Subodh Pathak - Academia.edu (original) (raw)

Papers by Subodh Pathak

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020

Indian Journal of Orthopaedics, 2020

Introduction Soft tissue defects due to trauma with crush injuries and post-tumor excision are la... more Introduction Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. Materials and Methods Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. Results The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4-28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above-knee amputation. Conclusion The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

The archives of bone and joint surgery, 2018

Background In the challenging tibial condyle fractures despite anatomical joint reconstruction, d... more Background In the challenging tibial condyle fractures despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study was to know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome. Methods Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively. Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically and radiologically and were assessed for functional outcome and development of osteoarthritis. Results The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was 41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. Average VAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47pati...

Indian Journal of Orthopaedics, 2021

Background The purpose of this study was to evaluate the flexion-gap of the native knees in the n... more Background The purpose of this study was to evaluate the flexion-gap of the native knees in the normal population and to assess any gender-specific variations in the flexion gap of the knees. Methods A total of 50 normal asymptomatic volunteers with normal knee radiographs were selected for MRI of the knee. The left knee was scanned in an open MRI using a T1-weighted sequence. Imaging was performed in neutral, passive varus and valgus stress at 90° of knee flexion by placing custom-made blocks on a special board consecutively below the distal part of the leg. Results The study population consisted of 26 males and 24 females with a mean age of 25.77 years. Under varus stress, the mean lateral flexion gap increased to 9.28 ± 1.53 mm and under valgus stress, the mean medial flexion gap increased to 2.75 ± 1.22 mm from neutral. The increase in the flexion gap on the lateral side was 5.28 ± 1.79 mm, which was significantly higher compared to that on the medial side. In gender-specific analysis, the mean lateral flexion gap was 10.21 mm in females and 8.46 mm in males under varus stress. Conclusion The findings of the study indicate that the lateral soft tissues are more lax compared to the medial soft tissue structures and this laxity is higher in females as compared to males. The study provides evidence of the existing physiological variations of these soft tissue structures resulting in a trapezoidal flexion gap in the native knees rather than the recommended rectangular gap.

Indian Journal of Orthopaedics, 2020

Background Management of complex wounds of the lower extremity with concomitant Achilles tendon i... more Background Management of complex wounds of the lower extremity with concomitant Achilles tendon injury is a challenging situation for orthopaedic surgeons and plastic surgeons. The objective of the current study was to evaluate the clinical outcome of chronic open defects of the Achilles tendon with composite tissue loss. We have performed single stage reconstruction using the central segment of the proximal part of the Achilles tendon as turn-down flap and was covered immediately with reverse sural flap. Materials and methods Between March 2017 and February 2020, five cases of chronic open composite Achilles tendon defects which were treated by a single stage reconstruction method of "Repair and Flap technique" were included in this study. The patient with the defect for more than 4 weeks duration and had substance loss of Achilles tendon together with loss of overlying skin and soft tissue was included the current study. Results All the flaps survived and healed well, providing stable coverage of the wound. The mean operative duration, including flap elevation, definitive flap inset and donor-site coverage was 98 min (range 90-120 min). Focal areas of skin graft loss were seen in two patients which healed with conservative management. The functional results evaluation was performed with The Achilles Tendon Total Rupture Score (ATRS). The mean Achilles Tendon Total Rupture Score (ATRS) was 70 (range 65-76) Conclusion To conclude, use of proximal turned down flap and coverage with reverse sural flap can be opted as a first option for the management of chronic open wounds with composite defects of the Achilles tendon. "Repair and Flap technique" will be a useful method of reconstruction in centres with limited resources for microsurgical flap. However, a multicenter study with more number of patients are required to further analyse this method. Keywords Repair and flap technique • Reverse sural flap • Achilles tendon • Chronic open wounds • Composite defect

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020

Background and aims: Currently there is limited knowledge on medical comorbidities and COVID-19; ... more Background and aims: Currently there is limited knowledge on medical comorbidities and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of various morbidities on serious events in COVID 19. Methods: PubMed, Cochrane Central Register of Clinical Trials were searched on April 28, 2020, to extract published articles that reported the outcomes of COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics". ICU admission, mechanical ventilation, ARDS, Pneumonia, death was considered serious events. The comorbidities assessed in the study were Hypertension (HTN), Diabetes mellitus (DM), Cardiovascular diseases (CVD), Chronic obstructive pulmonary disease (COPD) and Chronic Kidney disease (CKD). Subsequently, comparisons between comorbidity patient group and the non-comorbidity patient groups, in terms of serious events were made using the pooled estimates of odd's ratio (OR) Results: We identified 688 published results and 16 studies with 3994 patients were included in the systematic review. Serious events were seen in 526(13.16%) patients. Presence of hypertension with OR 2.95, diabetes mellitus with OR 3.07, Cardio vascular disease with OR 4.58, COPD with OR 6.66 and Chronic kidney disease with OR 5.32 had significant association in patients with COVID 19 on having serious events. Presence of diabetes mellitus (OR 2.78)) had a significant impact on death in COVID 19 patients with a p-value 0.004. Conclusions: Presence of medical comorbidities in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical intubation and mortality. The presence of Diabetes mellitus has a significant impact on mortality rate in COVID-19 patients.

Cureus, 2020

Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture ... more Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. It is usually associated with other injuries around the knee joint and hence is often missed. We conducted a comprehensive systematic review of papers published in the English language using PubMed, Web of Science, Scopus, and the Cochrane Database, which reported Hoffa's fracture associated with other injuries around the knee joint. We selected 11 eligible papers for final analysis and review. These papers had 12 patients with Hoffa's fracture, with associated injuries around the knee joint. The associated injuries with Hoffa's fracture were in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. The management principles for Hoffa's fracture with associated injuries around the knee joint are: having a high clinical index of suspicion for these injuries, obtaining all trauma series radiographs and computed tomography of the knee, achieving complete articular incongruity, and restoring the functions of the knee joint.

Journal of Musculoskeletal Research, 2017

Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending th... more Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.

Asia-Pacific Journal of Oncology Nursing, 2017

Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It ... more Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It is therefore important to provide stable and durable wound coverage to provide ability to withstand radiotherapy as well as providing cover to vital structures. Methods: Between July 2014 and June 2016, eight females and six male patients with defects around the knee were operated upon using a perforator plus flap from the anterior tibial artery perforator. In all except two patients, the defects were the result of posttumor extirpation, while in the latter, it was due to impending implant exposure following bone tumor excision and tibial prosthesis. A constant perforator at the neck of the fibula was found using hand-held Doppler. The base of the flap was always kept intact. The flap was then transposed toward the defect and inset in a tensionless manner. Results: The average flap dimension was 14 cm × 5.5 cm. The mean follow-up was 11 months (6-20 months). All the flaps survived well except in one patient who developed partial tip necrosis, providing stable coverage of the wound. Two patients developed local recurrence and had to undergo above-knee amputation. Conclusions: The planning for the reconstruction of defects following tumor resection is to be done in accordance with a multidisciplinary team approach involving oncosurgeon, reconstructive plastic surgeons, and radiation specialist. The perforator plus flap is an excellent choice in defects around the knee to cover neurovascular structures, bone, or implant.

International Journal of Research in Orthopaedics, 2017

Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could b... more Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could be carried out in limited operative environment. However, since the ABSTRACT Background: As fractures of the distal radius are the most common fractures of the upper extremity with no clear guidelines for mode of intervention it was decided to compare two of the most common methods of treatment. The aim of this study was to review a group of patients sustaining extra articular lower end radius fracture treated with percutaneous wiring and volar plating and compare their functional outcome at a significant follow up time. Methods: A prospective study was conducted at tertiary care center. A sample of 45 patients who had a displaced extra articular distal radius fracture and were subjected to treatment with either a plate (n =24) or k wiring (n =21). Outcome assessments were conducted at 6 months. Outcomes were measured on the basis of scores on the DASH questionnaire, wrist range of motion, and radiographic parameters. Results: Patients in the plate group had significantly better DASH scores (p=0.0431) and range of motion at six months compared with patients in the k wiring group. Collapse in radial length was observed in 2 patients with percutaneous wiring which led to suboptimal range of motion and increased DASH scores. Significance arc of motion at 6months in dorsiflexion and palmar flexion were p=0.0038 and when compared with opposite limb were significant in all three planes p=0.0217, p=0.0126 and p=0.0029. Conclusions: Based on our observation we found that treatment of dorsally displaced, unstable extra articular radius fractures across all age groups, volar-locked plates achieve a superior radiological and functional outcome with minimal complications.

International Journal of Research in Orthopaedics, 2017

Background: Complex forearm injuries are often associated with contamination, crushing, loss of t... more Background: Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective nonunion, stiffness, disabilities and secondary amputations. Methods: 23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final followup. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients. Results: All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. Conclusions: Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.

Journal of Clinical Orthopaedics and Trauma, 2017

Introduction: Currently there is no consensus if wide resection and curettage in giant cell tumor... more Introduction: Currently there is no consensus if wide resection and curettage in giant cell tumor have effect on local recurrence rate in the presence of a pathological fracture. Material and method: We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients of giant cell tumor with and without a pathological fracture. The odds ratio (OR) of local recurrence between wide resection and curettage group in giant cell tumor with pathological fracture was calculated. Results: 05 eligible papers were selected for final analysis. This included patients, of whom (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients of pathological fracture treated with wide resection and curettage was 0.298% (95% Confidence interval (CI) 0.0669-1.329, p = 0.97). Conclusion: Wide resection and curettage in patients of giant cell tumor with pathological fracture has difference in local recurrence rates. However the presence of a pathological fracture should no be only influential factor in the decision making to perform wide resection or curettage. A proper planning and judicious approach is required in giant cell tumor with pathological fracture for deciding the appropriate treatment method.

Journal of Clinical Orthopaedics and Trauma, 2017

Introduction: The management of pelvic sarcoma is challenging and goals of surgery are adequate o... more Introduction: The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life. Methods: We have evaluated the results of internal hemipelvecotmy including age, type of resection, reconstruction, radiotherapy or chemotherapy. From 2010 to 2016, 23 patients with pelvic bone tumors (13 with Ewing's sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection. Results: The mean follow-up was 18 months (0.5-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridement's and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury.One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24). Conclusions: Proper selection of patients, preopertive planning and wide surgical margins with reconstruction provides good functional outcomes following internal hemipelvectomy. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. The oncological and functional outcome after internal hemipelvectomy suggests that it's an effective method for treatment of patients with pelvic sarcomas.

International Journal of Research in Orthopaedics, 2017

This is often associated with laxity and with advancing disease there is progressive limitation o... more This is often associated with laxity and with advancing disease there is progressive limitation of function to carry out day to day activities. This is associated with 1 st web space contracture and Z deformity of the thumb due to adduction contracture of carpometacarpal joint and hyperextension of the metacarpophalangeal joint with a bump on the base of the thumb posing a cosmetic problem to women. Various procedures like simple trapezium excision, arthrodesis of trapeziometacarpal joint, osteotomy of 1 st metacarpal, tendon interposition ABSTRACT Background: Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis. Methods: This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score. Results: Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1 st web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain. Conclusions: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.

Journal of Musculoskeletal Research, 2018

Pain around the foot and ankle joint is often misdiagnosed as plantar fasciitis and may lead to d... more Pain around the foot and ankle joint is often misdiagnosed as plantar fasciitis and may lead to delayed diagnosis of osteosarcoma in foot. Delay in diagnosis can lead to adverse prognosis and poor survival outcomes. We present a patient who had primary osteosarcoma of the calcaneum that was initially diagnosed and treated for plantar fasciitis, resulting in a delay of diagnosis. The patient eventually was treated with neo-adjuvant chemotherapy followed by below-knee amputation and adjuvant chemotherapy. This case highlights the need to maintain an index of suspicion with close scrutiny of the radiographs. We suggest few clinical recommendations and need for a great suspicion while evaluating a mass arising from the calcaneum.

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020

Indian Journal of Orthopaedics, 2020

Introduction Soft tissue defects due to trauma with crush injuries and post-tumor excision are la... more Introduction Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. Materials and Methods Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. Results The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4-28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above-knee amputation. Conclusion The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

The archives of bone and joint surgery, 2018

Background In the challenging tibial condyle fractures despite anatomical joint reconstruction, d... more Background In the challenging tibial condyle fractures despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study was to know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome. Methods Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively. Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically and radiologically and were assessed for functional outcome and development of osteoarthritis. Results The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was 41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. Average VAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47pati...

Indian Journal of Orthopaedics, 2021

Background The purpose of this study was to evaluate the flexion-gap of the native knees in the n... more Background The purpose of this study was to evaluate the flexion-gap of the native knees in the normal population and to assess any gender-specific variations in the flexion gap of the knees. Methods A total of 50 normal asymptomatic volunteers with normal knee radiographs were selected for MRI of the knee. The left knee was scanned in an open MRI using a T1-weighted sequence. Imaging was performed in neutral, passive varus and valgus stress at 90° of knee flexion by placing custom-made blocks on a special board consecutively below the distal part of the leg. Results The study population consisted of 26 males and 24 females with a mean age of 25.77 years. Under varus stress, the mean lateral flexion gap increased to 9.28 ± 1.53 mm and under valgus stress, the mean medial flexion gap increased to 2.75 ± 1.22 mm from neutral. The increase in the flexion gap on the lateral side was 5.28 ± 1.79 mm, which was significantly higher compared to that on the medial side. In gender-specific analysis, the mean lateral flexion gap was 10.21 mm in females and 8.46 mm in males under varus stress. Conclusion The findings of the study indicate that the lateral soft tissues are more lax compared to the medial soft tissue structures and this laxity is higher in females as compared to males. The study provides evidence of the existing physiological variations of these soft tissue structures resulting in a trapezoidal flexion gap in the native knees rather than the recommended rectangular gap.

Indian Journal of Orthopaedics, 2020

Background Management of complex wounds of the lower extremity with concomitant Achilles tendon i... more Background Management of complex wounds of the lower extremity with concomitant Achilles tendon injury is a challenging situation for orthopaedic surgeons and plastic surgeons. The objective of the current study was to evaluate the clinical outcome of chronic open defects of the Achilles tendon with composite tissue loss. We have performed single stage reconstruction using the central segment of the proximal part of the Achilles tendon as turn-down flap and was covered immediately with reverse sural flap. Materials and methods Between March 2017 and February 2020, five cases of chronic open composite Achilles tendon defects which were treated by a single stage reconstruction method of "Repair and Flap technique" were included in this study. The patient with the defect for more than 4 weeks duration and had substance loss of Achilles tendon together with loss of overlying skin and soft tissue was included the current study. Results All the flaps survived and healed well, providing stable coverage of the wound. The mean operative duration, including flap elevation, definitive flap inset and donor-site coverage was 98 min (range 90-120 min). Focal areas of skin graft loss were seen in two patients which healed with conservative management. The functional results evaluation was performed with The Achilles Tendon Total Rupture Score (ATRS). The mean Achilles Tendon Total Rupture Score (ATRS) was 70 (range 65-76) Conclusion To conclude, use of proximal turned down flap and coverage with reverse sural flap can be opted as a first option for the management of chronic open wounds with composite defects of the Achilles tendon. "Repair and Flap technique" will be a useful method of reconstruction in centres with limited resources for microsurgical flap. However, a multicenter study with more number of patients are required to further analyse this method. Keywords Repair and flap technique • Reverse sural flap • Achilles tendon • Chronic open wounds • Composite defect

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020

Background and aims: Currently there is limited knowledge on medical comorbidities and COVID-19; ... more Background and aims: Currently there is limited knowledge on medical comorbidities and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of various morbidities on serious events in COVID 19. Methods: PubMed, Cochrane Central Register of Clinical Trials were searched on April 28, 2020, to extract published articles that reported the outcomes of COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics". ICU admission, mechanical ventilation, ARDS, Pneumonia, death was considered serious events. The comorbidities assessed in the study were Hypertension (HTN), Diabetes mellitus (DM), Cardiovascular diseases (CVD), Chronic obstructive pulmonary disease (COPD) and Chronic Kidney disease (CKD). Subsequently, comparisons between comorbidity patient group and the non-comorbidity patient groups, in terms of serious events were made using the pooled estimates of odd's ratio (OR) Results: We identified 688 published results and 16 studies with 3994 patients were included in the systematic review. Serious events were seen in 526(13.16%) patients. Presence of hypertension with OR 2.95, diabetes mellitus with OR 3.07, Cardio vascular disease with OR 4.58, COPD with OR 6.66 and Chronic kidney disease with OR 5.32 had significant association in patients with COVID 19 on having serious events. Presence of diabetes mellitus (OR 2.78)) had a significant impact on death in COVID 19 patients with a p-value 0.004. Conclusions: Presence of medical comorbidities in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical intubation and mortality. The presence of Diabetes mellitus has a significant impact on mortality rate in COVID-19 patients.

Cureus, 2020

Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture ... more Fractures of the distal femur typically occur in the axial and sagittal planes. A Hoffa fracture is a coronal plane fracture of the femoral condyle, which accounts for 8.7% to 13% of distal femoral fractures. It is usually associated with other injuries around the knee joint and hence is often missed. We conducted a comprehensive systematic review of papers published in the English language using PubMed, Web of Science, Scopus, and the Cochrane Database, which reported Hoffa's fracture associated with other injuries around the knee joint. We selected 11 eligible papers for final analysis and review. These papers had 12 patients with Hoffa's fracture, with associated injuries around the knee joint. The associated injuries with Hoffa's fracture were in the ipsilateral distal femur, proximal tibia fractures, patellar dislocation, patella fracture, and patellar tendon incarceration. The management principles for Hoffa's fracture with associated injuries around the knee joint are: having a high clinical index of suspicion for these injuries, obtaining all trauma series radiographs and computed tomography of the knee, achieving complete articular incongruity, and restoring the functions of the knee joint.

Journal of Musculoskeletal Research, 2017

Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending th... more Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.

Asia-Pacific Journal of Oncology Nursing, 2017

Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It ... more Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It is therefore important to provide stable and durable wound coverage to provide ability to withstand radiotherapy as well as providing cover to vital structures. Methods: Between July 2014 and June 2016, eight females and six male patients with defects around the knee were operated upon using a perforator plus flap from the anterior tibial artery perforator. In all except two patients, the defects were the result of posttumor extirpation, while in the latter, it was due to impending implant exposure following bone tumor excision and tibial prosthesis. A constant perforator at the neck of the fibula was found using hand-held Doppler. The base of the flap was always kept intact. The flap was then transposed toward the defect and inset in a tensionless manner. Results: The average flap dimension was 14 cm × 5.5 cm. The mean follow-up was 11 months (6-20 months). All the flaps survived well except in one patient who developed partial tip necrosis, providing stable coverage of the wound. Two patients developed local recurrence and had to undergo above-knee amputation. Conclusions: The planning for the reconstruction of defects following tumor resection is to be done in accordance with a multidisciplinary team approach involving oncosurgeon, reconstructive plastic surgeons, and radiation specialist. The perforator plus flap is an excellent choice in defects around the knee to cover neurovascular structures, bone, or implant.

International Journal of Research in Orthopaedics, 2017

Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could b... more Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could be carried out in limited operative environment. However, since the ABSTRACT Background: As fractures of the distal radius are the most common fractures of the upper extremity with no clear guidelines for mode of intervention it was decided to compare two of the most common methods of treatment. The aim of this study was to review a group of patients sustaining extra articular lower end radius fracture treated with percutaneous wiring and volar plating and compare their functional outcome at a significant follow up time. Methods: A prospective study was conducted at tertiary care center. A sample of 45 patients who had a displaced extra articular distal radius fracture and were subjected to treatment with either a plate (n =24) or k wiring (n =21). Outcome assessments were conducted at 6 months. Outcomes were measured on the basis of scores on the DASH questionnaire, wrist range of motion, and radiographic parameters. Results: Patients in the plate group had significantly better DASH scores (p=0.0431) and range of motion at six months compared with patients in the k wiring group. Collapse in radial length was observed in 2 patients with percutaneous wiring which led to suboptimal range of motion and increased DASH scores. Significance arc of motion at 6months in dorsiflexion and palmar flexion were p=0.0038 and when compared with opposite limb were significant in all three planes p=0.0217, p=0.0126 and p=0.0029. Conclusions: Based on our observation we found that treatment of dorsally displaced, unstable extra articular radius fractures across all age groups, volar-locked plates achieve a superior radiological and functional outcome with minimal complications.

International Journal of Research in Orthopaedics, 2017

Background: Complex forearm injuries are often associated with contamination, crushing, loss of t... more Background: Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective nonunion, stiffness, disabilities and secondary amputations. Methods: 23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final followup. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients. Results: All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. Conclusions: Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.

Journal of Clinical Orthopaedics and Trauma, 2017

Introduction: Currently there is no consensus if wide resection and curettage in giant cell tumor... more Introduction: Currently there is no consensus if wide resection and curettage in giant cell tumor have effect on local recurrence rate in the presence of a pathological fracture. Material and method: We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients of giant cell tumor with and without a pathological fracture. The odds ratio (OR) of local recurrence between wide resection and curettage group in giant cell tumor with pathological fracture was calculated. Results: 05 eligible papers were selected for final analysis. This included patients, of whom (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients of pathological fracture treated with wide resection and curettage was 0.298% (95% Confidence interval (CI) 0.0669-1.329, p = 0.97). Conclusion: Wide resection and curettage in patients of giant cell tumor with pathological fracture has difference in local recurrence rates. However the presence of a pathological fracture should no be only influential factor in the decision making to perform wide resection or curettage. A proper planning and judicious approach is required in giant cell tumor with pathological fracture for deciding the appropriate treatment method.

Journal of Clinical Orthopaedics and Trauma, 2017

Introduction: The management of pelvic sarcoma is challenging and goals of surgery are adequate o... more Introduction: The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life. Methods: We have evaluated the results of internal hemipelvecotmy including age, type of resection, reconstruction, radiotherapy or chemotherapy. From 2010 to 2016, 23 patients with pelvic bone tumors (13 with Ewing's sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection. Results: The mean follow-up was 18 months (0.5-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridement's and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury.One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24). Conclusions: Proper selection of patients, preopertive planning and wide surgical margins with reconstruction provides good functional outcomes following internal hemipelvectomy. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. The oncological and functional outcome after internal hemipelvectomy suggests that it's an effective method for treatment of patients with pelvic sarcomas.

International Journal of Research in Orthopaedics, 2017

This is often associated with laxity and with advancing disease there is progressive limitation o... more This is often associated with laxity and with advancing disease there is progressive limitation of function to carry out day to day activities. This is associated with 1 st web space contracture and Z deformity of the thumb due to adduction contracture of carpometacarpal joint and hyperextension of the metacarpophalangeal joint with a bump on the base of the thumb posing a cosmetic problem to women. Various procedures like simple trapezium excision, arthrodesis of trapeziometacarpal joint, osteotomy of 1 st metacarpal, tendon interposition ABSTRACT Background: Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis. Methods: This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score. Results: Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1 st web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain. Conclusions: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.

Journal of Musculoskeletal Research, 2018

Pain around the foot and ankle joint is often misdiagnosed as plantar fasciitis and may lead to d... more Pain around the foot and ankle joint is often misdiagnosed as plantar fasciitis and may lead to delayed diagnosis of osteosarcoma in foot. Delay in diagnosis can lead to adverse prognosis and poor survival outcomes. We present a patient who had primary osteosarcoma of the calcaneum that was initially diagnosed and treated for plantar fasciitis, resulting in a delay of diagnosis. The patient eventually was treated with neo-adjuvant chemotherapy followed by below-knee amputation and adjuvant chemotherapy. This case highlights the need to maintain an index of suspicion with close scrutiny of the radiographs. We suggest few clinical recommendations and need for a great suspicion while evaluating a mass arising from the calcaneum.