Knee Arthroplasty for Chronic Anterior Dislocation Knee with Intra- Articular Ganglion Cyst in the RetroPatellar Region in a Patient with Type 1 Neurofibromatosis

Vol 32| Issue 1 | Jan – June 2019 | page: 30-33 |  Ajayakumar T


Authors: Ajayakumar T [1]

[1] Department of Orthopaedics, Holy Family Hospital, Muthalakodam,
Thodupuzha, Kerla, India.

Address of correspondence :
Dr. Ajayakumar T,
Department of Orthopaedics, Holy Family Hospital, Muthalakodam,
Thodupuzha, Kerla, India.
E-mail: drtajay@gmail.com


Abstract

We present a case of chronic anterior dislocation of knee in a 65-year-old female. She was suffering from type 1 neurofibromatosis and was having an intra-articular ganglion cyst of size 7 cm × 4 cm in between the patella and anterior aspect of the lower end of femur. We performed semi-constrained knee arthroplasty after excising the intra-articular ganglion cyst with satisfactory results. Postoperatively, the patient became ambulant with painless stable knee.
Keywords: Chronic knee dislocation, Arthroplasty, Intra-articular ganglion cysts, Type 1 neurofibromatosis, Osteoarthritis.


References

1. David KS. Intra articular ganglion cyst of the knee. Knee Surg Sports Traumatol Arthrosc 2004;12:335-7.
2. Lingamfelter BS. Chronic knee dislocation and flexion contracture treated with open reduction and external fixation a case report. J Arthritis 2014;3:133.
3. Petrie RS, Trousdale RT, Cabanela ME. Total knee arthroplasty for chronic posterior knee dislocation: Report of 2 cases with technical considerations. J Arthroplasty 2000;15:380-6.
4. Kodaira S, Nakajima T, Takahashi R, Moriya S, Nakagawa T, Ohtake H, et al. A case of intra-articular ganglion cysts of the knee joint: Correlation between arthroscopic and magnetic resonance imaging. BMC Med Imaging 2016;16:36.
5. Ross JP, Brown NM, Levine BR. Chronic knee dislocation after total knee arthroplasty. Orthopedics 2015;38:e1155-9.
6. Patel J, Whiting J, Jones D. Secondary knee osteoarthritis due to neurofibromatosis Type 1 treated with above the knee a m p u t a t i o n : A C a s e r e p o r t . C a s e R e p O r t h o p 2013;2013:782106.
7. Matsukawa Y, Hara H, Ryu J, Nakano Y, Takeuchi M, Sasaki K, et al. Unilateral developments of osteoarthritis and Charcot’s joint in a patient with neurofibromatosis. Med Sci Monit 2009;15:CS113-6.
8. Lokiec F, Arbel R, Isakov J, Wientroub S. Neuropathic arthropathy of the knee associated with an intra-articular neurofibroma in a child. J Bone Joint Surg Br 1998;80:468-70.
9. Matthai T, Bhowmick K, Boopalan PR, George JC. Neglected anterior dislocation of the knee with common peroneal palsy. Case Rep Orthop 2015;2015:174965.
10. Odent T, Ranger P, Aarabi M, Hamdy RC, Fassier F. Total hip arthroplasty in a patient with neurofibromatosis Type I and recurrent spontaneous hip dislocation. Can J Surg 2004;47:219- 20.
11. Kelly DW, Ovanessoff SA, Rubin JP. Intra-articular neurofibroma: An unusual source of anterior knee pain. Am J
Orthop (Belle Mead NJ) 2012;41:492-5.
12. Liporace FA, Hommen JP, Su ET, Jeong GK, Dayan AJ. Semiconstrained knee arthroplasty in the setting of a chronic knee dislocation: A case report. J Orthop Trauma 2006;20:286- 8.
13. Indelli PF, Giori N, Maloney W. Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med 2015;8:390-7.
14. Jabalameli M, Bagherifard A, Hadi H, Askari A, Ghaffari S. Total knee arthroplasty for chronic anterior knee dislocation. Clin Med Insights Case Rep 2018;11:1179547618782882.


How to Cite this Article:  Ajayakumar T. Knee Arthroplasty for Chronic Anterior Dislocation Knee with Intra-Articular Ganglion Cystin the Retro patellar Region in a Patient with Type 1 Neurofibromatosis. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 30-33.

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Learning The Right Way

Vol 32 | Issue 1 | Jan – June 2019 | page: 1 | Suresh Pillai


Authors: Suresh Pillai [1]

[1] Department of Orthopaedics,
Baby Memorial Hospital, Calicut, kerala, India.

Address of Correspondence

Dr. Suresh S Pillai
Consultant Spine surgeon
Baby Memorial Hospital, Calicut, kerala, India.
E-mail: sureshorth@googlemail.com


Learning The Right Way

Medical science is an ever changing science. What was thought as the gold standard in yester years has become obsolete in the current period. Mankind has made quantum leap in every field of science with methodical and enthusiastic research. The science changes with newer and newer evidences and better and better ideas. It is the era that has seen Pluto no more a planet in the solar system, and even Einstein’s E=MC2 is challenged substantially.
Have you thought of, why we learn science in English? Why we teach our children in English? We know their prospects are brighter in English medium. Most of the research is documented in English. It is spoken all over the world etc. Even in India with so many languages and cultural diversities, we are united with English!!. Similarly with leading research and landmark discoveries the western world has gone far ahead!.
If we really wish to make a mark, it is mandatory to instil ethical and honest research in our students. It should be included in our curriculum. It should be acknowledged and properly rewarded. Ilizarov, from a small village is known across the world for his ingenious methods which benefitted the humanity.
With knowledge explosion, it is impossible to keep updated with each and everything that comes across our way. Medicos, especially find it difficult to strike a balance with profession, personal life, family life and social life. Most of them go unrecognized in any of the field, where they have talent. Finally they get frustrated and behave badly. It is of utmost importance to recognise the talent of each student and bring them up in their field of interest. This would benefit the society at its best. Our curriculum should be modified accordingly. Selection to medical profession should be purely based on merit and aptitude. It is a matter of public health. Health is the most important aspect of anybody’s life. Don’t compromise it for money or any other “considerations”. We should bring in the right student for the job. Give them the essential material to study, to keep their enthusiasm intact, rather than bombarding them with huge bundles of theoretical books. Teaching should bring out inquisitiveness in the student. Teach him to question “Science”.Teach him to” be a leader”. Let him take the responsibility of the society and the future generation.
Most centres don’t encourage questions, which I should say, is suicidal. Medical curriculum should be completely practically oriented. How a student would manage a situation. It should be practiced regularly. Creative criticism and inquisitiveness should be encouraged and rewarded on its merit. Let us build world citizens!. Let our children be the sought after ones across the world!
So, I take this opportunity to urge my seniors, colleagues and juniors to come out with pure research. It needs passion and an open and inquisitive mind. Nothing else! Arise, Awake , “nothing can withstand the assault of constant thoughts”!

Dr Suresh S Pillai
Editor
Kerala Journal of Orthopaedics


How to Cite this Article: Pillai S. Learning The Right Way. Kerala Journal of Orthopaedics Jan – June 2019; 32(1): 1.

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Functional and Radiological Outcome of Non-operative Management of Simple Bone Cyst of Humerus Presenting with Pathological Fracture

Vol 32| Issue 1 | Jan – June 2019 | page: 17-22 | Dominic Puthoor, Dijoe Davis, Shafeeq Muhammed Abubekkar


Authors: Dominic Puthoor [1], Dijoe Davis [1], Shafeeq Muhammed Abubekkar [1]

[1] Department Of Orthopaedics, Amala Institute Of Medical Sciences, Thrissur, Kerala, India

Address of Correspondence

Dr. Dominic Puthoor,
Orthopaedic Oncologist, Amala Institute Of Medical Sciences, Thrissur, Kerala, India.
E-mail: dkputhur@gmail.com


Abstract

Simple bone cyst (SBC) is a tumor-like lesion affecting bone. Humerus is the most common site of SBC. Most of the cases of SBC in humerus presents with a pathological fracture. In our study, patients presenting with pathological fracture of SBC in humerus were treated with intracystic injection of Depo-Medrol (methylprednisolone acetate) under computed tomography guidance followed by immobilization in U-slab for 1 month. Clinical and radiological assessment was done during follow-up. It is found that the patients promptly regain excellent function though radiologically healing of the lesion is only partial.
Keywords: Simple bone cyst, Tumor-like lesion, Pathological fracture.


References

1. Puthoor D, Davis D. Tumour-like lesions are we over treating them? J Bone Soft Tissue Tumors 2016;2:13-8.
2. Dominic KP, Dijoe D, Manathara LT. Tumour like lesions and their management: A retrospective study. Int J Res Orthop 2018;4:159-65.
3. Puthur DK. Tumour like lesions: Understand the difference. Kerala J Orthop 2013;26:137-41.
4. Christopher F, Bridge JA, Hogendoorn PC, Fredrik M. WHO Classificatiaon of Soft Tissue and Bone. 4th ed. ???: ???; 2013. p. 240-1, 301.
5. Schajowicz F. Histological Typing of Bone Tumours. World Health Organization; International Histological Classification of Tumours. 2nd ed. Geneva: World Health Organization; 1993. p. 36-42.
6. Lokiec F, Wientroub S. Simple bone cyst: Etiology, classification, pathology, and treatment modalities. J PediatrOrthop B 1998;7:262-73.
7. Kadhim M, Sethi S, Thacker MM. Unicameral bone cysts in the humerus: Treatment outcomes. J PediatrOrthop 2016;36:392-9.
8. Chang CH, Stanton RP, Glutting J. Unicameral bone cysts treated by injection of bone marrow or methylprednisolone. J Bone Joint Surg Br 2002;84:407-12.
9. Cho HS, Oh JH, Kim HS, Kang HG, Lee SH. Unicameral bone cysts. Bone Joint J 2007;89:222-6.
10. Nelson BL. Solitary bone cyst. Head Neck Pathol 2010;4:208-9.
11. Kim MC, Joo SD, Jung ST. The role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts. J Orthop Surg (Hong Kong) 2018;26:2309499018778366.
12. Enneking WF. Modification of the System for Functional Evaluation in the Surgical Management of Musculoskeletal Tumors. Limb Salvage in Musculoskeletal Oncology. New York: Churchill Livingstone; 1987.
13. Horstmann PF, Hettwer WH, Petersen MM. Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction. J Orthop Surg (Hong Kong) 2018;26:1-7.
14. Liu PT, Valadez SD, Chivers FS, Roberts CC, Beauchamp CP. Anatomically based guidelines for core needle biopsy of bone tumors: Implications for limb-sparing surgery. Radiographics 2007;27:189-205.
15. Espinosa LA, Jamadar DA, Jacobson JA, DeMaeseneer MO, Ebrahim FS, Sabb BJ, et al. CT-guided biopsy of bone: A radiologist’s perspective. AJR Am J Roentgenol 2008;190:W283-9.
16. Campanacci MD, Enneking WF. Simple bone cyst. In: Text Book Bone Soft Tissue Tumors. ???: ???; ???.
17. Campanacci M, De Sessa L, Trentani C. Scaglietti’s method for conservative treatment of simple bone cysts with local injections of methylprednisolone acetate. Ital J OrthopTraumatol 1977;3:27-36.
18. Cohen J. Etiology of simple bone cyst. J Bone Joint Surg Am 1970;52:1493-7.
19. Shindell R, Huurman WW, Lippiello L, Connolly JF. Prostaglandin levels in unicameral bone cysts treated by intralesional steroid injection. J PediatrOrthop 1989;9:516-9.


How to Cite this Article: Puthoor D, Davis D, Abubekkar S M. Functional and Radiological Outcome of Non-operative Management of Simple Bone Cyst of Humerus Presenting with Pathological Fracture. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 17-22 .

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Intradural Extramedullary Spinal Tumors – A Review of Modern Diagnostic and Treatment Options and a Report of a Series of 40 Cases

Vol 32| Issue 1 | Jan – June 2019 | page: 41-45 | Suresh S Pillai, M Harishankar


Authors: Suresh S Pillai [1], M Harishankar [1]

[1] Department of Orthopaedics, Baby Memorial Hospital, Calicut, kerala, India.

Address of Correspondence

Dr. Suresh S Pillai.
Consultant Spine surgeon Baby Memorial Hospital, Calicut, kerala, India.
E-mail: sureshorth@googlemail.com


Abstract

Spinal tumors are uncommon lesions and affect only a minority of the population. Spinal tumors comprise 15 % of all CNS tumors, with an incidence of 2-10 per 1,00,000. Location of the tumor is the most important aspect in the diagnosis of spinal tumor with regard to treatment and prognosis. Extradural lesions are more common (60% of all spinal tumors), with majority of lesions originating from the vertebrae. The clinical symptoms are often nonspecific and include back pain, radicular symptoms, and slowly progressive neurological deficits. Primary and most important diagnostic modality for intradural spinal tumors is MRI scan. Contrast material (defining the extent of intramedullary neoplasms and identifying areas of blood brain barrier break-down) and multiplanar imaging have broadened the use of MRI. Gross total tumor resection while preserving and improving the neurological function is the usual goal of surgery. If the complete removal of the tumor demands removal of more than one column of the spine, instrumented fusion of the adjacent levels may be deemed necessary. Here we discuss the literature review of intradural extramedullary tumors in a glance and clinical presentation, symptomatology, and prognosis of 40 extramedullary intradural tumor cases that we have operated on in a span of 15 years. Out of these 40 cases, majority were schwannomas. The incidence of schwannoma was found to be higher in the 30-50 age group. 5 cases of meningiomas, 5 cases of cystic schwannomas and 1 each of intradural metastasis, paraganglinoma, AV malformation, ependymoma, cellular schwannoma, intradural hematoma and intradural lipoma with tethering. All cases had postoperative improvement in neurological status to normalcy.

Keywords: Spinal tumors, Intradural extramedullary tumors, schwannomas, meningiomas, cystic schwannomas, intradural metastasis, paraganglinoma, AV malformation, ependymoma, cellular schwannoma, intradural hematoma, intradural lipoma , symptomatology, MRI, prognosis


References

1. Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: A review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci 2009;9Suppl 1:40-5.
2. Beall DP, Googe DJ, Emery RL, Thompson DB, Campbell SE, Ly JQ, et al. Extramedullary intradural spinal tumors: A pictorial review. CurrProblDiagnRadiol 2007;36:185-98.
3. el-Mahdy W, Kane PJ, Powell MP, Crockard HA. Spinal intraduraltumours: Part IExtramedullary. Br J Neurosurg 1999;13:550-7.
4. Borges G, Bonilha L, Proa M Jr.Fernandes YB, Ramina R, Zanardi V, et al. Imaging features and treatment of an intradural lumbar cystic schwannoma. ArqNeuropsiquiatr 2005;63:681-4.
5. Kasliwal MK, Kale SS, Sharma BS, Suri V. Totally cystic intraduralextramedullaryschwannoma. Turk Neurosurg 2008;18:404-6.
6. Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al. The NOMS framework: Approach to the treatment of spinal metastatic tumors. Oncologist 2013;18:744-51.
7. Klimo P Jr., Schmidt MH. Surgical management of spinal metastases. Oncologist 2004;9:188-96.
8. Prabhu VC, Bilsky MH, Jambhekar K, Panageas KS, Boland PJ, Lis E, et al. Results of preoperative embolization for metastatic spinal neoplasms. J Neurosurg 2003;98:156-64.
9. Böker DK, Wassmann H, Solymosi L. Paragangliomas of the spinal canal. SurgNeurol 1983;19:461-8.
10. Sundgren P, Annertz M, Englund E, Strömblad LG, Holtås S. Paragangliomas of the spinal canal. Neuroradiology 1999;41:788-94.


How to Cite this Article: Pillai S S, M Harishankar. Intradural Extramedullary Spinal Tumors – A Review of Modern Diagnostic and Treatment Options and a Report of a Series of 40 Cases. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 41-45.

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Chronic Medial Dislocation Elbow Treated with Open Reduction and Lateral Ulnar Collateral Ligament Reconstruction using Knotless Suture Anchors

Vol 32| Issue 1 | Jan – June 2019 | page: 38-40 | Ajayakumar T


Authors: Ajayakumar T  [1]

[1] Department of Orthopaedics, Holy Family Hospital, Muthalakodam,
Thodupuzha, Kerla, India.

Address of correspondence :
Dr. Ajayakumar T,
Department of Orthopaedics, Holy Family Hospital, Muthalakodam,
Thodupuzha, Kerla, India.
E-mail: drtajay@gmail.com


Abstract

Chronic unreduced elbow dislocations are rare injuries. This case report is about the successful 1-year follow-up outcome of a chronic medial elbow dislocation treated with open reduction and lateral ulnar collateral ligament (LUCL) reconstruction using palmaris longus graft and biocomposite suture anchors. A minimally invasive technique for reconstruction of LUCL is presented here which obviates the need for hinged external fixation. The author obtained written informed consent from the patient for print and electronic publication of the case report.
Keywords: Chronic elbow dislocation, lateral ulnar collateral ligament reconstruction, minimally invasive surgery, internal brace, suture anchors, isometry.


References

1. Rubino LJ, Herbenick MA, Finnan RP, Anloague P A. Chronic elbow dislocation treated with open reduction and lateral ulnar collateral ligament reconstruction. Am J Orthop (Belle Mead NJ) 2009;38:E98-100.
2. Jockel CR, Katolik LI, Zelouf DS. Simple medial elbow dislocations: A rare injury at risk for early instability. J Hand Surg Am 2013;38:1768-73.
3. Ohno Y, Shimizu K, Ohnishi K. Surgically treated chronic unreduced medial dislocation of the elbow in a 70-year-old man: A case report. J Shoulder Elbow Surg 2005;14:549-53.
4. Parag G, Soumya P, Sisir S, Vimal R, Aniruddha P, Subhashish M. A new technique for surgical management of old unreduced elbow dislocations: Results and analysis. J Orthop Allied Sci 2014;2:45-51.
5. Alaia MJ, Shearin JW, Kremenic IJ, McHugh MP, Nicholas SJ, Lee SJ, et al. Restoring isometry in lateral ulnar collateral ligament reconstruction. J Hand Surg Am 2015;40:1421-7.
6. Lee SJ, Mendez-Zfass M. Minimally invasive treatment of lateral ulnar collateral ligament injury. 2016;???:243-53. 7. Jones KJ, Dodson CC, Osbahr DC, Parisien RL, Weiland AJ, Altchek DW, et al. The docking technique for lateral ulnar collateral ligament reconstruction: Surgical technique and clinical outcomes. J Shoulder Elbow Surg 2012;21:389-95.
8. Chaudhry S, Dehne K, Hussain F. A review of suture anchors. Orthop Trauma 2017;33:263-70.
9. Bunker DL, Ilie V, Ilie V, Nicklin S. Tendon to bone healing and its implications for surgery. Muscles Ligaments Tendons J 2014;4:343-50.


How to Cite this Article:Ajayakumar T. Chronic Medial Dislocation Elbow Treated with Open Reduction and Lateral Ulnar Collateral Ligament Reconstruction using Knotless Suture Anchors. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 38-40

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Acrometastasis

Vol 32| Issue 1 | Jan – June 2019 | page: 27-29 | Tony Kavalakkatt, Neena Mampilly, Praphul G Das, Mohamed Mansoof Kanakkayil


Authors: Tony Kavalakkatt [¹], Neena Mampilly [¹], Praphul G Das [¹], Mohamed Mansoof Kanakkayil [¹]

[1] Department Of Orthopaedics,
Baby Memorial Hospital, Calicut, Kerla, India.

Address of Correspondence
Dr. Tony Kavalakkatt,
Department Of Orthopaedics,
Baby Memorial Hospital, Calicut, Kerla, India.
E-mail: tonykavalakkatt@yahoo.com


Abstract

Introduction: Acrometastasis is a rare phenomenon accounting to only 0.1% of metastatic disease. Every age can be affected and it has a male predominance. Acrometastasis is a sign of poor prognosis as it appears in patients with
widespread disease although rarely, it may be the first sign of occult malignancy in 10% of cases.
Case Report: A 54-year-old non-smoker female presented with swelling and pain right foot of 2-month duration with radiographic appearance of a radiolucent lesion involving the whole of calcaneum. Extended curettage and filling with bone cement were done. Biopsy showed metastatic adenocarcinoma. Computed tomography (CT)thorax showed primary lesion in the left lung and multiple secondaries involving dorsal vertebrae and thyroid confirmed by immuno histo-chemistry. Oncology consultation was done and the patient was started on palliative chemotherapy.
Discussion: Bone is a common site of metastasis occurring in up to 30% of people with malignancy, but acrometastasis is rare. Patients present with symptoms mimicking benign lesions like infection, and hence, diagnosis is challenging without a high index of clinical suspicion.
Conclusion: Although acrometastasis occurs in the late stage of malignancy, rarely, it can be the first sign of an occult malignancy and timely diagnosis and intervention may facilitate better long-term survival and symptomatic
management.
Keywords: Acrometastasis, Calcaneum, Lung cancer.


References

1. Mavrogenis AF, Mimidis G, Kokkalis ZT, Karampi ES, Karampela I, Papagelopoulos PJ, et al. Acrometastases. Eur J Orthop Surg Traumatol2014;24:279-83.
2. bStomeo D, Tulli A, Ziranu A, Perisano C, De Santis V, Maccauro G, et al. Acrometastasis: A literature review. Eur
Rev Med Pharmacol Sci 2015;19:2906-15.
3. Kerin R. Metastatic tumors of the hand. A review of the literature. J Bone Joint Surg Am 1983;65:1331-5.
4. Poh ME, Liam CK, Tan JL, Pang YK, Wong CK, Kow KS. Acrometastasis from an epidermal-growth-factor-receptor (EGFR) mutation-positive lung adenocarcinoma. Cancer Treat Commun??? 2(2-3):21-3.
5. Libson E, Bloom RA, Husband JE, Stoker DJ. Metastatic tumours of bones of the hand and foot. Skeletal Radiol
1987;16:387-92.
6. Trinidad J, Kaplansky D, Nerone V, Springer K. Metastatic adenosquamous carcinoma of the foot: A case report. J Foot Ankle Surg 2012;51:345-51.
7. Tolo ET, Cooney WP, Wenger DE. Renal cell carcinoma with metastases to the triquetrum: Case report. J Hand Surg Am 2002;27:876-81.
8. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg 1940;112:138-49.
9. Spiteri V, Bibra A, Ashwood N, Cobb J. Managing acrometastases treatment strategy with a case illustration.
Ann R Coll Surg Engl 2008;90:W8-11.
10. Flynn CJ, Danjoux C, Wong J, Christakis M, Rubenstein J, Yee A, et al. Two cases of acrometastasis to the hands and review of the literature. Curr Oncol 2008;15:51-8.


How to Cite this Article: Kavalakkatt T, Mampilly N, Das P G, Kanakkayil M M. Acrometastasis. Kerala Journal of
Orthopaedics Jan-June 2019; 32(1): 27-29.

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Algorithm for Management of Solitary Spinal Metastases

Vol 32| Issue 1 | Jan – June 2019 | page: 23-26 | Suresh S. Pillai, Ali Sabith, Jim Thomas Malayil


Authors: Suresh S. Pillai [¹], Ali Sabith [¹], Jim Thomas Malayil [¹]

[1] Baby Memorial Hospital, Calicut, Kerala, India.

Address of Correspondence
Dr. Suresh S. Pillai,
Consultant Spine Surgeon,
Baby Memorial Hospital Calicut, Kerala, India
E-mail:sureshorth@googlemail.com


Abstract

Spine is the most frequent site of spinal metastasis after liver and lung due to its extensive arterial supply. The cancer tissue replaces the spinal elements leading to its destruction and resultant instability and compression of the neural structures 4. 10% of tumor patients develop asymptomatic spinal metastasis and spinal cord compression(5,6). The purpose of treating patients with spinal metastasis are to relieve pain, stabilizing spinal structures , recovering or maintain neural function, controlling the metastasis in the local area and improving quality of life. This goal is achieved through a multidisciplinary approach. The aim of this article is to describe an algorithm for the management of solitary spinal metastasis. Different factors need consideration in planning treatment for solitary metastasis. Age, quality of life, tumor borders etc should be discussed in detail with the patient and his/her care givers. A multidisciplinary approach and a tumor board meeting would bring out the right choice for a given patient. Treatment may vary from irradiation, biopsy/surgery, chemotherapy, immuno-modulation, hormone therapy or palliative treatment alone
Keywords: Metastasis Spine, Solitary, Algorithm


References

1. Krishnaney AA, Steinmetz MP, Benzel EC., Biomechanics of metastatic spine cancer. Neurosurg Clin NAm 2004;15(4):375- 80
2. Hosono N , Yonenobu K , Fuji T , Ebara S , Yamashita K , Ono K Orthopedic management of spinal metastasis, Clin Orthop Relat Res 1995(312):148-159
3. Zhantao Deng, Bin Xu, Jiewen Jin, Jianning Zhao, Haidong Xu, Stratergies for management of spinal metastasis, a comprehensive review
4. Gasbarrini A, Cappuccio M, Mirabile L, Bandiera S, Terzi S, Barbanti Brodano G, Boriani S. Spinal metastases: treatment evaluation algorithm. Eur Rev Med Pharmacol Sci 2004; 8(6): 265-74.
5. Harrington KD, Orthopedic Surgical Management of Skeletal Complications of Malignancy, Cancer. 1997 15;80(8
Suppl):1614-27.
6. F. Bach, B. H. Larsen, K. Rohde, S. E. Børgesen, F. Gjerris, T. Bøge- Rasmussen, N. Agerlin, B. Rasmusson, P. Stjernholm, P. S. Sørensen. Metastatic spinal c o r d c o m p r e s s i o n , occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochirurgica 1990, 107, 1–2, pp 37–43
7. Lenz M, Freid JR. Metastases to the skeleton, brain and spinal cord from cancer of the breast and the effect of radiotherapy. Ann Surg. 1931;93(1):278-93.
8. Sundaresan N, Krol G, Digiacinto GV, et al: Metastatic tumors of the spine, in Sundaresan N, Schmidek HH, Schiller AL, et al (eds): Tumors of the Spine, diagnosis and clinical management pp 279-304. Philadelphia, WB Saunders, 1990.
9. Daniel M.Sciubba MD, TrangNguyen BS, Ziya L.Gokaslan MD, solitary vertebral metastasis, Orthop Clin N Am 40(2009)145- 154
10. Constans JP, Divitiis ED, Donzelli R, et al: Spinal metastases with neurological manifestations: Review of 600 cases. J Neurosurg 59:111-118, 1983.
11. Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors. Semin Neurol. 2004 24(4):375-83.
12. Schiff D, spinal cord compression. Neurol Clin 2003; 21 (1) 67- 86
13. Van der Sande JJ, Boogerd W, Kröger R et al, recurrent spinal epidural metastases: a prospective study with a complete follow up. J Neurol Neurosurg Psychiatry. 1999 May;66(5):623-7.
14. Sundaresan N1, Rothman A, Manhart K et al, Surgery for solitary metastases of the spine: rationale and results of treatment, spine 2002, 27(16), 1802-6
15. Batson OV: The function of vertebral veins and their role in the spread of metastases. Ann Surg 112:138-149, 1940
16. Ross J, Brant Zawadzki M, Moore JR et al, neoplasms, cysts, and other masses In Ross J editor
17. Choong PF, The molecular basis of skeletal metastases, Clin Orthop Relat Res. 2003;(415 Suppl):S19-31.
18. Yuh WT1, Quets JP, Lee HJ et al, Anatomic distribution of metastases in the vertebral body and modes of hematogenous spread, Spine 1996;21(19):2243-50
19. Bach F, Larsen BH, Rohde K, et al: Metastatic spinal cord compression: Occurrence, symptoms, clinical presentations, and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien) 107:37-43, 1990.
20. Botterell EH, Fitzgerald GW, Spinal cord compression produced by extradural malignant tumors; early recognition, treatment and results, Can Med Assoc J. 1959; 80(10):791-6.


How to Cite this Article:Pillai S S, Sabith A, Malayil J T. Algorithm for Management of Solitary Spinal Metastases. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 23-26 .

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PFNA-II for unstable intertrochanteric fractures – A prospective study on short term functional outcome

Vol 32| Issue 1 | Jan – June 2019 | page: 11-16 | Ranjith Parakkal Krishnan, Biju J Jacob, Dennis P Jose, Lazar J Chandy


Authors: Ranjith Parakkal Krishnan [¹], Biju J Jacob [¹], Dennis P Jose [¹], Lazar J Chandy [¹]

[1] Department Of Orthopaedics, V.P.S Lakeshore Hospital and Research Centre, Cochin, Kerala,
India.

Address of Correspondence
Dr. Ranjith Parakkal Krishnan,
V.P.S Lakeshore Hospital and Research Centre, Cochin, Kerala, India.
E-mail: ranjikrishna@gmail.com


Abstract

Background: This study was carried out to study the short term functional outcome of proximal femoral nail
antirotation-II (PFNA-II) in the treatment of unstable intertrochanteric fractures.
Materials and Methods: This prospective study includes 20 cases of unstable intertrochanteric fractures in the age group between 55-94 years. The patients included in the study underwent fixation of intertrochanteric fractures using PFNA-II. The study was conducted in the department of Orthopaedics in an advanced trauma centre in Kerala between August 2018 and June 2019. Patients were followed up and assessed clinically and radiologically at regular intervals at 6 weeks, 3 months and 6 months. Functional score was assessed using Oxford Hip Score and Harris Hip Score.
Results: 20 patients were followed up for a period of 6 months. The minimum and maximum age was 55 and 95 years respectively. Majority of the fractures were fell into AO A2.2( 45.0%). The average OT time was 58.75 minutes with standard deviation 21.82. The average blood loss was minimal ( 124.5 ml). 85% cases could achieve good reduction. Good results were achieved in 75% (n=15) and Excellent results in 20% (n=4) cases according to Harris hip score. There was a significant relationship between Oxford hip score and fracture reduction (p-value is less than 0.05). There was a significant progress in Oxford hip score and Harris hip score 3 month and 6 months. No cases of cut out or breakage of the implant were noted during the study period. There was no major complication or mortality noted during the follow up period.
Conclusion: PFNA-II is ideal implant for fixation of unstable intertrochanteric fractures in elderly patients with less operative time, low complication rate and with a good clinical outcome. However it is important to follow proper
operative technique in order to attain fracture stability and to avoid major complications.
Keywords: Intertrochanteric fracture, Hip fracture, Intramedullary nail, PFNA-II, Complications, Harris hip score,
Oxford Hip Score, unstable.


References

1. Dimon JH, Hughston JC. Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am. 1967; 49(3):440–50.
2. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A, et al. Incidence and economic burden of
osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007;229(3):465–75.
3. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD.Patients with femoral neck and intertrochanteric fractures. Are they the same? Clinical orthopedics and related research. 1996; (330):166-72.
4. Chong CP, Savige JA, Lim WK. Medical problems in hip f r a c t u r e p a t i e n t s . A r c h O r t h o p Tr a u m a S u r g . 2010;130:1355–61.
5. Kaufer H, Mathews LS, Sonstegard D. Stable Fixation of Intertrochanteric fractures. J Bone Joint Surg. 1974; 5
6A:899-907.
6. Monte-Secades R, Peña-Zemsch M, Rabuñal-Rey R, Bal- Alvaredo M, Pazos-Ferro A, Mateos-Colino A. Risk factors for the development of medical complications in patients with hip fracture. Rev CalidAsist. 2011; 26:76–82.
7. Kuzyk PR, Lobo J, Whelan D, zdero R, McKee MD, Schemitsch EH, et al. Biomechanical evaluation of
extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma
2009;23 (1):31–8. 8Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J, Luan HX, Yang F, Zheng H, He SJ. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a metaanalysis. Orthopedics & Traumatology: Surgery & Research. 2014 Dec 1;100(8):859-66.
9. Al-Yassari G, Langstaff RJ, Jones JW, Al-Lami M.The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture.Injury. 2002 Jun 1;33(5):395-9.
10. Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009; 40(4): 428-32.
11. Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNA and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg.
2008;128:1443–1446.
12. Tyagi V, Yang JH, Oh KJ. A computed tomography-based analysis of proximal femoral geometr y for lateral
impingement with two types of proximal femoral nail a n t i r o t a t i o n i n s u b t r o c h a n t e r i c f r a c t u r e s
Injury.2010;41:857–861.
13. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. JBJS. 1995 Jul 1;77(7):1058-64.
14. Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P. Measuring tip–apex distance using a picture archiv ing and
communication system (PACS). Injur y. 2008 Jul 1;39(7):786-90.
15. Banaszkiewicz PA. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold
arthroplasty: an end-result study using a new method of result evaluation. In Classic Papers in Orthopedics 2014 (pp. 13- 17).Springer, London.
16. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J.The use of the Oxford hip and knee
scores.The Journal of bone and joint surgery.British volume. 2007 Aug;89(8):1010-4.
17. Tyagi V, Yang JH, Oh KJ. A computed tomography-based analysis of proximal femoral geometr y for lateral
impingement with two types of proximal femoral nail a n t i r o t a t i o n i n s u b t r o c h a n t e r i c f r a c t u r e s
Injury.2010;41:857–861.
18. Rubio-Avila J, Madden K, Simunovic N, Bhandari M. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. Journal of Orthopedic Science. 2013 Jul 1;18(4):592-8.
19. Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. International orthopedics. 2010 Jun 1;34(5):719- 22.
20. Yaozeng X, Dechun G, Huilin Y, Guangming Z, Xianbin W. Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail. Injury. 2010 Dec 1;41(12):1234-8.


How to Cite this Article: Krishnan R P, Jacob B J, Jose D P, Chandy L J. “PFNA-II for unstable intertrochanteric fractures – A prospective study on short term functional outcome’’. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 11-16
.

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Is Abductor Lurch a certainty after Extended Trochanteric Osteotomy?

Vol 32| Issue 1 | Jan – June 2019 | page: 7-10 | George Jacob, Vinay Jaison Chacko, Jacob Varghese


Authors: George Jacob [¹], Vinay Jaison Chacko [¹], Jacob Varghese [¹]

[1] Department Of Orthopaedics, VPS Lakeshore Hospital, Kochi, Kerala, India.

Address of Correspondence
Dr. George Jacob,
VPS Lakeshore Hospital, Kochi, Kerala, India.
E-mail: drgeorge.jac@gmail.com


Abstract

Objective: Many studies assessing the outcomes of extended trochanteric osteotomy (ETO) and its role in revision
total hip arthroplasty (THA) have shown ETO to be an extremely useful tool in femoral stem explantation and reducing intra-operative fractures. However, the sagittal plane of the osteotomy means detachment of the abductor mechanism insertion and possible muscle injury. The removal of the trochanter also alters the horizontal offset of the affected hip. This can have an effect on hip biomechanics and result in a trendelenburg gait. We studied a small group of patients at our center for the incidence of abductor insufficiency post revision THA when combined with ETO.
Methods: 25 patients scheduled for revision THR with an average age of 55 years were assessed for abductor
insufficiency pre-operatively. Patients underwent revision THA performed by the senior author with use of an ETO for femoral stem explantation. Hip Harris scores, anteroposterior and lateral radiographs of the affected hip were taken pre and postoperatively at 6 weeks, 3 months, 6 months, 1 year and 2 years. Post oprative patients were assessed for abductor weakness, gait pattern and a trendelenburg test.
Results: Four osteotomy segments migrated more than 2mm on post-operative radiographs. The mean Harris Hip
Score improved from 35 to 81.4. A positive trendelenburg’s sign was noted in 14/25 patients. All patients had ≥5mm
decreased horizontal offset.
Conclusion: There is a significant incidence of abductor insufficiency in patients who have undergone ETO. It must
be further evaluated to determine the cause to reduced horizontal offset or muscle injury.
Keywords: Hip Replacement; Extended trochanteric osteotomy; Revision hip replacement; Abductor lurch;
Trendelenburg gait


References

1. Huo MH, Muller MS. What’s new in hip arthroplasty. Journal of Bone and Joint Surgery – Series A. 20042Oct;86(10):2341- 53.
2. Younger TI, Bradford MS, Magnus RE, Paprosky WG. Extended proximal femoral osteotomy: A new technique for
f e m o r a l r e v i s i o n a r t h r o p l a s t y. J A r t h r o p l a s t y. 1995;Jun;10(3):329-38.
3. Schurman D, Maloney W. Segmental cement extraction at revision total hip arthroplasty. Clin Orthop Relat Res
1992;Dec;(285):158-63.
4. Papagelopoulos PJ, Trousdale RT, Lewallen DG. Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res. 1996;Nov;(332):151-62.
5. Jando VT, Greidanus N V, Masri BA, Garbuz DS, Duncan CP. Trochanteric osteotomies in revision total hip arthroplasty: contemporary techniques and results. Instr Course Lect. 2005; ;54:143-55.
6. Paprosky WG, Martin EL. Removal of well-fixed femoral and acetabular components. American journal of orthopedics (Belle Mead, N.J.). 2002.; Aug;31(8):476-8.
7. Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ. Extended femoral osteotomy for revision of hip
arthroplasty: Results and complications. J Arthroplasty. 2005;Jan;20(1):79-83.
8. Wronka KS, Cnudde PHJ. Union rates and midterm results after Extended Trochanteric Osteotomy in Revision Hip Arthroplasty. Useful and safe technique. Acta Orthop Belg. 2017;Mar;83(1):53-56.
9. Lerch M, von Lewinski G, Windhagen H, Thorey F. Revision of total hip arthroplasty: Clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture. Technology and Health Care. 2008;16(4):293-300.
10. R. M, M. G-W. Outcomes of extended trochanteric osteotomy using a postero-lateral hip approach for revision
total hip arthroplasty. HIP Int. 2012; 22(4): 403 – 485.
11. Noble AR, Branham DB, Willis MC, Owen JR, Cramer BW, Wayne JS, et al. Mechanical effects of the extended
trochanter ic osteotomy. J Bone Jt Surg – Ser A . 2005;Mar;87(3):521-9.
12. Wagner H. [Revision prosthesis for the hip joint in severe bone loss]. Orthopade. 1987;Aug;16(4):295-300.


How to Cite this Article: Jacob G, Chacko V J, Varghese J. Is Abductor Lurch a certainty after Extended Trochanteric Osteotomy? Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 7-10 .

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Acute Calcific Tendinitis of Longus Colli, a Rare but Masquerading Entity of the Neck: A Case Series Study and Brief Review

Vol 32| Issue 1 | Jan – June 2019 | page: 2-6 | Tony Kavalakkatt, Ajith Thomas Abraham


Authors: Tony Kavalakkatt [¹], Ajith Thomas Abraham [¹]

[1] Department of Orthopaedics,
Baby Memorial Hospital, Calicut, Kerala, India.
Address of Correspondence
Dr. Tony Kavalakkatt,
Department of Orthopaedics, Baby Memorial
Hospital, Calicut, Kerala, India.
E-mail: tonykavalakkatt@yahoo.com


Abstract

Introduction: Calcific tendinitis involves calcium deposition in the substance of the tendon at its insertion producing intolerable pain and other symptoms. Due to the odd presentation of symptoms, they are often mis-diagnosed or inappropriately treated. This phenomenon is most commonly seen affecting the shoulder region.
Calcific deposition occurring in the longus colli muscle is very rare and only a handful of cases has been reported in the orthopedic literature. The exact pathogenesis of this condition is still under debate. It is a self-limiting condition,
characterized by neck pain and restriction of neck movements with mild elevation of acute-phase reactants.
Study: We are reporting four cases of acute calcific tendinitis of longus colli muscle presented to our hospital with
progressive pain in the neck and restricted neck movements. Mean age group of the patients was between 50 and 75
years. Blood investigations were normal except for raised acute-phase reactants in two patients. Radiological evaluation showed increased soft tissue shadow in front of C1-C2 vertebra region anteriorly. Computed tomography (CT) of the cervical region was done without using contrast, which turns out to be beneficial in diagnosing all our cases. The axial sections of the CT scan showed the presence of calcific deposits at the insertion of superior oblique part of longus colli muscle. They were managed conservatively with anti-inflammatory medications and adequate rest. Remarkable recovery was noted within few days of treatment.
Conclusion: For any case with neck pain and limited neck motion, calcific tendinitis of longus colli muscle can be
thought as a differential diagnosis even though their presentation is very rare so as to avoid unnecessary interventions.
Keywords: Calcific tendinitis, longus colli muscle, Pre-vertebral shadow.


References

1. Oliva F, Via AG, Maffulli N. Physiopathology of intratendinous calcific deposition. BMC Med 2012;10:95.
2. Oliva F, Via AG, Maffulli N. Calcific tendinopathy of the rotator cuff tendons. Sports Med Arthrosc Rev 2011;19:237-43.
3. McCarty DJ Jr., Gatter RA. Recurrent acute inflammation associated with focal apatite crystal deposition. Arthritis
Rheum 1966;9:804-19.
4. Harnier S, Kuhn J, Harzheim A, Bewermeyer H, Limmroth V. Retropharyngeal tendinitis: A rare differential diagnosis of severe headaches and neck pain. Headache 2008;48:158-61.
5. Ade S, Tunguturi T, Mitchell A. Acute calcific longus colli tendinitis: An underdiagnosed cause of neck pain and
dysphagia. Neurol Bull 2013;5:1-6.
6. Zibis AH, Giannis D, Malizos KN, Kitsioulis P, Arvanitis DL. Acute calcific tendinitis of the longus colli muscle: Case report and review of the literature. Eur Spine J 2013;22 Suppl 3:S434-8.
7. Offiah CE, Hall E. Acute calcific tendinitis of the longus colli muscle: Spectrum of CT appearances and anatomical
correlation. Br J Radiol 2009;82:e117-21.
8. Hartley J. Acute cervical pain associated with retropharyngeal calcium deposit. A case report. J Bone Joint Surg Am 1964;46:1753-4.
9. Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR. Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization. J Bone Joint Surg Am 1994;76:1636-42.
10. Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis, and management. J Am Acad Orthop Surg 1997;5:183-91.
11. Rui YF, Lui PP, Chan LS, Chan KM, Fu SC, Li G, et al. Does erroneous differentiation of tendon-derived stem cells. contribute to the pathogenesis of calcifying tendinopathy? Chin Med J (Engl) 2011;124:606-10.
12. Eastwood JD, Hudgins PA, Malone D. Retropharyngeal effusion in acute calcific prevertebral tendinitis: Diagnosis with CT and MR imaging. AJNR Am J Neuroradiol 1998;19:1789-92.
13. Rodrigue E, Costa JP. An Unusual cause of neck pain: Acute calcific tendinitis of the longus colli. J Med Cases 2014;5:171- 3.
14. Smith RV, Rinaldi J, Hood DR, Troost T. Hydroxyapatite deposition disease: An uncommon cause of acute
odynophagia. Otolaryngol Head Neck Surg 1996;114:321-3.


How to Cite this Article: Kavalakkatt T, Abraham A T. Acute Calcific Tendinitis of Longus Colli, a Rare but
Masquerading Entity of the Neck: A Case Series Study and Brief Review. Kerala Journal of Orthopaedics Jan-June 2019; 32(1): 2-6 .

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