than ASIA B group in terms of mean motor recovery percentage (14.33 vs 8.12, p = 0.014 at 6 months; 23.96 vs 16.56, p = 0.016 at 12 months) and mean spinal cord independent measures (SCIM) recovery percentage (43.01 vs 32.03, p = 0.039 at 6 months; 62.25 vs 38.4, p < 0.001 at 12 months). Surgery > 72 h after incomplete traumatic SCI, assessed at 2-4 months post injury, may still have encouraging outcomes. Our study may be the first from India to assess the outcome of delayed surgery in incomplete SCI patients but larger prospective studies involving multiple centres are needed for stronger evidence. Inclusion of non-operative cohort would have differentiated the result from spontaneous recovery.

<p class="abstract"><strong>Background:</strong> Split hand/foot malformation with longitudinal deficiency of tibia (SHFLD1) is an extremely rare congenital anomaly, even rarer are the descriptions in the literature of suitable techniques of treatment. Most of the literature available are case reports, based on genetic studies. This study highlights on functional management rather than anatomic correction of deformity. A clinician may not come across a patient with such a rare congenital disorder during his entire career.</p><p class="abstract"><strong>Methods:</strong> On retrospective review of hospital record from July 2008 to July 2018, we observed 5 cases of tibial deficiency associated with split hand and or split foot anomalies and diagnosed as SHHLD syndrome. Clinical and radiological analysis was done to plan out surgical and rehabilitation protocol for individual cases.<strong></strong></p><p class="abstract"><strong>Results:</strong> As per Flatt’s grouping of split hand, 3 limbs (37.5%) were group-1 type, 3 limbs (37.5%) of group-2 type and group-3 type was seen in 2 limbs (25%) of a patient with bilateral involvement. With respect to Jone’s radiological classification system, 4 limbs (57%) were of type Ia, 2 limbs (29%) were having type IV deformity and 1 limb (14%) was with type II deformity. One case agreed for amputation was fitted with above knee prosthesis and another one with custom designed bend knee prosthesis. Eldest case was rehabilitated with tricycle and modified orthosis. Surgical correction was tried in one case.</p><p class="abstract"><strong>Conclusions:</strong> Functional rehabilitation instead of anatomic correction should be tried at late presentation. Cleft closure should be done before development of functional adaptability.</p>

Evaluation of single and double limb support postural balance in patients with Anterior cruciate ligament (ACL)injury and comparison of the postural strategy adopted after ACL injury/deficiency(ACLD) with that of an age-matched healthy individual. Methods: The study group that included 33 subjects confirming inclusion criteria had undergone postural balance assessment using the HUMAC Balance system. The parameters of the center of pressure excursion were recorded on a force plate and compared with age, BMI matched 66 healthy volunteers of control group. The center of pressure excursions was monitored using dependable variables such as sway path length(cm), the average velocity of sway(cm/sec), and the mean COP stability score(%). The mobility component was recorded as the percentage (%) of time spent on each target. Result: A decrease in postural balance in the injury group was evidenced by a statistically significant decrease of stability score(p ¼ 0.015), increase in path length(p ¼ 0.002) and decrease on time on target mean score (p¼ <0.001),. Although, the stability score path length and average sway velocity scores in the sound limb of the ACLD group showed impaired balance, the differences were not statistically significant (p ¼ 0.180, p ¼ 0.561, and p ¼ 0.639 respectively) when compared with the dominant limb of the control group. Conclusion: HUMAC balance system is an effective and simplified measure for quantifying postural balance. Although overall postural stability in ACL injury is impaired, static postural balance is maintained by the compensatory of strategy of sound limb. However, the quantitative parameters of postural stability for the sound limb, despite of a lower mean value, did not show statistically significant differences from the dominant limb of the controlled group.