Sports-Related Musculoskeletal Injuries in Medical Students.

Background: Little attention is paid to the problem of sports-related injuries in amateur or nonathletes or recreational student athletes. We investigated the prevalence of sports-related musculoskeletal (MSK) injuries in medical students and attempted to identify the risk factors for these injuries. Methods: We conducted a cross-sectional questionnaire-based observational study on medical students of a tertiary care teaching hospital in central India. A total of 500 medical students were approached; the questionnaire consisted of details, such as age, gender, height, weight, predominant sport played or the sport during which they sustained an injury, estimated time spent playing every week, if they had undergone any formal training for the sport, any preexisting MSK condition, details of the injury and the treatment taken, if any, after joining medical school, and duration from getting injured to return to studies and sports. The odds ratio (OR) and logistic regression were calculated for multiple parameters. Statistical significance was set at P ≤ 0.05. Results: Seventy-four of the 402 students who responded reported sustaining a sports-related injury; 33 and 41 students reported injury while playing contact and noncontact sports, respectively. Of these, 58 students reported that they had received formal training in sports. Football, volleyball, cricket, and kabaddi were the sports during which most injuries occurred. The injury rate was 3.7 per 1000 playing or practice hours. Conclusions: Almost one-fifth of the students reported sustaining a sports-related MSK injury after joining medical school. The risk factors identified for these injuries were male gender, participation in team sports, participation in noncontact sports, and lack of adequate preparation or practice.

A study of attributable variables impacting orthopedic trauma surgical training.

PURPOSE: In medical colleges, resident training programs must provide adequate surgical experiences, making them qualified at the end of residency program. It is generally believed that it would take more time for a surgical resident to perform surgical procedures than a board-certified surgeon. There is no current benchmark with regards to operative time and surgical cases involving orthopedic surgery residents. In this study, we focused on two key aspects of surgical training variables, namely, surgical duration & C-arm shoots when the procedure is done by a faculty surgeon in comparison to done by an orthopedic resident under supervision of faculty surgeon. METHODS: It is an observational prospective study, we observed patients undergoing 1 of 5 common orthopedic trauma operations in a community teaching hospital. We recorded two variables, 'skin to skin' surgical duration & number of image intensifier television/C-arm shoots of faculty surgeons and orthopedic resident (postgraduate-3yr) under supervision of faculty surgeon. We calculated mean difference of two variables with or without resident & determined statistical significance, we also compared functional outcome at final follow-up. RESULTS: The total number of procedure observed was 402. On observing summarized results of all surgical procedures, faculty surgeons took on an average 33 min lesser (p < 0.05) & on an average 37 lesser number of shoots (p < 0.05) than resident surgeons. The difference in surgical duration tended to increase with the greater complexity of the surgical dissection. The difference in number of C-arm shoots tended to increase with the increase in surgical duration in closed procedures. In all the five procedures there was no significant difference (p > 0.05) in functional outcome of cases performed by faulty surgeon and resident. CONCLUSION: Little data has been previously published regarding the impact of teaching orthopedic resident in operating room. We demonstrate that resident participation increases the procedure time for commonly performed orthopedic procedures and also the number of C-arm shoots, hence there is a need for technical training facilities outside the operating room such as in cadaveric labs, saw bone labs & virtual surgery simulation. Also the preoperative plan should be thoroughly discussed by faculty surgeon with residents.

Danger zone of radial nerve in Indian population - A cadaveric study.

BACKGROUND: Identification of the radial nerve is necessary during surgery of the humerus fracture to avoid injury to it. Iatrogenic nerve injury during humerus fracture surgery is a well-known complication. Prevention of this type of injuries would be of great value. Aim of this study is to reduce the chance of iatrogenic nerve injury by defining of a danger zone in the distal upper arm regarding the radial nerve in indian population. METHODS: Thirty six upper limbs of eighteen adult human formalin preserved cadavers (14 males & 4 females) were used in this study. The posterior aspect of the arm was dissected to expose the radial nerve from the triangular space to the point where the radial nerve pierced the lateral intermuscular septum. Systematic identification of radial nerve and multiple measurements were done for each specimen. RESULTS: The mean humeral length was 30.96 + 1.23 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.5 + 0.79 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.34 + 0.41 cm. The mean length of radial nerve groove/spiral groove was 4.3 + 0.75 cm. CONCLUSIONS: Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and the zone of danger of the humerus provides more safety during the surgical interference of the humerus. To do this, the radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.

Evaluation of modified Ponseti technique in treatment of complex clubfeet.

BACKGROUND: Complex clubfoot does not respond to ponseti method. In 2006 Ponseti et al published the results of treatment of such complex club foot by modified ponseti technique, since then it has become standard method of treatment for complex clubfoot. There has been only few published result of this method and hence, here we are evaluating our experience with 16 patients (27 clubfeet) with complex clubfeet treated at our center by modified ponseti method. METHOD: Parents of patient fulfilling the criteria for complex clubfoot were consented and registered under the study. Pirani score at presentation, at prescription of foot abduction brace and at final follow up was noted. total number of casts required for desired correction, number of cast before and after tenotomy, need of tendoachilles tenotomy, relapse and complications were documented. RESULT: Average follow up duration was 14.762 months (Range 6 month to 22 months). Of the total 16 patients 11 had bilateral complex clubfoot and 5 had unilateral complex clubfoot, the mean pirani score at the time of presentation was 5.5741 (range 4.5-6), Mean pirani score at latest follow up was 0.0556. Average no. of casts required for the complete correction with modified ponseti method was 7.44 (ranging from 6 to 10 casts). All 27 feet (100%) required tendo achillies tenotomy. Percutaneous tenotomy was done in 19 feet while 8 feet required Mini-Open tenotomy (due to thick pad of fat tendon was not palpable). Relapse rate was 11.11% (3 feet) [all had relapse of equinus, fore foot adduction treated by remanipulation by modified ponseti technique, retenotomy and casting]. An excellent result was achieved with at final follow-up in all 27 feet. CONCLUSION: In our experience modified ponseti technique for treatment of complex clubfoot is a successful method of treatment if aided with tendoachilles tenotomy, also it has reduced the requirement of surgical intervention in such patients.Level of Evidence - Level IV.

A Long-Term Study of Application of Joshi's External Stabilizing System in Displaced Intra-articular Distal End Radius Fractures.

Background Fractures of the distal end radius are a common upper extremity fracture. Intra-articular distal end radius fractures are recognized as very complex injuries with a variable prognosis. The aim of the study was to assess the long-term functional outcome of patients treated with Joshi's external stabilizing system (JESS) for displaced intra-articular distal end radius fractures. Materials and Methods A total of 170 patients with intra-articular distal end radius fracture were treated with JESS from 2014 to 2017. The patients were followed up at 2, 6 weeks, 6 months, 1, and 2 years (final) after the surgery. The assessment of pain, range of motion, grip strength, and satisfaction were assessed at 6 months, 1, and 2 years (final) follow-up and scored according to modified Mayo wrist scoring system. Results The good and/or excellent results were found in 82.2% of cases. We observed that patients with age less than 50 years had greater prognosis as compared with patients with more than 50 years of age. Final outcome was also found better in males as compared with females at 6 months, 1, and 2 years postoperatively. Conclusion JESS is an effective treatment technique for intra-articular distal end radius fractures in our community. On long-term follow-up of the patients treated with JESS for intra-articular distal end radius fractures, the functional and radiological outcomes were good with low complication rate.