Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors' experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

Ankle instability after fibular resection

We have reviewed 104 patients who had partial resection of the fibula for use as a graft. Only 44 were completely free from symptoms, and six had developed significant ankle instability which had required reconstruction by a sliding graft. This procedure successfully restored ankle stability in all six cases.

The hand-foot syndrome in sickle-cell haemoglobinopathy

The hand-foot syndrome is a benign self-limiting condition seen in young children with sickle-cell haemoglobinopathy, usually at the time of a crisis. The authors have observed 36 cases among 4920 patients. The features and management of the condition are discussed and the published literature is reviewed.

Indian orthopaedics: the past, present, and future

The editorial summarizes the Indian orthopaedic history in brief and provides an overview of the articles to be published in the Indian traumatology edition.

Low bone mineral density in Indian patients with fragility fractures

OBJECTIVE

Low bone mineral density (BMD) is a major risk factor for fragility fractures in osteoporosis. In recent studies, its use with clinical risk factors has been shown to enhance prediction of fragility fractures. The present study was done to assess BMD in Indian patients with fragility fractures using digital X-ray radiogrammetry (DXR-BMD).

METHODS

A total of 228 patients (64 male and 164 female) admitted to an Orthopedic Hospital for management of fragility fracture were recruited. For each patient, DXR-BMD was obtained from an anteroposterior radiograph of the non-dominant hand.

RESULTS

The number of subjects with hip fracture was 104 (40 male, 64 female). Vertebral fractures were seen in 67 patients (11 male, 56 female) and distal radial fracture in 57 patients (13 male, 44 female). The DXR-BMD (g/cm(2)) was significantly lower in subjects with any fragility fracture (0.51 vs. 0.58 in men and 0.41 vs. 0.54 in women). When compared to the age-matched normative reference data by decade, all subjects with fragility fracture had significantly lower DXR-BMD except male subjects in the age decade of 40-49 years.

CONCLUSION

This study confirms lower DXR-BMD in Indian subjects with fragility fractures. This may have a potential role in fracture prediction when used with clinical risk factors in the Indian population.

The hand-foot syndrome in sickle-cell haemoglobinopathy

The hand-foot syndrome is a benign self-limiting condition seen in young children with sickle-cell haemoglobinopathy, usually at the time of a crisis. The authors have observed 36 cases among 4920 patients. The features and management of the condition are discussed and the published literature is reviewed.

Ankle instability after fibular resection

We have reviewed 104 patients who had partial resection of the fibula for use as a graft. Only 44 were completely free from symptoms, and six had developed significant ankle instability which had required reconstruction by a sliding graft. This procedure successfully restored ankle stability in all six cases.

Unusual compressive neuropathies of the upper limb

Compression neuropathies are one of the most common causes of upper extremity pain. This article has addressed the diagnosis and treatment of some of the more unusual neuropathies. As always, a thorough knowledge of anatomy and its valuation, and a careful and impulsive physical examination will guide the clinician to the appropriate diagnosis. Electrical studies, done carefully and with the clinical diagnosis as a label, will often be confirmatory. In cases not responsive to nonoperative measures, surgery to decompress the nerve and to restore missing function will usually proved a modicum of patient improvement.