Primary Isolated Spinal Hodgkin’s Lymphoma with Rapidly Progressive Neurodeficit: A Case Report

Vol 31 | Issue 1 | Jan – Apr 2018 | page: 9-11 | Shailesh Hadgaonkar, Ashish Yadav, Satish Rohra, Ketan Khurjekar, Ajay Kothari, Parag K. Sancheti, Ashok Shyam

Authors: Shailesh Hadgaonkar [1], Ashish Yadav [1], Satish Rohra [1], Ketan Khurjekar [1], Ajay Kothari [1], Parag K. Sancheti [1], Ashok Shyam [1]

[1] Department of Spine surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra. India,

Address of Correspondence
Dr. Ashish Yadav,
Department of Spine surgery,
Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra.  India


Introduction: Primary spinal lymphoma is a rare form of extra nodal lymphoma. Spinal cord compression is a rare complication of Hodgkin’s disease, occurring in only 5% of cases, usually in the setting of progressive, advanced disease.1 As the initial symptom of Hodgkin’s disease, it is extremely rare, with only a few cases reported in the literature. We present a case of a 60-year-old male patient with primary thoracic epidural lymphoma who presented with rapidly progressive neurological deficit. MRI and PET revealed an extradural mass compresing the spina; cord, arising from body and posterior elements of D4. Patient was treated with an early decompression surgery and Histology showed it to be a Hodgkin’s lymphoma. Patient gradually recovered from the neurodeficit and is undergoing chemotherapy under the guidance of a medical oncologist.Patient is walking independently without support at 3 months followup.
Conclusion: To summarise, even though very rare, spinal hodgkins lymphoma is a possibility. This extra nodal variant can progress rapidly and lead to devastating neurological complications if not intervened early. Chemotherapy and radiotherapy are often both needed post operatively for this type of lymphoma. Early decompression leads to good neurological outcome.


1. Al-Khayat H, Al-Khayat H, Al-Baker O, Groof A, Sadeq A, Hayati H, et al. Cervical radiculopathy secondary to Hodgkin’s lymphoma. Surg Neurol 2007;67:540-3.

2. Friedman M, Kim TH, Panahon AM. Spinal cord compression in malignant lymphoma. Treatment and results. Cancer 1976;37:1485-91.

3. Vieta SO, Friedell HL. A survey of Hodgkin’s disease and lymphosarcoma in bone. Radiology 1942;39:1-14.

4. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer 1972;29:252-60.

5. Mally R, Sharma M, Khan S, Velho V. Primary lumbo-sacral spinal epidural Non-Hodgkin’s lymphoma: A case report and review of literature. Asian Spine J 2011;5:192-5.

6. Perry JR, Deodhare SS, Bilbao JM, Murray D, Muller P. The significance of spinal cord compression as the initial manifestation of lymphoma. Neurosurgery 1993;32:157-62.

7. Anila KR, Nair RA, Prem S, Ramachandran K. Primary mixed cellularity classical hodgkin lymphoma of the lumbar spine – An unusual presentation. Gulf J Oncol 2015;1:88-91.

8. Burch PA, Grossman SA. Treatment of epidural cord compressions from Hodgkin’s disease with chemotherapy. A report of two cases and a review of the literature. Am J Med 1988;84:555-8.

9. Haddad P, Thaell JF, Kiely JM, Harrison EG, Miller RH. Lymphoma of the spinal extradural space. Cancer 1976;38:1862-6.

10. Traweek ST. Hodgkin’s disease – Intraspinal involvement. In: Bigner DD, McLendon RE, Bruner JM, editors. Russel and Rubinstein’s Pathology of Tumors of the Nervous System. 6th ed. New York: Arnold; 1998. p. 218.

11. Epelbaum R, Haim N, Ben-Shaker M, Ben Aire Y, Teisod M, Cohen Y. Non-Hodgkin’s lymphoma presenting with spinal epidural involvement. Cancer 1986;58:2120-4.

How to Cite this Article: Hadgaonkar S, Yadav A, Rohra S, Khurjekar K, Kothari A, Sancheti P K, Shyam A. Primary Isolated Spinal Hodgkin’s Lymphoma with Rapidly Progressive Neurodeficit: A Case Report. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):9-11.


(Abstract)      (Full Text HTML)   (Download PDF)

Fabella Syndrome – A Rare cause of Posterolateral Knee Pain: Case Report and Review of Literature

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 6-8 | Vishwanath, Shiju Majeed.

Authors: Viswanath [1], Shiju Majeed [2]

[1] Department of Orthopaedic, Baby Memorial Hospital, Kozhikode, Kerala, India,

[2]Department of Orthopaedic, Government Medical College, Thiruvananthapuram, Kerala, India.

Address of Correspondence
Dr. Shiju Majeed
Department of Orthopaedics, Government Medical College,
Thiruvananthapuram, Kerala, India.


Introduction: The purpose of this article is to educate clinicians about fabella syndrome as a possible cause of posterolateral knee pain and dysfunction. We report a case of a teenager who presented with posterolateral knee pain due to fabella syndrome. Fabellectomy was performed to relive her symptoms. PubMed literature review was performed to update on the existing knowledge on this unusual cause of posterolateral knee pain.
Keywords: Fabella syndrome, posterolateral knee pain, fabellectomy, sesamoid bone.


1. Minowa T, Murakami G, Kura H, Suzuki D, Han SH, Yamashita T, et al. Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments? J Orthop Sci 2004;9:59-65.

2. Müller W. The Knee-form, Function and Ligament Reconstruction. New York: Springer Verlag Berlin Heidelberg; 1982. p. 40, 96, 98, 192, 249, 252.

3. Driessen A, Balke M, Offerhaus C, White WJ, Shafizadeh S, Becher C, et al. The fabella syndrome-a rare cause of posterolateral knee pain: A review of the literature and two case reports. BMC Musculoskelet Disord 2014;15:100.

4. Okano E, Yoshioka T, Yanai T, Kohyama S, Kanamori A, Yamazaki M, et al. Fabella syndrome as an uncommon cause of posterolateral knee pain after total knee arthroplasty: A case report and review of the literature. Case Rep Orthop 2016;2016:4328462.

5. Kim T, Chung H, Lee H, Choi Y, Son JH. A case report and review on fabella syndrome after high tibial osteotomy. Medicine (Baltimore) 2018;97:e9585.

6. Zenteno Chávez B, Morales Chaparro IF, De la Torre IG. Fabella syndrome in a high performance runner. Case presentation and literature review. Acta Ortop Mex 2010;24:264-6.

7. Ehara S. Potentially symptomatic fabella: MR imaging review. Jpn J Radiol 2014;32:1-5.

8. Usmani S, Marafi F, Ahmed N, Al Kandari F. 18F-NaF PET-CT in symptomatic fabella syndrome. Clin Nucl Med 2017;42:e199-201.

9. Tabira Y, Saga T, Takahashi N, Watanabe K, Nakamura M, Yamaki KI. Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects. Clin Anat N Y N 2013;26:893-902.

10. Kubota Y, Toyoda Y, Kubota H, Kawai H, Yamamoto T. Common peroneal nerve palsy associated with the fabella syndrome. Anesthesiology 1986;65:552-3.

11. Ando Y, Miyamoto Y, Tokimura F, Nakazawa T, Hamaji H, Kanetaka M, et al. A case report on a very rare variant of popliteal artery entrapment syndrome due to an enlarged fabella associated with severe knee osteoarthritis. J Orthop Sci 2017;22:164-8.

12. Hire JM, Oliver DL, Hubbard RC, Fontaine ML, Bojescul JA. Snapping knee caused by symptomatic fabella in a native knee. Am J Orthop (Belle Mead NJ) 2014;43:377-9.

13. Zipple JT, Hammer RL, Loubert PV. Treatment of fabella syndrome with manual therapy: A case report. J Orthop Sports Phys Ther 2003;33:33-9.

How to Cite this Article: Viswanath, Majeed S. Fabella Syndrome – A Rare cause of Posterolateral Knee Pain: Case
Report and Review of Literature. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):6-8.


(Abstract)      (Full Text HTML)   (Download PDF)

Articular cartilage regeneration in the treatment of osteoarthrosis

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 35-40 | P S John, Varghese Thomas

Authors: P S John [1], Varghese Thomas [1]

[1] Department of Orthopaedics, Pushpagiri Institute of Medical Science & Research, Thiruvalla.

Address of Correspondence
Dr. P S John,
Department of Orthopaedics, Pushpagiri Institute of Medical Science & Research, Thiruvalla.


Osteoarthrosis (OA), the most common joint disorder, produces a tremendous burden on healthcare systems throughout the world. Since there is no effective cure, OA represents a unique opportunity for innovation in the development of treatment strategy. In contrast to traditional treatments with drugs, proteins or anti bodies, stem cells are expected to revolutionize the treatment of many degenerative diseases including osteoarthrosis. There are ongoing debates whether stem cells can be effective in the treatment of complex diseases like osteoarthrosis. In this review the application of various methods for cartilage regeneration using stem cells in the treatment of osteoarthrosis is discussed. It is suggested that further investigations into new treatment strategies or combination therapies might provide useful treatment options in the management of osteoarthrosis. It is very important to evaluate the safety and effectiveness of cell based therapy before clinical use. This review provides updated information on recent clinical trials and related applications of stem cells in cartilage regeneration, there by opening up new treatment horizons in the management of osteoarthrosis.
Keywords: Cartilage, regeneration, chondrocyte, stem cells..


1. Di Martino A, Kon E, Perdisa F, Sessa A, Filardo G, Neri MP, Bragonzoni L, Marcacci M. Surgical treatment of early knee osteoarthritis with a cell-free osteochondral scaffold: results at 24 months of follow-up. Injury. 2015;46 Suppl 8:S33–8.
2. Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Nonsurgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012;20:436–49.
3. Wittenauer R, Smith L, Aden K. Background paper 6.12 osteoarthritis. Geneva: World Health Organization; 2013.
4. Birchfield PC. Osteoarthritis overview. Geriatr Nurs 2001;223:124-30.
5. Arden N, Cooper C. Osteoarthritis handbook. Osteoarthritis: epidemiology. London: Informa Healthcare; 2005.
6. Zhen G, Wen C, Jia X, Li Y, Crane JL, Mears SC, et al. Inhibition of TGF-beta signaling in mesenchymal stem cells of subchondral bone attenuates osteoarthritis. Nat Med 2013; 196:704e12.
7. Diarra D, Stolina M, Polzer K, Zwerina J, Ominsky MS, Dwyer D, et al. Dickkopf-1 is a master regulator of joint remodeling. Nat Med 2007;132:156e63.
8. Hayami T, Pickarski M, Wesolowski GA, McLane J, Bone A, Destefano J, et al. The role of subchondral bone remodeling in osteoarthritis: reduction of cartilage degeneration and prevention of osteophyte formation by alendronate in the rat anterior cruciate ligament transection model. Arthritis Rheum 2004;504:1193-206.
9. Wen C, Lu WW, Chiu KY. Importance of subchondral bone in the pathogenesis and management of osteoarthritis from bench to bed. J Orthop Transl 2014;21:16e25.
10. Sharma L, Berenbaum F. Osteoarthritis: a companion to rheumatology. Amsterdam: Elsevier Health Sciences; 2007.
11. Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, et al. Osteoarthritis: an overview of the disease and its treatment strategies. Semin Arthritis Rheum 2005;351:1e10.
12. Noth U, Steinert AF, Tuan RS. Technology insight: adult mesenchymal stem cells for osteoarthritis therapy. Nat Clin Pract Rheumatol 2008;47:371e80.
13. Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol 2013;910:584e94.
14. Kon E, Filardo G, Roffi A, Andriolo L, Marcacci M. New trends for knee cartilage regeneration: from cell-free scaffolds to mesenchymal stem cells. Curr Rev Musculoskelet Med. 2012;5:236–43.
15. Filardo G, Madry H, Jelic M, Roffi A, Cucchiarini M, Kon E. Mesenchymal stem cells for the treatment of cartilage lesions: from preclinical findings to clinical application in orthopaedics. Knee Surg Sports Traumatol Arthrosc. 2013;21:1717–29.
16. Manferdini C, Maumus M, Gabusi E, Piacentini A, Filardo G, Peyrafitte JA, Jorgensen C, Bourin P, Fleury-Cappellesso S, Facchini A, et al. Adiposederived mesenchymal stem cells exert antiinflammatory effects on chondrocytes and synoviocytes from osteoarthritis patients through prostaglandin E2. Arthritis Rheum. 2013;65:1271–81.
17. Caplan AI. All MSCs are pericytes? Cell Stem Cell. 2008;3:229–30.
18. Perdisa F, Gostynska N, Roffi A, Filardo G, Marcacci M, Kon E. Adiposederived mesenchymal stem cells for the treatment of articular cartilage: a systematic review on preclinical and clinical evidence. Stem Cells Int. 2015;2015:597652.
19. Ahmed TA, Hincke MT. Mesenchymal stem cell-based tissue engineering strategies for repair of articular cartilage. Histol Histopathol. 2014;29:669–89.
20. Stevens MM. Biomaterials for bone tissue engineering. Mater Today 2008;115:18e25.
21. Bhardwaj N, Kundu SC. Chondrogenic differentiation of rat MSCs on porous scaffolds of silk fibroin/chitosan blends. Biomaterials 2012;3310:2848-57.
22. Awad HA, Wickham MQ, Leddy HA, Gimble JM, Guilak F. Chondrogenic differentiation of adipose-derived adult stem cells in agarose, alginate, and gelatin scaffolds. Biomaterials 2004;2516:3211e22.
23. Huang CYC, Reuben PM, D’Ippolito G, Schiller PC, Cheung HS. Chondrogenesis of human bone marrow-derived mesenchymal stem cells in agarose culture. Anat Rec A Discov Mol Cell Evol Biol 2004;278A1:428e36.
24. Kundu B, Kundu SC. Silk sericin/polyacrylamide in situ forming hydrogels for dermal reconstruction. Biomaterials 2012;3330:7456e67.
25. Teixeira LSM, Feijen J, van Blitterswijk CA, Dijkstra PJ, Karperien M. Enzyme-catalyzed crosslinkable hydrogels: emerging strategies for tissue engineering. Biomaterials 2012;335:1281e90.
26. Williams CG, Kim TK, Taboas A, Malik A, Manson P, Elisseeff J. In vitro chondrogenesis of bone marrow-derived mesenchymal stem cells in a photopolymerizing hydrogel. Tissue Eng 2003;94:679e88.
27. Niamsa N, Srisuwan Y, Baimark Y, Phinyocheep P, Kittipoom S. Preparation of nanocomposite chitosan/silk fibroin blend films containing nanopore structures. Carbohydr Polym 2009;781:60e5.
28. Re’em T, Kaminer-Israeli Y, Ruvinov E, Cohen S. Chondrogenesis of hMSC in affinity-bound TGF-beta scaffolds. Biomaterials 2012;333:751e61.
29. FDA News Release. FDA approves first autologous cellularized scaffold for the repair of cartilage defects of the knee. Available from:
30. ter Huurne M, Schelbergen R, Blattes R, Blom A, de Munter W, Grevers LC, et al. Antiinflammatory and chondroprotective effects of intraarticular injection of adiposederived stem cells in experimental osteoarthritis. Arthritis Rheum 2012;6411:3604e13.
31. Wakitani S, Goto T, Pineda SJ, Young RG, Mansour JM, Caplan AI, et al. Mesenchymal cell-based repair of large, fullthickness defects of articular cartilage. J Bone Jt Surg Am 1994;76:579e92.
32. Toghraie F, Razmkhah M, Gholipour MA, Faghih Z, Chenari N, Nezhad ST, et al. Scaffold-free adipose-derived stem cells (ASCs) improve experimentally induced osteoarthritis in rabbits. Arch Iran Med 2012;158:495e9.
33. Murphy JM, Fink DJ, Hunziker EB, Barry FP. Stem cell therapy in a caprine model of osteoarthritis. Arthritis Rheum 2003; 4812:3464e74.
34. Frisbie DD, Kisiday JD, Kawcak CE, Werpy NM, Mcllwraith CW. Evaluation of adipose-derived stromal vascular fraction or bone marrow-derived mesenchymal stem cells for treatment of osteoarthritis. J Orthop Res 2009;2712:1675e80.
35. Sato M, Uchida K, Nakajima H, Miyazaki T, Guerrero AR, Watanabe S, et al. Direct transplantation of mesenchymal stem cells into the knee joints of Hartley strain guinea pigs with spontaneous osteoarthritis. Arthritis Res Ther 2012;14:
36. Diekman BO, Wu CL, Louer CR, Furman BD, Huebner JL, Kraus VB, et al. Intra-articular delivery of purified mesenchymal stem cells from C57BL/6 or MRL/MpJ superhealer mice prevents posttraumatic arthritis. Cell Transpl 2013;228: 1395e408.
37. Horie M, Driscoll MD, Sampson HW, Sekiya I, Caroom CT, Prockop DJ, et al. Implantation of allogenic synovial stem cells promotes meniscal regeneration in a rabbit meniscal defect model. J Bone Jt Surg Am 2012;948:701e12.
38. Al Faqeh H, Nor Hamdan BM, Chen HC, Aminuddin BS,Ruszymah BH. The potential of intra-articular injection of chondrogenic-induced bone marrow stem cells to retard the progression of osteoarthritis in a sheep model. Exp Gerontol 2012;476:458-64.
39. Horie M, Sekiya I, Muneta T, Ichinose S, Matsumoto K, Saito H, et al. Intra-articular injected synovial stem cells differentiate into meniscal cells directly and promote meniscal regeneration without mobilization to distant organs in rat massive meniscal defect. Stem Cells 2009;274: 878e87.
40. Lee KBL, Hui JHP, Song IC, Ardany L, Lee EH. Injectable mesenchymal stem cell therapy for large cartilage defectsda porcine model. Stem Cells 2007;2511:2964e71.
41. Mokbel AN, El Tookhy OS, Shamaa AA, Rashed LA, Sabry D, El Sayed AM. Homing and reparative effect of intraarticular injection of autologus mesenchymal stem cells in osteoarthritic animal model. BMC Musculoskelet Disord 2011;12:259.
42. Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL, et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res 2017;5:16044.
43. Mokbel AN, El Tookhy OS, Shamaa AA, Rashed LA, Sabry D, El Sayed AM. Homing and reparative effect of intraarticular injection of autologus mesenchymal stem cells in osteoarthritic animal model. BMC Musculoskelet Disord 2011;12:259.
44. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994;33114:889e95.
45. Wakitani S, Yamamoto T. Response of the donor and recipient cells in mesenchymal cell transplantation to cartilage defect. Microsc Res Tech 2002;581:14e8.
46. Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M. Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthr Cartil 2002;103: 199e206.
47. Wakitani S, Nawata M, Tensho K, Okabe T, Machida H, Ohgushi H. Repair of articular cartilage defects in the patellofemoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. J Tissue Eng Regen Med 2007;11:74e9.
48. Centeno CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D. Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells. Pain Physician 2008;113:343e53.
49. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, et al. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med 2012;157:422e8.
50. Jo CH, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, et al. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Stem Cells 2014;325:1254-66..

How to Cite this Article: John P S, Thomas V. Articular cartilage regeneration in the treatment of osteoarthrosis. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):35-40 .


(Abstract)      (Full Text HTML)   (Download PDF)

A Comparison between Volar Plating and K-wire Fixation of Distal End Radius Fractures

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 2-5 | Dinto Davis, M Raffic, Sachin Joseph.

Authors: Dinto Davis [1], M Raffic [1], Sachin Joseph [1]

[1] Department of Orthopaedics, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Kerala, India.

Address of Correspondence
Dr. Dinto Davis,
Department of Orthopaedics,
Sree Gokulam Medical College, Trivandrum, Kerala, India.


Introduction: Distal end radius fracture is a common fracture seen in the routine orthopaedic practice. The optimal management of distal radius fractures remains controversial [1]. The aim of this study is to prospectively compare functional outcomes following volar plating and K-wire fixation of distal end radius fractures and investigate which method produced better outcomes. The functional outcome in terms of the range of movements, pain, and grip strength of the patients was assessed at 6 months in both groups by demerit score system of Gartland and Werley [2]. Functional outcome as per Gartland and Werley was 95% excellent to good results in plating group as compared to 75% in K-wire fixation group. The study emphasizes that open reduction and internal fixation with volar plating have excellent functional outcome when compared to K-wire fixation in distal radius fractures. When considering the cost, K-wire fixation is preferred over volar plating.
Keywords: Distal radius fracture, volar plating, k- wire, fixation.


1. Khan JI, Hussain FN, Mehmood T, Adil O. A comparative study of functional outcome of treatment of intra articular fractures of distal radius fixed with percutaneous Kirschner’s wires vs T-plate. Pak J Med Sci 2017;33:709-13.

2. Kwok IH, Leung F, Yuen G. Assessing results after distal radius fracture treatment. Geriatr Orthop Surg Rehabil 2011;2:15560.

3. Johnson NA, Dias JJ, Wildin CJ, Cutler L, Bhowal B, Ullah AS, et al. Comparison of distal radius fracture intra-articular step reduction with volar locking plates and K wires: A retrospective review of quality and maintenance of fracture reduction. J Hand Surg Eur Vol 2017;42:144-50.

4. Rizzo M, Katt BA, Carothers JT. Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures. Hand N Y N 2008;3:111-7.

5. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 12th ed., Vol. 4. St. Louis, Mo.; London: Mosby; 2012. p. 4664.

6. Franceschi F, Franceschetti E, Paciotti M, Cancilleri F, Maffulli N, Denaro V. Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: A systematic review and quantitative synthesis. Br Med Bull 2015;115:91-110.

7. Khan. Volar Plating in Distal End Radius Fractures and its Clinical and Radiological Outcome as Compared to other Methods of Treatment. Available from: issn=23192585;year=2016;volume=4;issue=1;spage=40;epage=44;au last=Khan. [Last cited on 2018 Mar 23].

8. Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, editors. Rockwood and Green’s Fractures in Adults: Two Volumes Plus Integrated Content Website. 7th ed. Philadelphia, PA: Wolters Kluwer; 2009. p. 2296.

9. Brennan SA, Kiernan C, Beecher S, O’Reilly RT, Devitt B, Kearns S, et al. Volar plate versus k-wire fixation of distal radius fractures. Injury 2015;47:372-6.

10. Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand – Which one to choose? Int Orthop 2008;32:1-6.

How to Cite this Article: Davis D, Raffic M, Joseph S. A Comparison between Volar Plating and K-wire Fixation of
Distal End Radius Fractures. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):2-5.


(Abstract)      (Full Text HTML)   (Download PDF)

It Is The Right Time

  Vol 31 | Issue 1 | Jan – Jun 2018 | page: 1 | Suresh S Pillai

Authors: Suresh S Pillai  [1]

[1] Editor, Kerala Journal of Orthopedics

Address of Correspondence
Dr.Suresh S Pillai
Consultant Spine surgeon
Baby Memorial Hospital, Calicut, kerala.

It Is The Right Time

Much awaited momentum is at reach for research in our state. We received enough number of articles for our last issue of Kerala Journal of Orthopaedics. Slowly people are recognizing the need for high quality research in Orthopaedics to stay abreast with the western world. We enough resources to conduct the research and be the leader in the country or in the world. Young colleagues should take this an opportunity and right time to begin. Come on. Let’s begin!!!

How to Cite this Article: Pillai S S. It Is The Right Time. Kerala Journal of Orthopaedics Jan – June 2018; 31(1):1 .

(Abstract)      (Full Text HTML)   (Download PDF)

Chopart’s Fracture-dislocation – rare Cases Management

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 31-34 | Anvar Khan, M Raffic.

Authors: Anvar P Khan [1], M Raffic  [1]

[1] Department of Orthopaedics, Sree Gokulam Medical College, Venjaramoodu, Kerala, India.

Address of Correspondence
Dr. Anvar P Khan,
Department of Orthopaedics,
Sree Gokulam Medical College and Research Foundation,
Venjaramoodu, Trivandrum. India.


Introduction: Among the uncommon midfoot injuries, Chopart fracture-dislocations are the most severe injuries and the most difficult foot injuries to diagnose and manage [1]. We are presenting clinical and radiological data and the outcome of two rare cases of Chopart fracture dislocation. Two adult males who sustained Chopart’s fracture dislocation were treated by open reduction and internal fixation with k-wires under anesthesia on an emergency basis. K-wires removed after 3 weeks and patients were mobilized after 6 weeks and returned to their work by 10th post-operative week. We recommend adequate evaluation on initial presentation and early accurate diagnosis and emergency management of Chopart’s [2] injuries, because missed or delayed diagnosis and treatment are associated with significant long-term morbidity.
Keywords: Calcaneocuboid, Chopart, dislocation, foot, fracture, midtarsal, reduction, Talonavicular.


1. Wolf JH. Francois Chopart (1743-1795)- inventor of the partial foot amputation at the tarsometatarsal articulation. Orthop Tarumatol 12:341-344, 2000.

2. Richter M, Thermann H, Huefner T, Schmidt U, Goesling T, Krettek C. Chopart joint fracture-dislocation: initial open reduction provides better outcome than closed reduction. Foot Ankle Int. 2004 May;25(5):340–8.

3. Dorp KB van, Vries MR de, Elst M van der, Schepers T. Chopart Joint Injury: A Study of Outcome and Morbidity. J Foot Ankle Surg [Internet]. 2010 Nov 1 [cited 2018 Mar 1 7 ] ; 4 9 ( 6 ) : 5 4 1 – 5 . A v a i l a b l e f r o m :

4. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics EBook. Elsevier Health Sciences; 2012. 5105 p.

5. Bucholz RW. Rockwood and Green’s Fractures in Adults: Two Volumes Plus Integrated Content Website (Rockwood, Green, and Wilkins’ Fractures). Lippincott Williams & Wilkins; 2012. 2059 p.

6. Eastaugh-Waring SJ, Saleh M. The management of a complex midfoot fracture with circular external fixation. Injury. 1994 Jan;25(1):61–3.

7. Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc and Chopart injuries. J Bone Joint Surg Am. 2012 Jul 18;94(14):1325–37.

8. Ramadorai MUE, Beuchel MW, Sangeorzan BJ. Fractures and Dislocations of the Tarsal Navicular. JAAOS – J Am Acad Orthop Surg [Internet]. 2016 Jun [cited 2018 Mar 1 7 ] ; 2 4 ( 6 ) : 3 7 9 . A v a i l a b l e f r o m :

9. Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br. 1975 Feb;57(1):89–97.

10. Swords MP, Schramski M, Switzer K, Nemec S. Chopart Fractures and Dislocations. Foot Ankle Clin [Internet]. 2008 Dec 1 [cited 2018 Mar 17];13(4):679–93. Available from:

11. Choi JC, Jung Y-H, Park SJ. Fracture and Dislocation of the Midtarsal Joint: A Case Report. J Korean Foot Ankle Soc [Internet]. 2017;21(3):108. Available from: as.2017.21.3.108.

12. Miller CM, Winter WG, Bucknell AL, Jonassen EA. Injuries to the midtarsal joint and lesser tarsal bones. J Am Acad Orthop Surg. 1998;6(4):249-258

13. Klaue K. Chopart fractures. Injury 35(suppl 2):SB64-SB70, 2004.

How to Cite this Article: Khan A P, Raffic M. Chopart’s Fracture-dislocation – rare Cases Management. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):31-34.


(Abstract)      (Full Text HTML)   (Download PDF)

Functional Outcome of Cemented Bipolar Hemiarthroplasty in Fracture Neck of Femur; Prospective Study

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 24-30 | T V Shyam Gopal, K Rajaram, Suresh Paul.

Authors: T V Shyam Gopal [1], K Rajaram [1], Suresh Paul  [1]

[1] Department of Orthopaedics, Lisie Hospital, Kochi, Kerala, India.

Address of Correspondence
Dr. T V Shyam Gopal,
Department of Orthopaedics,
Lisie Hospital, Kochi, Kerala, India.


Introduction: Hip fractures are the most devastating injuries in the elderly. Fractures of neck of femur have always presented great challenges to orthopaedicians and remains in many ways today THE UNSOLVED FRACTURE (as was called many years ago by Dickson and Nicoll) as far as treatment and results are concerned. A prospective observational study on functional outcome of cemented bipolar hemiarthroplasty in fracture neck of femur Duration: From April 1st 2016 to March 31th 2017. After analyzing functional results we conclude that the method is easy to learn, well tolerated by aged patients, early ambulation is possible thus lessening the chance of developing pulmonary complications and bed sores significantly and a re surgery is less frequently required. This also improves their quality of life and the ability to go back to their original functional status much earlier. Hence bipolar hemiarthroplasty should be considered as one of the modalities of the treatment of neck of femur fractures in elderly.
Keywords: Bipolar hemiarthroplasty, fracture neck of femur


1. Canaled TS. Campbells operative orthopaedics.10th Edition.Mosby; 2003.

2. Nicoll EA. The unsolved fracture. J Bone Joint Surgery[Br],1963;45-B,239241

3. Bhandari M, Devereaux PJ, Tornetta P 3rd,Swiontkowski MF, Berry DJ, Haidukewych G et al.; Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am., 2005; 87: 2122–2130

4. Sinno K, Sakr M, Girard J, Khatib H. The effectiveness of primary bipolar arthroplasty in treatment of unstableintertrochanteric fractures in elderly patients. North American Journal of Medical Sciences. 2010; 2(12):561-568 5 Bateman JE; Single assembly total hip prosthesis: Preliminary report. Orthop Dig. 1974; 2:15-19.

5. Robert WB, James DH. Rockwood Greens Fractures In Adults, 6th Edition LippincotWilliams &Wilkins;2001.

6. Singh GK, Deshmukh RG. Uncemented Austin-Moore and Cemented Thompson Unipolar Hemiarthroplasty for Displaced fracture Neck of Femur Comparison of Complications and Patient Satisfaction. Injury. 2006;37(2):169–174

7. Nather A, Seow CS, Lau P, Chan A. Mortality and morbidity for elderly patients with fracture neck of femur treated by hemiarthroplasty injury. J Bone Joint Surg. 1995;26:187–190

8. Johansson T, Jacobsson SA, Ivarsson I. Internal fixation versus total hip arthroplasty in treatment of displaced femoral neck fractures, a prospective randomized study of 100 hips.  Acta Orthop Scand. 2000;71:597–602 56 Rogmark C, Carlsson A, Johnell O, Sanbo I. Primary hemiarthroplasty in old patients with displaced femoral neck fracture: A 1 year follows up of 103 patients aged 80 years or more. . Acta Orthop Scand. 2002;73:605–610

9. Utrilla AL, Reig JS, Munoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. . J Orthop Trauma .2005;19:229–233.

10. DD Mue, MN Salihu, FO Awonusi,1 WT Yongu, JN Kortor, and IC Elach Outcome of treatment of fracture neck of femur using hemiarthroplasty versus dynamic hip screw J West Afr Coll Surg. 2013 Apr-Jun; 3(2): 27–45

11. SKS Marya, R Thukral, R Hasan, and M Tripathi Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly Indian J Orthop. 2011 May-Jun; 45(3): 236–242.

12. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, et al. (2001) Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. ClinOrthopRelatRes : 229242.

How to Cite this Article: Gopal V S, Rajaram K, Paul S. Functional Outcome of Cemented Bipolar Hemiarthroplasty in Fracture Neck of Femur Prospective Study. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):24-30.


(Abstract)      (Full Text HTML)   (Download PDF)

Bilateral Innominate Osteotomy in the Management of Exstrophyepispadias Complex – A Case Report

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 21-23 | Tony Kavalakkatt, V K Gopi, K P Arunlal, Jim Thomas Malayil, M Chandan.

Authors: Tony Kavalakkatt [1], V K Gopi [2], K P Arunlal [3]³, Jim Thomas Malayil [1], M Chandan  [1]

[1] Department of Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India,

[2] Department of Paediatric Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India,

[3] Department of Orthopaedics, Consultant Orthopaedic Surgeon, Baby Memorial Hospital, Kozhikode, Kerala, India,

Address of Correspondence
Dr. Tony Kavalakkatt,
Green view Colony, Kuthiravattom, Kozhikode. India


Introduction:Bladder exstrophy is a developmental defect presenting with a wide pubic separation and an exposed bladder at birth resulting from abnormal anterior rupture of the cloacal membrane early in the embryonic period. Pelvic osteotomies in conjunction with primary reconstruction of the genitor-urinary tract due to failure resulting from increased tension on the soft tissues and early wound dehiscence. This report re-enforces the crucial role of pelvic inominate osteotomy as part of the primary reconstruction in a patient with exstrophy-epispadias complex
Keywords: Bladder exstrophy, Pelvic Osteotomy, Primary Reconstruction.


1. Purves JT, Gearhart JP. Pelvic osteotomy in the modern treatment of the exstrophy-epispadias complex. Eur Assoc Urol Eur Board Urol 2007;5:188-96.

2. Sponseller PD, Jani MM, Jeffs RD, Gearhart JP. Anterior innominate osteotomy in repair of bladder exstrophy. J Bone
Joint Surg Am 2001;83-A:184-93.

3. Sponseller PD, Bisson LJ, Gearhart JP, Jeffs RD, Magid D, Fishman E, et al. The anatomy of the pelvis in the exstrophy complex. J Bone Joint Surg Am 1995;77:177-89.

How to Cite this Article: Kavalakkatt T, Gopi V K, Arunlal K P, Malayil J T, Chandan M. Bilateral Innominate Osteotomy in the Management of Exstrophy-epispadias Complex – A Case Report. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):21-23 .


(Abstract)      (Full Text HTML)   (Download PDF)

Atypical Guillain-Barre Syndrome in a known Case of Lumbar Canal Stenosis – A Clinical Dilemma

Vol 31 | Issue 1 | Jan – Apr 2018 | page: 19-20 | Vivek Vincent, Sudar Sreekumar, K P Ramkumar.

Authors: Vivek Vincent [1], Sudar Sreekumar [1], K P Ramkumar  [1]

[1] Department of Orthopaedics, Metropolitan Hospital, Thrissur. India.

Address of Correspondence
Dr. Vivek Vincent Valiyaveettil
Department of Orthopaedics,
Metropolitan Hospital, Thrissur. India.


Introduction: Guillian Barre is an autoimmune syndrome characterised by acute inflammatory demyelinating polyneuropathy.Patients suffering from GBS typically have pain,numbness,paraesthesia and weakness in upper limbs and lower limbs.They do mimic symptoms of lumbar canal stenosis at certain occasions which can be very misleading and lead to a wrong diagnosis and management.Here,we report a case of a 60 yr old gentleman with an atypical GBS presentation with underlying lumbar canal stenosis.
Keywords: Atypical Guillain Barre, Lumbar canal stenosis


1. Jung DY, Cho KT, Lee SC. Atypical guillain-barré syndrome misdiagnosed as lumbar spinal stenosis. J Korean Neurosurg Soc 2013;53:245-8.

2. Abai S, Kim SB, Kim JP, Lim YJ. Guillain-barré syndrome combined with acute cervical myelopathy. J Korean Neurosurg Soc 2010;48:298-300.

3. Gurwood AS, Drake J. Guillain-barré syndrome. Optometry 2006;77:540-6.

4. Hughes RA, Cornblath DR. Guillain-barré syndrome. Lancet 2005;366:1653-66.

5. Logullo F, Manicone M, Di Bella P, Provinciali L. Asymmetric guillain-barré syndrome. Neurol Sci 2006;27:355-9.

6. Mulkey SB, Glasier CM, El-Nabbout B, Walters WD, Ionita C, McCarthy MH, et al. Nerve root enhancement on spinal MRI in pediatric guillain-barré syndrome. Pediatr Neurol 2010;43:263-9.

7. Pithadia AB, Kakadia N. Guillain-barré syndrome (GBS). Pharmacol Rep 2010;62:220-32.

8. Ruts L, Drenthen J, Jongen JL, Hop WC, Visser GH, Jacobs BC, et al. Pain in guillain-barre syndrome: A long-term follow-up study. Neurology 2010;75:1439-47.

9. Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM, et al. Lumbar spinal stenosis: Syndrome, diagnostics and treatment. Nat Rev Neurol 2009;5:392-403.

10. Storm PB, Chou D, Tamargo RJ. Lumbar spinal stenosis, Cauda equina syndrome, and multiple lumbosacral radiculopathies. Phys Med Rehabil Clin N Am 2002;13:71333, ix.

11. van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of guillain-barré syndrome. Lancet Neurol 2008;7:939-50.

12. Yikilmaz A, Doganay S, Gumus H, Per H, Kumandas S, Coskun A, et al. Magnetic resonance imaging of childhood guillain-barre syndrome. Childs Nerv Syst 2010;26:1103-8.

13. Yuki N, Kokubun N, Kuwabara S, Sekiguchi Y, Ito M, Odaka M, et al. Guillain-barré syndrome associated with normal or exaggerated tendon reflexes. J Neurol 2012;259:1181-90.

How to Cite this Article: Vincent V, Sreekumar S, Ramkumar K P .Atypical Guillain-Barre Syndrome in a known Case of Lumbar Canal Stenosis – A Clinical Dilemma. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):19-20.


(Abstract)      (Full Text HTML)   (Download PDF)

The Ambiguous Role of Hemostatic Matrix in Total Knee Arthroplasty: A Randomized Controlled Trial

Vol 31 | Issue 1 | Jan – Jun 2018 | page: 15-18 | Appu Benny Thomas, Jacob Varghese, Gnanavel, J C Vinay, Biju Pankappilly.

Authors: Appu Benny Thomas [1], Jacob Varghese [1], Gnanavel [1], J C Vinay [1], Biju Pankappilly [1]

[1] Department of Orthopedics, VPS Lakeshore Hospital and Research Center, Kochi, Kerala, India.

Address of Correspondence
Dr. Appu Benny Thomas
Department of Orthopedics,
VPS Lakeshore Hospital and Research Center, Kochi, Kerala, India


Background: Blood loss which is one of the major complications following major surgeries and leads to significant morbidity and substantially increases the need for blood transfusions. Use of hemostatic agent’s intraoperatively is one of the widely used techniques to reduce blood loss. The use of hemostatic agents to reduce blood loss has been widely studied with mixed results. The aim of this study was to evaluate whether the use of Floseal®, a hemostatic most commonly used in our hospital as an adjuvant to conventional hemostasis reduces blood loss and reduces the requirement of transfusions postoperatively in patients undergoing total knee arthroplasty (TKA).
Materials and Methods: This study was a prospective randomized controlled trial conducted on 67 female patients operated between January 2012 and January 2013 with the primary endpoint being blood loss as estimated by a decrease in hemoglobin (Hb) on days 0, 1, and 4 postoperatively. The number of transfusions required postoperatively was also assessed. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients in whom the hemostatic was not used. Group B consisted of 32 patients in whom 5ml of hemostatic matrix Floseal®. All the statistical analyses were performed using GraphPad Prism 7.0. Results: Sixty-seven patients participated in the study, and the data of all the patients were analyzed. The demographic data and the mean percentage decrease of Hb from pre-operative values were analyzed which did not show any statistical difference. The odds ratio and relative risk were less than one and were not statistically significant.
Conclusion: The use of a hemostatic agent does not necessarily decrease the need for blood transfusions postoperatively, and the role of hemostatic agents in TKA for reducing blood loss remains uncertain.
Keywords: Blood transfusion, Hemostatic Matrix, Total Knee Arthroplasty.


1. Sundaram CP, Keenan AC. Evolution of hemostatic agents in surgical practice. Indian J Urol 2010;26:374-8.

2. Kim HJ, Fraser MR, Kahn B, Lyman S, Figgie MP. The efficacy of a thrombin-based hemostatic agent in unilateral total knee arthroplasty: A randomized controlled trial. J Bone Joint Surg Am 2012;94:1160-5.

3. Wang C, Han Z, Zhang T, Ma JX, Jiang X, Wang Y, et al. The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: A meta-analysis. J Orthop Surg Res 2014;9:90.

4. Widman J, Isacson J Surgical hemostasis after tourniquet release does not reduce blood loss in knee replacement. A prospective randomized study of 81 patients. Acta Orthop Scand 1999;70:268-70.

5. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2011;19:1121-30.

6. Jones HW, Savage L, White C, Goddard R, Lumley H, Kashif F, et al. Postoperative autologous blood salvage drains – Are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases. Acta Orthop Belg 2004;70:466-73.

7. Iwai T, Tsuji S, Tomita T, Sugamoto K, Hideki Y, Hamada M. Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty. Int Orthop 2013;37:441-5.

8. Sepah YJ, Umer M, Ahmad T, Nasim F, Chaudhry MU, Umar M. Use of tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement. J Orthop Surg Res 2011;6:22.

9. Carlin G, Karlström G, Modig J, Saldeen T. Effect of dextran on fibrinolysis inhibition activity in the blood after major surgery. Acta Anaesthesiol Scand 1980;24:375-8.

10. Choi YJ, Hwang JK, Ahn HS, Bae EJ, Kim CH, Kim E. The effect of aprotinin for reducing blood loss and amount of transfusion in total knee arthroplasty. J Korean Knee Soc 2005;17:241-5.

11. Camarasa MA, Olle G, Serra-Prat M, Martín A, Sanchez M, Ricos P, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement: A randomized clinical trial. Br J Anaesth 2006;96:576-82.

12. Gazzeri R, Galarza M, Alfier A. Safety biocompatibility of gelatin hemostatic matrix (Floseal and Surgiflo) in neurosurgical procedures. Surg Technol Int 2012;22:49-54.

13. Harris JA, Uppal S, Kamdar N, Swenson CW, Campbell D, Morgan DM. A retrospective cohort study of hemostatic agent use during hysterectomy and risk of post-operative complications. Int J Gynaecol Obstet 2017;136:232-7.

14. Di Francesco A, Flamini S, Fiori F, Mastri F. Safety biocompatibility of gelatin hemostatic matrix (Floseal and Surgiflo) in neurosurgical procedures. Indian J Orthop 2013;47:474-81.

15. Bloomfield MR, Klika AK, Molloy RM, Froimson MI, Krebs VE, Barsoum WK. Prospective randomized evaluation of a collagen/thrombin and autologous platelet hemostatic agent during total knee arthroplasty. J Arthroplasty 2012;27:695702.

How to Cite this Article: Thomas A B, Varghese J, Gnanavel, Vinay J C, Pankappilly B. The Ambiguous Role of Hemostatic Matrix in Total Knee Arthroplasty: A Randomized Controlled Trial. Kerala Journal of Orthopaedics Jan- Jun 2018;31(1):12-15 .


(Abstract)      (Full Text HTML)   (Download PDF)