Divesh Jalan - Academia.edu (original) (raw)

Papers by Divesh Jalan

Research paper thumbnail of Giant lipoma: an unusual cause of carpal tunnel syndrome

The Pan African medical journal, 2011

Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in t... more Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. A 48-year old manual laborer man presented to us with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers along with a progressively increasing swelling in the hand and wrist. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed along with excision of the lipoma using extensile open approach. Intraoperatively, median nerve and its digital branches were foun...

Research paper thumbnail of Author's reply

Indian journal of orthopaedics

Research paper thumbnail of Measurement of Ulnar Variance in a Regional Subset of Indian Population— A Pilot Study of 30 Subjects

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015

The variation of level of distal articulating surface of ulna with respect to distal articulating... more The variation of level of distal articulating surface of ulna with respect to distal articulating surface of radius is known as ulnar variance (UV). Positive and negative UV has been implicated in various wrist and hand pathologies. To measure ulnar variance in a regional subset of Indian population and to compare two techniques of measurement of ulnar variance viz. method of perpendiculars and modification of the concentric circles method. UV was measured in a regional subset of Indian population comprising of 30 subjects. The mean age of patients was 35.9 years. There were 16 males and 14 females in the study group. Antero-posterior (AP) X-rays of wrist in neutral position were taken and UV was measured using method of perpendiculars and the modified circle method. The mean UV using method of perpendiculars (UVA) was 0.387 mm and using modified circle method (UVB) was 0.507mm. A higher predominance of positive UV in this regional subset of Indian population was observed. There was no correlation between UV with respect to age and sex. No statistically significant difference was observed between the two methods of measurement utilized in the study. The documentation of a negative and positive ulnar variance will help in prophylactic and timely intervention for various wrist pathologies, if required. However, a larger sample size with a longer follow up is required to suggest a correlation of ulnar variance with clinically symptomatic disease.

Research paper thumbnail of A case of acute septic arthritis hip caused by Brucella melitensis in an adolescent child

BMJ Case Reports, 2015

Brucella is among the most common zoonotic diseases affecting humans. Although musculoskeletal in... more Brucella is among the most common zoonotic diseases affecting humans. Although musculoskeletal involvement is seen in a large proportion of patients, the disease is often diagnosed late or misdiagnosed due to its subtle nature and rarity, and lack of awareness among clinicians. In this report, a 12-year-old girl was diagnosed with acute septic arthritis of the hip based on clinico-radiological features, and managed with standard treatment, including arthrotomy. However, the child did not respond to the treatment. Based on the histopathology and local endemicity, Brucella was suspected, and confirmed after serological testing. The child subsequently responded to treatment and, at latest follow-up at 1 year, had a full painless range of motion, with no relapse.

Research paper thumbnail of To the Editor

Journal of orthopaedic trauma, Jan 7, 2015

Research paper thumbnail of Giant lipoma: an unusual cause of carpal tunnel syndrome

The Pan African medical journal, 2011

Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in t... more Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. A 48-year old manual laborer man presented to us with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers along with a progressively increasing swelling in the hand and wrist. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed along with excision of the lipoma using extensile open approach. Intraoperatively, median nerve and its digital branches were foun...

Research paper thumbnail of Results of titanium elastic nailing in paediatric femoral diaphyseal fractures----report of 30 cases

Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association, 2013

Fractures of the femur are the most incapacitating fractures. For children aged 6-14 years, there... more Fractures of the femur are the most incapacitating fractures. For children aged 6-14 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer recommended. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. Thirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 1 year. The final results were evaluated using Flynn's criteria. Technical difficulties and complications associated with the procedure were also analysed. Overall results were excellent in 20 cases and satisfactory in 10 cases. No patient had poor result. The average hospital stay was 9 days. All the fractures healed with an average time to union of 6.86 weeks. The most common complication encountered was soft tissue irritation at th...

Research paper thumbnail of ransient Patellar Dislocation Resulting in Simultaneous Osteochondral Fractures of Patella and Lateral Femoral Condyle – A Case Report

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fra... more Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fractures involving the medial facet of patella or lateral femoral condyle. Simultaneous osteochondral fractures are rare and have not been reported in the adult. The authors report a case of combined osteochondral fracture of patella and lateral femoral condyle following acute patellar dislocation in an adult, which was misdiagnosed as meniscal injury. Both the osteochondral fracture fragments were rigidly fixed with headless compression screws and repair of the medial retinaculum was done. At latest follow up after two years, patient had regained full range of motion with no further episodes of patellar dislocation. The rarity of this combination of injury along with difficulty in interpreting radiographs makes this case interesting.

Research paper thumbnail of Aneurysmal bone cyst of medial cuneiform and a novel surgical technique for mid-foot reconstruction

BMJ case reports, 2014

Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has ne... more Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.

Research paper thumbnail of Comment on Madelaine et al.: Results and complications of single-stage total knee arthroplasty and high tibial osteotomy

International Orthopaedics, 2014

ABSTRACT Dear Editor,We read the article by Madelaine et al. [1] entitled “Results and complicati... more ABSTRACT Dear Editor,We read the article by Madelaine et al. [1] entitled “Results and complications of single-stage total knee arthroplasty and high tibial osteotomy” with keen interest. We appreciate the authors’ work; however, we would like to point out certain issues, which we believe will contribute to the effectiveness of the study.The authors mention measurement of the femoral mechanical axis (mFA), tibial mechanical axis (mTA) and femorotibial mechanical axis (mFTA) on weight-bearing long-leg films to determine the magnitude and location of the extra-articular deformity. However, it is not clear from the study as to how the authors have arrived at these angles and how they have concluded that the deformity measured is an extra-articular deformity.The authors recommend grafting the osteotomy defect with autograft bone from the bony cuts. It is, however, not clear from the article whether the same technique had been used in their study.We would be curious to know whether the autogra ...

Research paper thumbnail of Intraarticular osteochondroma of the knee

Indian Journal of Orthopaedics, 2014

Osteochondromas are usually extra articular and grow away from the joint towards the diaphysis. I... more Osteochondromas are usually extra articular and grow away from the joint towards the diaphysis. Intraarticular osteochondromas are very rare and often misdiagnosed. We report a case of 16-year-old boy who presented with pain and clicking sound in the right knee for last 6 months. On examination, click was felt at the terminal flexion of the knee. The lateral radiograph of the right knee showed a radio opaque shadow at the posterior aspect of the distal end of femur, which was further evaluated with an MRI. Arthroscopy showed a hard lesion arising from the roof of the intercondylar notch of femur. It was excised arthroscopically. Histopathology revealed it to be an osteochondroma. Thus, intraarticular osteochondroma of the knee can be considered as a rare cause of pain in young patients.

Research paper thumbnail of Ewing's Sarcoma of the Sacroiliac Joint Presenting as Tubercular Sacroiliitis: A Diagnostic Dilemma

Asian Spine Journal, 2014

We report a case of Ewing's sarcoma of the sacroiliac joint in a 21-year-old male mimicking tuber... more We report a case of Ewing's sarcoma of the sacroiliac joint in a 21-year-old male mimicking tubercular sacroiliitis, a rare entity not reported in literature. He presented with pain in the lower back radiating to the right lower limb along with constitutional symptoms of 3 months duration. On examination, the right sacroiliac joint was tender. The laboratory investigations showed anaemia, leukocytosis and raised erythrocyte sedimentation rate. On X-ray, features of right sacroiliitis were seen. This was further investigated with magnetic resonance imaging (MRI), which showed features consistent with tubercular sacroiliitis. Patient was then started on antitubercular treatment, but the improvement was not consistent. So, a contrast MRI was done, which indicated features of primary sarcoma. It was then further conirmed by a computed tomography-guided biopsy, which showed features consistent with Ewing's sarcoma of the sacroiliac joint.

Research paper thumbnail of Comment on Lan et al.: S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

International Orthopaedics, 2014

Research paper thumbnail of Management of nonunion of lower-extremity long bones using mono-lateral external fixator – Report of 37 cases

Injury, 2014

The management of nonunion has remained a constant challenge. The associated bone defect, shorten... more The management of nonunion has remained a constant challenge. The associated bone defect, shortening, deformity and infection complicate the management. A mono-lateral external fixator may minimise some of the problems frequently encountered in these patients. We report our results of prospectively evaluated 37 consecutive patients regarding nonunion of lower-extremity long bones managed using a mono-lateral external fixator. A total of 37 patients (7 femurs and 30 tibias), mean age 36 years, were stabilised using a mono-lateral fixator for nonunion of long bones. The mean time since injury was 8 months. Fifteen cases were infected and they received debridement and antibiotic treatment as per culture and sensitivity reports. In cases where the bone gap or shortening was &amp;amp;amp;amp;amp;amp;gt;3 cm in the tibia and &amp;amp;amp;amp;amp;amp;gt;5 cm in the femur, corticotomy and bone transport (bifocal procedure) was done and in the remaining cases, only compression-distraction (monofocal procedure) was done. The bone and functional results were assessed at the end of treatment according to the criteria described by Paley et al. Union was achieved in 34 cases (91.9%). The average time for union was 5 months. Five cases were treated with the bifocal method and 32 cases were treated with the monofocal method. The average length gain in the bifocal method was 5.7 cm, mean duration of treatment was 8.2 months and bone healing index (BHI) was 1.44 months cm(-1). In six cases, the monofocal treatment was used for limb lengthening. The average length gain was 1.9 cm, mean duration of treatment was 4.83 months and BHI was 2.5 months cm(-1). Bone grafting was required in two cases at the docking site. The bone results were excellent in 24 cases, good in nine cases, fair in one case and poor in three cases. The functional results were excellent in 27 cases, good in six cases, fair in one case and poor in three cases. The most common complication in this series was pin-tract infection (11.5%). A mono-lateral external fixator is an effective method for treating nonunion in the lower extremity with or without bone loss. The nonunion site can be carefully controlled with simultaneous correction of angulation and length.

Research paper thumbnail of Head size and dislocation rate in primary total hip arthroplasty

Indian Journal of Orthopaedics, 2013

Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such ... more Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA.

Research paper thumbnail of Role of vascular endothelial growth factor as a tumour marker in osteosarcoma: a prospective study

International Orthopaedics, 2012

A prospective study was undertaken to evaluate the diagnostic and prognostic significance of seru... more A prospective study was undertaken to evaluate the diagnostic and prognostic significance of serum levels of vascular endothelial growth factor (VEGF) in patients with primary localised osteosarcoma. Serum VEGF levels were measured by an enzyme-linked immunosorbent assay (ELISA) in blood samples collected prechemotherapy, postchemotherapy, and postsurgery in 40 patients with histologically proven primary osteosarcoma. Comparison was made between serum VEGF level of healthy controls (n = 10) and prechemotherapy patient sera to evaluate its diagnostic potential. Serum VEGF levels of patients with and without metastasis were compared. Immunohistochemical staining was done to establish the correlation between serum and tissue VEGF expression. The Kaplan-Meier curve was used for survival analysis No significant relationship was observed between serum VEGF levels and age, gender, tumour size, local recurrence or histopathological subtypes of osteosarcoma. We observed significantly raised mean serum VEGF in patient sera compared with healthy controls (p = 0.001). Significant fall in mean serum VEGF level was observed following chemotherapy (p = 0.001). Patients who developed metastases had significantly higher serum VEGF levels compared with the nonmetastatic group (P = 0.001). Serum VEGF levels correlated well with VEGF expression in tissues. Serum VEGF levels might prove to be of diagnostic, predictive and prognostic value in patients with primary osteosarcoma, although further studies with larger sample size and longer follow-up is needed to support the hypothesis.

Research paper thumbnail of Giant lipoma: an unusual cause of carpal tunnel syndrome

The Pan African medical journal, 2011

Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in t... more Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. A 48-year old manual laborer man presented to us with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers along with a progressively increasing swelling in the hand and wrist. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed along with excision of the lipoma using extensile open approach. Intraoperatively, median nerve and its digital branches were foun...

Research paper thumbnail of Author's reply

Indian journal of orthopaedics

Research paper thumbnail of Measurement of Ulnar Variance in a Regional Subset of Indian Population— A Pilot Study of 30 Subjects

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015

The variation of level of distal articulating surface of ulna with respect to distal articulating... more The variation of level of distal articulating surface of ulna with respect to distal articulating surface of radius is known as ulnar variance (UV). Positive and negative UV has been implicated in various wrist and hand pathologies. To measure ulnar variance in a regional subset of Indian population and to compare two techniques of measurement of ulnar variance viz. method of perpendiculars and modification of the concentric circles method. UV was measured in a regional subset of Indian population comprising of 30 subjects. The mean age of patients was 35.9 years. There were 16 males and 14 females in the study group. Antero-posterior (AP) X-rays of wrist in neutral position were taken and UV was measured using method of perpendiculars and the modified circle method. The mean UV using method of perpendiculars (UVA) was 0.387 mm and using modified circle method (UVB) was 0.507mm. A higher predominance of positive UV in this regional subset of Indian population was observed. There was no correlation between UV with respect to age and sex. No statistically significant difference was observed between the two methods of measurement utilized in the study. The documentation of a negative and positive ulnar variance will help in prophylactic and timely intervention for various wrist pathologies, if required. However, a larger sample size with a longer follow up is required to suggest a correlation of ulnar variance with clinically symptomatic disease.

Research paper thumbnail of A case of acute septic arthritis hip caused by Brucella melitensis in an adolescent child

BMJ Case Reports, 2015

Brucella is among the most common zoonotic diseases affecting humans. Although musculoskeletal in... more Brucella is among the most common zoonotic diseases affecting humans. Although musculoskeletal involvement is seen in a large proportion of patients, the disease is often diagnosed late or misdiagnosed due to its subtle nature and rarity, and lack of awareness among clinicians. In this report, a 12-year-old girl was diagnosed with acute septic arthritis of the hip based on clinico-radiological features, and managed with standard treatment, including arthrotomy. However, the child did not respond to the treatment. Based on the histopathology and local endemicity, Brucella was suspected, and confirmed after serological testing. The child subsequently responded to treatment and, at latest follow-up at 1 year, had a full painless range of motion, with no relapse.

Research paper thumbnail of To the Editor

Journal of orthopaedic trauma, Jan 7, 2015

Research paper thumbnail of Giant lipoma: an unusual cause of carpal tunnel syndrome

The Pan African medical journal, 2011

Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in t... more Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. A 48-year old manual laborer man presented to us with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers along with a progressively increasing swelling in the hand and wrist. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed along with excision of the lipoma using extensile open approach. Intraoperatively, median nerve and its digital branches were foun...

Research paper thumbnail of Results of titanium elastic nailing in paediatric femoral diaphyseal fractures----report of 30 cases

Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association, 2013

Fractures of the femur are the most incapacitating fractures. For children aged 6-14 years, there... more Fractures of the femur are the most incapacitating fractures. For children aged 6-14 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer recommended. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. Thirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 1 year. The final results were evaluated using Flynn's criteria. Technical difficulties and complications associated with the procedure were also analysed. Overall results were excellent in 20 cases and satisfactory in 10 cases. No patient had poor result. The average hospital stay was 9 days. All the fractures healed with an average time to union of 6.86 weeks. The most common complication encountered was soft tissue irritation at th...

Research paper thumbnail of ransient Patellar Dislocation Resulting in Simultaneous Osteochondral Fractures of Patella and Lateral Femoral Condyle – A Case Report

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fra... more Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fractures involving the medial facet of patella or lateral femoral condyle. Simultaneous osteochondral fractures are rare and have not been reported in the adult. The authors report a case of combined osteochondral fracture of patella and lateral femoral condyle following acute patellar dislocation in an adult, which was misdiagnosed as meniscal injury. Both the osteochondral fracture fragments were rigidly fixed with headless compression screws and repair of the medial retinaculum was done. At latest follow up after two years, patient had regained full range of motion with no further episodes of patellar dislocation. The rarity of this combination of injury along with difficulty in interpreting radiographs makes this case interesting.

Research paper thumbnail of Aneurysmal bone cyst of medial cuneiform and a novel surgical technique for mid-foot reconstruction

BMJ case reports, 2014

Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has ne... more Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.

Research paper thumbnail of Comment on Madelaine et al.: Results and complications of single-stage total knee arthroplasty and high tibial osteotomy

International Orthopaedics, 2014

ABSTRACT Dear Editor,We read the article by Madelaine et al. [1] entitled “Results and complicati... more ABSTRACT Dear Editor,We read the article by Madelaine et al. [1] entitled “Results and complications of single-stage total knee arthroplasty and high tibial osteotomy” with keen interest. We appreciate the authors’ work; however, we would like to point out certain issues, which we believe will contribute to the effectiveness of the study.The authors mention measurement of the femoral mechanical axis (mFA), tibial mechanical axis (mTA) and femorotibial mechanical axis (mFTA) on weight-bearing long-leg films to determine the magnitude and location of the extra-articular deformity. However, it is not clear from the study as to how the authors have arrived at these angles and how they have concluded that the deformity measured is an extra-articular deformity.The authors recommend grafting the osteotomy defect with autograft bone from the bony cuts. It is, however, not clear from the article whether the same technique had been used in their study.We would be curious to know whether the autogra ...

Research paper thumbnail of Intraarticular osteochondroma of the knee

Indian Journal of Orthopaedics, 2014

Osteochondromas are usually extra articular and grow away from the joint towards the diaphysis. I... more Osteochondromas are usually extra articular and grow away from the joint towards the diaphysis. Intraarticular osteochondromas are very rare and often misdiagnosed. We report a case of 16-year-old boy who presented with pain and clicking sound in the right knee for last 6 months. On examination, click was felt at the terminal flexion of the knee. The lateral radiograph of the right knee showed a radio opaque shadow at the posterior aspect of the distal end of femur, which was further evaluated with an MRI. Arthroscopy showed a hard lesion arising from the roof of the intercondylar notch of femur. It was excised arthroscopically. Histopathology revealed it to be an osteochondroma. Thus, intraarticular osteochondroma of the knee can be considered as a rare cause of pain in young patients.

Research paper thumbnail of Ewing's Sarcoma of the Sacroiliac Joint Presenting as Tubercular Sacroiliitis: A Diagnostic Dilemma

Asian Spine Journal, 2014

We report a case of Ewing's sarcoma of the sacroiliac joint in a 21-year-old male mimicking tuber... more We report a case of Ewing's sarcoma of the sacroiliac joint in a 21-year-old male mimicking tubercular sacroiliitis, a rare entity not reported in literature. He presented with pain in the lower back radiating to the right lower limb along with constitutional symptoms of 3 months duration. On examination, the right sacroiliac joint was tender. The laboratory investigations showed anaemia, leukocytosis and raised erythrocyte sedimentation rate. On X-ray, features of right sacroiliitis were seen. This was further investigated with magnetic resonance imaging (MRI), which showed features consistent with tubercular sacroiliitis. Patient was then started on antitubercular treatment, but the improvement was not consistent. So, a contrast MRI was done, which indicated features of primary sarcoma. It was then further conirmed by a computed tomography-guided biopsy, which showed features consistent with Ewing's sarcoma of the sacroiliac joint.

Research paper thumbnail of Comment on Lan et al.: S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

International Orthopaedics, 2014

Research paper thumbnail of Management of nonunion of lower-extremity long bones using mono-lateral external fixator – Report of 37 cases

Injury, 2014

The management of nonunion has remained a constant challenge. The associated bone defect, shorten... more The management of nonunion has remained a constant challenge. The associated bone defect, shortening, deformity and infection complicate the management. A mono-lateral external fixator may minimise some of the problems frequently encountered in these patients. We report our results of prospectively evaluated 37 consecutive patients regarding nonunion of lower-extremity long bones managed using a mono-lateral external fixator. A total of 37 patients (7 femurs and 30 tibias), mean age 36 years, were stabilised using a mono-lateral fixator for nonunion of long bones. The mean time since injury was 8 months. Fifteen cases were infected and they received debridement and antibiotic treatment as per culture and sensitivity reports. In cases where the bone gap or shortening was &amp;amp;amp;amp;amp;amp;gt;3 cm in the tibia and &amp;amp;amp;amp;amp;amp;gt;5 cm in the femur, corticotomy and bone transport (bifocal procedure) was done and in the remaining cases, only compression-distraction (monofocal procedure) was done. The bone and functional results were assessed at the end of treatment according to the criteria described by Paley et al. Union was achieved in 34 cases (91.9%). The average time for union was 5 months. Five cases were treated with the bifocal method and 32 cases were treated with the monofocal method. The average length gain in the bifocal method was 5.7 cm, mean duration of treatment was 8.2 months and bone healing index (BHI) was 1.44 months cm(-1). In six cases, the monofocal treatment was used for limb lengthening. The average length gain was 1.9 cm, mean duration of treatment was 4.83 months and BHI was 2.5 months cm(-1). Bone grafting was required in two cases at the docking site. The bone results were excellent in 24 cases, good in nine cases, fair in one case and poor in three cases. The functional results were excellent in 27 cases, good in six cases, fair in one case and poor in three cases. The most common complication in this series was pin-tract infection (11.5%). A mono-lateral external fixator is an effective method for treating nonunion in the lower extremity with or without bone loss. The nonunion site can be carefully controlled with simultaneous correction of angulation and length.

Research paper thumbnail of Head size and dislocation rate in primary total hip arthroplasty

Indian Journal of Orthopaedics, 2013

Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such ... more Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA.

Research paper thumbnail of Role of vascular endothelial growth factor as a tumour marker in osteosarcoma: a prospective study

International Orthopaedics, 2012

A prospective study was undertaken to evaluate the diagnostic and prognostic significance of seru... more A prospective study was undertaken to evaluate the diagnostic and prognostic significance of serum levels of vascular endothelial growth factor (VEGF) in patients with primary localised osteosarcoma. Serum VEGF levels were measured by an enzyme-linked immunosorbent assay (ELISA) in blood samples collected prechemotherapy, postchemotherapy, and postsurgery in 40 patients with histologically proven primary osteosarcoma. Comparison was made between serum VEGF level of healthy controls (n = 10) and prechemotherapy patient sera to evaluate its diagnostic potential. Serum VEGF levels of patients with and without metastasis were compared. Immunohistochemical staining was done to establish the correlation between serum and tissue VEGF expression. The Kaplan-Meier curve was used for survival analysis No significant relationship was observed between serum VEGF levels and age, gender, tumour size, local recurrence or histopathological subtypes of osteosarcoma. We observed significantly raised mean serum VEGF in patient sera compared with healthy controls (p = 0.001). Significant fall in mean serum VEGF level was observed following chemotherapy (p = 0.001). Patients who developed metastases had significantly higher serum VEGF levels compared with the nonmetastatic group (P = 0.001). Serum VEGF levels correlated well with VEGF expression in tissues. Serum VEGF levels might prove to be of diagnostic, predictive and prognostic value in patients with primary osteosarcoma, although further studies with larger sample size and longer follow-up is needed to support the hypothesis.