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Sadangi S, Saraiya H, Salunke AA, Bharwani N, Patel K, Pandya S, Warikoo V, Pandya S. The surgical management and oncologic outcomes of patients with fungating soft tissue sarcoma treated at a tertiary cancer centre and review of literature. J Orthop 2024; 53:94-100. [PMID: 38495576 PMCID: PMC10940886 DOI: 10.1016/j.jor.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
Background Currently there is limited literature available on fungating soft tissue sarcoma and its effect of outcomes. In the current study we evaluated the surgical management and oncologic outcomes of patient with fungating soft tissue sarcoma. Materials and methods This was a retrospective observational study of patients with fungating sarcoma between January 2015 till January 2019 at a tertiary cancer care centre. A total of 59 patients were considered of which 16 had metastasis at presentation. The duration of symptoms prior to presentation averaged 10.2 months (median, 7.2months; range, 1-57 months). Median tumor length was 10 cm. Results 56% patients underwent amputation and 44% were treated with limb salvage. Following limb salvage surgery in10 cases primary closure of defect was performed and 6 cases required skin grafting for closure of defect. In 6 patients local flap was used for coverage of defect and 4 patients required free flap surgery. Two-year overall survival (OS) of the study cohort were 52.2% and 58% respectively. Two-year disease free survival (DFS) and OS in 43 non metastatic patients at presentation was seen in 58%(95% CI,38%-74%) and 66.5%(95% CI,42%-81%) respectively. The two-year disease OS in 16 patients with metastasis at presentation was 33.2 %. On univariate analysis, tumor size and metastatic at presentation had significant effect on survival. Conclusion Tumor size and metastatic at presentation has significant impact on survival in these patients. The oncologic outcomes including Disease free survival, overall survival and local recurrence rates similar amongst the two surgical modalities (amputation versus limb salvage). Amputation rates are more amongst fungating soft tissue sarcoma but limb salvage can be attempted whenever feasible keeping tumor free surgical margins under consideration.
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Affiliation(s)
- Sudam Sadangi
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Hemant Saraiya
- Department of Onco-Plastic Surgery, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
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Banala TR, Salunke AA, Bharwani N, Patel K, Maharjan D, Patel S, Warikoo V, Sharma M, Pandya S. Distal Ulna Giant Cell Tumor treated by Resection without Reconstruction: What were the functional outcomes and review of literature. J Orthop 2024; 53:118-124. [PMID: 38495577 PMCID: PMC10940127 DOI: 10.1016/j.jor.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Giant Cell Tumours (GCT) are benign tumours with aggressive potential that disrupt the local bony architecture, which can be especially problematic in peri-articular locations. Our aim was to assess the outcomes of patients with GCT of the distal ulna who were treated by resection without reconstruction. Methods The study included 21 patients with distal ulna GCT that were treated with resection without reconstruction. There were 12 males and 9 females, with a mean age of 30.4years (range 14-45 years). The patients mean follow-up period was 4.4 years, with a two-year minimum follow-up. Results Painful swelling was the presenting symtom in all cases. Nineteen patients had Campanacci grade 3 and two had Campanacci grade 2. The mean resected length of the distal ulna was 6.8 cm (range 4-10) cm. The Musculoskeletal Tumor Society score (MSTS) was 26.1. (range 22-28). Grip strength of the affected hand was reduced by 10.5% on average. (range 0%-16%). Two patients were having multi-centric disease on presentation and none of the cases had pathological fracture on presentation. One case had a local recurrence which was treated with surgery. Conclusion Based on current study, GCT of the distal ulna, en bloc resection without reconstruction can be recommended as a valuable treatment option for Campanacci grades 2 and 3 tumours. Resection of the distal end of the ulna without reconstruction results in excellent functional outcomes, with forearm rotational movement and hand function preserved. According to review of literature this is the largest series of GCT Ulna and we recommend a multicentre and comparitive studies on this topic.
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Affiliation(s)
- Tarun Reddy Banala
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Dipendra Maharjan
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shailesh Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
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Salunke AA, Nandy K, Kamani M, Parmar R, Bharwani N, Pathak S, Patel K, Pandya S. Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature. J Orthop 2024; 52:37-48. [PMID: 38404696 PMCID: PMC10891286 DOI: 10.1016/j.jor.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature. Methods During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%). Results The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %). Conclusions The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Rahul Parmar
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | | | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Shukla S, Salunke AA, Trivedi M, Patel K, Pandya S, Suthar R, Reddy T, Kapoor K, Yala P, Krishna G, Bharwani N, Pandya S. Clinicopathological and oncological outcomes in upper extremity Ewing's sarcoma: A single institutional experience. J Orthop 2024; 49:148-155. [PMID: 38682008 PMCID: PMC11043629 DOI: 10.1016/j.jor.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 05/01/2024] Open
Abstract
Background Ewing's sarcoma is highly aggressive bone tumor having predilection for younger age groups with t (11,22) translocation, recombines the FLI-1 and EWS genes on chromosome 22. This disease requires multi-disciplinary treatment withneo-adjuvant chemotherapy followed by surgery or radiotherapy and adjuvant chemotherapy. This study was aimed to assess the demographic distribution, clinical behaviour and oncological outcome of Ewings Sarcoma involving upper extremity. Methods From 2015 to 2022, 45 patients of upper extremity Ewing's sarcoma underwent treatment at a territory cancer centre. A total of 26 patients treated with surgical management were included in the study comprising 15 males (57.7 %) and 11 females (42.3 %). Mean age of presentation was 26 years (3-43 years). The most common site for Ewings sarcoma of upper extremity was Humerus(42 %) followed by Scapula(27 %), Radius(15 %), Ulna(8 %), Metacarpals(4 %) and Clavicle(4 %). Out of 26 cases, 19 (73%) underwent limb salvage surgery and 7 (27%) underwent ampuation surgery. Results In limb salvage group reconstruction with Extra-corporeal radiotherapy (ECRT), Ulna centralization, Megaprosthesis and 3D printed scapula was performed following wide resection of tumor. In Amputation group ray resection in one case and forequarter amputation was performed in six cases. Mean serum LDH value was 335 IU/L (2.3X Normal value) and serum albumin was 4.04 gm/dl. Mean tumour necrosis after neo-adjuvant chemotherapy was 68 %. Out of 26 cases, 19(73 %) cases underwent limb salvage and 7 patients underwent amputation surgery. Out of 26, 13 (50 %) patients developed metastasis on follow up. The Event free survival (EFS) in current study was 70 % at 12 months and 40 % at 24 months. Mean Event free survival (EFS) in current study was 33.5 months (22.3-44.6) and Median Event free survival (EFS) in current study was 25 months (19.7-30.2). Conclusion This study characterises demographic and oncologic outcomes of upper extremity ewings sarcoma in Indian subpopulation. Pain and swelling were prominent clinical findings at presentation in patients with upper extremity Ewing's sarcoma. The survival rate following limb salvage surgery in Ewings sarcoma of upper extremity was comparable to that of patients with amputation surgery. Ewings sarcoma of upper extremity was associated with higher LDH level which was raised more than twice the normal range and can led to worse oncologic outcomes. A comparative study on upper extremity and lower extremity ewings sarcoma will be of help to improve literature on this rare disease.
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Affiliation(s)
- Shivang Shukla
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | | | - Maharshi Trivedi
- Gujarat Cancer and Research Institute, (Medical Oncology), Ahmedabad, Gujarat, India
| | - Keval Patel
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Ritesh Suthar
- Gujarat Cancer and Research Institute, (Nuclear Medicine), Ahmedabad, Gujarat, India
| | - Tarun Reddy
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Kanika Kapoor
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Poojitha Yala
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Geetha Krishna
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
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Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, Bharwani N, Trivedi P, Pandya S. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop 2024; 48:13-19. [PMID: 38059219 PMCID: PMC10696180 DOI: 10.1016/j.jor.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.
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Affiliation(s)
- Amisha Gami
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Suthar R, Bharwani N, Pareek P, Salunke AA, Patel K, Shukla S, Aron J, Kapoor K, Yalla P, Rathod P, Pandya S, Pandya S. Role of bone scintigraphy (bone scan) in skeletal osteosarcoma: A retrospective audit and review from tertiary oncology centre. J Orthop 2024; 48:20-24. [PMID: 38059218 PMCID: PMC10696193 DOI: 10.1016/j.jor.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Bone scan is a investigation which uses radionuclide phosphonate compound for whole skeletal survey. In this current study we have done the analysis of the role of bone scan in skeletal osteosarcoma at tertiary oncology care centre. Material & methods This is a retrospective study conducted in a tertiary oncology centre from January 2022 to February 2023. A total of 92 patients with skeletal OGS were included in our study undergone 99 mTCcMDP whole body bone scan. 99 mTc MDP was prepared freshly every morning and dose for each patient were calculated as per EANM guidelines. Images were acquired 2-3 h of post injection. All images were acquired at GE infinia dual head machine with peak setting at 140Kev and LEAP collimator. Suspicious lesions on planer bone scan were correlated with SPECT fused with CT. All the bone scans were reviewed retrospectively by two independent nuclear medicine physicians. Results In this study group, 86 patients with biopsy proven skeletal OGS underwent 99 mTCcMDP bone scan of which 63 were males and 23 were females (2.7:1) with age of study group ranging from 7years to 48years. Patients referred for bone scan were retrospectively categorized in two groups, first group patients (52) were referred for initial staging of disease and second group of patients (34) were referred for follow-up or re-staging of the disease. Total 09 patients showed distant skeletal metastases on bone scan, out of which 05 were in initial staging group and 04 in follow up group. Conclusion Osteosarcoma has propensity to metastasize to many sites in the body however most common site being lung followed by skeletal, nodal and rarely soft tissue metastasis. Bone scan enjoys a optimal sensitivity in case of osteosarcoma to detect skeletal metastasis but have low specificity. However being a cost effective and faster investigation makes it a wise investigation of choice in case of osteosarcoma for skeletal metastasis evaluation.
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Affiliation(s)
- Ritesh Suthar
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Nandlal Bharwani
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Pravin Pareek
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Keval Patel
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivang Shukla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Jebin Aron
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Kanika Kapoor
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Poojitha Yalla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Priyank Rathod
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivam Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shashank Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
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Pathak SK, Salunke AA, Menon PH, Thivari P, Nandy K, Yongsheng C. Corticosteroid Injection for the Treatment of Trigger Finger: A Meta-Analysis of Randomised Control Trials. J Hand Surg Asian Pac Vol 2022; 27:89-97. [PMID: 35135421 DOI: 10.1142/s242483552250014x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were ('stenosing tenosynovitis' OR 'trigger finger') AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40-0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08-0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic).
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Affiliation(s)
| | | | - Prem Haridas Menon
- Department of Orthopaedics, Government Medical College, Thiruvananthapuram, Kerala, India
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Pathak SK, Salunke AA, Chawla JS, Sharma A, Ratna HVK, Gautam RK. Bilateral Radial Head Fracture Secondary to Weighted Push-Up Exercise: Case Report and Review of Literature of a Rare Injury. Indian J Orthop 2022; 56:162-167. [PMID: 35070157 PMCID: PMC8748555 DOI: 10.1007/s43465-021-00427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/13/2021] [Indexed: 02/04/2023]
Abstract
A 33-year-old male presented with bilateral radial head fractures after weighted prone push-up exercise. The patient had Mason type I and II on right and left sides, respectively. He was managed conservatively with limited immobilisation and early range of motion exercises. The fracture healed and patient had no complaints at the last follow-up of 13 months. Bilateral radial head fracture is rare with push-up exercise, and can be successfully treated conservatively with immobilisation and early rehabilitation. Although push-up exercises are an excellent workout with known benefits, unusual modifications of standard techniques should be avoided.
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Affiliation(s)
- Subodh Kumar Pathak
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | | | - Jasneet Singh Chawla
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Aryan Sharma
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Harish V. K. Ratna
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Rakesh Kumar Gautam
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
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Pathak SK, Salunke AA, Virk JS, Kumar N. Giant cell tumour of EHL tendon sheath in young: a rare case report and review of the literature. BMJ Case Rep 2021; 14:e242980. [PMID: 34544702 PMCID: PMC8454440 DOI: 10.1136/bcr-2021-242980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Giant cell tumour of tendon sheath also known as benign synovioma is a slow-growing benign tumour originating from tendon sheath, ligaments or bursa. We present a case of swelling over the left foot of 7-month duration in 11-year-old boy diagnosed as giant cell tumour of tendon sheath. There was an extensive pressure effect of tumour mass on the second metatarsal evident by scalloping. Local excision was planned and executed, and reduction in scalloping was evident at 26-month follow-up with no recurrence. We conclude that en bloc resection of tumour with a hydrogen peroxide lavage may result in a favourable prognosis without recurrence.
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Affiliation(s)
| | | | | | - Naveen Kumar
- Orthopedics, Maharishi Markandeshwar University, Ambala, Haryana, India
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Nandy K, Dhanwate A, Salunke AA, Tank T, Patel K, Kumar Pathak S, Menon P, Upadhay S, Shanmugasundaram S, Bhirud C, Sharma A, Patil P, Sonawane S, Pandya S. A community response survey on an ABCD scoring system for patient's self assessment with symptoms of COVID-19. Diabetes Metab Syndr 2021; 15:102141. [PMID: 34186368 PMCID: PMC8139228 DOI: 10.1016/j.dsx.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Kunal Nandy
- Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India.
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India.
| | - Tanmay Tank
- Department of Anaesthesia Gujarat Cancer and Research Institute Ahmedabad, India
| | - Keval Patel
- Department of Surgical Oncology Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India
| | - Subodh Kumar Pathak
- Department of Orthopaedics MMIMSR, MM Deemed to be University, Mullana, Ambala, India
| | - Prem Menon
- Department of Orthopaedics Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sachin Upadhay
- Department of Orthopaedics Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | | | - Chirag Bhirud
- Department of Surgical Oncology Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India
| | - Ankit Sharma
- Department of Surgical Oncology Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India
| | - Pritam Patil
- Department Plastic Surgery Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India
| | | | - Shashank Pandya
- Gujarat Cancer and Research Institute Ahmedabad, Gujarat, India
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Pathak SK, Sethi M, Salunke AA, Thivari P, Gautam RK, Anjum R, Chawla J, Sharma A. Is Flexion Gap Rectangular in Native Indian Knees? Results of an MRI Study. Indian J Orthop 2021; 55:1127-1134. [PMID: 34824712 PMCID: PMC8586387 DOI: 10.1007/s43465-021-00418-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/05/2021] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Subodh Kumar Pathak
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, M M Deemed to be University, Mullana, India
| | - Manish Sethi
- Department of Orthopaedics, Phull Neuro Hospital, Patiala, India
| | | | - Praveen Thivari
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, M M Deemed to be University, Mullana, India
| | - Rakesh Kumar Gautam
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, M M Deemed to be University, Mullana, India
| | - Rashid Anjum
- Department of Orthopaedics, ASCOMS & Hospital, Jammu, India
| | - Jasneet Chawla
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, M M Deemed to be University, Mullana, India
| | - Aryan Sharma
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, M M Deemed to be University, Mullana, India
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Salunke AA, Nandy K, Puj K, Kamani M, Pathak S, Shah J, Bhalerao RH, Jain A, Sharma M, Warikoo V, Patel K, Rathod P, Bhatt S, Tank T, Pandya S. A proposed "Radiological Evaluation Score for Bone Tumors" (REST): An objective system for assessment of a radiograph in patients with suspected bone tumor. Musculoskelet Surg 2021; 106:371-382. [PMID: 33982208 DOI: 10.1007/s12306-021-00711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although radiographs have been widely used in the evaluation of patients with suspected bone tumors, the lack of an objective radiological assessment method leads to a challenge in reaching correct diagnosis. The study aimed to propose a Radiological Evaluation Score for Bone Tumors (REST) which includes eight radiological factors [characteristics, content, cortical breach, distinctiveness, distribution, periosteal reaction, fracture, and soft tissue swelling] to form a single score along with its validation by multidisciplinary observers. METHODS We reviewed the radiographs of 100 patients with a primary bone tumor which were selected at random from the database between January 2017 and January 2019 of a tertiary cancer center. Four reviewers (two orthopedic oncologists and two surgical oncologists) independently assessed the radiographs, based on the reporting system of REST. We constituted two groups according to the probable diagnosis of bone tumor (suspected benign tumor and suspected malignant tumor). RESULTS The mean score in the suspected benign tumor group was 1.1 (range 0-3, 95% CI 0.8-1.3) and in malignant tumor group was 6.1 (range 2-8, 95% CI 5.8-6.4). A receiver operator characteristic (ROC) curve for REST was with a cutoff of 3.5, with the most diagnostic value area under curve (AUC) of 0.99. The sensitivity was 98% and specificity was 100% with a positive predictive value of 100% and a negative predictive value of 98%. The inter-observer correlation coefficient was 0.985 (p value < 0.05), and Fleiss kappa value for the prediction of the benign or malignant lesion was 0.97 (p value < 0.05). The characteristics and content of tumor, cortical erosion, distinctiveness, distribution, periosteal reaction, and soft tissue mass had a significant correlation with the aggressiveness of bone lesion p value < 0.05. CONCLUSIONS The Radiological Evaluation Score for Bone Tumors (REST) is a structured reporting and objective method for the assessment of radiographs in patients with suspected bone tumors. This method is a reliable and helpful tool for clinicians in their outdoor patient department to differentiate a radiograph of a suspected benign tumor from a malignant bone tumor.
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Affiliation(s)
- A A Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Nandy
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - K Puj
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - M Kamani
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Pathak
- Department of Orthopedics, MM Institute of Medical Sciences & Research, Ambala, India
| | - J Shah
- Osteo Care - Ortho Onco Clinic, Ahmedabad, Gujarat, India
| | - R H Bhalerao
- Department of Electrical Engineering and Computer Science, Institute of Infrastructure, Technology, Research And Management, Ahmedabad, Gujarat, India
| | - A Jain
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - M Sharma
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - V Warikoo
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - K Patel
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - P Rathod
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Bhatt
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - T Tank
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Pandya
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Pathak SK, Salunke AA, Pandey A, Singh M, Chawla J, Sharma A. Letter to the editor in response to: Effect of COVID-19 lockdown on patients with chronic diseases. Diabetes Metab Syndr 2021; 15:1057-1058. [PMID: 33814293 PMCID: PMC8005254 DOI: 10.1016/j.dsx.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/24/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Subodh Kumar Pathak
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Apurva Pandey
- Department of Radiation Oncology, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Manjeet Singh
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Jasneet Chawla
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Aryan Sharma
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
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14
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Salunke AA, Nandy K, Kamani M, Puj K, Pathak S, Patel K, Bhalerao RH, Jain A, Sharma M, Warikoo V, Bhatt S, Rathod P, Pandya S. A proposed ''A to Z RAM (Radiograph Assessment Method)'' for triage of patients with a suspected bone tumour. Radiography (Lond) 2021; 27:823-830. [PMID: 33487526 DOI: 10.1016/j.radi.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We propose a ''A to Z RAM (Radiograph Assessment Method)'' for evaluation of Radiograph of patients with a suspected bone tumour. METHODS In the current study, ten radiological features with letters 'A, B, C, D, E, F and Z' were used and which included the age of the patient, involved part of the bone, characteristics, content, distinctiveness, the exterior of the bone, fracture, and zone of transition. Four independent observers (orthopaedic oncologists and surgical oncologists) evaluated a set of 30 radiographs of bone tumour selected at random from our hospital database based on A to Z RAM. We classified the lesions into two groups according to the traffic signal system; Green (suspected benign lesion) and Red (suspected malignant lesion). RESULTS There were 18 (60%) benign bone lesions and 12 (40%) malignant lesions in the current study. 91.6% of malignant tumours and 88.8% of the benign tumours were identified correctly by the four observers. The inter-observer variability with Fleiss kappa was 0.884 (95% CI 0.7-1.03 p-value < 0.05), suggestive of agreement not by chance. These radiographs were again reassessed by the four observers after 3 months. The interobserver variability by Fleiss kappa was 1.0 (95% CI 0.8-1.1) suggesting complete agreement amongst the observers. Both orthopaedic oncologists had intra-observer kappa as 1.0 each and both surgical oncologists had 0.795 and 0.930 respectively. CONCLUSION The proposed A to Z RAM is an easy to use and reproducible method for reviewing radiographs in the out-patient department along with clinical findings for better management of patients with suspected bone lesions. The A to Z RAM can be a medical triage tool and subdivide bone lesions into two subgroups i.e. suspected benign lesion with a suggestion of further investigations with MRI and biopsy and suspected malignant lesion with a suggestion of MRI or early referral to a tertiary cancer center with expertise in orthopaedic oncology. IMPLICATIONS FOR PRACTICE The A to Z RAM (Radiologic Assessment Method) is a reproducible method for reviewing radiographs in the out-patient department and can be an aid for better management of patients. A to Z RAM is useful as a medical triage system, subdividing patients according to the probable diagnosis into a suspected benign lesion and suspected malignant lesion.
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Affiliation(s)
- A A Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Nandy
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Kamani
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Puj
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pathak
- Department of Orthopedics, MM University, Ambala, India.
| | - K Patel
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - R H Bhalerao
- Deptartment of Electrical Engineering, IITRAM, Ahmedabad, Gujarat, India.
| | - A Jain
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Sharma
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - V Warikoo
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Bhatt
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - P Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
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Pathak SK, Pandey S, Pandey A, Salunke AA, Thivari P, Ratna HVK, Chawla J. Focus on uncommon symptoms of COVID-19: Potential reason for spread of infection. Diabetes Metab Syndr 2020; 14:1873-1874. [PMID: 32998094 PMCID: PMC7493791 DOI: 10.1016/j.dsx.2020.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
Focus on uncommon symptoms of COVID-19: Potential reason for spread of infection.
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Affiliation(s)
- Subodh Kumar Pathak
- Department of Orthopaedics, MMIMSR, M M Deemed to be University, Ambala, India.
| | | | - Apurva Pandey
- Department of Radiation Oncology, MMIMSR, M M Deemed to be University, Ambala, India.
| | | | - Praveen Thivari
- Department of Orthopaedics, MMIMSR, M M Deemed to be University, Ambala, India.
| | - Harish V K Ratna
- Department of Orthopaedics, MMIMSR, M M Deemed to be University, Ambala, India.
| | - Jasneet Chawla
- Department of Orthopaedics, MMIMSR, M M Deemed to be University, Ambala, India.
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Pandey S, Pathak SK, Pandey A, Salunke AA, Chawla J, Sharma A, Sharma S, Thivari P, Ratna HVK. Ivermectin in COVID-19: What do we know? Diabetes Metab Syndr 2020; 14:1921-1922. [PMID: 33032231 PMCID: PMC7521351 DOI: 10.1016/j.dsx.2020.09.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - Subodh Kumar Pathak
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Apurva Pandey
- Department of Radiation Oncology, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | | | - Jasneet Chawla
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Aryan Sharma
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Sarthak Sharma
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Praveen Thivari
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
| | - Harish V K Ratna
- Department of Orthopaedics, MMIMSR, MM Deemed to be University, Ambala, Haryana, India.
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Salunke AA, Warikoo V, Kumar Pathak S, Nandy K, Mujawar J, Mendhe H, Shah A, Kottakota V, Menon V, Pandya S. A proposed ABCD scoring system for better triage of patients with COVID-19: Use of clinical features and radiopathological findings. Diabetes Metab Syndr 2020; 14:1637-1640. [PMID: 32892061 PMCID: PMC7448768 DOI: 10.1016/j.dsx.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND AIMS Currently there are limited tools available for triage of patients with COVID -19. We propose a new ABCD scoring system for patients who have been tested positive for COVID-19. METHODS The ABCD score is for patients who have been tested positive for COVID-19 and admitted in a hospital. This score includes age of the patient, blood tests included leukopenia, lymphocytopenia, CRP level, LDH level,D-Dimer, Chest radiograph and CT Scan, Comorbidities and Dyspnea. RESULTS The triage score had letters from alphabets which included A, B, C, D. The score was developed using these variables which outputs a value from 0 to 1. We had used the code according to traffic signal system; green(mild), yellow moderate) and red(severe). The suggestions for mild (green)category: symptomatic treatment in ward, in moderate (yellow) category: active treatment, semi critical care and oxygen supplementation, in severe (red) category: critical care and intensive care. CONCLUSIONS This study is, to our knowledge, is the first scoring tool that has been prepared by Indian health care processional's and used alphabets A, B,C,D as variables for evaluation of admitted patients with COVID-19. This triage tool will be helpful in better management of patients with COVID-19. This score component includes clinical and radiopathological findings.A multi-centre study is required to validate all available scoring systems.
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Affiliation(s)
| | - Vikas Warikoo
- Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Kunal Nandy
- Gujarat Cancer and Research Institue, Ahmedabad, Gujarat, India
| | | | - Harshal Mendhe
- Department of Preventive and Social Medicine, GMC, Rajandgaon, Chattisgarh, India
| | - Anand Shah
- Department of Preventive and Social Medicine, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Vivek Menon
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Salunke AA, Nandy K, Pathak SK, Shah J, Kamani M, Kottakota V, Thivari P, Pandey A, Patel K, Rathod P, Bhatt S, Dave P, Pandya S. Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:1431-1437. [PMID: 32755847 PMCID: PMC7833306 DOI: 10.1016/j.dsx.2020.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMSBACKGROUND Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19. METHODS PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics" with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis. RESULTS There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1-4). CONCLUSIONS Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Subodh Kumar Pathak
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, India
| | - Jaymin Shah
- Department of Orthopedic Oncology, Osteocare Ortho Onco Clinic, Ahmedabad, Gujarat, India
| | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Viswanth Kottakota
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Praveen Thivari
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, India
| | - Apurva Pandey
- Department of Radiation Oncology, MMIMSR, MM Deemed to be University, Ambala, Haryana, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priyank Rathod
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Supreet Bhatt
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Pariseema Dave
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Salunke AA, Pathak SK, Dhanwate A, Warikoo V, Nandy K, Mendhe H, Kottakota V, Shinde RM, Patil SA, Petiwala T, Pandya S. A proposed ABCD scoring system for patient's self assessment and at emergency department with symptoms of COVID-19. Diabetes Metab Syndr 2020; 14:1495-1501. [PMID: 32795741 PMCID: PMC7399652 DOI: 10.1016/j.dsx.2020.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
| | | | - Anant Dhanwate
- Department of Anatomy, Government Medical College(GMC), Akola, Maharashtra, India
| | - Vikas Warikoo
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Harshal Mendhe
- Department of Preventive and Social Medicine, Government Medical College, Rajnandgaon, Chhattisgarh, India
| | - Viswanth Kottakota
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Rahul Madhukar Shinde
- Department of Skin and Venereal Disease, ACPM Medical College, Dhule, Maharashtra, India
| | - Shubham Ashok Patil
- Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | | | - Shashank Pandya
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Salunke AA, Shah J, Chauhan TS, Parmar R, Kumar A, Koyani H, Garg N, Bhole M, Merja M, Pandit J, Pandya S, Kamani M. Reconstruction with biological methods following intercalary excision of femoral diaphyseal tumors. J Orthop Surg (Hong Kong) 2020; 27:2309499018822242. [PMID: 30798734 DOI: 10.1177/2309499018822242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to assess outcomes of biological (nonvascularized fibula grafts and extracorporeal irradiated autologous bone grafts) methods used for reconstruction of intercalary defects after resection of femoral diaphyseal tumors. MATERIALS AND METHODS This study included 28 patients who had undergone intercalary resection in femoral diaphyseal tumors between 2011 and 2016. The mean follow-up period was 24 months (range 12-57 months). RESULTS The mean union time for diaphyseo-diaphyseal union was 10.5 and 11 months in nonvascularized fibula group and extracorporeal radiotherapy (ECRT) group, respectively. The mean union time for metaphyseo-diaphyseal union was 6.5 months in both nonvascularized fibula and ECRT groups. Six patients had distant metastasis, and one patient had local recurrence. The mean Musculoskeletal Tumor Society score was 28 at the last follow-up. Two patients had surgical site infection in the nonvascularized fibula group. Implant failure was found in one patient of the ECRT group requiring revision surgery. Three patients had nonunion (two from the nonvascularized fibula group and one from the ECRT group). CONCLUSION The present study indicates that the biological reconstruction modalities provide good functional outcomes in diaphyseal tumors of femur. Nonvasularized fibula and ECRT-treated autografts reconstruction provides good results, and union timing is comparable. The outcomes of the current study are promising as compared to the results in the reviewed literature. The reconstruction method depends on the resources available at the oncological center and the conversance with the method of the treating surgeon.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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21
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Konchada S, Mishra D, Sinha VK, Pradhan P, Salunke AA. "Banana patella", fibrous dysplasia of patella: A rare case report. J Clin Orthop Trauma 2019; 10:418-421. [PMID: 30828218 PMCID: PMC6382953 DOI: 10.1016/j.jcot.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Patella is a very uncommon site for primary bone tumours and fibrous dysplasia lesion in patella has never been reported. Fibrous dysplasia is a benign fibrosseous lesion of the bone where the fibrous connective tissue replaces the normal bone. CASE REPORT We report a case of 23 years female with 7 years history of progressive swelling and anterior knee pain. Radiographs showed enlarged, deformed patella like a shape of banana. The patient underwent patellectomy with extensor mechanism repair and biopsy proved to be fibrous dysplasia. CONCLUSION Fibrous dysplasia involving patella is very rare and never been reported earlier. Although primary patellar neoplasm are not common but should be kept in mind in chronic anterior knee pain with swelling for early diagnosis and intervention with intralesional therapy otherwise patellectomy has to be done in more advanced, deformed and enlarged lesions.
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Affiliation(s)
- Srikant Konchada
- Dept. of Orthopaedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India,Corresponding author at: Dept. of Orthopaedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India.
| | - Debashish Mishra
- Dept. of Orthopaedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Vijoy Kumar Sinha
- Dept. of Orthopaedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Prita Pradhan
- Dept. of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
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22
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Sheth H, Salunke AA, Barve R, Nirkhe R. Arthroscopic ACL reconstruction using fixed suspensory device versus adjustable suspensory device for femoral side graft fixation: What are the outcomes? J Clin Orthop Trauma 2019; 10:138-142. [PMID: 30705549 PMCID: PMC6349677 DOI: 10.1016/j.jcot.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/03/2017] [Accepted: 09/09/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the outcomes of Arthroscopic ACL Reconstruction using Fixed suspensory device and Adjustable suspensory device for femoral side graft fixation. MATERIAL AND METHODS We conducted a prospective study of sixty two patients with ACL deficient knees treated with arthroscopic ACL reconstruction. Consecutively patients were operated with fixed loop and adjustable loop suspensory devices for femoral side graft fixation and no randomization was done. RESULTS Functional assessment was performed with VAS score, IKDC score and Lyshom score before and after surgery with ACL reconstruction. The postoperative Lyshom score in fixed loop group and adjustable loop group was 94.23 and 94.32 respectively. The IKDC score in fixed group and adjustable group was 92.03 and 92.16 respectively. VAS in fixed loop group improved from score of 5-3, while in adjustable loop group from score of 4-3. There was significant improvement in stability of knee assessed by Lachman's test, anterior drawer test, and Pivot shiff's test and both methods of fixation provide stability to knee. The complications included; restriction of terminal flexion in 12 patients: 6 in each group. There was no implant breakage in both groups. CONCLUSION Arthroscopic ACL reconstruction using fixed loop and adjustable loop suspensory devices are equally effective fixation methods.
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Affiliation(s)
- Hardik Sheth
- Department of Orthopedics, Ruby Hall Clinic, Pune, India,Corresponding author.
| | | | - Raghav Barve
- Department of Orthopedics, Ruby Hall Clinic, Pune, India
| | - Rajat Nirkhe
- Department of Orthopedics, Ruby Hall Clinic, Pune, India
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23
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Salunke AA, Singh S, Kanani H, Chokshi J, Nambi GI, Raval P, Vala P, Jain S, Chaudhari S, Patel A, Panchal R. Intraosseous Ganglion Cyst of Scaphoid: An Uncommon Cause of Radial Wrist Pain. J Hand Surg Asian Pac Vol 2018; 21:109-12. [PMID: 27454514 DOI: 10.1142/s242483551672005x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain.
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Affiliation(s)
- Abhijeet Ashok Salunke
- * Department of Orthopedics, Pramukswami Medical College, Karamsad-388325, Anand, Gujarat, India
| | - Saranjeet Singh
- † Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Himanshu Kanani
- † Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Jimmy Chokshi
- † Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - G I Nambi
- ‡ K.M.Nallasamy Hospital, Erode, India
| | - Pradyumna Raval
- § Tayside Orthopedic Rehabilitation Technology Centre, University of Dundee, Scotland
| | - Pathik Vala
- † Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Shantanu Jain
- † Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Sanjay Chaudhari
- ∥ Department of Pathology, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Amit Patel
- * Department of Orthopedics, Pramukswami Medical College, Karamsad-388325, Anand, Gujarat, India
| | - Ramesh Panchal
- * Department of Orthopedics, Pramukswami Medical College, Karamsad-388325, Anand, Gujarat, India
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24
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Orthopedic Onco Surgery, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Jaymin Shah
- Department of Orthopedic Onco Surgery, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Nayan Gupta
- Department of Orthopedic Onco Surgery, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Jyotindra Pandit
- Department of Orthopedic Onco Surgery, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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25
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Nambi G, Salunke AA, Thirumalaisamy S, Babu VL, Baskaran K, Janarthanan T, Boopathi K, Chen YS. Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap. Chin J Traumatol 2017; 20:99-102. [PMID: 28359591 PMCID: PMC5392714 DOI: 10.1016/j.cjtee.2016.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 05/17/2016] [Accepted: 06/02/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the role of immediate and definitive management of Gustilo type III A/B tibia fractures with intramedullary nailing and fasciocutaneous flap. METHODS From August 2010 to July 2012, 22 patients with Gustilo Grade III A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap & reamed intramedullary nailing and were included in the study. The severity of the injury was calculated with Ganga Hospital injury severity score. RESULTS The mean age of patients was 41 years and the follow-up time ranged from six months to one year. Among the 22 patients, 73% were type III B fractures with upper leg involved in 55% of them. The time interval from injury to completion of surgery was 8-14 h. The incidence of bone infection requiring secondary procedure was 9%; the major and minor soft tissue complication rate was 9% and 14% respectively. The limb salvage rate was 100%. CONCLUSION Multidisciplinary management of severe lower limb trauma is important and provides good outcomes. Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade III A & B tibia fractures.
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Affiliation(s)
- G.I. Nambi
- Plastic & Reconstructive Microvascular Services, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - Abhijeet Ashok Salunke
- Department of Orthopaedics, Pramukswami Medical College, Srikrishna Hospital, Karamsad 388325, Anand, Gujrat, India,Corresponding author.
| | - S.G. Thirumalaisamy
- Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - V. Lenin Babu
- Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - K. Baskaran
- Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - T. Janarthanan
- Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - K. Boopathi
- Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India
| | - Yong Sheng Chen
- Department of Orthopedics, National University Hospital, Singapore
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26
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Salunke AA, Shah J, Warikoo V, Chakraborty A, Sahijwani H, Sharma M, Jha R, Dhange A, Pathak S, Pandit J, Pruthi M, Pandya S, Jain A. Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes. J Clin Orthop Trauma 2017; 8:249-253. [PMID: 28951642 PMCID: PMC5605741 DOI: 10.1016/j.jcot.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jaymin Shah
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | - Vikas Warikoo
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | | | | | - Mohit Sharma
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | - Rohit Jha
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | - Avdhoot Dhange
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | | | | | | | - Shashank Pandya
- Oncosurgery Department, Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
| | - Abhishek Jain
- Gujarat Cancer research Institute, Ahemdabad, Gujarat, India
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Salunke AA, Shah J, Warikoo V, Chakraborty A, Pokharkar H, Chen Y, Pruthi M, Pandit J. Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis. J Orthop Surg (Hong Kong) 2017; 25:2309499016684972. [PMID: 28142350 DOI: 10.1177/2309499016684972] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. METHODS Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. RESULT Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12-36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22-28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5-8) months and ulna to carpal junction at 4.5 (4-6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). CONCLUSION Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.
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Affiliation(s)
| | - Jaymin Shah
- 1 Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- 1 Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | | | | | | | - Manish Pruthi
- 4 Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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28
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Sahijwani H, Warikoo V, Salunke AA, Shah J, Bhavsar P, Wagh R, Pathak S. Anterior Tibial Artery Perforator Plus Flaps: Role in Coverage of Posttumor Excision Defects Around the Knee Joint and Upper Leg. Asia Pac J Oncol Nurs 2017; 4:342-347. [PMID: 28966964 PMCID: PMC5559946 DOI: 10.4103/apjon.apjon_32_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: 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.
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Affiliation(s)
| | - Vikas Warikoo
- Department of Oncosurgery, Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | | | - Jaymin Shah
- Department of Oncosurgery, Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - Preetish Bhavsar
- Plastic Surgeon, Lakshmi Hospital, Dombivali, Mumbai, Maharashtra, India
| | - Rahul Wagh
- Department of Oncosurgery, Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - Subodh Pathak
- Orthopedic Surgeon, Pramukswami Medical College, Anand, Gujarat, India
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Salunke AA, Chen Y, Tan JH, Chen X, Foo TL, Gartner LE, Puhaindran ME. Intramuscular schwannoma: clinical and magnetic resonance imaging features. Singapore Med J 2016; 56:555-7. [PMID: 26512147 DOI: 10.11622/smedj.2015151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Schwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours. METHODS Between January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas. RESULTS The mean age of the eight patients was 40 (range 27-57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4-72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinel's sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits. CONCLUSION Intramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Division of Musculoskeletal Oncology, National University Hospital, Singapore ; Pramukhswami Medical College & MS Patel Cancer Centre, Karamsad, Gujarat, India
| | - Yongsheng Chen
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xi Chen
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Tun-Lin Foo
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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Salunke AA, Pathak S, Chauhan TS, Shah J. Letter to the Editor: Wide resection versus curettage with adjuvant therapy for giant cell tumour of bone. J Orthop Surg (Hong Kong) 2016; 24:427. [PMID: 28031521 DOI: 10.1177/1602400332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Jaymin Shah
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
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Salunke AA, Warikoo V, Sahijwani H, Chakraborty A, Shah J, Pokharkar H, Chen Y. Letter to the Editor: Segmental excision versus intralesional curettage with adjuvant therapy for giant cell tumour of bone. J Orthop Surg (Hong Kong) 2016; 24:281. [PMID: 27574282 DOI: 10.1177/1602400238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A A Salunke
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - V Warikoo
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - H Sahijwani
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - A Chakraborty
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | - J Shah
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
| | | | - Y Chen
- National University Hospital Singapore, Singapore
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32
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Salunke AA, Chakraborty A, Shah J. Letter to the Editor: Osteochondromatosis and osteochondroma involving bilateral patella and patellar tendon: a case report. J Orthop Surg (Hong Kong) 2016; 24:281. [PMID: 27574283 DOI: 10.1177/1602400239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A A Salunke
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
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Salunke AA, Chakraborty A, Pokharkar H, Shah J, Meena DK. Letter to the Editor: Wrist fusion through centralisation of the ulna for recurrent giant cell tumour of the distal radius. J Orthop Surg (Hong Kong) 2016; 24:280. [PMID: 27574281 DOI: 10.1177/1602400236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- A A Salunke
- Gujarat Cancer Research Institute, Ahmedabad, India
| | | | | | - J Shah
- Gujarat Cancer Research Institute, Ahmedabad, India
| | - D K Meena
- Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India
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Salunke AA, Shah J, Warikoo V, Kumar R, Galande A, Pokharkar H, Pandit J. Salvage of the proximal femur following pathological fractures involving benign bone tumors. J Surg Oncol 2016; 114:254. [DOI: 10.1002/jso.24291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 03/31/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Jaymin Shah
- Gujarat Cancer Research Institute (G.C.R.I.); Ahemdabad India
| | - Vikas Warikoo
- Gujarat Cancer Research Institute (G.C.R.I.); Ahemdabad India
| | - Ramesh Kumar
- Gujarat Cancer Research Institute (G.C.R.I.); Ahemdabad India
| | - Ashok Galande
- Gujarat Cancer Research Institute (G.C.R.I.); Ahemdabad India
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Salunke AA. Letter to the Editor: Curettage without bone grafting for a simple bone cyst in the capitate. J Orthop Surg (Hong Kong) 2016; 24:137. [PMID: 27122533 DOI: 10.1177/230949901602400136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A A Salunke
- Gujarat Cancer Research Institute, Ahmedabad, India
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Abstract
We present a 65-year-old man with osteosarcoma of the talus that was misdiagnosed as osteoarthritis. The patient eventually underwent below-knee amputation and adjuvant chemotherapy.
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Affiliation(s)
- A A Salunke
- Department of Orthopedics, Pramukswami Medical College, Karamsad, Anand, Gujrat, India
| | - Y Chen
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - J Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - X Chen
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - C Pearce
- Department of Orthopaedic Surgery, Alexandra Hospital (JHS), Singapore
| | - M Puhaindran
- Division of Musculoskeletal Oncology, National University Hospital Singapore, Singapore
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Nambi G, Salunke AA, Chung S, Kumar KR, Chaudhari VA, Dhanwate AD. Extended anterolateral thigh pedicled flap for reconstruction of trochanteric and gluteal defects: A new & innovative approach for reconstruction. Chin J Traumatol 2016; 19:113-5. [PMID: 27140220 PMCID: PMC4897841 DOI: 10.1016/j.cjtee.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for ante- rolateral thigh (ALT) flap. Oblique branch of LCFA is an alternative pedicle that can be used in micro- vascular surgery. According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction. Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident, who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.
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Affiliation(s)
- G.I. Nambi
- Plastic & Reconstructive Microvascular Services, Kovai Medical Center & Hospital, Tamilnadu 641014, India
| | - Abhijeet Ashok Salunke
- Department of Orthopedics, Pramukswami Medical College, Gujrat, India
- Corresponding author.
| | - Szeryn Chung
- Department of Hand Surgery, Singapore General Hospital, Singapore
| | - K.S. Raj Kumar
- General & Laparoscopic Surgical Services, Kovai Medical Center & Hospital, Tamilnadu 641014, India
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Salunke AA. Letter to the Editor: Correlation between survival and tumour characteristics in patients with chondrosarcoma. J Orthop Surg (Hong Kong) 2016; 24:138. [PMID: 27122534 DOI: 10.1177/230949901602400138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A A Salunke
- Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India
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Salunke AA, Nambi GI, Sudhakar N. Post chemotherapy extravasation injuries: Hypogastric flap for reconstruction of wounds over dorsum of hand. J Cancer Res Ther 2016; 11:835-9. [PMID: 26881527 DOI: 10.4103/0973-1482.144589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Management of extravasation injuries over the dorsum of hand after administration of chemotherapeutic agents. AIM To study the results of hypogastric flap reconstruction in chemotherapy extravasation wounds over dorsum of hand. SETTINGS AND DESIGN Retrospective study. SUBJECTS AND METHODS At our center over 3-years period, 32 patients were treated for chemotherapy extravasation wounds. Out of these 32 patients, seven had wound over dorsum of hand. There were five males and two females, and their mean age was 45 years (range, 19 - 64 years). These patients with wound over the dorsum of hand were treated with multiple debridements and hypogastric flap reconstruction. RESULTS The mean interval between extravasation wound and surgical treatment was 6.28 days (range, 4 - 10). The mean size of extravasation wound defect was 14 × 8 (range, 12 × 7 to 18 × 8). Non-dominant hand was involved in six patients and dominant hand in one patient. In four patients, the hypogastric flap was supplemented with skin graft. The hypogastric flap settled well in all patients and enabled a good wound cover. Complete division of the flap and final insetting was done under local anesthesia after 3 weeks; this was followed by limb mobilization exercises. Contour difference over the dorsum of hand was present in all the cases. The range of movement of the hand was functionally restricted in one patient. No patient in current series developed wound infection. CONCLUSION Hypogastric flap is a reliable flap to cover wound over dorsum of hand after extravasation of chemotherapeutic agents.
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Affiliation(s)
| | - G I Nambi
- Plastic and Reconstructive Microvascular Services, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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Salunke AA, Chen Y, Xi C, Puhaindran M. Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities? J Cancer Res Ther 2016; 11:1043. [PMID: 26881673 DOI: 10.4103/0973-1482.163790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Abhijeet Ashok Salunke
- M. S. Patel Cancer Centre, Sri Krishna Hospital, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
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Salunke AA, Chen Y, Chen X, Tan JH, Singh G, Tai BC, Khin LW, Puhaindran ME. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?: a meta-analysis. Bone Joint J 2016; 97-B:1566-71. [PMID: 26530662 DOI: 10.1302/0301-620x.97b11.35326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.
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Affiliation(s)
- A A Salunke
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Y Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - X Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - J H Tan
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - G Singh
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - B C Tai
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - L W Khin
- National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - M E Puhaindran
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Abstract
Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.
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Salunke AA, Vala PC, Singh H, Parwani R, Gandhi S, Shah D. Intraosseous leiomyoma of the calcaneum: An unusual bone tumor of foot and review of literature. J Clin Orthop Trauma 2016; 7:61-64. [PMID: 28018075 PMCID: PMC5167433 DOI: 10.1016/j.jcot.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/07/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022] Open
Abstract
Leiomyoma is a benign tumor of smooth muscle origin and commonly diagnosed in the uterus, gastrointestinal tract, skin, and mucous membranes. To the best of our knowledge, the only reported intraosseous leiomyomas in extremities occurred in the proximal aspect and distal aspect of the femur, in the tibia, and in the ulna. We are not aware of any previous reports of intraosseous leiomyomas in the foot. The radiograph of the intraosseous leiomyoma shows unilocular or multilocular lytic lesion with sclerotic rim. Due to lack of definitive radiological features on magnetic resonance imaging and computed tomography diagnosis of this rare tumor is established with histopathological study and immuno-histochemistry markers. Smooth muscle spindle cells and positive immunohistochemistry markers for muscle cells is hall mark for the diagnosis. The treatment of intraosseous leiomyoma is surgical intervention by excision with wide margin and curettage followed by filling the cavity. The diagnosis of this tumor is challenging due to its extraordinarily rare incidence. Intraosseous leiomyoma should be included in the differential diagnosis of intraosseous lesion with benign radiographic feature. We report of the first published case of primary intraosseous leiomyoma of calcaneum in a 22-year-old male patient.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
- Corresponding author at: Department of Orthopedics, Pramukswami Medical College, Karamsad, Anand 388325, Gujarat, India.Department of Orthopedics, Pramukswami Medical CollegeKaramsadAnandGujarat388325India
| | | | | | | | - Sanjay Gandhi
- Green Cross Pathology Lab., Ahmedabad, Gujarat, India
| | - Diva Shah
- Department of Radiology, Pramukswami Medical College, Karamsad, Anand 388325, Gujarat, India
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Salunke AA, Menon PH, Nambi GI, Tan J, Patel V, Chen Y, Kumar J. Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report. SAO PAULO MED J 2015; 133:531-4. [PMID: 26465811 PMCID: PMC10496552 DOI: 10.1590/1516-3180.2014.9061512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.
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Affiliation(s)
- Abhijeet Ashok Salunke
- MD. Clinical Fellow, Division of Musculoskeletal Oncology, National University Hospital, Singapore. Assistant Professor, Department of Orthopedics, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
| | - Prem Haridas Menon
- MD. Clinical Fellow, Department of Orthopedics, National University Hospital, Singapore.
| | - Gurunathampalayam Ilango Nambi
- MD. Consultant, Department of Plastic & Reconstructive Microvascular Services, Kovai Medical Center & Hospital, Coimbatore, Tamil Nadu, India.
| | - Junhao Tan
- Medical Student, Yong Lin Loo School of Medicine, National University of Singapore, Singapore.
| | - Vivek Patel
- MD. Assistant Professor, Department of Orthopedics and Traumatology, Pramukswami Medical College, Karamsad, Anand, Gujarat, India.
| | - Yongsheng Chen
- MD. Resident, Hand & Reconstructive Microsurgery Cluster, Department of Orthopedics, National University Hospital, Singapore.
| | - Jay Kumar
- MD. Resident, Department of Orthopedics and Traumatology, Pramukswami Medical College, Karamsad, Anand, Gujarat, India.
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Nambi GI, Salunke AA. Propeller Flap Reconstruction in Post Oncological Thigh Defect: "The Move in Flap". Indian J Surg Oncol 2015; 6:135-7. [PMID: 26405422 DOI: 10.1007/s13193-015-0399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022] Open
Abstract
Reconstruction of soft tissue defects of the limb after tumor resection is challenging question for oncosurgeons. The management differs from reconstruction of post traumatic defects due to the complexity of the primary surgery and subsequent radiation. The conventional propeller flap is based on a perforator which is located close to the defect; but in present case the perforator was located far away from the defect. So we describe it as "Move in flap" as the flap rotated a large volume of soft tissue lying between the defect and the perforator. We present a case of post oncological thigh defect with reconstruction using a propeller flap based on distal anteromedial perforator.
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Affiliation(s)
- G I Nambi
- Plastic & Reconstructive Microvascular Services, Comprehensive Cancer Center, Kovai Medical Center & Hospital, Avinashi road, Coimbatore, Tamilnadu India
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Affiliation(s)
- A A Salunke
- Department of Orthopedic Surgery, Pramukswami Medical College, Anand, Gujrat, India; Division of Musculoskeletal Oncology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore,
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Salunke AA, Nambi GI, Dhanwate AD, Siriwardana HARP. Superficial ulnar artery: Clinical recommendations to avoid iatrogenic complications due to variation in arterial system. Niger Med J 2014; 55:276-7. [PMID: 25013265 PMCID: PMC4089062 DOI: 10.4103/0300-1652.132071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Superficial ulnar artery is an uncommon variation in which the ulnar artery is having its course superficial to the flexors of the forearm and may arise directly from axillary or brachial arteries. The proper understanding and knowledge of variation of arterial systems is helpful for judicious planning of various reconstructive procedures in oncological, orthopaedic and reconstructive surgeries. We present a case of variant course of ulnar artery which was noted during exploration of a right distal forearm wound. We suggest few clinical recommendations to avoid iatrogenic complications due to variation in arterial system.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Clinical Fellow, Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Gurunathampalayam Ilango Nambi
- Clinical Fellow, Hand and Reconstructive Microsurgery, National University Hospital, Singapore ; Plastic and Reconstructive Microvascular Services, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - Anant Dattatray Dhanwate
- Assistant Professor, Department of Anatomy, Government Medical College, Aurangabad, Maharashtra, India
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Salunke AA, Nambi GI, Manoharan A. Osteomyelits of the pubic bone with vesicocutaneous - vesicovaginal fistula: A delayed complication of post-cervical cancer radiotherapy. Niger Med J 2014; 55:83-5. [PMID: 24970977 PMCID: PMC4071670 DOI: 10.4103/0300-1652.128179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Vagino-vesico-cutaneous fistula is a rare condition characterised by continuous dribbling of urine and secondary infection of the involved areas with poor self-esteem. Osteomyelitis is delayed complication of radiotherapy treatment for cervical cancer. Treatment of these conditions is a challenging entity especially after previous surgery and irradiation. We present a case of vesicocutaneous - vesico vaginal fistula with osteomyelits of the right pubic bone which was a late complication of post-cervical cancer radiotherapy.
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Affiliation(s)
| | | | - Arumugam Manoharan
- Plastic and Reconstructive Services, Comprehensive Cancer Center, Kovai Medical Center and Hospital, Coimbatore, Tamilnadu, India
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Salunke AA, Rajkumar KS, Nambi GI, Chaudhari VA. Massive panniculectomy: a novel method of treatment of postlaparotomy wound dehiscence in morbid obesity. Can J Surg 2014; 57:E53-4. [PMID: 24666460 DOI: 10.1503/cjs.029213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Abhijeet Ashok Salunke
- Assistant Professor, Department of Orthopedics, Sri Krishna Hospital, Pramukswami Medical College, Gujarat, India, Clinical Fellow, Orthopedic Oncosurgery, National University Hospital, Singapore
| | - K S Rajkumar
- Department of General Surgery and Laparoscopic Services, Kovai Medical Center and Hospital, Coimbatore, Tamilnadu, India
| | - G I Nambi
- Department of Plastic and Reconstructive Microvascular Services, Kovai Medical Center & Hospital Coimbatore, Tamilnadu, India, Clinical Fellow, Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Vikram Anil Chaudhari
- Department of Surgical Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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