Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience.

PURPOSE: High-velocity gunshot fractures are primarily a domain of military medicine. Traditionally, the management of choice for these injuries has been an external fixation. However, we present a series of high-velocity gunshot fractures of tibia managed with primary internal fixation. METHODS: Twenty-nine cases of high-velocity gunshot tibial fractures presenting within six hours of trauma were taken up for primary internal fixation and followed up at two months, four months, six months and one year including telephonic follow-up for five patients. RESULTS: Cases with various grades of open fracture were taken up for debridement and primary internal fixation within a mean period of three hours 40 minutes post trauma. Twenty-two cases were managed with unreamed interlocking nail and fixation was done with plate in seven cases. Five cases developed early superficial infection and four developed deep infection. All tibia united; however, secondary procedures were required in six cases to achieve union. One patient developed infected non-union which was managed with rail fixator. One patient was left with chronic discharging sinus. CONCLUSIONS: High-velocity gunshot wounds of leg present special challenge to the orthopaedic surgeons. Timely intervention, through debridement and meticulous soft-tissue handling, can give good results with primary internal fixation. Our results are comparable to open fractures of tibia due to other causes and with other studies using external fixation. Further randomised controlled trials are needed to substantiate our findings.

Emergence of COVID-19 Variants: An Update.

Severe acute respiratory disease virus-2 (SARS CoV-2) is one of the deadliest global threats faced by mankind to date. Despite the colossal efforts, the viral pandemic swept across all boundaries. Besides the virulence and susceptible population, the low proofreading capacity and error-prone mechanism of RNA-dependent RNA polymerase (RdRp) have contributed to new variants and reinfections. The World Health Organization has officially categorized these variants as variants of concern or variants of interest. This nomenclature is not merely to suffice the surveillance but also to have effective treatment and vaccine options in place. Coronavirus disease 2019 (COVID-19) variants have the propensity to render the available treatment strategies futile owing to the mutations they acquire. The futility of treatment strategies can be attributed either to the ineffectiveness or the shortage of supply given the skyrocketing increase in the number of cases. Presently, the Omicron variant is the most widespread one and is known to escape the protection, be it immune-derived, vaccination-derived, or hybrid. WHO has recommended modification in vaccine development policies and few companies have introduced Omicron-adapted vaccine jabs. Keeping in view the unending tale of COVID-19 variants and the huge data available on the same, this review focuses on providing insight into the emergence and ongoing dynamics of these new COVID-19 variants.

Angle Stable Plate Fixation vs Hemicallotasis in Medial Opening Wedge High Tibial Osteotomy: A Comparative Study.

Background: Varus alignment associated with medial compartment degeneration is the most common presentation of knee osteoarthritis and often presents in young active adults where arthroplasty might be unsuitable. Purpose: To compare the accuracy of the angle stable medial high tibia plate and self-adjusting HTO (high tibial osteotomy) fixator in achieving correction of varus deformity of the knee by medial opening wedge HTO and to evaluate functionality between the groups. Study Design: Prospective randomized control study. Methods: Forty patients each underwent medial opening wedge high tibial osteotomy with acute correction and stabilization using the angle stable plate (ASP group) or with the hemicallotasis technique using the self-adjusting HTO external fixator (HCO group). Anatomical and functional outcomes were compared to the pre-operative values at the 6th and 12th month. Results: The FTA (femoro-tibial axis), mechanical axis, and functional scores improved significantly in both groups. There was also a significant change in the patellar height and tibial slope. Except for a better KOOS (Knee Injury and Osteoarthritis Outcome Score) in the angle stable plate group at the 6-month follow-up, there were no significant differences between the groups. Conclusion: Both methods of performing a medially based proximal tibial osteotomy gave equivalent outcomes at the 1-year follow-up.

Osteopenia in Scaphoid Fracture: An Indicator of Good Prognosis or Is it Cause for Concern?: A Case Report.

CASE: A 32-year-old man sustained a scaphoid waist fracture and was managed nonoperatively in a short-arm cast. Radiographic follow-up at 6 weeks showed marked loss of radiodensity of the whole scaphoid, although the fracture was clinically united. Patchy ossification at 3 months was followed by the complete restoration of radiodensity and trabecular pattern by 20 weeks. The patient had an uneventful and full functional recovery. CONCLUSION: This, perhaps unreported, finding seems to be an indicator of preserved vascularity in scaphoid fractures. Further research/reporting of this radiological pattern in these fractures will help improve their understanding and management.