Sumit Arora - Academia.edu (original) (raw)

Papers by Sumit Arora

Research paper thumbnail of Concomitant methicillin-resistant Staphylococcus aureus infection in tubercular sacroiliitis masquerading as anti-tubercular drug resistance: Role for molecular diagnosis

Indian Journal of Tuberculosis

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.

Research paper thumbnail of Unusual association of elbow dislocation with humeral biepicondylar fracture in a child: A case report and review of literature

Journal of Clinical Orthopaedics and Trauma

Research paper thumbnail of Thawing frozen shoulder by steroid injection

Journal of Orthopaedic Surgery, 2017

Research paper thumbnail of “Caught by the Eye of Sound” – Epigastric Swelling due to Xiphisternal Tuberculosis

Polish Journal of Radiology, 2017

Background: Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and e... more Background: Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and epigastric hernia, less common causes being carcinoma of the stomach or pancreas, whereas diseases of the sternum presenting as an epigastric swelling is extremely uncommon. We report a case of tubercular infection of the sternum located in the xiphoid process resulting in its presentation as an epigastric swelling.

Research paper thumbnail of Immunotherapy for non-responders among patients of spinal tuberculosis

Indian Journal of Tuberculosis, 2016

Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Imm... more Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Immunotherapy supposedly increases cure rate while reducing the duration of treatment and tissue damage. Non-responders are those patients of tuberculosis who do not respond to anti-tubercular therapy (ATT) in the desired manner despite the mycobacteria showing sensitivity to the given drugs. The role of immunotherapy in the treatment of this particular subset of patients has been investigated scarcely. The present study included a retrospective review of prospectively collected clinico-radiological data of 14 non-responder patients who were taking ATT for spinal tuberculosis for a mean duration of 10.3 months. An immunotherapeutic regime comprising of single intramuscular injection of vitamin D 600,000IU, 3 days course of oral albendazole 200mg daily, salmonella vaccine 0.5ml intramuscular and influenza vaccine 0.5ml intramuscular were added to ATT. The vaccines and the course of oral albendazole were repeated after a month. Before immunotherapy, seven patients were partially dependent while other seven were completely dependent on others for activities of daily living. All except one patient after treatment became independent till last follow-up (p value <0.01). Post immunotherapy, ATT was continued for mean duration of 4.9 months with mean follow-up of 22.4 months. All patients showed good clinical response within 2-6 weeks after the initiation of immunotherapy. The crux to success of the immunotherapy regime is its potential to restore the existing Th1 Th2 imbalance and to provide substitute to the anergic and dysfunctional immune cells.

Research paper thumbnail of Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures

Strategies in Trauma and Limb Reconstruction, 2016

Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of ... more Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.

Research paper thumbnail of Primary leiomyosarcoma of femur

Journal of Clinical Orthopaedics and Trauma, 2016

Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged f... more Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.

Research paper thumbnail of Letter to the Editor: Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation

Journal of orthopaedic surgery (Hong Kong), 2015

ABSTRACT

Research paper thumbnail of Medial patellofemoral ligament reconstruction

Journal of clinical orthopaedics and trauma, 2013

Research paper thumbnail of Isolated Capitate Fracture with Associated Dorsal Dislocation of the Proximal Pole

Research paper thumbnail of Minimally-invasive bone graft harvesting technique without sophisticated instruments

American journal of orthopedics (Belle Mead, N.J.)

Bone graft is required for various reconstructive orthopedic procedures. At times, a small amount... more Bone graft is required for various reconstructive orthopedic procedures. At times, a small amount of cancellous bone graft is required, especially in hand and upper limb surgeries. We describe a minimally invasive technique to harvest bone graft from the iliac crest that may help reduce the morbidity associated with the procedure. This technique uses simple instruments readily available in any orthopedic operation theater.

Research paper thumbnail of Is Major Outer Membrane Protein of Chlamydia Trachomatis a Major Antigenic Protein in Genitourinary -Induced Reactive Arthritis?

Purpose of the Study: Chlamydia trachomatis is a major causative agent of genitourinary infection... more Purpose of the Study: Chlamydia trachomatis is a major causative agent of genitourinary infection-induced Reactive Arthritis (ReA). The Major Outer Membrane Protein (MOMP) plays a major role in chlamydial pathogenesis and is upregulated in acute phase while its expression gets downregulated during chronic infection and it also becomes untreatable. The present study was conducted to detect MOMP in synovial fluid of patients with ReA by direct immunofluorescence technique followed by its confirmation by nucleic acid amplification test. Methods: A total of thirty age-and sex-matched arthritic patients (ReA/ Rheumatoid Arthritis (RA)/ Osteoarthritis (OA) were enrolled following ESSG and ACR criteria. Patients with RA and OA served as controls. Fluid was aspirated from knee joints in each patient. Fluorescein isothiocyanate-conjugated monoclonal antibody to C. trachomatis MOMP (Microtrak, USA) was used to stain synovial cells. Further confirmation was done by detecting nucleic acid DNA f...

Research paper thumbnail of Efficacy of single dose preoperative versus pre- and postoperative injectable cefazolin in surgeries around hip joint

Journal of Clinical Orthopaedics and Trauma, 2015

Research paper thumbnail of Giant Cell Tumor of the Tendon Sheath Around the Foot and Ankle A Report of Three Cases and a Literature Review

Journal of the American Podiatric Medical Association, 2015

The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We presen... more The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We present three rare cases of giant cell tumor of tendon sheath arising from the tendon sheaths of the flexor hallucis longus, peroneus brevis, and extensor hallucis brevis tendons, along with a literature review of such cases in the foot and ankle region. All of the patients were treated with surgical excision of the mass and were asymptomatic after minimum follow-up of 18 months. Giant cell tumor of tendon sheath involving the foot and ankle region is a rare clinical entity, and good results can be expected after surgical excision.

Research paper thumbnail of Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation

Journal of orthopaedic surgery (Hong Kong), 2015

To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the co... more To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength ...

Research paper thumbnail of Evaluation of functional outcome and complications of locking calcaneum plate for fracture calcaneum

Journal of Clinical Orthopaedics and Trauma, 2015

Research paper thumbnail of Letter to the editor: Concomitant fungal and bacterial atlanto-axial osteomyelitis: a case report

Journal of orthopaedic surgery (Hong Kong), 2010

Research paper thumbnail of Cervical Spine Injury Recovery Prediction Scale: a means of predicting neurological recovery in patients with acute subaxial cervical spine injury

Journal of orthopaedic surgery (Hong Kong), 2011

To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict ou... more To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict outcomes for patients with acute subaxial cervical spine injury (CSI). 42 men and 18 women (mean age, 41 years) with acute subaxial (C3-C7) CSI and a neurological deficit were evaluated clinically and radiologically after crutch-field skeletal traction. The comprehensive CSIRPS comprised 5 predictor variables: American Spinal Injury Association (ASIA) impairment scale, maximum cord compression, maximum canal compromise, signal intensity pattern in the cord, and Cervical Spine Injury Severity Score (CSISS). Point values of each predictor were weighted based on consensus and experience, and the total effect was computed using the CSIRPS. A receiver operating characteristic (ROC) curve was plotted with the CSIRPS data to obtain the critical value that can predict walkers from non-walkers. The Chi squared value for CSIRPS was 55.771 and the contingency coefficient was 0.694 (p<0.0001), both...

Research paper thumbnail of An unusual presentation of hemophilia B: pseudotumor of proximal tibia

American journal of orthopedics (Belle Mead, N.J.), 2011

Hemophilia is one of the most common genetically inherited causes of bleeding disorders. The usua... more Hemophilia is one of the most common genetically inherited causes of bleeding disorders. The usual presentation is continuous bleeding from a wound. Very seldom, it presents as a pseudotumor of bone. When left untreated, it may induce compression and pressure necrosis of adjacent structures. Careful evaluation and a high index of suspicion are usually required to arrive at the correct diagnosis. In this article, we report the case of a 10-year-old boy with hemophilia B (Christmas disease) that presented as a pseudotumor producing a large defect in the proximal tibia.

Research paper thumbnail of Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss

Journal of orthopaedic surgery (Hong Kong), 2012

To review records of 15 patients who underwent distraction osteogenesis/bone transport using a mo... more To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union of the femoral shaft. 13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed. The patients had undergone a mean of 2.9 (range, 1-7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6-18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5-17) cm. The mean treatment duration was 7.3 (range, 5-15) months. The mean lengthening index was 12.3 (range, 11.5-15) d...

Research paper thumbnail of Concomitant methicillin-resistant Staphylococcus aureus infection in tubercular sacroiliitis masquerading as anti-tubercular drug resistance: Role for molecular diagnosis

Indian Journal of Tuberculosis

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.

Research paper thumbnail of Unusual association of elbow dislocation with humeral biepicondylar fracture in a child: A case report and review of literature

Journal of Clinical Orthopaedics and Trauma

Research paper thumbnail of Thawing frozen shoulder by steroid injection

Journal of Orthopaedic Surgery, 2017

Research paper thumbnail of “Caught by the Eye of Sound” – Epigastric Swelling due to Xiphisternal Tuberculosis

Polish Journal of Radiology, 2017

Background: Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and e... more Background: Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and epigastric hernia, less common causes being carcinoma of the stomach or pancreas, whereas diseases of the sternum presenting as an epigastric swelling is extremely uncommon. We report a case of tubercular infection of the sternum located in the xiphoid process resulting in its presentation as an epigastric swelling.

Research paper thumbnail of Immunotherapy for non-responders among patients of spinal tuberculosis

Indian Journal of Tuberculosis, 2016

Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Imm... more Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Immunotherapy supposedly increases cure rate while reducing the duration of treatment and tissue damage. Non-responders are those patients of tuberculosis who do not respond to anti-tubercular therapy (ATT) in the desired manner despite the mycobacteria showing sensitivity to the given drugs. The role of immunotherapy in the treatment of this particular subset of patients has been investigated scarcely. The present study included a retrospective review of prospectively collected clinico-radiological data of 14 non-responder patients who were taking ATT for spinal tuberculosis for a mean duration of 10.3 months. An immunotherapeutic regime comprising of single intramuscular injection of vitamin D 600,000IU, 3 days course of oral albendazole 200mg daily, salmonella vaccine 0.5ml intramuscular and influenza vaccine 0.5ml intramuscular were added to ATT. The vaccines and the course of oral albendazole were repeated after a month. Before immunotherapy, seven patients were partially dependent while other seven were completely dependent on others for activities of daily living. All except one patient after treatment became independent till last follow-up (p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Post immunotherapy, ATT was continued for mean duration of 4.9 months with mean follow-up of 22.4 months. All patients showed good clinical response within 2-6 weeks after the initiation of immunotherapy. The crux to success of the immunotherapy regime is its potential to restore the existing Th1 Th2 imbalance and to provide substitute to the anergic and dysfunctional immune cells.

Research paper thumbnail of Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures

Strategies in Trauma and Limb Reconstruction, 2016

Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of ... more Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.

Research paper thumbnail of Primary leiomyosarcoma of femur

Journal of Clinical Orthopaedics and Trauma, 2016

Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged f... more Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.

Research paper thumbnail of Letter to the Editor: Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation

Journal of orthopaedic surgery (Hong Kong), 2015

ABSTRACT

Research paper thumbnail of Medial patellofemoral ligament reconstruction

Journal of clinical orthopaedics and trauma, 2013

Research paper thumbnail of Isolated Capitate Fracture with Associated Dorsal Dislocation of the Proximal Pole

Research paper thumbnail of Minimally-invasive bone graft harvesting technique without sophisticated instruments

American journal of orthopedics (Belle Mead, N.J.)

Bone graft is required for various reconstructive orthopedic procedures. At times, a small amount... more Bone graft is required for various reconstructive orthopedic procedures. At times, a small amount of cancellous bone graft is required, especially in hand and upper limb surgeries. We describe a minimally invasive technique to harvest bone graft from the iliac crest that may help reduce the morbidity associated with the procedure. This technique uses simple instruments readily available in any orthopedic operation theater.

Research paper thumbnail of Is Major Outer Membrane Protein of Chlamydia Trachomatis a Major Antigenic Protein in Genitourinary -Induced Reactive Arthritis?

Purpose of the Study: Chlamydia trachomatis is a major causative agent of genitourinary infection... more Purpose of the Study: Chlamydia trachomatis is a major causative agent of genitourinary infection-induced Reactive Arthritis (ReA). The Major Outer Membrane Protein (MOMP) plays a major role in chlamydial pathogenesis and is upregulated in acute phase while its expression gets downregulated during chronic infection and it also becomes untreatable. The present study was conducted to detect MOMP in synovial fluid of patients with ReA by direct immunofluorescence technique followed by its confirmation by nucleic acid amplification test. Methods: A total of thirty age-and sex-matched arthritic patients (ReA/ Rheumatoid Arthritis (RA)/ Osteoarthritis (OA) were enrolled following ESSG and ACR criteria. Patients with RA and OA served as controls. Fluid was aspirated from knee joints in each patient. Fluorescein isothiocyanate-conjugated monoclonal antibody to C. trachomatis MOMP (Microtrak, USA) was used to stain synovial cells. Further confirmation was done by detecting nucleic acid DNA f...

Research paper thumbnail of Efficacy of single dose preoperative versus pre- and postoperative injectable cefazolin in surgeries around hip joint

Journal of Clinical Orthopaedics and Trauma, 2015

Research paper thumbnail of Giant Cell Tumor of the Tendon Sheath Around the Foot and Ankle A Report of Three Cases and a Literature Review

Journal of the American Podiatric Medical Association, 2015

The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We presen... more The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We present three rare cases of giant cell tumor of tendon sheath arising from the tendon sheaths of the flexor hallucis longus, peroneus brevis, and extensor hallucis brevis tendons, along with a literature review of such cases in the foot and ankle region. All of the patients were treated with surgical excision of the mass and were asymptomatic after minimum follow-up of 18 months. Giant cell tumor of tendon sheath involving the foot and ankle region is a rare clinical entity, and good results can be expected after surgical excision.

Research paper thumbnail of Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation

Journal of orthopaedic surgery (Hong Kong), 2015

To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the co... more To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength ...

Research paper thumbnail of Evaluation of functional outcome and complications of locking calcaneum plate for fracture calcaneum

Journal of Clinical Orthopaedics and Trauma, 2015

Research paper thumbnail of Letter to the editor: Concomitant fungal and bacterial atlanto-axial osteomyelitis: a case report

Journal of orthopaedic surgery (Hong Kong), 2010

Research paper thumbnail of Cervical Spine Injury Recovery Prediction Scale: a means of predicting neurological recovery in patients with acute subaxial cervical spine injury

Journal of orthopaedic surgery (Hong Kong), 2011

To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict ou... more To develop a comprehensive Cervical Spine Injury Recovery Prediction Scale (CSIRPS) to predict outcomes for patients with acute subaxial cervical spine injury (CSI). 42 men and 18 women (mean age, 41 years) with acute subaxial (C3-C7) CSI and a neurological deficit were evaluated clinically and radiologically after crutch-field skeletal traction. The comprehensive CSIRPS comprised 5 predictor variables: American Spinal Injury Association (ASIA) impairment scale, maximum cord compression, maximum canal compromise, signal intensity pattern in the cord, and Cervical Spine Injury Severity Score (CSISS). Point values of each predictor were weighted based on consensus and experience, and the total effect was computed using the CSIRPS. A receiver operating characteristic (ROC) curve was plotted with the CSIRPS data to obtain the critical value that can predict walkers from non-walkers. The Chi squared value for CSIRPS was 55.771 and the contingency coefficient was 0.694 (p<0.0001), both...

Research paper thumbnail of An unusual presentation of hemophilia B: pseudotumor of proximal tibia

American journal of orthopedics (Belle Mead, N.J.), 2011

Hemophilia is one of the most common genetically inherited causes of bleeding disorders. The usua... more Hemophilia is one of the most common genetically inherited causes of bleeding disorders. The usual presentation is continuous bleeding from a wound. Very seldom, it presents as a pseudotumor of bone. When left untreated, it may induce compression and pressure necrosis of adjacent structures. Careful evaluation and a high index of suspicion are usually required to arrive at the correct diagnosis. In this article, we report the case of a 10-year-old boy with hemophilia B (Christmas disease) that presented as a pseudotumor producing a large defect in the proximal tibia.

Research paper thumbnail of Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss

Journal of orthopaedic surgery (Hong Kong), 2012

To review records of 15 patients who underwent distraction osteogenesis/bone transport using a mo... more To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union of the femoral shaft. 13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed. The patients had undergone a mean of 2.9 (range, 1-7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6-18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5-17) cm. The mean treatment duration was 7.3 (range, 5-15) months. The mean lengthening index was 12.3 (range, 11.5-15) d...