Journal of Clinical Orthopaedics & Trauma RSS feed: Articles in Press. Journal of Clinical Orthopaedics and Trauma is the official, peer-reviewed publication of the Delhi Orthopaedic Association. The Journal is published twice a year (June and December) by Elsevier, a division of Reed-Elsevier (India) Private Limited. It is circulated to all bona fide members of Delhi Orthopaedic Association, all medical college libraries of India and subscribers. The Journal accepts original articles on clinical or laboratory research in the field of Clinical Orthopaedics and Trauma and review articles on topics of current interest. In addition, the Journal features articles of educational value to postgraduate students. Delhi Orthopaedic Association has taken new initiatives to foster Clinical Orthopaedics and Trauma Care across the country. The association has over 800 members and as a group, is making a large contribution to international literature. Besides there are problems specific to this region and the solutions for these need to be exchanged and this Journal would make a great contribution to disseminate the knowledge amongst members. The Editorial Board comprises 49 eminent Orthopaedic surgeons from India and abroad. Although preference is given to original work carried out in the Indian subcontinent, contributions are welcome from across the world. http://www.journal-cot.com//inpress?rss=yesElsevier Inc.en © 2012 Delhi Orthopedic Association. Published by Elsevier Inc. All rights reserved. Journal of Clinical Orthopaedics & Trauma0976-56622012-05-21 © 2012 Delhi Orthopedic Association. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journal-cot.com/article/PIIS0976566212000136/abstract?rss=yesAbstract: Background: The hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same.Methods: The study was conducted by1. Review of available national and international literature on the subject.2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire.3. By analyzing the data using appropriate statistical methods.Results: Eighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people.Conclusion: The five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness.Study of patient satisfaction at surgical unit of tertiary care teaching hospital - Corrected ProofP.H. Mishra, Shakti Gupta10.1016/j.jcot.2012.04.002Journal of Clinical Orthopaedics & Trauma (2012)2012-05-21Journal of Clinical Orthopaedics & Trauma2012-05-21ORIGINAL ARTICLEhttp://www.journal-cot.com/article/PIIS0976566212000148/abstract?rss=yesAbstract: Introduction: In this fast moving & advancing era no body want to remain handicapped in immobilization by cast with limited movement. As our knowledge is growing, orthopedic implants and appliances also advancing, and creating a very potential options to manage fracture shaft of humerus by internal fixation either by plate osteosynthesis or interlocking nailing. We are here to evaluate the options of internal fixation; nailing and plating.Material and method: We prospectively evaluated the results of 30 patients having humeral Shaft fracture. Who were internally fixed by antegrade interlocking nailing (15) and DCP plate (15). Patients are followed up on average of 16–19 months and results were evaluated with standard protocol.Results: All fractures united uneventfully with usual complication. However we need 2 reoperation in nailing and 1 case of plating for bone grafting.Conclusion: Internal fixation have immense use in providing better results in form of less deformity, early mobilization and good union. Plating is better option for fixation in terms of less union time, better joint function and lesser reoperation However Nailing is good alternative as minimal invasive approach, less infection, less nerve injury, less chance of implant failure.Humeral shaft fracture management, a prospective study; nailing or plating - Corrected ProofRupesh Kumar, Pankaj Singh, Lal Jee Chaudhary, Shailendra Singh10.1016/j.jcot.2012.04.003Journal of Clinical Orthopaedics & Trauma (2012)2012-05-21Journal of Clinical Orthopaedics & Trauma2012-05-21ORIGINAL ARTICLEhttp://www.journal-cot.com/article/PIIS097656621200015X/abstract?rss=yesAbstract: Osteosarcoma is the most common malignant primary neoplasm of bone. For an optimal oncological outcome, surgical removal of tumor is an essential component of its multidisciplinary treatment. Limb salvage surgery has long been established as the standard of care for osteosarcoma. While limb-salvaging techniques have acceptable rates of disease control, amputation remains a valid procedure in selected cases. In current orthopedic oncology practice, the focus is on optimizing the balance between preservation of form and function of the limb and adequate oncological clearance at the same time. Improving the functional outcome and longevity of reconstructive procedures also remains a challenge.Current concepts in surgical treatment of osteosarcoma - Corrected ProofAkshay Tiwari10.1016/j.jcot.2012.04.004Journal of Clinical Orthopaedics & Trauma (2012)2012-05-21Journal of Clinical Orthopaedics & Trauma2012-05-21REVIEW ARTICLEhttp://www.journal-cot.com/article/PIIS0976566212000185/abstract?rss=yesJust few weeks back, while surfing the net, I stumbled upon the programme schedule of a major orthopaedic conference of the world. The list consisted of the usual presentations in the various subspecialties, symposia and the general topics of interest for the orthopaedic surgeons. One thing which caught my eye was the section devoted to the latest technologies in the field of orthopaedics. This made me think regarding the state of affairs in our own country regarding the same. Are we even cognisant of the latest technologies in the field of science and communication which have inundated the market and made their way into the medical field as well? Orthopaedics has long been considered to be a specialty which relies more on getting the investigations done to diagnose the pathology and offer treatment for the same. Most of us work in the ‘macro’ world looking at the radiographs, MRI and the CT scans and do not think about the ‘micro’ world. With the unfolding of the new millennia, there has been a lot of change in all fields including orthopaedics. But the question still remains; are we, the orthopaedic surgeons in India, even aware of these changes? What efforts are being made to incorporate these changes in our specialty or our curriculum?Emerging technologies in orthopaedics: Are we ready for the challenge? - Corrected ProofVivek Trikha10.1016/j.jcot.2012.04.006Journal of Clinical Orthopaedics & Trauma (2012)2012-05-18Journal of Clinical Orthopaedics & Trauma2012-05-18EDITORIALhttp://www.journal-cot.com/article/PIIS0976566212000173/abstract?rss=yesAbstract: Bilateral anterior dislocation of the shoulders with fractures of both greater tuberosities is very rare. A 76-year-old woman sustained a bilateral anterior dislocation of her shoulders with fractures of the greater tuberosity on both sides after a fall on stairs. Her arms were abducted and externally rotated. Radiological examination revealed the bilateral anterior dislocation and also the bilateral fractures of the greater tuberosity. Prompt closed reduction followed by a 3 weeks immobilization and subsequent rehabilitation allows a good outcome. Results at one-year follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral anterior shoulder dislocation associated with fractures of both greater tuberosities in elderly woman.Bilateral anterior shoulder dislocation with bilateral fractures of the greater tuberosity: A case report - Corrected ProofF. Dlimi, M. Mahfoud, A. Lahlou, A. El Bardouni, M.S. Berrada, M. El Yaacoubi10.1016/j.jcot.2011.04.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-17Journal of Clinical Orthopaedics & Trauma2012-05-17CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000057/abstract?rss=yesAbstract: Accessory ossicles and sesamoid bones are skeletal variations, more commonly seen in the region of foot and ankle. Most such accessory and sesamoid bones remain asymptomatic. However overuse and trauma can make such feet symptomatic. Knowledge of such bony ossicles is essential in the management of patients presenting with foot pain.Dorsal foot pain can be caused by a symptomatic Os intermetatarseum – an accessory ossicle found between the bases of first and second metatarsals and the medial cuneiform. Its incidence has not been well established because of insufficient appropriate multi-centric anatomical, radiological and orthopaedic studies. A case of dorsal foot pain in a soccer player, caused by an Os intermetatarseum is reported here. A brief review of the literature is also presented.Os intermetatarseum – A case report - Corrected ProofViswanath H. Chavali10.1016/j.jcot.2011.11.002Journal of Clinical Orthopaedics & Trauma (2012)2012-05-14Journal of Clinical Orthopaedics & Trauma2012-05-14CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000112/abstract?rss=yesAbstract: Chronic iliac osteomyelitis classically presents radiologically as an ill defined radiolucent lesion with moth eaten appearance along with periosteal reaction and sequestrum formation. Our case report presents a rare radiological picture of iliac bone osteomyelitis in the form of an expansile mutiloculated lytic lesion.Chronic osteomyelitis of ilium presenting as an expansile mutiloculated lytic lesion – A case report - Corrected ProofKopuri Ravi Kiran, Y. Poornachandra Rao, V. Somnadham, T.V. Suresh Babu, N. Krishna Prasad10.1016/j.jcot.2011.10.002Journal of Clinical Orthopaedics & Trauma (2012)2012-05-14Journal of Clinical Orthopaedics & Trauma2012-05-14CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000069/abstract?rss=yesAbstract: A 40-year-male treated with hip screw for unstable inter trochanteric fracture femur, had an implant failure after an aggressive therapy session .The Dynamic Condylar Screw was removed and fracture was fixed with Proximal Femoral Nail. The nail also failed to achieve its goal of fracture union, as a result of a unique type of reverse Z effect, in contradiction to expected Z effect resulting in intrapelvic migration of proximal hip lag screw of the proximal femoral nail.Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis - Corrected ProofHitesh Lal, Deepak Kumar Sharma, Deepak Mittal10.1016/j.jcot.2012.02.002Journal of Clinical Orthopaedics & Trauma (2012)2012-05-11Journal of Clinical Orthopaedics & Trauma2012-05-11CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000082/abstract?rss=yesAbstract: The treatment of displaced proximal tibial fractures is challenging. Recent developments in the techniques of internal fixation, including the development of locking plates and minimally invasive surgical techniques have revolutionaries the treatment of such fractures. We present a case of proximal displaced tibial fracture that was treated with anatomical proximal tibial locking plate using minimally invasive percutaneous plate osteosynthesis. Patient made uneventful recovery even after he sustained re-injury and plate bending and was manipulated under anaesthesia for the same.Salvage of proximal tibia fracture treated with locked compression plate - Corrected ProofSumit Arora, Navneet Goel, Pankaj Aggarwal, Ashwani Singh, Sambit Panda10.1016/j.jcot.2011.10.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-11Journal of Clinical Orthopaedics & Trauma2012-05-11CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000100/abstract?rss=yesAbstract: Osteonecrosis of the knee is a well-described cause of acute knee pain. It can lead to significant functional impairment, rapid arthritic joint changes and subsequent collapse. Several hypotheses exist different treatment options are used ranging from conservative management to joint arthroplasty. The majority of cases involve the distal femoral condyle and to a much lesser extent the medial tibial plateau.We are presenting a rare case of osteonecrosis of the proximal tibia affecting the lateral tibial condyle in 44 years old Caucasian male which was treated successfully using osteonecrotic tantalum rods with 26 month follow-up.Management of osteonecrosis of proximal tibia using trabecular osteonecrotic rods - Corrected ProofBiyyam Rao, Tamer Kamal10.1016/j.jcot.2012.03.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-11Journal of Clinical Orthopaedics & Trauma2012-05-11CASE REPORThttp://www.journal-cot.com/article/PIIS0976566212000124/abstract?rss=yesAbstract: Purpose: The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems.Proximal femoral fractures: Principles of management and review of literature - Corrected ProofRavi Mittal, Sumit Banerjee10.1016/j.jcot.2012.04.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-11Journal of Clinical Orthopaedics & Trauma2012-05-11REVIEW ARTICLEhttp://www.journal-cot.com/article/PIIS0976566212000033/abstract?rss=yesAbstract: Developmental dysplasia of hip (DDH) is one entity one occasionally comes across while in a busy orthopaedic or paediatric outpatient department. The knowledge of risk factors and awareness of the condition is must for every orthopaedic surgeon and paediatrician as well lest the diagnosis will be missed. An early diagnosis can alter the prognosis of the disease and prevent late disabilities.Risk factors and diagnosis of developmental dysplasia of hip in children - Corrected ProofAnil Agarwal, Neeraj Gupta10.1016/j.jcot.2011.11.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-10Journal of Clinical Orthopaedics & Trauma2012-05-10REVIEW ARTICLEhttp://www.journal-cot.com/article/PIIS0976566212000045/abstract?rss=yesAbstract: Approximately 50% of infant and toddler long bone fractures are attributed to non-accidental trauma; however, differentiating from benign mechanisms is subjective, due to an absence of evidence-based diagnostic tools. Previous studies investigated small ranges of rotational velocities in animal long bone models, although did not report the variation in the spiral fracture angle. This study considered the fracture angle as a potential clinical measure, correlating this data with a wider range of rotational velocities. The spiral fracture angle was measured relative to the long axis, whilst noting the narrowest diaphysial diameter, location of the fracture, and the extent of comminution and periosteal disruption. Twenty-six bones failed in spiral fracture, with the potting material failing in the remaining tests. All spiral fractures centred on the narrowest diaphysial diameter. Slower rotational velocities caused fracture angles approaching 45°, whereas fractures at greater velocities caused fracture angles nearer 30°. A relatively strong trend (R2=0.78) is reported when the normalised fracture angle (against the narrowest diaphysial dimension) was plotted against the rotational rate. A relationship has been identified between the angle of spiral fracture and the rotational velocity using the immature bovine metatarsal model. This trend forms a scientific foundation from which to explore developing a diagnostic, evidence-based tool that may ultimately serve to assist differentiating between accidental and non-accidental injury.Biomechanical investigation into the torsional failure of immature long bone - Corrected ProofPeter S. Theobald, Assad Qureshi, Michael D. Jones10.1016/j.jcot.2012.02.001Journal of Clinical Orthopaedics & Trauma (2012)2012-05-10Journal of Clinical Orthopaedics & Trauma2012-05-10REVIEW ARTICLEhttp://www.journal-cot.com/article/PIIS0976566212000094/abstract?rss=yesImmediate management of fractures of the distal radius may include manipulation under anaesthetic (MUA), to restore a more anatomical position and aid functional recovery. The decision to manipulate is often an empirical one, made by assessment of fracture characteristics such as angulation, often estimated visually. We assessed the accuracy of estimations of fracture angulation by all orthopaedic and emergency medicine staff in two hospitals, and found a marked discrepancy between estimated and measured angles.Estimation of radiographic measurements in fracture distal radius. Should we be using digital measuring tools? - Corrected ProofSimon Nicholson, Bijayendra Singh10.1016/j.jcot.2012.02.003Journal of Clinical Orthopaedics & Trauma (2012)2012-05-10Journal of Clinical Orthopaedics & Trauma2012-05-10LETTER TO THE EDITOR