Surgical Management of Non-Union Patella Fracture: A Case Series and Review of the Literature.

BACKGROUND: The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is the rare entity with incidence of 2.4-12.5%. The fractured proximal fragment of the patella is retracted proximally leading to fracture gap of various centimetres. Various surgical modalities are described to manage such fracture morphologies. METHODS: Ten neglected patella fracture morphology were included in the study. Five patients with transverse fracture was treated with ORIF with TBW. Two patients with communited fracture was treated with ORIF with TBW (K wires) and cerclage wire. Three patients with inferior pole patella was managed by open reduction and Krachow suture using fibre wire. The results were assessed in terms of time of union, knee range of motion, extension lag, quadriceps power, fracture gap, Knee society score, Kujala knee score and any complications. Follow-up with radiographs was done at 2, 4, 6 and 12 months. RESULTS: All patients presented with a mean duration of 9.3 months (7-13months) after the trauma with mean gap between the fracture fragments of 5.2cm (3.8-6.6cm) in maximum flexion and 2.6cm (2.0- 3.0cm) in full passive extension. The mean duration of the radiological union was 5months (3-6months). The average range of motion achieved at the end of 12 months ranges from 10o to 110o. The quadriceps power in all patients were 4+ or 5 at 6 and 12months. The mean Knee Society Score was 75 (Range 72-82) and mean Kujala knee score was 73 (Range 70- 82) at the end of 12 months. CONCLUSION: We conclude that in cases of non-union patella ORIF using TBW has the best result. V-Y plasty is rarely required for fracture reduction. The need for bone grafting can be assessed on case to case basis. Partial/total patellectomy should be avoided and Krackow suture technique is helpful in management of inferior pole patella fractures.

Positive QuantiFERON test and the severity of COVID-19 disease: A prospective study.

BACKGROUND: A strong negative correlation is reported between the Bacille Calmette Guerin (BCG) index and COVID-19 mortality. The present study explored if frequent exposure to strong Th1 antigens like Mycobacteria or Salmonella have any effect on the progression of the disease in COVID-19 patients. METHODS: This prospective comparative study comprised of 3 groups of 20 each of mild or asymptomatic COVID-19 patients (A), severely ill patients (S) and healthy volunteers with a COVID Negative report (H). RESULTS: QuantiFERON TB Gold (QFT) which is interferon gamma release assay (IGRA) against Mtb antigen was used to quantify immunity status of patients against the tuberculosis. Group S showed positive QFT in only 15% patients as against 50% QFT positive patients in group A and H. All fourteen patients in group S with QFT negative report died while 5 of six survived patients showed positive QFT report either on initial or repeat testing done at 6 weeks. The sixth survived patient was QFT negative but showed high antibody titre against H antigen (TH) on Widal test. All severely ill group S patients showed huge reduction of IGRA even to the mitogen stimulus thus suggesting gross general unresponsiveness of T cells. Presence of BCG scar showed no correlation with prevalence or progression of the disease. CONCLUSION: Population in an endemic area of tuberculosis and typhoid with good community exposure to these antigen is likely to withstand COVID -19 better and show reduced mortality following it.

Kite String Injury Causing a Complete Tear of the Tendoachilles.

Kite flying is a common activity in many countries, particularly India. Fierce competition has led to the use of dangerous kite threads like manja (which is a cotton or nylon thread coated with powdered glass) to gain an edge over rivals. The sharp manja can not only cause linear abrasions or deep incised wounds among flyers but it can inflict equally serious injuries to onlookers or unwary pedestrians and two-wheeler riders on the street. Hand, throat, angle of mouth, nose, and feet are some common sites of injury. We report a case of a 62-year-old man who sustained a manja cut injury through the tendoachilles while walking on the roadside when his foot got entangled in the barely visible thin thread as a bicycle rushed past him. The wound was debrided and tendoachilles repaired using the Krackow technique. The patient had reasonable strength in plantar-flexion and good active range of motion at the ankle when last seen at the one-year follow-up. The aim of this article is to highlight the hazards of manja and the need to revisit and acknowledge the clinical, social, and administrative implications of this unusual but noteworthy mechanism of limb and life-threatening injury.