This study aimed to evaluate whether patients with advanced non-small-cell lung cancer experience disrupted rest -activity daily rhythms, poor sleep quality, weakness, and maintain attributes that are linked to circadian function such as fatigue. This report describes the rest -activity patterns of 33 non-small-cell lung cancer patients who participated in a randomised clinical trial evaluating the benefits of melatonin. Data are reported on circadian function, health-related quality of life (QoL), subjective sleep quality, and anxiety/depression levels prior to randomisation and treatment. Actigraphy data, an objective measure of circadian function, demonstrated that patients' rest -activity circadian function differs significantly from control subjects. Our patients reported poor sleep quality and high levels of fatigue. Ferrans and Powers QoL Index instrument found a high level of dissatisfaction with healthrelated QoL. Data from the European Organization for Research and Treatment for Cancer reported poor capacity to fulfil the activities of daily living. Patients studied in the hospital during or near chemotherapy had significantly more abnormal circadian function than those studied in the ambulatory setting. Our data indicate that measurement of circadian sleep/activity dynamics should be accomplished in the outpatient/home setting for a minimum of 4 -7 circadian cycles to assure that they are most representative of the patients' true condition. We conclude that the daily sleep/activity patterns of patients with advanced lung cancer are disturbed. These are accompanied by marked disruption of QoL and function. These data argue for investigating how much of this poor functioning and QoL are actually caused by this circadian disruption, and, whether behavioural, light-based, and or pharmacologic strategies to correct the circadian/sleep activity patterns can improve function and QoL.

BackgroundTriceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event.Case DetailsWe present a case of triceps tendon avulsion which was missed in the initial workup by a local practitioner. Careful physical examination and evaluation of the X-rays clinched the diagnosis. The patient was treated surgically by transosseous suture technique using the Krakow method. The end result was a good range of movement and a power equal to the uninjured side. A high index of suspicion, physical examination seeking a palpable gap, and search for a ‘flake’ fracture on lateral radiographs will help make the diagnosis of triceps avulsion. Early recognition of these injuries and prompt intervention are the cornerstones of a successful outcome. A second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or during any unclear joint injury. We recommend a primary repair through a transosseous suture technique using Krakow method for optimal results.

Backgroud Coronavirus Disease 2019 (COVID-19) has spread globally affecting all strata of people including the orthopaedic surgeons of India. We have witnessed a drastic fall in the number of patients. The aim of study was to assess the extent to which the Indian orthopaedic practice has been affected by the pandemic. Methods We conducted an online survey amongst currently practicing Indian orthopaedic surgeons. Those currently not in practice or under training or having left clinical practice before the onset of pandemic were excluded. A total of 533 orthopaedic surgeons took part in the study amongst which, complete responses were obtained from 407 individuals. Statistical analysis was done to see the association between demographic profile of study participants and various variables of orthopaedic practice. Results There was drastic fall in all the parameters of orthopaedic practice. Over half of the practicing surgeons witnessed fall in outpatients over 90%. Most had stopped elective surgeries (64%) and even emergency ones (21%) altogether. More than 50% of doctors had their earnings reduced by > 75%. We found a statistically highly significant association of reduction in earnings with the sector, type of setup and duration of practice. (p-value < 0.001). Conclusion This study suggests that orthopaedic surgeons across all sectors in different kinds of setups have been affected in their outpatient and operative numbers. With regards to earnings, those working in private and running their own (individual) hospitals & clinics have been most severely affected while those in government sector and medical colleges have been affected the least.

BackgroundVolkmann’s ischemic contracture is a less common but crippling condition affecting the extremities. Once the condition sets in, the prognosis always remains guarded, even after long and intensive physiotherapy and various restorative surgical techniques. This study was undertaken to evaluate the long-term functional results of the Max Page muscle slide operation in patients with Volkmann’s ischemic contracture of the forearm of moderate degree (Tsuge classification).Materials and methodsNineteen patients treated between 1997 and 2009 were evaluated. The functional outcome (measured as the dexterity score, hand grip strength, sensibility, and appearance) was analyzed postoperatively. The pre- and postoperative values were compared using a paired t test. The final results were graded as good, fair, and poor.ResultsThe average age at the time of presentation was 18 years (range 3–25 years). Tight external splintage for injuries around elbow and forearm was the primary factor. The mean period of follow-up was 3.53 years. Fifteen patients were able to achieve good functional results. Three had fair and one had poor results. All three variables showed significant improvements postoperatively. Wound dehiscence was the most common complication. One patient needed a second surgery to restore good hand function.ConclusionThe Max Page muscle sliding operation to treat Volkmann’s ischemic contracture of moderate degree gives good functional results. The procedure is simple and easy to perform. Adequate muscle release and proper postoperative physiotherapy are key to achieving good results.

Background:Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing paratricipital approach which allows early elbow mobilization and preserving triceps strength.Materials and Methods:Twenty five patients with intraarticular distal humerus fracture were operated using triceps-sparing paratricipital approach with orthogonal plate construct. There were 16 male and 9 female patients and average age was 42.16 years (range 23-65 years). The mechanism of injury was fall from height (n = 8), road traffic accident (n = 13) and ground level fall (n = 4). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtained at follow up period.Results:All fractures united primarily. At the mean follow up of 13.58 months (range 6-22 months), mean elbow flexion was 121.08° (range 94°–142°) and mean motion arc was 114.92°(range 65°-140°). The mean MEPI score was 94.40 points (range 70–100) with 17 excellent, five good, and three fair results. The mean flexion deformity or extension loss was 6.16° (range 5°–15°).Conclusion:Open reduction and internal fixation of intraarticular distal humerus fractures with triceps-sparing paratricipital approach provide adequate exposure with no adverse effect on triceps muscle strength and allows early initiation of elbow motion. We analyzed, age and injury to surgical interval with relation to functional range of elbow using Z-test which is insignificant.