Grade 3 Proximal Humerus Giant Cell Tumour: Is Resection and Reconstruction with Prosthesis a Valuable Option?

Grade 3 proximal humerus giant cell tumours are uncommon and the results of their surgical management with prosthetic replacement are not well established. We retrospectively studied patients with grade 3 giant cell tumours of proximal humerus treated with excision and prosthetic replacement from January 2009 and December 2018. We identified 13 patients who underwent tumour excision and prosthetic replacement. There were 7 (53.8%) men and 6 (46.2%) women. The mean age at diagnosis was 30.4 years (range 16-48 years). The mean follow-up period was 72.2 months (range 24-132). Margins were positive in 4 (30.8%) patients, ≤ 1 mm in 8 (61.5%) patients, and negative in 1 (7.7%) patient. Local recurrence was seen in 2 (15.4%) patients. 1 out of 2 (50%) patients with local recurrence had pathological fracture at presentation and margins were positive in both (100%) patients. There were 3 (23.1%) complications-1 patient with joint subluxation, 1 patient with fracture post trauma, and 1 patient with surgical site infection. The mean overall Musculoskeletal Tumour Society score was 24 out of 30 (range 21-29). Resection of grade 3 proximal humerus giant cell tumour and reconstruction with prosthesis results in low recurrence rate and good functional outcome and is a valuable treatment option for such tumours.

Pseudoparalysis Secondary to Vitamin C Deficiency: A Rare Presentation in a Toddler.

CASE: We present a 17-month-old girl with postencephalitic sequelae only on high-calorie cereal milk through a nasogastric tube. She presented with a 3-week history of swelling and decreased lower limb movements. Synovial fluid analysis ruled out septic arthritis. Plain radiograph and magnetic resonance imaging (MRI) were suggestive of scurvy. She was diagnosed to have pseudoparalysis secondary to scurvy. She was started on vitamin C supplements, after which she showed good clinical improvement. CONCLUSION: This case report is to re-emphasize the need for awareness of the possibility of scurvy in children with poor nutritional status due to feeding difficulties.

Profile and outcome of COVID-19 patients treated at a secondary hospital in Central India during the second wave of the pandemic.

Background: The second wave of the coronavirus disease 2019 (COVID-19) pandemic resulted in a significant rise in the number of infections and deaths as compared to the first wave. The published literature till now is limited to tertiary hospitals. We did this study to describe the demographic characteristics and outcomes of patients admitted to a secondary care hospital in central India during the second wave of the pandemic. Methods: This was a single-center, retrospective observational study conducted in a secondary hospital in central India. The data of patients with COVID-19 infection admitted between March 25 to May 25, 2021, were retrieved and analyzed. Results: A total of 184 patients were included in the study. The mean age was 54.8 ± 14.5 years. Comorbidities included hypertension (40.2%), diabetes mellitus (29.9%), hypothyroidism (4.3%), and asthma (2.7%). The most common presenting complaints were cough (78.8%), breathlessness (61.4%), and fever (60.9%). The mean duration of symptoms was 5.4 ± 2.6 days. According to High-Resolution Computerised Tomography (HRCT) chest severity score, 29/181 (16%) patients had mild disease, 135/181 (74.5%) patients had moderate disease, and 17/181 (9.5%) patients had severe disease. The majority of the patients received remdesivir (90.2%) and 123 patients (66.8%) received corticosteroids. Half the patients (52.2%; n = 96) required intensive care unit admission, 79.3% (145 patients) required oxygen support, and 8.1% (15 patients) required non-invasive ventilator support. Conclusion: Our study from a secondary hospital setup showed that the second wave was very severe with a high requirement of oxygen support and intensive care monitoring.

Changing pattern of trauma during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic compelled the Indian government to enforce a complete nationwide lockdown on 24th March 2020. METHODS: This retrospective study was done to analyse the profile of trauma patients presenting to the emergency department (ED) from January to August 2020. Data from 69 days of lockdown and 83 days of pre-lockdown periods were used to calculate the 30-day incidence rates. RESULTS: During the 7-month study period, 5220 patients presented to our ED with trauma; 2296 in the prelockdown phase (83 days), 1205 during the lockdown phase (69 days), and 1719 during the postlockdown phase (92 days). There was a significant decrease (36.7%) in the 30-day incidence rate of trauma victims presenting to the ED during the lockdown phase (525) compared with the prelockdown phase (830). The 30-day incidence of road traffic accidents (RTA), fall from height, fall on level ground and other trauma decreased by 53.2%, 26%, 23.2% and 12.9%, respectively, while assault cases increased by 8.3% during the lockdown period as compared with the prelockdown period. During the lockdown period, the 30-day incidence of trauma victims with a positive blood alcohol content decreased by 39.6% with a significant drop in the strict lockdown month of April 2020. CONCLUSIONS: A significant reduction in the incidence rate of trauma victims, especially RTA and geriatric trauma was seen during the gruelling lockdown period of the COVID 19 pandemic.

Foot and Ankle Giant Cell Tumors Are Not so Aggressive After All: A Retrospective Study.

Giant cell tumors are most commonly seen around the knee and rarely around the foot and ankle. Therefore there is a paucity of data regarding the options of surgery, outcomes and recurrence of Giant cell tumors involving the foot and ankle. We retrospectively studied patients with Giant cell tumors of the foot and ankle from January 2009 to December 2017. We identified 19 (N = 19) patients with a minimum of 1-year follow-up. Their data was retrieved from the electronic database and analyzed. The mean follow-up period was 36.2 (range 12-96) months. On an average, the patients underwent 1.6 surgeries. The surgeries performed were extended curettage and bone graft/cement in 8 (42.1%) patients, excision and bone graft in 8 (42.1%) patients and excision and mega prosthesis in 3 (15.79%) patients. The most common complication was wound infection seen in 3 (15.79%) patients. None of the patients who underwent index procedure in our center (biopsy and surgery) had local recurrence. There were 9 (47.36%) patients with primary procedure elsewhere - 7 of them had no recurrence after surgery in our center. One (5.26%) amputation was eventually performed due to complications and not as a primary surgery. At the final review, all 19 (100%) patients with >1 year follow up were in remission. Local recurrence and wound infection were exclusively found in patients who presented to us after invasive procedures done elsewhere. With good surgical clearance, the uncommon presentations of foot and ankle Giant cell tumors can be treated to attain complete remission.

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy.

STUDY DESIGN: Retrospective case series. PURPOSE: This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy. OVERVIEW OF LITERATURE: Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention. METHODS: This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score. RESULTS: A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores. CONCLUSIONS: Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.