Buddhadev Chowdhury | All India Institute of Medical Sciences, New Delhi (original) (raw)

Papers by Buddhadev Chowdhury

DOAJ (DOAJ: Directory of Open Access Journals), 2017

Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach ... more Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss. Methods: Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs. Result: Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37), p=0.90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91), p=0.73 (I2=0%). The operative time was significantly shorter with modified Stoppa approach (MD 48.79 (-80.29 to-17.30), p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15), p=0.56, I2=0%) and blood loss (MD=-212.89 (-476.27 to 50.49) p=0.06, I2=71%). Conclusion: Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results.

Injury-international Journal of The Care of The Injured, Oct 1, 2020

PubMed, Dec 1, 2013

Advanced trauma life support is currently considered to be the gold standard for the practice of ... more Advanced trauma life support is currently considered to be the gold standard for the practice of acute trauma management. The effectiveness of the ATLS in improving patient outcome has been shown in numerous studies. Introduction of ATLS program has significantly improved trauma patient outcome. Integral to the success of this course lies in the systematic approach to the trauma patient. The aim is rapid and accurate assessment of the patient’s physiological status and further management based on these parameters. A standardized and organized approach to trauma patients helps to prevent secondary injury and improve outcome. 2 It has been suggested that a trauma management system based on ATLS training and the development of the trauma team concept has apparent benefit for patient survival. Clinicians with previous ATLS training or exposure to ATLS principles are more ordered in their approach to patient management during trauma. The aim is to provide a system of care that is safe, effective and able to be practiced in all trauma receiving hospitals. Today the ATLS is being practiced in more than 60

European Journal of Orthopaedic Surgery and Traumatology, Oct 24, 2020

Background This study aims to describe an uncommon presentation of posterior wall acetabular frac... more Background This study aims to describe an uncommon presentation of posterior wall acetabular fracture-dislocation with displacement of fracture fragment anterior to femoral head with its management and clinico-radiological outcome. Methods This retrospective review was performed at a Level I trauma centre over a period of six years. Hospital records, radiological database, operative register and follow-up data identified 7 patients with anteriorly lying posterior wall fragment of acetabulum. Analysis was performed with 6 patients having complete follow-up ranging from 2 to 7 years. The patients were operated with standard Kocher-Langenbeck approach; modification of this approach with trochanteric flip osteotomy and safe surgical dislocation was performed based on the location of the anteriorly lying fragment. Final functional and radiographic outcome was analysed according to modified Merle D'Aubigné and Postel score, and Matta's grade, respectively. Results This uncommon presentation was observed in 11.11% of patients out of 63 patients with isolated posterior wall acetabular fractures managed during the study period. Anteriorly displaced posterior wall fragment was located in anterosuperior (n, 3), anterocentral (n, 2) and anteroinferior (n, 1) quadrants anterior to the femoral head. Final clinical and radiographic outcome revealed good-to-excellent outcome in 5 (83.33%) patients, and poor in one. One patient developed progressive arthrosis of hip which required total hip arthroplasty within 2 years. Conclusion This unusual pattern of posterior wall fracture requires adequate pre-operative planning, careful handling of the fractured fragments along with its soft tissue attachments during surgery, and preferably a concomitant trochanteric flip osteotomy with/without surgical hip dislocation to achieve good results.

European Journal of Orthopaedic Surgery and Traumatology, Feb 4, 2022

African Journal of Emergency Medicine, Sep 1, 2015

European Journal of Orthopaedic Surgery and Traumatology, Feb 18, 2021

Journal of clinical orthopaedics and trauma, 2016

Background: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed ... more Background: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction. Purpose: To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population. Methods: We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores. Results: At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively. Conclusion: Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

Archives of Orthopaedic and Trauma Surgery, Mar 18, 2014

Researches from the developing world contribute only a limited proportion to the total research o... more Researches from the developing world contribute only a limited proportion to the total research output published in leading orthopedics journals. Some of them believe that there is substantial editorial bias against their work. We assessed the composition of the editorial boards of leading orthopedic journals. The editorial boards of 18 leading orthopedic journals according to their impact factor were retrieved from their website. We evaluated in which countries the editorial board members were based and classified these countries using the World Bank income criteria. Individuals from number of countries can be found on the editorial boards of the investigated journals, but most of them are based in high-income countries. While 1,302 of the 1,401 editorial board members are based in countries with a high income according to the World Bank criteria, 37 are based in an upper middle income, 2 in lower middle income and none in a low-income economy. The percentage of editorial board members in leading orthopedic journals is dominated by high-income countries with serious underrepresentation from low-income countries.

PubMed, Dec 1, 2017

Various studies comparing operative and non-operative intervention for displaced intrarticular ca... more Various studies comparing operative and non-operative intervention for displaced intrarticular calcaneal fractures have reported conflicting findings in the past. The objective of this meta-analysis was to compare the efficacy and safety of open reduction and internal fixation (ORIF) vis-a-vis conservative management. Relevant randomized controlled trials (RCTs) comparing operative and non-operative intervention for displaced intraarticular calcaneal fractures were assessed and included in this meta-analysis. Data was extracted independently and methodological quality was further assessed. The inclusion criteria of this meta-analysis were: randomized controlled trials comparing operative with non-operative intervention for displaced intra-articular fractures of calcaneum and reporting atleast one of the main outcomes as failure to resume pre-injury work, residual pain and other complications. Eight randomized controlled trials fulfilled the criteria for this meta-analysis. Pooled results showed that patients managed conservatively failed to resume pre-injury work (RR 0.60, 95% CI = 0.37-0.98, P = 0.04). However operative intervention was associated with more complications (RR 1.74, 95% CI = 1.28 to 2.37, P = 0.0005). There was no statistically significant difference in residual pain (RR 0.73 95% CI = 0.40-1.36, P = 0.33) and reoperation (RR = 0.75, 95% CI = 0.48-1.16, P = 0.20) between the two groups. Surgery can benefit patients with calcaneal fracture and increases their likelihood to resume pre-injury work. However, the complication rates are significantly higher in the operative group. Since the included trials have used different scores to measure patient outcomes, hence little effective data could.

The Journal of Hand Surgery, Mar 1, 2015

Indian journal of neurosurgery, Jul 28, 2015

Thoracolumbar region is the most commonly affected region of spine in trauma, but still no consen... more Thoracolumbar region is the most commonly affected region of spine in trauma, but still no consensus exists on various aspects of its management. The management of thoracolumbar fractures has evolved considerably with time, but there are certain areas where there is still no consensus. Only few level I evidence are available to make any recommendation. This article reviews the current literature on evaluation, treatment, timing of surgery, choice of approach, and length of fusion.

Annals of Medical and Health Sciences Research, 2014

Posterior shoulder dislocations are rare and represent 2-5% of all traumatic shoulder dislocation... more Posterior shoulder dislocations are rare and represent 2-5% of all traumatic shoulder dislocation. A combination of this injury with ipsilateral humeral shaft fracture is extremely rare event. We here report a case of posterior shoulder dislocation with ipsilateral fracture shaft of humerus following road traffic accident. Through this report, we highlight the rarity of the condition and review the available literature on the subject. We also emphasize the importance of complete physical and radiological examination when dealing with such cases to ensure early detection and its subsequent treatment.

European Journal of Orthopaedic Surgery and Traumatology, May 15, 2015

Introduction The use of barbed sutures in various surgical specialities has shown lower operative... more Introduction The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty. Methods We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs. Results Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36-2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI-2.74, CI-3.06,-2.42, P \ 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time. Conclusion Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.

The Knee, 2004

All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive te... more All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive tests. For obese or muscular built patients these tests are cumbersome and often unsuitable. We describe for the first time a new method, the 'Delhi active test', by which a torn ACL can be detected irrespective of the size or build of the patient. The results of this test are reproducible and the diagnostic accuracy is comparable with other tests. We suggest that the 'Delhi active test' be used as one of the routine clinical methods to detect the torn ACL.

European Journal of Orthopaedic Surgery and Traumatology, Mar 19, 2023

The Bone & Joint Journal

Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in prov... more Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. Methods A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in ...

Background: The purpose of this study was to analyze morphometry of the subaxial cervical spine p... more Background: The purpose of this study was to analyze morphometry of the subaxial cervical spine pedicles in an Indian population based on computed tomography (CT), and thus assess the safety and feasibility of cervical pedicle screw in the subaxial cervical spine. Methods: CT scans of 500 subaxial cervical spine vertebrae were analyzed from 100 patients presenting to our institution and undergoing cervical spine CT scan for an unrelated cause as part of ATLS protocol. Pedicle width (PW), pedicle axis length (PAL), pedicle transverse angulation (PTA), and lateral pedicle distance (LPD) were calculated on axial CT scans, and pedicle height (PH), pedicle length (PL), superior pedicle distance (SPD), and pedicle sagittal angulation (PSA) were calculated on sagittal CT scans. Results: The mean PW ranged from 4.3 mm at C3 to 5.7 mm at C7. Mean PH ranged from 5.5 mm at C3 to 6.1 mm at C7. Mean PTA ranged from 44.58 at C3 to 37.18 at C7. PSA ranged from 16.658 at C3 to 3.298 at C7. Mean LPD...

DOAJ (DOAJ: Directory of Open Access Journals), 2017

Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach ... more Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss. Methods: Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs. Result: Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37), p=0.90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91), p=0.73 (I2=0%). The operative time was significantly shorter with modified Stoppa approach (MD 48.79 (-80.29 to-17.30), p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15), p=0.56, I2=0%) and blood loss (MD=-212.89 (-476.27 to 50.49) p=0.06, I2=71%). Conclusion: Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results.

Injury-international Journal of The Care of The Injured, Oct 1, 2020

PubMed, Dec 1, 2013

Advanced trauma life support is currently considered to be the gold standard for the practice of ... more Advanced trauma life support is currently considered to be the gold standard for the practice of acute trauma management. The effectiveness of the ATLS in improving patient outcome has been shown in numerous studies. Introduction of ATLS program has significantly improved trauma patient outcome. Integral to the success of this course lies in the systematic approach to the trauma patient. The aim is rapid and accurate assessment of the patient’s physiological status and further management based on these parameters. A standardized and organized approach to trauma patients helps to prevent secondary injury and improve outcome. 2 It has been suggested that a trauma management system based on ATLS training and the development of the trauma team concept has apparent benefit for patient survival. Clinicians with previous ATLS training or exposure to ATLS principles are more ordered in their approach to patient management during trauma. The aim is to provide a system of care that is safe, effective and able to be practiced in all trauma receiving hospitals. Today the ATLS is being practiced in more than 60

European Journal of Orthopaedic Surgery and Traumatology, Oct 24, 2020

Background This study aims to describe an uncommon presentation of posterior wall acetabular frac... more Background This study aims to describe an uncommon presentation of posterior wall acetabular fracture-dislocation with displacement of fracture fragment anterior to femoral head with its management and clinico-radiological outcome. Methods This retrospective review was performed at a Level I trauma centre over a period of six years. Hospital records, radiological database, operative register and follow-up data identified 7 patients with anteriorly lying posterior wall fragment of acetabulum. Analysis was performed with 6 patients having complete follow-up ranging from 2 to 7 years. The patients were operated with standard Kocher-Langenbeck approach; modification of this approach with trochanteric flip osteotomy and safe surgical dislocation was performed based on the location of the anteriorly lying fragment. Final functional and radiographic outcome was analysed according to modified Merle D'Aubigné and Postel score, and Matta's grade, respectively. Results This uncommon presentation was observed in 11.11% of patients out of 63 patients with isolated posterior wall acetabular fractures managed during the study period. Anteriorly displaced posterior wall fragment was located in anterosuperior (n, 3), anterocentral (n, 2) and anteroinferior (n, 1) quadrants anterior to the femoral head. Final clinical and radiographic outcome revealed good-to-excellent outcome in 5 (83.33%) patients, and poor in one. One patient developed progressive arthrosis of hip which required total hip arthroplasty within 2 years. Conclusion This unusual pattern of posterior wall fracture requires adequate pre-operative planning, careful handling of the fractured fragments along with its soft tissue attachments during surgery, and preferably a concomitant trochanteric flip osteotomy with/without surgical hip dislocation to achieve good results.

European Journal of Orthopaedic Surgery and Traumatology, Feb 4, 2022

African Journal of Emergency Medicine, Sep 1, 2015

European Journal of Orthopaedic Surgery and Traumatology, Feb 18, 2021

Journal of clinical orthopaedics and trauma, 2016

Background: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed ... more Background: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction. Purpose: To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population. Methods: We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores. Results: At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively. Conclusion: Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

Archives of Orthopaedic and Trauma Surgery, Mar 18, 2014

Researches from the developing world contribute only a limited proportion to the total research o... more Researches from the developing world contribute only a limited proportion to the total research output published in leading orthopedics journals. Some of them believe that there is substantial editorial bias against their work. We assessed the composition of the editorial boards of leading orthopedic journals. The editorial boards of 18 leading orthopedic journals according to their impact factor were retrieved from their website. We evaluated in which countries the editorial board members were based and classified these countries using the World Bank income criteria. Individuals from number of countries can be found on the editorial boards of the investigated journals, but most of them are based in high-income countries. While 1,302 of the 1,401 editorial board members are based in countries with a high income according to the World Bank criteria, 37 are based in an upper middle income, 2 in lower middle income and none in a low-income economy. The percentage of editorial board members in leading orthopedic journals is dominated by high-income countries with serious underrepresentation from low-income countries.

PubMed, Dec 1, 2017

Various studies comparing operative and non-operative intervention for displaced intrarticular ca... more Various studies comparing operative and non-operative intervention for displaced intrarticular calcaneal fractures have reported conflicting findings in the past. The objective of this meta-analysis was to compare the efficacy and safety of open reduction and internal fixation (ORIF) vis-a-vis conservative management. Relevant randomized controlled trials (RCTs) comparing operative and non-operative intervention for displaced intraarticular calcaneal fractures were assessed and included in this meta-analysis. Data was extracted independently and methodological quality was further assessed. The inclusion criteria of this meta-analysis were: randomized controlled trials comparing operative with non-operative intervention for displaced intra-articular fractures of calcaneum and reporting atleast one of the main outcomes as failure to resume pre-injury work, residual pain and other complications. Eight randomized controlled trials fulfilled the criteria for this meta-analysis. Pooled results showed that patients managed conservatively failed to resume pre-injury work (RR 0.60, 95% CI = 0.37-0.98, P = 0.04). However operative intervention was associated with more complications (RR 1.74, 95% CI = 1.28 to 2.37, P = 0.0005). There was no statistically significant difference in residual pain (RR 0.73 95% CI = 0.40-1.36, P = 0.33) and reoperation (RR = 0.75, 95% CI = 0.48-1.16, P = 0.20) between the two groups. Surgery can benefit patients with calcaneal fracture and increases their likelihood to resume pre-injury work. However, the complication rates are significantly higher in the operative group. Since the included trials have used different scores to measure patient outcomes, hence little effective data could.

The Journal of Hand Surgery, Mar 1, 2015

Indian journal of neurosurgery, Jul 28, 2015

Thoracolumbar region is the most commonly affected region of spine in trauma, but still no consen... more Thoracolumbar region is the most commonly affected region of spine in trauma, but still no consensus exists on various aspects of its management. The management of thoracolumbar fractures has evolved considerably with time, but there are certain areas where there is still no consensus. Only few level I evidence are available to make any recommendation. This article reviews the current literature on evaluation, treatment, timing of surgery, choice of approach, and length of fusion.

Annals of Medical and Health Sciences Research, 2014

Posterior shoulder dislocations are rare and represent 2-5% of all traumatic shoulder dislocation... more Posterior shoulder dislocations are rare and represent 2-5% of all traumatic shoulder dislocation. A combination of this injury with ipsilateral humeral shaft fracture is extremely rare event. We here report a case of posterior shoulder dislocation with ipsilateral fracture shaft of humerus following road traffic accident. Through this report, we highlight the rarity of the condition and review the available literature on the subject. We also emphasize the importance of complete physical and radiological examination when dealing with such cases to ensure early detection and its subsequent treatment.

European Journal of Orthopaedic Surgery and Traumatology, May 15, 2015

Introduction The use of barbed sutures in various surgical specialities has shown lower operative... more Introduction The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty. Methods We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs. Results Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36-2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI-2.74, CI-3.06,-2.42, P \ 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time. Conclusion Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.

The Knee, 2004

All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive te... more All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive tests. For obese or muscular built patients these tests are cumbersome and often unsuitable. We describe for the first time a new method, the 'Delhi active test', by which a torn ACL can be detected irrespective of the size or build of the patient. The results of this test are reproducible and the diagnostic accuracy is comparable with other tests. We suggest that the 'Delhi active test' be used as one of the routine clinical methods to detect the torn ACL.

European Journal of Orthopaedic Surgery and Traumatology, Mar 19, 2023

The Bone & Joint Journal

Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in prov... more Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. Methods A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in ...

Background: The purpose of this study was to analyze morphometry of the subaxial cervical spine p... more Background: The purpose of this study was to analyze morphometry of the subaxial cervical spine pedicles in an Indian population based on computed tomography (CT), and thus assess the safety and feasibility of cervical pedicle screw in the subaxial cervical spine. Methods: CT scans of 500 subaxial cervical spine vertebrae were analyzed from 100 patients presenting to our institution and undergoing cervical spine CT scan for an unrelated cause as part of ATLS protocol. Pedicle width (PW), pedicle axis length (PAL), pedicle transverse angulation (PTA), and lateral pedicle distance (LPD) were calculated on axial CT scans, and pedicle height (PH), pedicle length (PL), superior pedicle distance (SPD), and pedicle sagittal angulation (PSA) were calculated on sagittal CT scans. Results: The mean PW ranged from 4.3 mm at C3 to 5.7 mm at C7. Mean PH ranged from 5.5 mm at C3 to 6.1 mm at C7. Mean PTA ranged from 44.58 at C3 to 37.18 at C7. PSA ranged from 16.658 at C3 to 3.298 at C7. Mean LPD...