Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study.

Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.

Impact of COVID-19 on orthopaedic residents-an Indian perspective.

OBJECTIVES: The COVID-19 pandemic is a public health emergency causing a deleterious effect on the health system. It affected all the specialties and subspecialties in the medical field causing havoc in the health institutions. This pandemic affected both orthopaedic consultants and the residents who are under training. Our purpose was to study the impact of COVID-19 on orthopaedic residents in their professional life. METHOD: The study design was a computer-based digital online survey of the orthopaedic residents in India. The survey had 15 questions with multiple options related to the effect of COVID-19 on their orthopedic department, effect on teaching, surgical exposure, hands-on surgeries, the effect on workload, effect on mental stress, exposure to arthroplasty, arthroscopic surgeries, spine surgeries, and deformity correction surgeries. RESULTS: Elective surgeries stopped in 91% of the hospitals, academic teaching stopped in 98% of the institutions. Eighty-six percent of the residents are not getting adequate surgical exposure, 73% of the residents are getting negligible hands-on surgical training. Residents are mentally stressed related to academic examinations, academic training, and also because of COVID 19 duties. Residents are getting the least exposure in subspecialties like arthroplasty, arthroscopy, and spine. CONCLUSION: The COVID-19 pandemic not only affected the orthopaedic consultants but also the orthopaedic residents to a great extent as residents are the backbone of any department/institution. The pandemic affected significantly resident's academic teaching, surgical exposure, hands-on training and mental stress related to COVID duties, academic training disturbance, and also academic examinations.

Synovial Chondromatosis of Hip in a Young Patient Salvaged With Mini Arthrotomy Without Hip Dislocation - A Case Report.

INTRODUCTION: Synovial chondromatosis is a rare, benign disorder of the synovium, which leads to loose body formation due to metaplastic transformation. It presents as multiple cartilaginous bodies in the synovial joints, bursae and in tendon sheaths. The diagnosis often delayed in hip involvement due to insidious onset of symptoms. Surgical management is essential to manage synovial chondromatosis, which includes hip dislocation and debridement, arthroscopic removal or using arthrotomy. CASE REPORT: A 20-year-old male patient presented with complaints of pain in the left hip since 1 year and difficulty in walking for 6 months. On examination, the patient had mild tenderness over the left hip with the restriction of joint movements. He had flexion deformity of 30°, adduction and external rotation deformity of 10 and 15°, respectively. X-ray of the pelvis with both hips anteroposterior and left hip lateral view revealed calcified nodular mass over superior, inferior part of the femoral head, and anterior part of the neck with decreased joint space. As the patient was disabled with pain, stiffness especially restricted flexion and abduction and difficulty in daily routine activities, we planned for surgical excision of the loose bodies. Using lateral approach to the hip, intra-articular loose bodies were removed through arthrotomy without hip dislocation. At present 2-year follow-up, the patient is having full hip range of motion with no difficulty in squatting, sitting cross-legged, and radiological examination showed no evidence of recurrence. The patient is fully satisfied with the chosen treatment and participating in running and other sports. CONCLUSION: Although hip synovial chondromatosis are rare, early surgical intervention with complete removal of loose bodies, joint distraction for 6 weeks to allow healing, and early initiation of hip physiotherapy helps in getting better outcome even in patients with early stages of hip arthritis. The early surgical intervention also prevents the progression of the joint degeneration, which in turn helps in postponing replacement surgeries in young patients. Satisfactory outcomes can be achieved by salvaging the natural hip joint.

Idiopathic Proximal Radioulnar Synostosis - A Rare Case Report and Review of Literature.

INTRODUCTION: Radioulnar synostosis is a bony connection between the radius and ulna, which causes restriction of the active and passive rotational movements of the forearm such as supination and pronation, which can lead to significant functional disability in the patients. CASE REPORT: A 35-year-old male carpenter presented with the complaint of right forearm supination and pronation restriction for the past 8 months with minimal pain at the elbow region with no previous history of trauma or surgery. On examination, forearm supination and pronation movements were completely restricted with normal elbow flexion and extension and with no neurovascular deficit. X-ray of the right radius ulna with elbow revealed synostosis between proximal radius and ulna at the level of the radial tuberosity. Synostosis was removed using both anterior and posterior approaches. Postoperatively patient is having good supination and pronation movements, no pain, and difficulty in his occupation. CONCLUSION: Idiopathic proximal radioulnar synostosis should be suspected in patients having restricted rotatory movements of forearm with no previous history of trauma or surgery and this is the first reported case of idiopathic proximal radioulnar synostosis. Complete resection of the synostosis with early initiation of aggressive physiotherapy helps in getting good functional outcomes.