Capsulotomy as a measure to control pain and reducing hemarthrosis in arthroscopic DB ACL reconstruction surgery: a prospective randomized control study.

PURPOSE: The aim of the study was to evaluate the effect of capsulotomy as a measure of pain relief and hemarthrosis prevention in the arthroscopic double-bundle anterior cruciate ligament reconstruction. METHODS: This was a case control study conducted between April 2013 and Dec 2013, in which 64 patients were enrolled. Capsulotomy was done at the end of the procedure in 31 patients, who were compared with a control group. Pain score (VAS) and grade of hemarthrosis on post-op day 1 and post-op day 2 were compared between the two groups and patients followed up to a minimum of 24 months. RESULTS: There was a statistically significant difference (p value < 0.05) in the pain scores and hemarthrosis grade of the capsulotomy group compared to the control group. The mean pain score on post-op day 1 in the capsulotomy group was 2.71 ± 0.97, whereas it was 4 ± 1.22 in the non-capsulotomy group. The difference between the two groups was statistically significant both at day 1 of post-op and day 2 of post-op (p value < 0.05). The difference between the two groups in terms of hemarthrosis grading was statistically significant both at day 1 of post-op and day 2 of post-op (p value < 0.05). The difference between the two groups in terms of thigh circumference measurements was statistically significant both on day 1 and day 2 of post-op (p value < 0.05). CONCLUSION: We conclude that capsulotomy is a safe and effective measure of pain relief and hemarthrosis management in arthroscopic ACL reconstruction surgeries.

Ponseti Casting Technique: Using the Flags.

Ponseti casts for congenital clubfoot are generally removed in the clinics by soaking and unwrapping them. It is often difficult to find the plaster bandage edge for unwrapping it. The use of flags at cast ends can ease this problem.

Nail changes in casted and braced clubfoot: A preliminary study.

BACKGROUND: The study aimed at finding whether there are any nail changes specific to treatment in clubfoot. METHODS: Sixty new, 26 undergoing serial corrective casting, and 247 clubfoot patients using foot abduction braces were prospectively studied. The casted and braced group formed the basis of the study to observe nail changes, if any. The new patients and opposite normal foot (in unilateral casted cases) were taken as controls. OBSERVATIONS: Acute paronychia, ingrown toe nail, onychoshizia, onychorrhexis, nail plate concavity, latent onychomadesis, and distal onycholysis were observed in feet undergoing corrective casting and bracing. Micronychia, malalignment and thinning of nail plate were the observed congenital nail anomalies. CONCLUSIONS: Nail changes in clubfeet are not infrequent. Certain nail changes might be etiologically linked to casting and bracing. Some of nail changes might require urgent medical care.

Bone histology of Neogene angulate tortoises (Testudines: Testudinidae) from South Africa: palaeobiological and skeletochronological implications.

Here we examine the tibial microstructure of modern and fossil angulate tortoises to assess the histology and growth from the late Miocene-early Pliocene, Pleistocene through to modern forms. The cross-sections of all the tibiae sampled revealed highly vascularized, uninterrupted, fibrolamellar bone tissue during early ontogeny, which suggests that early growth was fast. However, later in ontogeny, growth was slower, as indicated by the deposition of parallel-fibred bone tissue in the outer cortex, and even ceased periodically, as indicated by lines of arrested growth. Comparative analyses of the growth rates of the tortoises from different time periods showed that the tortoises from the late Miocene-early Pliocene Langebaanweg locality and from Diepkloof Rock Shelter had relatively slower growth rates under less optimal growth conditions. Additionally, these prehistoric specimens show extensive remodelling, and several generations of secondary osteons further suggest functional and/or metabolic stresses on the skeleton. Palaeoenvironmental reconstructions suggest that it was mostly cooler and drier with seasonal fluctuations in late Miocene-early Pliocene, and it is likely that Chersina responded to these conditions by having a lower rate of growth as compared with their modern counterparts, which thrive in the current prevailing more favourable Mediterranean type of climate.

Inter-element variation in the bone histology of Anteosaurus (Dinocephalia, Anteosauridae) from the Tapinocephalus Assemblage Zone of the Karoo Basin of South Africa.

Despite its abundance in the Permian fossil record of South Africa, little is known about the life history of Anteosaurus. Here we examine the bone microstructure of multiple skeletal elements of Anteosaurus from the Tapinocephalus Assemblage Zone of the Karoo Basin. The bone histology of Anteosaurus magnificus reveals that the cortex is composed of highly vascularized, uninterrupted fibrolamellar bone tissue surrounding the inner spongy medullary region. However, the histology of two ribs and a previously described femur of another Anteosaurus taxon revealed an interrupted growth pattern with lines of arrested growth and peripheral rest lines occurring in the compacta, indicating periodic pauses in growth possibly linked to the slowing down of growth during maturity. Given that the fibula of the same individual has well-vascularised fibrolamellar bone tissue without any growth marks in the cortex; this suggests variation in skeletal growth. Based on our histological results, three growth dynamic stages are deduced for the genus Anteosaurus: (i) the earliest growth stage is represented by the predominance of highly vascularized, uninterrupted fibrolamellar bone tissue in the inner cortex, which suggests rapid periosteal bone deposition during early ontogeny; (ii) the next stage of growth shows periodic interruptions in the bone deposition as indicated by the deposition of lines of arrested growth; (iii) the third stage shows the development of lamellar bone tissue with rest lines in the peripheral part of the cortex suggesting a slowing down of growth prior to death. Most of the skeletal elements are characterized by thick bone walls, extensive secondary reconstruction and the complete infilling of the medullary cavity. However, the radius and a previously studied femur have open medullary cavities with struts of bony trabeculae. Based on histologic structures and comparisons with extant taxa, it is likely that Anteosaurus may have been more terrestrial as its osteology point towards terrestriality, but it may have occasionally inhabited ephemeral pools like modern semi-aquatic Hippopotamus.

Long bone histology of Chersina angulata : Interelement variation and life history data.

The current study deduced the growth pattern and lifestyle habits of Chersina angulata based on bone histology and cross-sectional geometry of limb bones. Femora, humeri, and tibiae of seven different-sized individuals representing different ontogenetic stages were assessed to determine the interelement and intraskeletal histological variation within and among the tortoises. The bone histology of adult propodials consists of a highly vascularized, uninterrupted fibrolamellar bone tissue with a woven texture in the perimedullary and midcortical regions suggesting overall fast early growth. However, later in ontogeny, growth was slow and even ceased periodically as suggested by slowly formed parallel-fibered bone tissue and several growth marks in the pericortical region. In juvenile individuals, fibrolamellar bone tissue is restricted to the perimedullary regions of propodials as remnants of bone formed during the earliest stages of ontogeny. The epipodials are characterized by having parallel-fibered bone tissue present in their cortices; however, periodic arrests in growth are recorded at various times. Remnants of fibrolamellar bone tissue formed during early ontogeny occur in the epipodials of only a few individuals. Interelement variation is evident, in terms of variation in the orientation of vascular canals between individuals and within the same diaphyseal cross-sections. Different elements show varying cross-sectional geometry, which appear to be correlated with the fossorial behavior of the species. Our results show that of all the long bones, the tibia is least remodeled during ontogeny and it is therefore the best element for skeletochronology.

Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report.

Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis.

Steenbeek Brace: Patterns of Wear.

UNLABELLED: Steenbeek foot abduction brace (SFAB) is an essential orthotic for maintaining correction in congenital talipes equinovarus treated with Ponseti method. As the brace is used up to 3 to 4 years of age, we examined the brace wear pattern according to a child's development and age. We studied 100 SFABs that were rendered unusable or returned by parents due to advanced brace wear. SFABs returned due to other reasons such as foot outgrowing shoe size were excluded. Each part of the brace (outer sole, insole, upper leather, abduction bar, shoe laces) was carefully inspected to observe any pattern of damage. We grouped the pattern of brace wear as per the probable causative factors into 3 broad categories: due to general use in all age groups, sitters and crawlers, and walking children. Shredded tongue, elongated/torn shoelace hole, peeled paint of metal abduction bar, shredded outer sole, and frayed shoelace were due to general use. Due to sitting and crawling with the brace on, shoe wore on its anteromedial, anterolateral, and posterolateral parts at the junction of the upper leather and outer sole. The commonest area of shoe wear in walkers was the abduction bar, which either broke from the welded junction between bar and metal or was bent at midpoint. The SFAB wear pattern was related to the age of the child and his/her activities. The reusability of the brace can probably be extended with simple improvisations and instructing parents about the correct use of the brace. LEVELS OF EVIDENCE: Prognostic, Level IV: Case series.

Lymphocyte/monocyte ratio in osteoarticular tuberculosis in children: a haematological biomarker revisited.

INTRODUCTION: *Work attributed to Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi-110031(India)This study tested the hypothesis whether the lymphocyte/monocyte ratio (L/M ratio) altered significantly during treatment of paediatric osteoarticular tuberculosis (OATB) for it to be a useful monitor of the response to therapy. MATERIAL AND METHODS: Thirty immunocompetent paediatric patients with OATB treated with 6 months of uninterrupted multidrug anti-tubercular treatment with resultant clinical and radiological healing of the lesion were included. Haemoglobin, total leucocyte, monocyte and lymphocyte count, and erythrocyte sedimentation rate (ESR) were collected at 0, 2 and 6 months, and were analysed. RESULTS: The L/M ratio altered from high (11) at the start of treatment towards normalisation (9) at 2 months and (7.7) at 6 months. There was no correlation with declining ESR levels. CONCLUSIONS: The L/M ratio may have potential as an effective biomarker response.

Shoulder tuberculosis in children: a report of two cases.

We report 2 children who underwent multidrug antituberculous therapy with rifampicin, isoniazid, ethambutol, and pyrazinamide followed by dedicated physiotherapy for tuberculosis of the shoulder. Both patients regained a range of motion comparable with the contralateral side after 9 to 10 months.

Scurvy in pediatric age group - A disease often forgotten?

Scurvy is caused by prolonged severe dietary deficiency of vitamin C. Being rare as compared to other nutritional deficiencies, it is seldom suspected and this frequently leads to delayed recognition of this disorder. Children with abnormal dietary habits, mental illness or physical disabilities are prone to develop this disease. The disease spectrum of scurvy is quite varied and includes dermatological, dental, bone and systemic manifestations. Subperiosteal hematoma, ring epiphysis, metaphyseal white line and rarefaction zone along with epiphyseal slips are common radiological findings. High index of suspicion, detailed history and bilateral limb radiographs aids physician in diagnosing this eternal masquerader. We searched Pubmed for recent literature (2009-2014) with search terms "scurvy" "vitamin C deficiency" "ascorbic acid deficiency" "scurvy and children" "scurvy and pediatric age group". There were a total of 36 articles relevant to pediatric scurvy in children (7 reviews and 29 case reports) which were retrieved. The review briefly recapitulates the role of vitamin C, the various disease manifestations and the treatment of scurvy to create awareness of the disease which still is reported from our country, although sporadically. The recent advances related to scurvy and its management in pediatric age group are also incorporated.

Unusual case of Hashimoto's encephalopathy and pseudo-obstruction in a patient with undiagnosed hypothyroidism: a case report.

INTRODUCTION: Hashimoto's encephalopathy is a relatively rare condition associated with an elevated concentration of circulating serum anti-thyroid antibodies, and is usually responsive to steroid therapy. However, hypothyroidism is a rare cause of pseudo-obstruction so here we present a case report of Hashimoto's encephalopathy with gut pseudo-obstruction in an undiagnosed hypothyroid patient. CASE PRESENTATION: A diagnosis of unknown aetiology of encephalopathy with gut dysmotility in an undiagnosed profound hypothyroidism case associated with cognitive decline and behavioural disorder was made in a 60-year-old Indian man. The associated clinical and laboratory features led to the final diagnosis of overt hypothyroidism with Hashimoto's encephalopathy with gut pseudo-obstruction. CONCLUSIONS: Hashimoto's encephalopathy is a rare disorder presenting with acute or sub acute encephalopathy of unknown aetiology so there are considerable chances of misdiagnosing it. The unusualness of this case is that since hypothyroidism is a rare cause of intestinal pseudo-obstruction, and presented concomitant with Hashimoto's encephalopathy, that itself is a rare entity. Intestinal pseudo-obstruction is a potentially serious complication that must be recognized and treated promptly with adequate thyroid hormone therapy.