Ajay Gupta - Academia.edu (original) (raw)

Papers by Ajay Gupta

The archives of bone and joint surgery, 2021

Background The neglected patella fracture leading to non-union of the fracture in long term. Non-... more Background The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is the rare entity with incidence of 2.4-12.5%. The fractured proximal fragment of the patella is retracted proximally leading to fracture gap of various centimetres. Various surgical modalities are described to manage such fracture morphologies. Methods Ten neglected patella fracture morphology were included in the study. Five patients with transverse fracture was treated with ORIF with TBW. Two patients with communited fracture was treated with ORIF with TBW (K wires) and cerclage wire. Three patients with inferior pole patella was managed by open reduction and Krachow suture using fibre wire. The results were assessed in terms of time of union, knee range of motion, extension lag, quadriceps power, fracture gap, Knee society score, Kujala knee score and any complications. Follow-up with radiographs was done at 2, 4, 6 and 12 months. Results All patients presented with a ...

BMC Musculoskeletal Disorders, 2001

Background: Interlocking nailing, which has become the method of choice for treating fractures of... more Background: Interlocking nailing, which has become the method of choice for treating fractures of the femoral and tibial shafts, still lacks ability to provide the important contact-compression at the fracture. An intramedullary compression nail is described, which provides axial compression at the fracture site with tightening of the specially designed distal interlocking screw. This uses the same principle as dynamic compression plating. Methods: The study included 11 femoral and tibial nailings performed for various clinical applications such as acute fractures, non-unions and malunions. Results: All the fractures attained radiological union, with good skeletal continuity across the fracture, within an average time of 13 weeks in fresh fractures and 18 weeks in non-unions. Conclusions: Active compression through intramedullary compression nailing has great utility for treating non-unions where it provides greater degree of impaction of its irregular ends. This may prove greatly advantageous to the fracture union through increased stability and the osteogenic potential, particularly when utilized in combination with the small diameter unreamed nails.

The Journal of Bone and Joint Surgery, 1998

A primary hydatid cyst in the pelvis is rare, and usually presents with pressure symptoms affecti... more A primary hydatid cyst in the pelvis is rare, and usually presents with pressure symptoms affecting the adjacent abdominal organs. We describe such a cyst which protruded through the sciatic notch and presented as a gluteal swelling with a foot drop due to compression of the lumbosacral nerve roots. Surgical excision and postoperative treatment with albendazole for six weeks were effective in controlling the disease and preventing recurrence.

Acta Orthopaedica Scandinavica, 1991

BMC Musculoskeletal Disorders, 2002

Background: Carpal malalignment following the malunited distal radial fracture is described to de... more Background: Carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. It worsens gradually after healing of the fracture due to continued loading of the wrist. It is also reported to develop during the immobilization itself rather than after fracture healing. The present work was aimed to study the natural course and the quantitative assessment of such adaptive carpal realignment following distal radial fracture. Methods: In a prospective study, 118 distal radial fractures treated with different modalities were followed-up with serial radiographs for a year for assessment of various radiological parameters. Results: Two patterns of carpal malalignment were identified depending upon the effective radiolunate flexion (ERLF) measured on pre-reduction radiographs. The midcarpal malalignment was seen in 98 radial fractures (83%) with the lunate following the dorsiflexed fracture fragment and a measured ERLF of less than 25°. The second pattern of radio-carpal malalignment showed the fracture fragment to dorsiflex without taking the lunate with a measured ERLF of more than 25°. The scaphoid did not follow the fracture fragment in both the patterns of malalignment. Conclusion: It is better to assess distal radial fractures for any wrist ligamentous injury on the post-reduction film with the restored radial anatomy than on the pre-reduction film since most carpal malalignments get corrected with the reduction of the fracture. Similar carpal malalignment reappear with the redisplacement of the fracture as seen in pre-reduction radiographs and develops during the immobilization rather than as a later compensatory mechanism for the malunion.

Indian Journal of Tuberculosis, 2018

A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right... more A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right sided gluteal and thigh abscess. Suspecting treatment failure, surgical evacuation of purulent material was done. The bacteriological isolation showed positivity for methicillin-resistant Staphylococcus aureus. Although the microbiological and histopathology examination of the specimen were negative for tubercular isolates, the cartridge based -nucleic acid amplification tests revealed positive genes for Mycobacterium tuberculosis and additional primers showed sensitivity for rifampicin and isoniazid. She was adequately treated with vancomycin for six weeks and anti-tubercular drugs for eight months and followed till the bony ankyloses at 18 months. This is a rare case based scenario wherein concomitant staphylococcal infection in tubercular sacroiliitis masqueraded as anti-tubercular drug resistance. The cartridge-based nucleic acid amplification test for tuberculosis is a rapid and sensitive modality in identifying mycobacteria even mixed infections and also determine drug resistance. There are fewer consensuses in the literature regarding the drugs and duration of anti-tubercular regime for tuberculous sacroiliitis with most regimes using four drugs between six to eighteen months.

European Journal of Orthopaedic Surgery & Traumatology, 2008

... Skeletal Radiol 5:275–278 3. Kenan S, Bonar S, Jones C, Lewis MM (1988) Subperiosteal hem-ang... more ... Skeletal Radiol 5:275–278 3. Kenan S, Bonar S, Jones C, Lewis MM (1988) Subperiosteal hem-angioma: a case report and review of the literature. ... Skeletal Radiol 27:182–187 7. Ozawa CR, Banfi A, Glazer NL, Thurston G, Springer ML, Kraft PE, McDonald DM, Blau HM (2004 ...

The Indian journal of tuberculosis, 2008

Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Early prese... more Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Early presentations are easily confused with traumatic event and commonly missed. We describe a case presenting with scapholunate dissociation initially, which later progressed to full blown arthritis. Similar presentation has never been documented.

European Journal of Orthopaedic Surgery & Traumatology, 2009

... 123 CASE REPORT Open perineal dislocation of hip in a child Dhananjaya Sabat · DaljeetSingh ·... more ... 123 CASE REPORT Open perineal dislocation of hip in a child Dhananjaya Sabat · DaljeetSingh · Vinod Kumar · Ajay Gupta Received: 30 June 2008 / Accepted: 19 December 2008 / Published online: 7 January 2009 © Springer-Verlag 2009 Introduction ...

Spine, 2011

A case report and review of literature. To present a rare case of os odontoideum complicating cra... more A case report and review of literature. To present a rare case of os odontoideum complicating craniovertebral junction (CVJ) tuberculosis (TB) and discuss the treatment outcome. CVJ is a rare site of predilection for Mycobacterium tuberculosis. The treatment protocol for this entity has periodically undergone swings between conservative treatment and radical surgery. To the best of our knowledge, os odontoideum complicating TB of this region has not been reported before in the literature. We report on a 17-year-old patient with CVJ TB in setting of dystopic os odontoideum. The patient presented with fever, cervical pain and weakness of all the four limbs, and was treated with antitubercular chemotherapy along with cervical traction, followed by halo-vest. Patient made uneventful recovery with conservative form of treatment and was asymptomatic at 36 months of follow-up. This case has the originality of being the first report of CVJ TB with dystopic os odontoideum. High index of suspicion by the clinician must be practiced to make the appropriate diagnosis.

Clinical Biomechanics, 2005

Supination and pronation movements occur primarily at the forearm though are possible at the wris... more Supination and pronation movements occur primarily at the forearm though are possible at the wrist joint too. The axial rotation of the wrist also called the radiometacarpal rotation has been quantified but for its passive range which may never occur during the day-to-day routine activities. It is normally not possible for the wrist joint to rotate axially in an active manner. However, voluntary effort to rotate the forearm while keeping the hand fixed on a custom designed device is able to provide active rotation of the wrist which occurs in a manner similar to that occurring during the daily routine activities. The present study measured axial rotation of the wrist in 20 asymptomatic volunteers who had axial CT done of their wrist with elbow in 10-30 degrees flexion and forearm positioned parallel to the long axis of the table with thumb pointing up towards the roof. The examination was repeated twice while the subject actively tried to supinate and pronate the forearm against the fixed hand and the metacarpals using maximum voluntary effort on a custom designed positioning device. The mean radiometacarpal supination and pronation were 17.15 degrees (SD 7.9) and 17.0 degrees (SD 10) respectively. The movement was found to occur predominantly at midcarpal joint with radiocarpal joint contributing only 18% to supination and 31% to pronation. The radiometacarpal rotation has a crucial bearing in the development of the wrist prostheses. The design of the prostheses should consider accommodating axial movements that occur in the carpus during the activities of daily living.

The archives of bone and joint surgery, 2021

Background The neglected patella fracture leading to non-union of the fracture in long term. Non-... more Background The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is the rare entity with incidence of 2.4-12.5%. The fractured proximal fragment of the patella is retracted proximally leading to fracture gap of various centimetres. Various surgical modalities are described to manage such fracture morphologies. Methods Ten neglected patella fracture morphology were included in the study. Five patients with transverse fracture was treated with ORIF with TBW. Two patients with communited fracture was treated with ORIF with TBW (K wires) and cerclage wire. Three patients with inferior pole patella was managed by open reduction and Krachow suture using fibre wire. The results were assessed in terms of time of union, knee range of motion, extension lag, quadriceps power, fracture gap, Knee society score, Kujala knee score and any complications. Follow-up with radiographs was done at 2, 4, 6 and 12 months. Results All patients presented with a ...

BMC Musculoskeletal Disorders, 2001

Background: Interlocking nailing, which has become the method of choice for treating fractures of... more Background: Interlocking nailing, which has become the method of choice for treating fractures of the femoral and tibial shafts, still lacks ability to provide the important contact-compression at the fracture. An intramedullary compression nail is described, which provides axial compression at the fracture site with tightening of the specially designed distal interlocking screw. This uses the same principle as dynamic compression plating. Methods: The study included 11 femoral and tibial nailings performed for various clinical applications such as acute fractures, non-unions and malunions. Results: All the fractures attained radiological union, with good skeletal continuity across the fracture, within an average time of 13 weeks in fresh fractures and 18 weeks in non-unions. Conclusions: Active compression through intramedullary compression nailing has great utility for treating non-unions where it provides greater degree of impaction of its irregular ends. This may prove greatly advantageous to the fracture union through increased stability and the osteogenic potential, particularly when utilized in combination with the small diameter unreamed nails.

The Journal of Bone and Joint Surgery, 1998

A primary hydatid cyst in the pelvis is rare, and usually presents with pressure symptoms affecti... more A primary hydatid cyst in the pelvis is rare, and usually presents with pressure symptoms affecting the adjacent abdominal organs. We describe such a cyst which protruded through the sciatic notch and presented as a gluteal swelling with a foot drop due to compression of the lumbosacral nerve roots. Surgical excision and postoperative treatment with albendazole for six weeks were effective in controlling the disease and preventing recurrence.

Acta Orthopaedica Scandinavica, 1991

BMC Musculoskeletal Disorders, 2002

Background: Carpal malalignment following the malunited distal radial fracture is described to de... more Background: Carpal malalignment following the malunited distal radial fracture is described to develop as an adaptation to realign the hand to the malunion. It worsens gradually after healing of the fracture due to continued loading of the wrist. It is also reported to develop during the immobilization itself rather than after fracture healing. The present work was aimed to study the natural course and the quantitative assessment of such adaptive carpal realignment following distal radial fracture. Methods: In a prospective study, 118 distal radial fractures treated with different modalities were followed-up with serial radiographs for a year for assessment of various radiological parameters. Results: Two patterns of carpal malalignment were identified depending upon the effective radiolunate flexion (ERLF) measured on pre-reduction radiographs. The midcarpal malalignment was seen in 98 radial fractures (83%) with the lunate following the dorsiflexed fracture fragment and a measured ERLF of less than 25°. The second pattern of radio-carpal malalignment showed the fracture fragment to dorsiflex without taking the lunate with a measured ERLF of more than 25°. The scaphoid did not follow the fracture fragment in both the patterns of malalignment. Conclusion: It is better to assess distal radial fractures for any wrist ligamentous injury on the post-reduction film with the restored radial anatomy than on the pre-reduction film since most carpal malalignments get corrected with the reduction of the fracture. Similar carpal malalignment reappear with the redisplacement of the fracture as seen in pre-reduction radiographs and develops during the immobilization rather than as a later compensatory mechanism for the malunion.

Indian Journal of Tuberculosis, 2018

A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right... more A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right sided gluteal and thigh abscess. Suspecting treatment failure, surgical evacuation of purulent material was done. The bacteriological isolation showed positivity for methicillin-resistant Staphylococcus aureus. Although the microbiological and histopathology examination of the specimen were negative for tubercular isolates, the cartridge based -nucleic acid amplification tests revealed positive genes for Mycobacterium tuberculosis and additional primers showed sensitivity for rifampicin and isoniazid. She was adequately treated with vancomycin for six weeks and anti-tubercular drugs for eight months and followed till the bony ankyloses at 18 months. This is a rare case based scenario wherein concomitant staphylococcal infection in tubercular sacroiliitis masqueraded as anti-tubercular drug resistance. The cartridge-based nucleic acid amplification test for tuberculosis is a rapid and sensitive modality in identifying mycobacteria even mixed infections and also determine drug resistance. There are fewer consensuses in the literature regarding the drugs and duration of anti-tubercular regime for tuberculous sacroiliitis with most regimes using four drugs between six to eighteen months.

European Journal of Orthopaedic Surgery & Traumatology, 2008

... Skeletal Radiol 5:275–278 3. Kenan S, Bonar S, Jones C, Lewis MM (1988) Subperiosteal hem-ang... more ... Skeletal Radiol 5:275–278 3. Kenan S, Bonar S, Jones C, Lewis MM (1988) Subperiosteal hem-angioma: a case report and review of the literature. ... Skeletal Radiol 27:182–187 7. Ozawa CR, Banfi A, Glazer NL, Thurston G, Springer ML, Kraft PE, McDonald DM, Blau HM (2004 ...

The Indian journal of tuberculosis, 2008

Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Early prese... more Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Early presentations are easily confused with traumatic event and commonly missed. We describe a case presenting with scapholunate dissociation initially, which later progressed to full blown arthritis. Similar presentation has never been documented.

European Journal of Orthopaedic Surgery & Traumatology, 2009

... 123 CASE REPORT Open perineal dislocation of hip in a child Dhananjaya Sabat · DaljeetSingh ·... more ... 123 CASE REPORT Open perineal dislocation of hip in a child Dhananjaya Sabat · DaljeetSingh · Vinod Kumar · Ajay Gupta Received: 30 June 2008 / Accepted: 19 December 2008 / Published online: 7 January 2009 © Springer-Verlag 2009 Introduction ...

Spine, 2011

A case report and review of literature. To present a rare case of os odontoideum complicating cra... more A case report and review of literature. To present a rare case of os odontoideum complicating craniovertebral junction (CVJ) tuberculosis (TB) and discuss the treatment outcome. CVJ is a rare site of predilection for Mycobacterium tuberculosis. The treatment protocol for this entity has periodically undergone swings between conservative treatment and radical surgery. To the best of our knowledge, os odontoideum complicating TB of this region has not been reported before in the literature. We report on a 17-year-old patient with CVJ TB in setting of dystopic os odontoideum. The patient presented with fever, cervical pain and weakness of all the four limbs, and was treated with antitubercular chemotherapy along with cervical traction, followed by halo-vest. Patient made uneventful recovery with conservative form of treatment and was asymptomatic at 36 months of follow-up. This case has the originality of being the first report of CVJ TB with dystopic os odontoideum. High index of suspicion by the clinician must be practiced to make the appropriate diagnosis.

Clinical Biomechanics, 2005

Supination and pronation movements occur primarily at the forearm though are possible at the wris... more Supination and pronation movements occur primarily at the forearm though are possible at the wrist joint too. The axial rotation of the wrist also called the radiometacarpal rotation has been quantified but for its passive range which may never occur during the day-to-day routine activities. It is normally not possible for the wrist joint to rotate axially in an active manner. However, voluntary effort to rotate the forearm while keeping the hand fixed on a custom designed device is able to provide active rotation of the wrist which occurs in a manner similar to that occurring during the daily routine activities. The present study measured axial rotation of the wrist in 20 asymptomatic volunteers who had axial CT done of their wrist with elbow in 10-30 degrees flexion and forearm positioned parallel to the long axis of the table with thumb pointing up towards the roof. The examination was repeated twice while the subject actively tried to supinate and pronate the forearm against the fixed hand and the metacarpals using maximum voluntary effort on a custom designed positioning device. The mean radiometacarpal supination and pronation were 17.15 degrees (SD 7.9) and 17.0 degrees (SD 10) respectively. The movement was found to occur predominantly at midcarpal joint with radiocarpal joint contributing only 18% to supination and 31% to pronation. The radiometacarpal rotation has a crucial bearing in the development of the wrist prostheses. The design of the prostheses should consider accommodating axial movements that occur in the carpus during the activities of daily living.