Bone sarcoma surgery in times of COVID-19 pandemic lockdown-early experience from a tertiary centre in India.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) lockdown has presented a unique challenge for sarcoma care. The purpose of this study is to evaluate the early results and feasibility of surgeries for bone sarcomas during the COVID-19 lockdown. METHODS: Our prospectively collected orthopaedic oncological database was reviewed to include two groups of patients- those who underwent surgery in the immediate 4 weeks before lockdown (non-lockdown group) and those operated in the first 4 weeks of lockdown (lockdown group). All patients were followed-up clinically and telephonically to collect the outcome data. RESULTS: Out of the 91 patients who qualified for inclusion, fifty were classified into the non-lockdown group while 41 patients formed the lockdown group. Both the groups were comparable with respect to baseline demographic parameters. However, during the lockdown period 37 patients (90%) had undergone a major surgical intervention as against 24 patients (48%) in the non-lockdown group (P < .001). There was no significant difference in type of anaesthesia, median estimated blood loss and procedure duration. None of the patients/health care workers had evidence of severe acute respiratory syndrome-coronavirus 2 infection at 15 days follow-up. CONCLUSION: Our study results suggest that appendicular bone tumours can be safely operated with adequate precautions during the lockdown period.

Uncommon Pathogen: Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty.

Introduction: Achromobacter xylosoxidans is an uncommon opportunistic organism, mainly causing infection in immune-compromised hosts. A. xylosoxidans is a non-fermenting Gram-negative bacillus. Being closely associated with Alcaligenes species was also called A. xylosoxidans. Case Report: A few cases of periprosthetic infection by A. xylosoxidans have been reported outside India. A periprosthetic infection with A. xylosoxidans following a total knee arthroplasty is reported in a female. Conclusion: A. xylosoxidans is a pathogen capable of causing prosthetic joint infection even in immunocompetent patients. Thorough debridement and appropriate antibiotic treatment is essential for the success of revision surgery.

Bilateral Floating Knee Injuries Managed by Intramedullary Nailing - An Unusual Injury.

Introduction: Floating knee injuries were first described in 1975 by McBryde as concurrent femur and tibial fractures in an ipsilateral limb. They usually occurred in a polytrauma setting and presented with poor functional outcomes with frequent post-operative complications. Management of this injury was based on patient and fracture characteristics and can be done by external fixators, plating, and nailing. Case Report: A 24-year-old female presented with bilateral floating knees. She was operated on for a left femoral fracture with retrograde nailing when she developed tachycardia and underwent external fixation of the remaining fractures. She later developed a fat embolism which was managed accordingly for the same. After adequate stabilization, her right femur and tibia fractures were fixed by intramedullary nailing through a single percutaneous approach along with nailing for the left tibial fracture. She has satisfactory clinical outcomes on follow-up. Conclusion: Bilateral floating knee injuries are extremely rare injuries and should be managed on an emergency basis. Intraoperative and post-operative complications should be anticipated and managed accordingly. Good functional outcomes can be obtained by intramedullary nailing.

Uneven global and racial representation in major orthopaedic clinical trials: Trends over a decade.

Background: The presence of geographic and demographic disparities in randomized controlled trials (RCTs) may affect the external validity of trials. While some studies have addressed racial or ethnic disparities, they have been limited to a certain region, and there is limited information about the global representation in orthopaedic research. Methods: RCTs published in major medical and orthopaedic journals from 2010 to 2019 were identified. After screening 6961 articles, 1769 trials enrolling 323,506 patients were included. The details of individual trials such as the country of origin, the proportion of women, and the proportion of different racial groups were recorded. Factors associated with reporting and representation of specific demographic groups, and annual changes were assessed. Results: Majority of the trials were from were from United States (US) (N = 380, 21.5%). US (30.7%, N = 99,356), United Kingdom (15.7%, N = 50,691) and Canada (8.3%, N = 26,890) accounted for majority of the enrolled patients. 59.1% of the patients were women. Among US trials reporting race, 81.2% were White, and 9.9% were African American. There was no significant variation in the global distribution (p = 0.056), percentage of women (p = 0.811), or percentage of Whites (p = 0.389) over the years. Conclusion: The top three countries contributed to about 55% of the enrolled patients, whereas they contributed to only 6% of the world population. Overall, women appeared to be adequately represented in the trials, while racial minorities were underrepresented. There has not been any considerable improvement in the representation of developing regions or minorities over the last decade.

Mid-Carpal Joint Sparing Procedure for Idiopathic Avascular Necrosis of Capitate.

Background Avascular necrosis of the capitate (AVNC) is an uncommon pathology of the wrist. Several procedures have been described for the treatment of AVNC. The type of treatment varies depending upon the stages. In early stages, revascularization procedures are performed. If secondary osteoarthritis develops, then the treatment options include intercarpal fusion, four corner fusion, prosthesis replacement of the capitate, tendon interposition, and wrist arthrodesis. No long-term study is available for choosing an appropriate method of the treatment for AVNC. Case Description Herein, we report a case of AVNC that was managed by hemi-resection of the capitate with capito-hamate fusion and tendon interposition. One year after surgery, patient was asymptomatic and radiographs revealed fusion of capito-hamate joint and maintenance of the mid-carpal joint space. There was no evidence of carpal collapse. Literature Review All the literature about mid-carpal joint sparing (MCJS) procedures has been reviewed in this report. This is a goal behind writing of this case report as there have been very few publications about these procedures. Clinical Relevance This case illustrates the successful treatment of AVNC by MCJS procedure. The intercarpal fusion and the four corner fusion are one time procedures, and these can be used if the MCJS procedure fails or sometimes, as primary procedure, if the patient gives consent for the same. It appears prudent to save arthrodesis procedures for the future.

Total Knee Arthroplasty in Rheumatoid Arthritis patients with a medial stabilized prosthesis - A retrospective analysis.

BACKGROUND: Total Knee Arthroplasty (TKA) has been described as an effective and successful mode of treatment in alleviation of pain and restoration of function in patients with Rheumatoid Arthritis (RA). The array of bone and soft tissue deformities in RA patients can impact initial success and long term durability of TKA. Medial Pivot (MP) prosthesis is fixed bearing asymmetric pivoting design that provides anterior-posterior stability without any post and conserves bone on the femoral side. There are few reports of suitability of experience with MP in RA. METHODS: Twenty six patients (average age 55 years) with end stage arthritis secondary to RA operated with MP prosthesis were retrospectively followed up. At a minimum follow up of three years, all patients were assessed using Knee Society Score (KSS), Oxford Knee Score (OKS), Pain Catastrophising Scale (PCS) and radiological outcomes. RESULTS: At final follow-up, patients reported significant improvement in mean KSS-Objective and Functional scores, Oxford Knee Score and Pain Catastrophising Scale (p < 0.05). The mean range of motion achieved at the end of two years ranged from 0 ͦ (extension) to 109.4 ͦ (full flexion). There was no evidence of loosening or osteolysis at minimum follow up of three years. CONCLUSION: These results endorse satisfactory clinical and radiological outcomes at minimum follow up of three years following Medial Pivot Prosthetic Knee design in RA patients. Further long term follow up is needed to determine the survival analysis of MP design in these patients.

Multifocal giant cell tumors of tendon sheath along a single tendon: A case report with review of literature.

The giant cell tumor of tendon sheath (GCTTS) or nodular tenosynovitis arises as discrete solitary nodule in the tendon sheath near joints of toes and fingers. Multifocal giant cell tumor of tendon sheath is a rare entity, of which the etiology is not yet fully understood and it is different from diffuse type of GCTTS. Diffuse type of GCTTS occurs around large joints having a main mass from which a small satellite nodule may arise. Multifocal GCTTS along a single tendon is a more rare entity. Herein, we describe a case of multifocal GCTTS along the tendon sheath of flexor digitorum profundus tendon of index finger. The patient was managed by surgical excision of the tumor swellings with no recurrence at two years follow up.