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Bhat AK, Fijad N, Acharya AM. Morphometry of sigmoid notch: A novel method of shape assessment for clinical practice. J Orthop 2024; 47:80-86. [PMID: 38059049 PMCID: PMC10696302 DOI: 10.1016/j.jor.2023.11.007] [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: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Using a novel technique, we assess and describe the distal radioulnar joint (DRUJ) anatomy with reference to sigmoid notch shapes. The purpose of this study was to develop a non-invasive, fast, reliable and reproducible technique for analysing the shapes of sigmoid notch on CT scans. Methods 40 cadaveric wrist specimens exposing the sigmoid notch and 100 normal adult wrist CT scans with end on axial sections showing the sigmoid notch outline were obtained. The shape of the sigmoid notch was assessed on both using the geometric construction method. Results Of the 40 cadaveric specimens, 42 % were C-shaped, 33 % were flat,17 % were Ski sloped, and 8 % were S-shaped.Of the 100 wrist CT scans, 48 % were C-shaped sigmoid notch, 17 % were flat, 15 % were ski-sloped, and 20 % were S-shaped shapes. Conclusions Our sample population had a higher prevalence of C-shaped sigmoids in both cadaveric and CT-based studies. It is considered the most stable shape because of its increased depth. The DRUJ morphology in our sample population can be inferred to have a stable configuration. Clinical relevance The relationships and measurements demonstrated in this study can be a guide when considering ligament reconstruction for DRUJ instability, managing complex fractures involving the DRUJ and in decision-making for notchplasty, osteotomy and arthroplasty of DRUJ.
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Affiliation(s)
- Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - N.R. Fijad
- Department of Orthopaedics, Malabar Medical, College Hospital and Research Centre, India
| | - Ashwath M. Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Pai G M, Bhat AK, Acharya AM. A Novel Method of Spinal Accessory Nerve Banking Using Silicone Catheter for Functioning Free Muscle Transfer. Tech Hand Up Extrem Surg 2023; 27:210-213. [PMID: 37357693 DOI: 10.1097/bth.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
In secondary brachial plexus reconstruction, exploring an area that has already been operated on is challenging and time-consuming for a surgeon, especially in centers with a single-team approach. Due to their inertness and lack of adverse effects, silicone Foley catheters were used successfully during the reconstruction of flexor tendons. Based on the concept, we have achieved an acceptable functional outcome by banking the spinal accessory nerve in a silicon catheter for gracilis reanimation, which permits smooth dissection, maintains the length, and shortens the operating time for subsequent reconstruction. Level of Evidence: Level V.
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Affiliation(s)
- Mithun Pai G
- Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Bhat AK, G MP, Acharya AM. Outcomes of radialization with ulnar cuff osteotomy for radial longitudinal deficiency: a medium-term follow-up study. J Hand Surg Eur Vol 2023; 48:1168-1176. [PMID: 37401123 DOI: 10.1177/17531934231185024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Addressing the deforming stresses arising from soft tissue and continued skeletal development is crucial to obtain long-term correction of forearm carpal alignment in Radial longitudinal deficiency. The aim of the present study was to report the medium-term follow-up results of radialization with ulnar cuff osteotomy in children. A total of 17 patients (21 involved limbs) with a mean follow-up of 66 months (range 50 to 96) were reviewed. Mean correction of the hand forearm angle at the final follow-up was 51°. Mean hand forearm position preoperatively and at the final follow-up were -1.1 cm (SD 0.9) and +1.3 cm (SD 0.8), respectively. This metaphyseal osteotomy relaxed the radial structures throughout the original phase of deformity correction. The mean ulnar growth was 62% of the contralateral side at the final follow-up. Our technique may provide a feasible solution to the correction and prevent recurrence of deformity while maintaining ulnar growth in the medium to longer term.Level of evidence: III.
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Affiliation(s)
- Anil K Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mithun Pai G
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwath M Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Acharya N, Acharya AM, Bhat AK, Upadhya D, Punja D, Suhani S. The outcome of polyethylene glycol fusion augmented by electrical stimulation in a delayed setting of nerve repair following neurotmesis in a rat model. Acta Neurochir (Wien) 2023; 165:3993-4002. [PMID: 37907766 PMCID: PMC10739326 DOI: 10.1007/s00701-023-05854-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Polyethylene glycol is known to improve recovery following its use in repair of acute peripheral nerve injury. The duration till which PEG works remains a subject of intense research. We studied the effect of PEG with augmentation of 20Htz of electrical stimulation (ES) following neurorrhaphy at 48 h in a rodent sciatic nerve neurotmesis model. METHOD Twenty-four Sprague Dawley rats were divided into 4 groups. In group I, the sciatic nerve was transected and repaired immediately. In group II, PEG fusion was done additionally after acute repair. In group III, repair and PEG fusion were done at 48 h. In group IV, ES of 20Htz at 2 mA for 1 h was added to the steps followed for group III. Weekly assessment of sciatic functional index (SFI), pinprick, and cold allodynia tests were done at 3 weeks and euthanized. Sciatic nerve axonal count and muscle weight were done. RESULTS Groups II, III, and IV showed significantly better recovery of SFI (II: 70.10 ± 1.24/III: 84.00 ± 2.59/IV: 74.40 ± 1.71 vs I: 90.00 ± 1.38) (p < 0.001) and axonal counts (II: 4040 ± 270/III: 2121 ± 450/IV:2380 ± 158 vs I: 1024 ± 094) (p < 0.001) at 3 weeks. The experimental groups showed earlier recovery of sensation in comparison to the controls as demonstrated by pinprick and cold allodynia tests and improved muscle weights. Addition of electrical stimulation helped in better score with SFI (III: 84.00 ± 2.59 vs IV: 74.40 ± 1.71) (p < 0.001) and muscle weight (plantar flexors) (III: 0.49 ± 0.02 vs IV: 0.55 ± 0.01) (p < 0.001) in delayed repair and PEG fusions. CONCLUSION This study shows that PEG fusion of peripheral nerve repair in augmentation with ES results in better outcomes, and this benefit can be demonstrated up to a window period of 48 h after injury.
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Affiliation(s)
- Nanda Acharya
- Department of Physiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - A M Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Anil K Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104.
| | - Dinesh Upadhya
- Centre for Molecular Neurosciences, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Dhiren Punja
- Department of Physiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Sumalatha Suhani
- Department of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
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Acharya AM, Bhat AK, Pai G M, Bansal E. Epithelioid malignant peripheral nerve sheath tumour of the ulnar nerve around the elbow: a diagnostic and therapeutic challenge. BMJ Case Rep 2023; 16:e256900. [PMID: 38000811 PMCID: PMC10679999 DOI: 10.1136/bcr-2023-256900] [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] [Indexed: 11/26/2023] Open
Abstract
Epithelioid malignant peripheral nerve sheath tumour (EMPNST) is a rare histological subtype of malignant peripheral nerve sheath tumour (MPNST), accounting for 5% to 17% of MPNSTs. The clinical and MRI findings of EMPNST mimic those of nerve abscesses, similar to the presentation in Hansen's disease. We present one such case with this kind of diagnostic dilemma. Intraoperative findings suggest a tumour changed the course of management subsequently. The development of neurological deficits postoperatively after tumour resection was a reconstructive challenge. To provide motor power and sensation through a procedure that provides a complete functional outcome for a young patient, distal nerve transfers were chosen. This provided an improvement in the quality of life and hastened the neurological recovery of the involved limb. Level of evidence: V.
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Affiliation(s)
- Ashwath M Acharya
- Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil K Bhat
- Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mithun Pai G
- Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ekanki Bansal
- Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Bhat AK, Shetty S, Acharya AM. Cancellous compression bone grafting using headless screw as a strut in scaphoid nonunion by a single volar approach. Eur J Orthop Surg Traumatol 2023; 33:2821-2830. [PMID: 36806619 PMCID: PMC10504105 DOI: 10.1007/s00590-023-03485-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE An array of fixation and grafting techniques for scaphoid nonunion have been described over time, achieving varied results pertaining to union and scaphoid alignment. The aim of this study was to check for union rates and correction of scaphoid parameters achieved by our technique of using screw as a strut and cancellous compression grafting harvested from the distal radius by a single volar approach. METHODS Retrospective analysis of all patients operated by the said technique was done from 2013 to 2019. Thirty-eight patients including 36 males and two females in the age range of 20-56 years were analyzed. Union rates, change in scaphoid alignment parameters and graft site characteristics were documented. RESULTS Of the patients analyzed, 5/38 were nonunions of proximal pole, 19/38 of waist and 14/38 were of distal pole which included nonunions of cystic type or with humpback deformity. Patients were followed up for an average of 22.2 months and union was achieved in all cases with a mean period of 15.7 ± 3.7 weeks. There was significant improvement in the scaphoid alignment postoperatively. One case of implant migration and one case of scaphoid nonunion advanced collapse were noted. The mean duration of donor site healing was noted to be 16.9 ± 2.5 weeks except two outliers which took longer time. There were no cases of donor site fracture or other complications. CONCLUSION Union rates, correction of scaphoid parameters and minimal complications justifies this technique as a novel one in the management of scaphoid nonunion at all levels, with minimal donor site morbidity and attained by the single volar approach.
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Affiliation(s)
- Anil K Bhat
- Department of Orthopaedics, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
| | - Sourab Shetty
- Department of Orthopaedics, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India.
| | - Ashwath M Acharya
- Department of Orthopaedics, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India
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Pai GM, Bhat AK, Acharya AM, Datta A. Bilateral Post-traumatic Brachial Plexus Injury in an Adult: A Note on the Probable Mechanism of Injury. Indian J Orthop 2023; 57:1545-1550. [PMID: 37609014 PMCID: PMC10441834 DOI: 10.1007/s43465-023-00948-w] [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: 12/20/2022] [Accepted: 06/27/2023] [Indexed: 08/24/2023]
Abstract
Bilateral brachial plexus injury is rare following a motor vehicle accident in an adult. We report a 35-year-old man with a bilateral brachial plexus injury. Explaining the mechanism of such an injury is essential to prognosticate the outcome. Fall from the bike, and the position determines the mechanism. The head-shoulder hitting the surface has an avulsion injury (ipsilateral), and the recoiling effect causes traction injury to the contralateral side. Our case had a C5,6 avulsion injury on the right side (ipsilateral) and a C5,6 traction injury (contralateral) to his left side. Surgical exploration and distal nerve transfers were done on the right side. The patient improved his shoulder and elbow function of grade 3, neurolysis of the brachial plexus was done on the left side, and the recovery was complete at 12 months of follow-up.
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Affiliation(s)
- G. Mithun Pai
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Ashwath M. Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Aakriti Datta
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
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Bhat AK, Pai GM, Acharya AM, Manohar A. Wrist Arthrodesis Using a Trapezoidal Wedge Graft from the Distal Radius and a Low-Profile Reconstruction Plate. Indian J Orthop 2023; 57:1092-1099. [PMID: 37384010 PMCID: PMC10293482 DOI: 10.1007/s43465-023-00884-9] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/24/2023] [Indexed: 06/30/2023]
Abstract
Background Various intramedullary or dorsally based fusions have been utilised to perform wrist arthrodesis. Although the dorsal plate is rigid and well constructed, the standard of care was replenishing the arthrodesis site with an iliac crest bone graft. Due to the high morbidity of the donor site, alternatives such as distal radius bone grafts have gained popularity. In this study, wrist arthrodesis was performed with a locally accessible trapezoidal wedge graft from the distal radius and a low-profile reconstruction plate to evaluate the radiological and functional outcome. Methods We retrospectively reviewed 22 wrists, 14 brachial plexus injuries, 4 post-traumatic injuries, and 4 rheumatoid arthritis patients, with a mean follow-up of 31 months. Union was evaluated on radiography. The functional outcomes were evaluated using a visual analog scale incorporated into a questionnaire. Results All 22 fusions united successfully, with a mean duration of 12 weeks and a wrist position of an average 17.5 degrees of extension and 6 degrees of ulnar deviation. The aesthetics of the wrist showed the most significant change, and overall satisfaction levels increased. Conclusions A locally accessible cortico-cancellous graft from the dorsum of the radius is a reliable alternative to an iliac crest or carpal bone graft with high potential for the union. It also serves as a stable strut in our construct, allowing us to use a low-profile reconstruction plate. The Reconstruction (3.5 System) plate can be used safely with excellent results and a low implant prominence or breakage risk.
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Affiliation(s)
- Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - G. Mithun Pai
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Ashwath M. Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Amruth Manohar
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
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Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023; 107:105-114. [PMID: 35195844 PMCID: PMC10020267 DOI: 10.1007/s12306-022-00735-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.
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Affiliation(s)
| | | | - A M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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Pai G M, Bhat AK, M Acharya A, Reddy SP. Unusual presentation of carpal tunnel syndrome due to Mycobacterium marinum infection of hand. BMJ Case Rep 2022; 15:15/12/e251692. [PMID: 36535734 PMCID: PMC9764620 DOI: 10.1136/bcr-2022-251692] [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] [Indexed: 12/23/2022] Open
Abstract
We report a case of a fisherman presenting with a rare and unusual carpal tunnel syndrome due to Mycobacterium marinum infection of the hand and wrist. The infection resulted in severe pain, paresthesia and restriction of movement in the hand.Flexor tenosynovectomy, followed by histological and microbiological studies, indicated the presence of atypical mycobacteria. The patient was started on a combination antimicrobial therapy for 6 months. The patient regained full range of motion and returned to perform daily activities with ease.Diagnosis of M. marinum infection of the hand is challenging as the presentation mimics other conditions and may have nonspecific histological findings. This atypical mycobacterium may also show resistance to commonly used antitubercular drugs. Hand surgeons should maintain a high index of suspicion of M. marinum and adopt a multiteam approach to prevent delay in diagnosis for successful treatment.
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Affiliation(s)
- Mithun Pai G
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil K Bhat
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwath M Acharya
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreya Pulli Reddy
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Latha T, Bhat AK, Hande HM, Mukhopadhyay C, Devi ES, Nayak BS, George A. Effectiveness of Extended Infection Control Measures on Methicillin-Resistant Staphylococcus aureus Infection Among Orthopaedic Patients. Indian J Orthop 2022; 56:1804-1812. [PMID: 36187590 PMCID: PMC9485330 DOI: 10.1007/s43465-022-00713-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose The purpose of the study was to find the effectiveness of Extended Infection Control Measures (EICM) in reducing the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection among orthopaedic surgery patients. Methods The study adopted a quasi-experimental design and was conducted in the orthopaedic units of a tertiary care hospital. This study recruited 168 orthopaedic patients and 154 healthcare professionals (HCPs). EICM included hand hygiene, decolonizing the patients and HCPS, staff education, feedback of surveillance data, treatment of high-risk and MRSA-infected patients, having separate equipment for MRSA-infected patients, and appropriate cleaning of patient's unit. Results The EICM effectively reduced MRSA infection from 21.2 to 6% (p < 0.001). It also resulted in improving the knowledge of HCPs in the prevention and management of MRSA infection (p < 0.001), and all colonized HCPs were successfully (100%) decolonized. Conclusion EICM is a promising intervention to combat MRSA infection among orthopaedic wards. Hence, it can be executed in orthopaedic wards, thereby improving the treatment quality and reducing the infection-related consequences. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00713-5.
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Affiliation(s)
- T. Latha
- College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Anil K. Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - H. Manjunatha Hande
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Elsa Sanatombi Devi
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Baby S. Nayak
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Anice George
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
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Jerome JTJ, Bhat AK. Hand Surgery Day in India. J Hand Microsurg 2022; 14:187. [PMID: 35996458 PMCID: PMC9392586 DOI: 10.1055/s-0042-1755631] [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] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India
| | - Anil K. Bhat
- Associate Dean, Professor, and Head, Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Acharya AM, Bhat AK, Jyothish G, Mukadam A. Delayed Presentation of Sciatic Nerve Injury with Gap: A Case Report with a Unique Solution from the Past. JBJS Case Connect 2022; 12:01709767-202203000-00051. [PMID: 35171848 DOI: 10.2106/jbjs.cc.21.00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 35-year-old farmer presented with a foot ulcer on his left flail foot because of a sciatic nerve injury of 1-year duration. A gap of 11 cm was observed in the sciatic nerve for which he underwent 2-staged pedicled peroneal nerve grafting and posterior bone block procedure for the ankle. He had S3 grade sensation at 5-year follow-up without any recurrence of ulcer and a stable foot without external support for walking. CONCLUSION Staged pedicled peroneal nerve grafting with a posterior bone block procedure is a viable solution for very large sciatic nerve defect with predictable results.
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Affiliation(s)
- Ashwath M Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
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Bhat AK, M V, Acharya AM. Functional Assessment of 3D Printed Prosthesis in Children with Congenital Hand Differences-A Prospective Observational Study. J Hand Surg Asian Pac Vol 2021; 26:535-544. [PMID: 34789089 DOI: 10.1142/s2424835521500508] [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] [Indexed: 11/18/2022]
Abstract
Background: Children with congenital differences who require prosthesis, have special needs due to their growth and psychosocial factors. Cosmetic or body-powered prosthesis provides basic functional needs but poses a financial burden on the family. Prostheses with advanced functions need to be deferred until adulthood. 3D printed prosthesis is a novel alternative being cost-effective for children. Since limited literature is available on the functionality of 3D printed prosthesis and none in the South Asian population, this study was done to assess its utility in congenital hand amputations. Methods: Fourteen children with congenital hand amputations were selected for a prospective observational study. Unilateral below Elbow test (UBET), Box and Block test and ABILHAND questionnaire were used for assessment with and without prosthesis after six months. Results: Eleven patients completed the follow-up. Box and Block test improved from a mean score of 24 to 35 with the prosthesis implying an improvement in manual gross dexterity (p -0.049). UBET (p -0.002) and ABILHAND questionnaire (p < 0.001) showed a decrease in score with the use of a prosthesis which suggested a lack of lateral and tripod pinch in the current design of a prosthesis. Patients with below elbow prosthesis performed better. Conclusions: 3D printed prostheses are an excellent option for use as a transitional prosthesis as they are inexpensive, serves to improve needs with respect to grasping activities at both wrist and elbow level amputation and customizable according to patients' need and limb deficiency and replaceable as the child grows with age. Current designs are useful with respect to grasping activities.
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Affiliation(s)
- Anil K Bhat
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India
| | - Vamsikrishna M
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India
| | - Ashwath M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India
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Bhat AK, Jindal R, Acharya AM. The influence of ethnic differences based on upper limb anthropometry on grip and pinch strength. J Clin Orthop Trauma 2021; 21:101504. [PMID: 34367910 PMCID: PMC8321953 DOI: 10.1016/j.jcot.2021.101504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/23/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Ethnic differences in upper limb anthropometry have significant variations which can influence surgical outcomes and rehabilitation. We hypothesize that there would be a significant difference in the anthropometry based on ethnicity and gender which will reflect on objective measurements. METHODS We performed 13 anthropometric measurements of the upper limb, grip and three types of pinch strength in 210 volunteers across seven ethnicities in young adults at our university campus. We compared them statistically based on ethnic and gender differences. RESULTS There was a significant correlation noted between grip, palmar and tip to tip pinch strength in 12 of the 13 anthropometric measurements. Key pinch correlated with eight parameters. Mean grip and pinch strength are noted to be more in males and from developed nations across all ethnicities. CONCLUSIONS This study shows that there is significant variation between the anthropometric measurements based on gender and ethnicity which correlates with differences in grip and pinch strength.
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Bhat AK, Vijayan S, Acharya AM, Shetty S, Ampar N, Kanhangad MP, Hegde N. Operation theatre protocol for COVID-19 cases requiring orthopaedic surgery: A workflow without altering the existing infrastructure. J Clin Orthop Trauma 2021; 17:163-168. [PMID: 33776361 PMCID: PMC7979274 DOI: 10.1016/j.jcot.2021.03.014] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The surge in the number of trauma cases following relaxation of lockdowns in the backdrop of COVID-19 pandemic, has strained the existing infrastructure to cater to these patients and also prevent the spread of infection. Moreover, with the rise of newer strains, the period ahead has to be tread carefully to prevent resurgence of infections. There have been recommendations regarding the ideal setup to operate orthopaedic cases in this pandemic scenario. However, many of the hospitals in India with financial and logistic constraints are unable to implement these structural changes into their existing setup. We propose a model which can be used in an existing operation theatre which has a single entry and exit corridor, which is the layout in many hospitals. METHODOLOGY A protocol with the consultation of a panel of health care professionals was designed on the basis of WHO guidelines in a way so as to remain dynamic. Prior to its implementation, online classes were conducted and a dry run of the protocol was done with the whole team involved. The theatre layout is one with a single entry and exit and had predesignated rooms. The personnel were divided into 3 teams, each with a fixed set of people and preset workflow, to be followed during entry and exit. Five COVID positive cases have been operated since then using the protocol and has been used as a pilot study to further amend the protocol. CONCLUSION This model can be used as a guideline by hospitals having a limited infrastructure, to develop their own protocol to operate on COVID positive cases, in the present situation of increasing trauma cases post the relaxation of lockdown and also in any subsequent waves of infection with newer strains. Simulation and periodic stringent audits with the entire team would prove successful in rectifying errors and avoiding any possible contamination.
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Affiliation(s)
- Anil K. Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sandeep Vijayan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ashwath M. Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sourab Shetty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India,Corresponding author.
| | - Nishanth Ampar
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Madhava Pai Kanhangad
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nikhil Hegde
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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Acharya AM, Bhat AK, Hegde N. The Middle Trunk Fascicle: A Simple, Effective Nerve Transfer for Suprascapular Nerve in Upper Brachial Plexus Injuries. J Hand Surg Asian Pac Vol 2021; 26:107-111. [PMID: 33559571 DOI: 10.1142/s242483552172005x] [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] [Indexed: 11/18/2022]
Abstract
A new nerve transfer option of using viable fascicle of the ipsilateral middle trunk for suprascapular nerve reconstruction is presented. The procedure was used in two patients with upper brachial plexus injury involving loss of shoulder abduction and external rotation. Clinical evaluation and nerve conduction studies in both patients confirmed axonopathy of C5, C6 roots and C5 root, respectively. The proximal root stumps were unavailable for nerve grafting due to a very proximal root level scarring. The middle trunk fascicle was dissected on its superior surface and transferred to the non-functional suprascapular nerve. After 24 months follow up full abduction and external rotation could be achieved in both the patients. It is a simple and easy option for transfer to a suprascapular nerve in upper brachial plexus injuries. It lies next only to the upper trunk and does not require any additional dissection time. Donor deficit was not observed in our two patients.
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Affiliation(s)
- Ashwath M Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Karnataka, India
| | - Anil K Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Karnataka, India
| | - Nikhil Hegde
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Karnataka, India
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Siddarth Kamath K, Jayakrishnan KN, Acharya A, Bhat AK. 'Vanishing carpal bones' in a patient with congenital adrenal hyperplasia - A diagnostic dilemma. J Orthop 2020; 22:493-496. [PMID: 33100741 DOI: 10.1016/j.jor.2020.10.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022] Open
Abstract
The vanishing bone disease, also known as Gorhams disease usually involves long bones. Isolated carpal bone involvement is uncommon. A 14 year old male presented with pain in the right wrist joint since 4 months. He was a known case of Congenital Adrenal Hyperplasia on oral steroids for 3 years. X-rays showed deformed arthritic scaphoid, lunate and capitate. A proximal row carpectomy was performed to provide functional wrist mobility to the patient. Histopathological examination was consistent with Gorham's disease. In a patient with systemic disease receiving steroid therapy Gorhams disease poses a diagnostic challenge.
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Affiliation(s)
- K Siddarth Kamath
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, India
| | - K N Jayakrishnan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, India
| | - Ashwath Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, India
| | - Anil K Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, India
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Chaturvedi S, Gupta A, Krishnan S V, Bhat AK. Design, usage and review of a cost effective and innovative face shield in a tertiary care teaching hospital during COVID-19 pandemic. J Orthop 2020; 21:331-336. [PMID: 32753794 PMCID: PMC7378517 DOI: 10.1016/j.jor.2020.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/30/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background A major challenge of the coronavirus pandemic is personal protective equipment (PPE) shortage. The open source community mobilised solutions to combat this using 3D printing technology. One such solution was the face shield, which protects facial areas from droplet contamination when used by orthopaedic and other front line health care workers (HCWs). Objectives To assess the efficacy of an in-house developed face shield based on feedback by HCWs and its usage in triaging zones and operation theatre in a tertiary care hospital. Methods A protective face shield was developed and distributed among the orthopaedic surgeons and front line HCWs involved in the ICU in our hospital and neighbouring facilities. Feedback was obtained using a questionnaire utilising a Likert scale. Results 227 face shields were distributed to the HCWs in our hospital (157) and neighbouring facilities (70). Design modifications were done as per the needs of the HCWs. 37 HCWs provided feedback giving the face shields an overall mean score of 7.92 out of 10. The poly vinyl chloride (PVC) film visors were better for airway management procedures as it can be tucked into PPE suit and visors with overhead projector (OHP) sheets were suitable for ICU and operative procedures. Conclusion A locally developed face shield design by an inter disciplinary team in synchrony with HCWs is found to increase its acceptability and efficacy. Face shields can be made more effective in different triaging and treatment situations by varying the device setup.
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Affiliation(s)
- Satyam Chaturvedi
- Hastha - Center for Congenital Hand Differences, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Amartya Gupta
- Hastha - Center for Congenital Hand Differences, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vimal Krishnan S
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Anil K. Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
- Corresponding author. Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education [MAHE], Udupi, 576 104, Karnataka, India.
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Jerome JTJ, Mercier F, Mudgal CS, Arenas-Prat J, Vinagre G, Goorens CK, Rivera-Chavarría IJ, Sechachalam S, Mofikoya B, Thoma A, Medina C, Rivera-Chavarría IJ, Henry M, Afshar A, Dailiana ZH, Prasetyono TOH, Artiaco S, Madhusudhan TR, Ukaj S, Reigstad O, Hamada Y, Bedi R, Poggetti A, Al-Qattan MM, Siala M, Viswanathan A, Romero-Reveron R, Hong JP, Khalid KA, Bhaskaran S, Venkatadass K, Leechavengvongs S, Goorens CK, Nazim S, Georgescu AV, Tremp M, Nakarmi KK, Ellabban MA, Chan P, Aristov A, Patel S, Moreno-Serrano CL, Rai S, Kanna RM, Malshikare VA, Tanabe K, Thomas S, Gokkus K, Baek SH, Brandt J, Rith Y, Olazabal A, Saaiq M, Patil V, Jithendran N, Parekh H, Minamikawa Y, Atagawi AA, Hadi JA, Berezowsky CA, Moya-Angeler J, Altamirano-Cruz MA, Galvis R LA, Antezana A, Paczesny L, Fernandes CH, Asadullah M, Yuan-Shun L, Makelov B, Dodakundi C, Regmi R, Pereira GU, Zhang S, Sayoojianadhan B, Callupe I, Rakha MI, Papes D, Ganesan RP, Mohan M, Jeyaraman A, Prabhakar P, Rajniashokan A, Geethan I, Chandrasekar S, Löw S, Thangavelu K, Giudici LD, Palanisamy Y, Vaidyanathan S, Boretto J, Ramirez MA, Goundar TS, Kuppusamy T, Kanniyan K, Srivastava A, Chiu YC, Bhat AK, Gopinath NR, Vasudevan VP, Abraham V. Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease. J Hand Microsurg 2020; 12:135-162. [PMID: 33408440 DOI: 10.1055/s-0040-1713964] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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Affiliation(s)
- J Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
| | | | - Chaitanya S Mudgal
- Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States.,Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Joan Arenas-Prat
- Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chul Ki Goorens
- Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
| | | | | | - Bolaji Mofikoya
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theddeus O H Prasetyono
- Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Ole Reigstad
- Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
| | - Yoshitaka Hamada
- Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
| | | | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
| | | | - Mahdi Siala
- Service d'Orthopedie, chu de purpan, Toulouse, France
| | | | - Rafael Romero-Reveron
- Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Joon Pio Hong
- Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
| | - Kamarul Ariffin Khalid
- Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
| | | | | | | | - Chul Ki Goorens
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Sifi Nazim
- Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
| | | | - Mathias Tremp
- Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
| | | | - Mohamed A Ellabban
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
| | - Pingtak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | | | | | | | | | - Katsuhisa Tanabe
- Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
| | - Simon Thomas
- Department of Ort hopaedics, Rohini, Delhi, India
| | - Kemal Gokkus
- Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | - Yin Rith
- Department of Orthopaedics, Cambodia
| | | | - Muhammad Saaiq
- Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Vijay Patil
- Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
| | | | - Md Asadullah
- Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
| | | | | | | | - Rabindra Regmi
- Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
| | | | - Shuwei Zhang
- Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binoy Sayoojianadhan
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
| | | | - Mohamed I Rakha
- Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
| | - Dino Papes
- Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
| | - Ramesh Prabu Ganesan
- Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
| | | | | | - Ponnaian Prabhakar
- Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
| | | | | | | | - Steffen Löw
- Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
| | | | - Luca Dei Giudici
- Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
| | | | | | | | | | | | - Thirumavalavan Kuppusamy
- Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
| | | | | | - Yung-Cheng Chiu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Anil K Bhat
- Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Vineet Abraham
- Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
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Bhat AK, Acharya A, Mishra D. Correlation of HISS and Strickland Score with the Michigan Hand Outcome Questionnaire in hand injuries. J Clin Orthop Trauma 2020; 11:620-625. [PMID: 32684699 PMCID: PMC7355061 DOI: 10.1016/j.jcot.2020.05.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The widely used Hand Injury Severity Score (HISS) has intrinsic drawbacks like inability to score vascular status and questionable correlation with Disability of Arm, shoulder and Hand. We compared it with the Strickland score which is easier to calculate and has provision for evaluation of vascular status. We assessed correlation of both the scores with the Michigan Hand Outcome Questionnaire (MHQ). METHODS In a prospective study of 1574 patients admitted with hand injuries, we recorded their HISS and Strickland scores and followed them up for a year and later interviewed for MHQ score. Statistical correlation was done comparing the HISS and Strickland score with the MHQ using the SPSS package. RESULTS Majority of these injuries were in manual labourers (47.5%) with agricultural or industrial background with a mean age of 25 years (18-26 years). Using the One-way ANOVA test we found a significant correlation between the HISS and MHQ (P Value < 0.001). Using the Unpaired T-test, statistically significant association (P < 0.001) was seen between the Strickland score and MHQ. The correlation between HISS and Strickland Score done by One-way ANOVA Test was also found to be significant (P Value < 0.001). On evaluating the group of patients with a Strickland score >10, we observed that the MHQ was almost similar between those who underwent amputation with those who underwent a successful salvage, though not statistically significant. CONCLUSION HISS and Strickland score correlated significantly with each other and with the MHQ. Strickland score was easy and quicker to determine the salvagability of hand injury. However, small group of patients who may benefit from salvage in spite of a high Strickland score where factors like patient's age, occupation, comorbid health condition, motivation, expenses, and social environment needs to be taken into account in decision making.
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Affiliation(s)
| | - A.M. Acharya
- Corresponding author. Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, 576104, India.
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Bhat AK, Acharya A. Current concepts in the management Radial Longitudinal Deficiency. J Clin Orthop Trauma 2020; 11:597-605. [PMID: 32684696 PMCID: PMC7355065 DOI: 10.1016/j.jcot.2020.05.027] [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: 04/07/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
Radial longitudinal deficiency represents a spectrum of musculoskeletal hypoplasia and dysplasia affecting the upper limb involving mainly the radial aspect of the forearm, wrist, and hand and not infrequently the proximal arm. 2/3rd of the patients with this condition suffer from an associated medical or musculoskeletal disorder and 1/3rd of them show features of a well-known syndrome with systemic manifestations. Hence it is mandatory to do a detailed clinical, radiological and laboratory evaluation which should also include genetic counselling and assessment. Its management has evolved greatly since the beginning of last century. The vast variations developed for the treatment only reflects on the persisting controversy on the ideal treatment which still eludes the medical fraternity. Current treatment options for wrist deformities include radialization or centralization with or without distraction which unfortunately has often shown poor outcomes with high rates of recurrence and poor growth of ulna leading some workers to suggest alternative techniques, which include microsurgical reconstruction using the proximal fibula and the second toe. The management of the associated hypoplastic thumb has been encouraging with recent improvements in classifications and increased options for milder deformities. The article reviews the management options available for this common condition with respect to the recent developments in literature.
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Affiliation(s)
| | - A.M. Acharya
- Corresponding author. Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, 576104, India.
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Cherian BS, Bhat AK, Rajagopal KV, Maddukuri SB, Paul D, Mathai NJ. Comparison of MRI & direct MR arthrography with arthroscopy in diagnosing ligament injuries of wrist. J Orthop 2019; 19:203-207. [PMID: 32071514 DOI: 10.1016/j.jor.2019.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Ligament injuries around the wrist leading to chronic wrist pain are often a diagnostic dilemma.Various imaging modalities like wrist radiographs, CT and MRI have been used to improve the diagnostic accuracy. The objective of this study was to assess the value of MRI & direct magnetic resonance arthrography (MRA) of the wrist for detecting & evaluating tears of the triangular fibrocartilage complex (TFCC) & scapholunate & luno triquetral interosseous ligament (LTIL & SLIL) injuries in comparison with arthroscopy of the wrist. Materials & methods All patients presenting with chronic wrist pain of more than 3 months duration with suspected ligament injuries were included. MRI was performed with 8 channel wrist coil on 1.5 T machine. (PHILIPS, Netherlands). MRA was performed after obtaining consent. Retrospective MR findings were then correlated with results in those patients who underwent arthroscopy. Arthroscopic correlation was obtained in 22 (46.8%) cases out of the 45 patients who underwent both MRI & MRA. Results The gold standard arthroscopic procedure diagnosed 15 peripheral & 6 central TFCC tears in 22 patients. 4 scapholunate ligament tears were also identified. MRI diagnosed 16 peripheral & 5 central TFCC tears in these 22 patients. MRA identified 9 central tears and 14 peripheral tears. The sensitivity in diagnosing an overall TFCC tears with MRI as well as MRA was 94.4 & 100%. The specificity of the MRI and MRA in diagnosing an overall TFCC tear was 100% & 75% respectively. Discussion & conclusions Direct MRA has better sensitivity in detecting TFCC central tears. In view of 'substantial' agreement between MRI & MRA with Kappa analysis, conventional MRI can be relied on, in diagnosing TFCC injury. With comparatively low specificity, caution and restraint is advised in interpreting MRA, which may influence decision on surgery.
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Affiliation(s)
- Blessin S Cherian
- Unit of Hand & Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Anil K Bhat
- Unit of Hand & Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Satish B Maddukuri
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Don Paul
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Naveen Joseph Mathai
- Unit of Hand & Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, 576104, India
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Nayak A, D'Souza A, Bhat AK, Rao A, Acharya AM. Role of Early Referral and Surgical Intervention in Brachial Plexus Birth Palsy: Awareness Among Obstetricians and Pediatricians in a Teaching Hospital. Int Q Community Health Educ 2019; 40:363-366. [PMID: 31652077 DOI: 10.1177/0272684x19883523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cross-sectional study was conducted using a validated and standardized questionnaire answered by willing pediatricians and obstetricians at our university teaching hospitals. Nearly two thirds of the pediatricians (62.8%) and three fourths of the obstetricians (73.6%) continued to accept the terminology of obstetric brachial plexus birth palsy which is a misnomer; 32.6% of pediatricians felt that they were unaware of the current trends in its management. Parental reluctance (23.5%) and inadequate knowledge in current approaches among surgeons and pediatricians (41.2%) were suggested as chief causes for the delay in their adequate referral and management using surgical exploration, nerve grafting, and nerve transfer. The delayed presentations of birth brachial plexus injuries with missed opportunity for optimum treatment can be partly attributed to inadequate information available on definitive guidelines in its management among the stakeholders including parents, primary care physicians, and surgeons.
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Affiliation(s)
- A Nayak
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - A D'Souza
- Department of Anatomy, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Anil K Bhat
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Arati Rao
- Department of Public Health, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Ashwath M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, Karnataka, India
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Acharya AM, Cherian BS, Bhat AK. Diagnostic accuracy of MRI for traumatic adult brachial plexus injury: A comparison study with surgical findings. J Orthop 2019; 17:53-58. [PMID: 31879474 DOI: 10.1016/j.jor.2019.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/23/2019] [Accepted: 08/11/2019] [Indexed: 01/09/2023] Open
Abstract
We studied the diagnostic accuracy of MRI in 35 adult patients with traumatic brachial plexus injury in comparison with intra operative findings. The overall sensitivity to detect root avulsions was 39% and specificity was 75%. MRI was more useful in the diagnosis of lower root avulsions. At trunk and division level injuries, the sensitivity was 87% but specificity was only 26%. It was not able to differentiate the type and extent of post-ganglionic injuries. The accuracy of pseudomeningocele as avulsion on surgical finding was 96% (27/28). Pseudomeningocele correlates well with root avulsions. Its presence warrants early referral and surgical exploration.
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Affiliation(s)
- A M Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
| | - Blessin S Cherian
- Consultant Orthopaedic Surgeon, Department of Orthopaedics, Muthoot Hospital, College Road, Kozencherry, Pathanamthitta District, Kerala, 689641, India
| | - Anil K Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
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Abstract
Carpometacarpal (CMC) joint dislocation other than thumb are rare injuries and can be easily missed. These injuries account for <1% of all hand injuries and are frequently overlooked or missed. CMC dislocations can occur either in dorsal or volar direction and be associated with fractures. However, dorsal dislocation is more commonly encountered than volar dislocation. Volar CMC joint dislocations are rare and need a high level of suspicion for diagnosing and prevention of complications. We present a 36-year-old woman with post-traumatic neglected volar dislocation of all the five CMC joints leading to a windswept deformity of the hand.
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Affiliation(s)
- Prajwal P Mane
- Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Anil K Bhat
- Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Ashwath Acharya
- Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
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Acharya AM, Ravikiran N, Jayakrishnan KN, Bhat AK. The role of pedicled abdominal flaps in hand and forearm composite tissue injuries: Results of technical refinements for safe harvest. J Orthop 2019; 16:369-376. [PMID: 31193279 DOI: 10.1016/j.jor.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/08/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
We evaluated the outcome of new technical refinements in abdominal flap coverage of major defects in upper limb for its reliability and safety. 68 patients were assessed for indications, additional procedures, complications and DASH questionnaire evaluation at the end of a year. The mean size of flap was 56 cm2 (range 6-250 cm2). Median DASH score was 11.5 (range: 0-63). Hand stiffness was observed in 39% of patients. However, this was absent in whom prophylactic pinning of metacarpophalangeal joints were done in James position. Abdominal flaps give satisfactory results in hand injuries. Competent hand therapy program is essential to get best results.
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Affiliation(s)
- A M Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
| | - N Ravikiran
- Department of Plastic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - K N Jayakrishnan
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
| | - Anil K Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal, Manipal Academy of Higher Education, India
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Abstract
We report functional and cosmetic outcomes in 14 patients (six bilateral and eight unilateral) with type IV radial longitudinal deficiency who underwent radialization. Follow-up ranged from 5 to 19 years. Outcome measures were grip and pinch strengths, Percival and Sykes score, Vilkki score, Cattaneo grading, and a questionnaire to patients. Radiological assessment included the hand-forearm angle, the hand-forearm position, and ulna length and width. At final follow-up, the length of the affected ulna was 56% of the length of the normal ulna. The distal ulna hypertrophied to 97% of the opposite distal radius and a median loss of correction of hand-forearm angle was 9°. All hands improved on Vilkki severity grade and on the Cattaneo functional and aesthetic grading. We conclude that radialization is an effective procedure in these cases, but secondary procedures may be required for the long-term maintenance of wrist alignment and hand function. Level of evidence: IV.
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Affiliation(s)
- Anil K Bhat
- Hand and Microsurgery Unit, Manipal University, Karnataka, India
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Gundmi S, Maiya AG, Bhat AK, Hande MH, Kumar AS. Screening for basal metabolic rate and visceral fat among postmenopausal osteoporosis with type 2 diabetes mellitus. Diabetes Metab Syndr 2019; 13:981-984. [PMID: 31336555 DOI: 10.1016/j.dsx.2019.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In people with type 2 diabetes mellitus, there is an increase in basal metabolic rate (BMR) which is associated with level of glycaemic control. Women with postmenopausal osteoporosis have decreased BMR. The aim of the present study is to find the BMR using Meffin-St Jeor predictive equation in women with type 2 diabetes mellitus (T2DM) who have attained menopause with osteoporosis. MATERIALS & METHODS 100 women who have attained menopause, who were diagnosed to have osteoporosis with type 2 diabetes mellitus were assessed for BMR using Meffin-St Jeor predictive equation. Detailed history of diabetes and menopause were obtained. Blood glucose value was measured using standard glucometers. Body composition for visceral fat (VF) was measured using bioelectrical impedance analysis. Level of physical activity of the participants was measured using global physical activity questionnaire (GPAQ). RESULTS The median BMR of the participants was 1.075 (714, 1483.25). Statistically significant correlation was found between BMR and GPAQ (rs = 0.731), BMR and VF (rs = 0.678). However BMR was not correlated with FBS (rs = 0.083) duration of diabetes (rs = -0.046). CONCLUSION There is a decrease in BMR in women with T2DM with postmenopausal osteoporosis. BMR was significantly correlated with level of physical activity and visceral fat.
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Affiliation(s)
- Shubha Gundmi
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
| | - Arun G Maiya
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
| | - Anil K Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
| | - Manjunatha H Hande
- Department of General Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
| | - A Sampath Kumar
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India.
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Thomas JE, Bhat AK, Rao M, Guddattu V, Sekhar M S. Use of Vitamin D Supplements in Osteoarthritis: An Observational Study in a Tertiary Health Care Facility. J Am Coll Nutr 2018; 38:227-234. [PMID: 30485164 DOI: 10.1080/07315724.2018.1494641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/14/2023]
Abstract
OBJECTIVE The purpose of the study was to assess impact of vitamin D supplements on the disease progression and overall health of osteoarthritis (OA) patients. METHODOLOGY A cohort study was carried out for 8 months (August 2017-March 2018) in the Orthopedics Department of Kasturba Hospital, Manipal, India, a tertiary care hospital. One hundred and forty-two patients who were diagnosed with OA (grades 1-3) with low serum 25(OH)D levels (severely deficient, deficient, or insufficient) were selected for the study. These patients were categorized into two cohorts: a control cohort (CC) and a study cohort (SC). CC members were patients (n = 71) who had not received vitamin D supplements, and SC members were patients (n = 71) who had received vitamin D supplements. Severity grading of OA, pain score, and health assessment were performed using the Kellgren-Laurence grading score, visual analogue scale (VAS), and WOMAC, respectively, at baseline and after 3 months of follow-up. RESULTS Subjects in the both CC and SC reported no statistically significant difference (similar in both group) in severity grade (p = 0.303), pain score (p = 0.099), parathyroid hormone (PTH) (p = 0.083), and health status (p = 0.76) at baseline. After 3 months of follow-up (post vitamin D supplementation), OA patients have shown statistically significant difference in severity grades, serum 25(OH)D status, PTH level (p < 0.001), and overall health status (p = 0.001) in the SC with respect to baseline. Likewise, percentage distribution of positive changes was significantly higher in severity grade, pain score, serum 25(OH)D level, overall health status (p < 0.001), and PTH (p = 0.040) of SC as compared to CC at follow-up. CONCLUSION Vitamin D supplements have significantly improved serum 25(OH)D levels, PTH, severity grade, and pain score of OA patients. Most importantly, vitamin D supplements have shown improvement in the overall health of OA patients, emphasizing the place of vitamin D supplements in the management of OA. Clinical Trial Registry-India (CTRI) registration no: CTRI/2017/12/011031.
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Affiliation(s)
- Jino Elsa Thomas
- a Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences , Manipal Academy of Higher Education , Manipal , Karnataka , India
| | - Anil K Bhat
- b Department of Orthopaedics, Kasturba Medical College , Manipal Academy of Higher Education , Manipal , Karnataka , India
| | - Mahadev Rao
- a Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences , Manipal Academy of Higher Education , Manipal , Karnataka , India
| | - Vasudeva Guddattu
- c Department of Statistics, Prasanna School of Public Health , Manipal Academy of Higher Education , Manipal , Karnataka , India
| | - Sonal Sekhar M
- a Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences , Manipal Academy of Higher Education , Manipal , Karnataka , India
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Bhat AK, Acharya AM, Narayana Kurup JK, Chakraborti A. Bilateral Bifid Median Nerve with Bilateral Carpal Tunnel Syndrome: An Atypical Presentation, a Rare Cause and a Familiar Disease. J Hand Surg Asian Pac Vol 2018; 23:274-277. [PMID: 29734910 DOI: 10.1142/s2424835518720165] [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
We report a case of bilateral carpal tunnel syndrome (CTS) with bilateral bifid median nerve (BMN) without a persistent median artery diagnosed by clinical examination, NCV and Ultrasonography. Bilateral BMN to produce bilateral CTS is extremely rare and is contrary to the popular classifications which state that BMN without persistent median artery or its anomalies will not produce CTS. Ultrasonogram is of additional help to identify such aberrations in the median nerve to prevent iatrogenic injuries during carpal tunnel decompression.
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Affiliation(s)
- Anil K Bhat
- * Hand and Microsurgery Unit, Department of Orthopedics, India
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Bhat AK, Kurup JKN, Acharya AM. Volar Translunate Perilunate Dislocation: Case Report and Analysis of Review of Literature. J Hand Microsurg 2018; 11:S16-S21. [PMID: 31616121 DOI: 10.1055/s-0038-1648335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/21/2017] [Accepted: 04/02/2018] [Indexed: 10/14/2022] Open
Abstract
Volar translunate perilunate dislocations are the rarest form of perilunate dislocations with only a handful of cases reported till now. The injury mechanism is not uniform, and the pattern of injury does not follow traditional classifications. We report a case of volar translunate perilunate dislocation with a review of literature of very few previous reported cases of these rare injuries.
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Affiliation(s)
- Anil K Bhat
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Jayakrishnan K Narayana Kurup
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ashwath M Acharya
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Gundmi S, Maiya AG, Bhat AK, Ravishankar N, Hande MH, Rajagopal K. Hand dysfunction in type 2 diabetes mellitus: Systematic review with meta-analysis. Ann Phys Rehabil Med 2018; 61:99-104. [DOI: 10.1016/j.rehab.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/24/2017] [Accepted: 12/24/2017] [Indexed: 11/29/2022]
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Bhat AK, Acharya AM, Nahas N. Radialization With Ulnar Cuff Osteotomy: A Technique for Deformity Correction in Radial Longitudinal Deficiency. J Hand Surg Am 2018; 43:293.e1-293.e7. [PMID: 29502582 DOI: 10.1016/j.jhsa.2017.11.012] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/16/2017] [Indexed: 02/02/2023]
Abstract
Various procedures described for deformity correction in radial longitudinal deficiency (RLD) have encountered problems of stiffness, instability, and inadequate correction. Many surgical modifications of these procedures have still resulted in deformity recurrence, shortening, and damage to the epiphysis. To align the hand with the forearm, the deforming forces from both soft tissues and skeletal growth should be addressed without damaging the ulnar epiphysis or the carpus. To achieve this, we propose a metaphyseal ulnar cuff osteotomy during radialization. After soft tissue release, the overlap of carpus to ulna is shortened at the metaphysis in the form of a subperiosteal cuff along with additional tendon balancing. This procedure has helped us in correcting the deformity without damaging the epiphysis or the carpus and has maintained correction through the initial critical growth period of the child.
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Affiliation(s)
- Anil K Bhat
- Unit of Hand and Microsurgery, Department of Orthopedics, Kasturba Medical College Hospital, Manipal University, Manipal, Karnataka, India.
| | - A M Acharya
- Unit of Hand and Microsurgery, Department of Orthopedics, Kasturba Medical College Hospital, Manipal University, Manipal, Karnataka, India
| | - Naufal Nahas
- Unit of Hand and Microsurgery, Department of Orthopedics, Kasturba Medical College Hospital, Manipal University, Manipal, Karnataka, India
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Bhat AK, Acharya AM, Manoh S, Kamble V. A Prospective Study of Acute Undisplaced and Minimally Displaced Scaphoid Fractures Managed by Aggressive Conservative Approach. J Hand Surg Asian Pac Vol 2018; 23:18-25. [PMID: 29409429 DOI: 10.1142/s2424835518500029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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 To identify acute un-displaced and minimally displaced scaphoid fractures which are unlikely to unite with non-operative treatment at six weeks with CT scan and stabilize them with percutaneous screw fixation with the aim of preventing non-union. METHODS A scaphoid series radiographs of wrist were obtained for patients with undisplaced or minimally displaced fractures and were immobilized in a thumb spica cast for six weeks. At six weeks, CT scan was done for patients showing doubtful signs of clinical and radiographic union. Patients with a gap less than 2 mm were continued on cast for an additional two to four weeks. Those with gap more than 2 mm underwent percutaneous screw fixation. In both cases the immobilisation was discontinued when the fracture was considered to be united and mobilization was initiated. RESULTS 21 out of 39 patients managed initially with cast for six weeks showed clinical and radiological evidence of union. 18 patients showed persistent tenderness of which eight showed a clear gap in radiographs and 10 patients had doubtful union. Eight of these 10 patients on CT scan showed fracture gap of more than 2 mm while two patients showed fracture gap of less than 2 mm. Hence, 16 patients underwent percutaneous fixation. Repeat radiographs showed progression to union at an average of 3.8 weeks from surgery. Remaining two eventually united on continuing the cast. All patients showed confirmed union at one year on follow up. CONCLUSIONS An objective measurement of fracture gap by CT scan at six weeks is useful in predicting cases with tendency for delayed union. Early percutaneous fixation of fractures would not further jeopardize the blood supply of fracture site. This aggressive conservative management also avoids unnecessary surgery in all acute scaphoid fractures.
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Affiliation(s)
- Anil K Bhat
- * Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath M Acharya
- * Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, India
| | - S Manoh
- * Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Vinay Kamble
- * Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, India
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Abstract
Ancient schwannoma is a rare variant of schwannoma associated with a longstanding course. They differ from classical schwannomas in the long duration for this subtype of schwannoma to develop and also by demonstrating haemorrhagic and degenerative changes with nuclear atypia. It is because of these histologic hallmarks that they are frequently misdiagnosed as malignant tumours. They usually involve the major nerves of flexor surfaces in upper extremity such as the ulnar and median nerve but schwannomas of the radial nerve are a rare entity. We report two cases of ancient schwannoma involving the radial nerve at mid arm and dorsum of the hand. The differential diagnoses included atypical soft tissue sarcomas and tumours of neural origin. Imaging and histopathology are crucial in diagnoses of these tumours.
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Affiliation(s)
- Anil K. Bhat
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ashwath M. Acharya
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Jayakrishnan K. Narayanakurup
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vijay Shankar
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Bhat AK, Mane PP, Acharya A, Madi S. Simultaneous combined complete tear of radial and ulnar collateral ligaments of thumb in an adolescent. BMJ Case Rep 2017; 2017:bcr-2017-220550. [PMID: 28963384 DOI: 10.1136/bcr-2017-220550] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated tear of collateral ligaments of thumb are common but combined injuries of both radial and ulnar collateral ligaments are rare. These cases are reported in athletes involved in high-impact sports. Here, we report a case of a 15-year-old boy with pain at base of the thumb and instability following low-impact sporting activity. On subsequent clinicoradiological assessment, simultaneous combined complete tear of both radial and ulnar collateral ligaments of the thumb was noted. Delayed primary repair of both collateral ligaments was done. This case highlights the rarity of this type of injury in an adolescent and also the use of appropriate clinical tests and imaging modalities for early diagnosis of such injuries. Restoration of joint stability as early as possible either by repair or reconstruction of ligaments needs to be considered to prevent secondary osteoarthritis of metacarpophalangeal joint.
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Affiliation(s)
- Anil K Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal university, Manipal, Karnataka, India
| | - Prajwal Prabhudev Mane
- Department of Orthopaedics, Kasturba Medical College, Manipal university, Manipal, Karnataka, India
| | - Ashwath Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal university, Manipal, Karnataka, India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal university, Manipal, Karnataka, India
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Bhat AK, Madi S, Mane PP, Acharya A. Bilateral tarsal tunnel syndrome attributed to bilateral fibrous tarsal coalition and symmetrical hypertrophy of the sustentaculum tali. BMJ Case Rep 2017; 2017:bcr-2017-220087. [PMID: 28883007 DOI: 10.1136/bcr-2017-220087] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tarsal tunnel syndrome (TTS) is one of the frequently encountered entrapment neuropathies of the lower limb. Most often the aetiology is considered to be idiopathic. However, it has to be thoroughly investigated to rule out diverse extrinsic and intrinsic causes. The sustentaculum tali (ST) forms the superior part of the distal tarsal tunnel, and any increase in its size may result in irritation of the tibial nerve or its branches, the medial and lateral plantar nerves or decrease the overall volume of the tarsal tunnel culminating to clinical features of TTS. A hypertrophied ST is an extremely rare cause for TTS, and we report perhaps a first case of bilateral TTS in a young adult due to bilateral symmetrical hypertrophied ST which in turn was a result of bilateral fibrous tarsal coalition. Staged bilateral surgical excision of the hypertrophied part of ST and the underlying fibrous tarsal coalition ensured prompt symptomatic relief.
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Affiliation(s)
- Anil K Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Prajwal Prabhudev Mane
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ashwath Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Abstract
BACKGROUND Rhabdomyosarcomas are malignant tumors arising from striated muscle but can be often confused with primitive neuroectodermal tumors and Ewing sarcoma. They are often classified based on age of presentation and histological features. Three major types of rhabdomyosarcomas are embryonal, alveolar, and pleomorphic with characteristic presentations. METHOD Here, we present a case of embryonal rhabdomyosarcoma in the hand of a 5-month-old child with lymphatic metastasis, the age, site, and metastasis being unusual feature for this type of rhabdomyosarcoma. RESULT The child succumbed to the complications soon after initiation of chemotherapy. CONCLUSION Age, site, metastasis at birth and treatment related complications contribute to the poor outcome.
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Affiliation(s)
- Jayakrishnan K. Narayana Kurup
- Manipal University, India,Jayakrishnan K. Narayana Kurup, Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India.
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Bhat AK, A N, Acharya A, Kumar Y. Novel Presentation of Uncommon Wrist Injury: Simultaneous Lunate and Perilunate Fracture Dislocation (scapho-capitate Syndrome) of Both Wrists. J Orthop Case Rep 2016; 6:50-52. [PMID: 27703938 PMCID: PMC5040572 DOI: 10.13107/jocr.2250-0685.430] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Perilunate and lunate dislocations are uncommon high energy injuries and have extensive soft tissue, cartilaginous and bony damage. The most common pattern is trans-scaphoid perilunate fracture dislocation which constitutes approximately 50% of these injuries. Unusual injury pattern like Scaphocapitate syndrome can occur with fracture through scaphoid waist and capitate that rotates the proximal capitate 180° so that its proximal articular surface points distally. With this case report, we would like to present a novel presentation of an uncommon wrist injury. Case report: We present a case of simultaneous lunate dislocation in one wrist and perilunate fracture dislocation (Scapho- capitate syndrome) in the contralateral wrist which occurred simultaneously in a young male following a two wheeler accident. The injury was missed initially at the primary treating centre. Upon diagnosis, the patient underwent open reduction and internal fixation along with ligament repair. The patient was subsequently followed up for a period of four years and was found to have very good clinical and radiological outcome. Conclusion: These injuries occurring simultaneously in contralateral wrists are exceptionally rare and unusual as the mechanisms of injury are different. These are high velocity injuries and are often missed, especially in presence of other major injuries. These high energy injuries need accurate diagnosis, early and aggressive treatment in order to prevent complications
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Affiliation(s)
- Anil K Bhat
- Department Of Orthopaedics, Kasturba Medical College, Manipal. India
| | - Nishanth A
- Department Of Orthopaedics, Kasturba Medical College, Manipal. India
| | - Ashwath Acharya
- Department Of Orthopaedics, Kasturba Medical College, Manipal. India
| | - Yogesh Kumar
- Department Of Orthopaedics, Manipal Hospital-Bangalore. India
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Abstract
We report a case of intraneural synovial sarcoma of the median nerve in a 39 year old lady with multiple local recurrences over thirteen years with no distant metastasis. The diagnosis of biphasic type of synovial sarcoma was confirmed by histopathology and immunohistochemistry. At the time of the fourth recurrence below elbow amputation was performed. This case is being reported for its rarity and propensity for local recurrence without distant metastasis.
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Affiliation(s)
- A K Bhat
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal University, India
| | - K N Jayakrishnan
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal University, India
| | - A M Acharya
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal University, India
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Bhat AK, Acharya AM, Soni N. Reconstruction of Attritional Rupture of Flexor Tendons with Fascia Lata Graft Following Distal Radius Fracture Malunion. J Hand Surg Asian Pac Vol 2016; 21:410-3. [PMID: 27595963 DOI: 10.1142/s2424835516720176] [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] [Indexed: 11/18/2022]
Abstract
Incidence of multiple flexor tendon rupture following distal radius fractures is rare with very few cases being reported in literature. We present an unusual case of a patient who had come to us with complaints of weakness and paresthesia of the right hand of one month prior and with a past history of dorsal plating for distal radius fracture nine years ago. Radiographs showed a distal radius fracture malunion with intact dorsal plate and protrusion of screws through the volar cortex. On exploration, attritional ruptures of all digital flexors were found with sparing of the Flexor Pollicis Longus tendon. The fibrous mass was excised and flexors reconstructed with a fascia lata graft. Attempt was made to correct the malunion with radial and ulnar osteotomies. At one year the patient had excellent restoration of digital flexion.
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Affiliation(s)
- A K Bhat
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, India
| | - A M Acharya
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, India
| | - N Soni
- 1 Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, India
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Abstract
A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps. The problem of birth brachial plexus palsy is proving to be a global health burden both in developed countries and in developing countries such as India. The lack of awareness among the general public and primary healthcare providers and inadequate orthopaedic and neurosurgeons trained to treat the condition have worsened the prognosis. This case lays stress on the delayed complications in birth brachial palsy and its effective management.
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Affiliation(s)
- Sambeet Patra
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Jayakrishnan K Narayana Kurup
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ashwath M Acharya
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Anil K Bhat
- Hand and Microsurgery Unit, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Abstract
INTRODUCTION Neck pain associated with pain in the arm (cervicobrachial pain) is a common complaint in patients seeking physiotherapy management. The source of symptoms for this complaint is commonly presumed to be neural. However, this pain pattern could also result from various other innervated tissue structures of the upper quarter. Knowledge about frequency of neural structures being a predominant source of symptoms would help in implementing appropriate therapeutic strategies such as neural tissue mobilization along with other complimentary therapies for optimal outcomes. AIM To determine the frequency of cervicobrachial pain being neurogenic. MATERIALS AND METHODS Participants (n=361) aged between 20-65 years, reporting cervicobrachial pain were screened for neurogenic nature of symptoms. These physical signs included: active and passive movement dysfunction, adverse responses to neural tissue provocation tests, tenderness on palpating nerve trunks and related cutaneous tissues and evidence of a related local area of pathology (Clinical/radiological). The consistency of all these signs was checked to identify a significant neural involvement. RESULTS Descriptive statistics were used to analyse data. Of 361 participants, 206 were males (44.6 ±10.8 years) and 155 were females (41.8 ± 11.2 years). The frequency of neurogenic cervicobrachial pain was determined to be 19.9% (n=72) and the non-neurogenic sources for symptoms were attributed to 80.1% (n=289) of screened participants. CONCLUSION Lower frequency of cervicobrachial pain being neurogenic indicates thorough screening for appropriate therapeutic interventions to be successful.
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Affiliation(s)
- Ranganath Gangavelli
- Assistant Professor -Selection Grade, Department of Physiotherapy, School of Allied Health Sciences , Manipal University, Manipal, India
| | - N Sreekumaran Nair
- Professor and Head, Department of Statistics, Manipal University , Manipal, India
| | - Anil K Bhat
- Professor and Head, Department of Orthopedics, Kasturba Medical College , Manipal University, Manipal, India
| | - John M Solomon
- Associate Professor, Department of Physiotherapy, School of Allied Health Sciences , Manipal University, Manipal, India
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Vijayan S, Bhat AK, Hameed SA, Kumar B. Chondroblastoma of the scaphoid: A case report. J Cancer Res Ther 2015; 11:669. [PMID: 26458718 DOI: 10.4103/0973-1482.151938] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Benign Chondroblastoma generally occur in the epiphysis of long bones and rarely arise in carpal bones. We report a young male with chondroblastoma of scaphoid treated with curettage, bone grafting and K-wire fixation. At the last follow-up, 4 years after surgery, the patient was asymptomatic without recurrence.
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Affiliation(s)
- Sandeep Vijayan
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Eapen C, Kumar B, Bhat AK, Venugopal A. Extensor Pollicis Longus Injury in Addition to De Quervain's with Text Messaging on Mobile Phones. J Clin Diagn Res 2014; 8:LC01-4. [PMID: 25584249 DOI: 10.7860/jcdr/2014/8304.5094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 01/02/2014] [Accepted: 05/03/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. BACKGROUND Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. MATERIALS AND METHODS Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. RESULTS Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. CONCLUSION Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. APPLICATION Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist.
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Affiliation(s)
- Charu Eapen
- Associate Professor, Senior Scale, Department of Physiotherapy, KMC Mangalore , Manipal University, Manipal, India
| | - Bhaskaranand Kumar
- Professor and Former HOD, Department of Orthopaedics, KMC Manipal , Manipal University, Manipal, India
| | - Anil K Bhat
- Professor, Department of Orthopaedics, KMC Manipal , Manipal University, Manipal, India
| | - Anand Venugopal
- Professor, Department of Radiodiagnosis, KMC Mangalore , Manipal University, Manipal, India
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Bhat AK, Acharya AM, Rosario P, Anuradha CK, Rao L. Superficial angiomyxoma of the thumb mimicking a malignant bone tumor: case report. J Hand Surg Am 2014; 39:937-9. [PMID: 24582847 DOI: 10.1016/j.jhsa.2014.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/30/2013] [Revised: 01/12/2014] [Accepted: 01/14/2014] [Indexed: 02/02/2023]
Abstract
Superficial angiomyxoma is a distinctive cutaneous soft tissue neoplasm commonly involving dermal and subcutaneous tissues and showing a prominent angiomyxoid matrix interspersed with numerous blood vessels. We report a case of superficial angiomyxoma in a 70-year-old man who presented with a fungating swelling on the distal phalanx of the thumb mimicking a malignant tumor. The diagnosis of superficial angiomyxoma was made based on histopathology and immunohistochemistry. We report this lesion because of its rare presentation with extensive distal phalangeal osteolysis mimicking a malignant bone tumor.
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Affiliation(s)
- Anil K Bhat
- Hand and Microsurgery Unit, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India; Department of Pathology, Kasturba Medical College Hospital, Manipal University, Manipal, India
| | - Ashwath M Acharya
- Hand and Microsurgery Unit, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India; Department of Pathology, Kasturba Medical College Hospital, Manipal University, Manipal, India.
| | - Prashant Rosario
- Hand and Microsurgery Unit, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India; Department of Pathology, Kasturba Medical College Hospital, Manipal University, Manipal, India
| | - C K Anuradha
- Hand and Microsurgery Unit, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India; Department of Pathology, Kasturba Medical College Hospital, Manipal University, Manipal, India
| | - Lakshmi Rao
- Hand and Microsurgery Unit, Department of Orthopaedics, Kasturba Medical College Hospital, Manipal University, Manipal, India; Department of Pathology, Kasturba Medical College Hospital, Manipal University, Manipal, India
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Abstract
Purpose: In recent years, ownership and usage of cell phones have become widespread, especially amongst young people. The increasing use of text messaging on mobile phones has focused concern on possible musculoskeletal disorders for the users. Hence the purpose of this study was to find the prevalence of cumulative trauma disorders (CTDs) of the upper limb in cell phone users. Methods: A questionnaire-based survey was undertaken to detect the prevalence of CTDs in 1500 college students. Results: The response rate of the survey was 91.9%. Overall prevalence of CTD in the upper limb was found to be 18.5%. Maximum symptoms were noted in thumb (52%). Pain (61.7%) and fatigue (44.3%) were the two most common symptoms reported by the respondents. Conclusions: Mild form of CTD is present in students using cell phones and mainly depends on the pattern of phone usage.
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Affiliation(s)
- Charu Eapen
- Department of Physiotherapy, KMC Mangalore, Manipal University, Karnataka, India
| | - Bhaskaranand Kumar
- Department of Orthopedics, KMC Manipal, Manipal University, Karnataka, India
| | - Anil K. Bhat
- Department of Orthopedics, KMC Manipal, Manipal University, Karnataka, India
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Abstract
One of the most difficult and intricate surgeries in the field of hand surgery is that of Pollicization. It involves transfer of one of the fingers to create a new functioning thumb when it is absent. This elegant surgical technique has evolved over the 100 years from a simple, though unaesthetic transposition of digits to a complex procedure which demands an intelligent use of skin flaps, osteotomy and muscle balancing to create an almost normal looking aesthetic thumb. We present a review of this procedure briefly touching on its historical development, indications, and refinements in the critical steps of the technique, long term results and complications.Pollicization continues to be one of the most useful surgeries in improving the function of the hand and has stood the test of time.
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Affiliation(s)
- Bhaskaranand Kumar
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
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Abstract
Imaging techniques play an important role in evaluating the complex anatomy of bone and soft tissues of the wrist. The standard wrist radiographs and specialized views still form a very important imaging modality to unravel the wrist pathology in their simplest forms. This article discusses the routine radiography of the wrist followed by ancillary views and dynamic studies for each of the routine view described that helps reveal both static and dynamic pathologies. The literature search was carried out using the search strings or key words, and the databases were searched using the time frame of 1990 to 2011 that included Scopus, MD consult, Web of Knowledge, Pub Med, Ovid Medline and Cochrane Library. The print journals and books available at Manipal University library were hand searched and secondary search was done for the relevant articles included in the references of primary articles. Full articles as well as abstracts were used for the review.
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Affiliation(s)
- Anil K. Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Bhaskaranand Kumar
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Ashwath Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
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