Triple modified French osteotomy: a possible answer to cubitus varus deformity. A technical note.

BACKGROUND: Cubitus varus is the most common delayed complication of pediatric supracondylar humerus fractures. We developed a new technique, the triple modified French osteotomy, that we believe may be the answer to this common but yet unsolved deformity. MATERIALS AND METHODS: Ten patients aged between 6 and 12 years with post-traumatic cubitus varus deformity were operated on with the triple modified French technique. A varus angle of more than 10° measured on the radiograph was an indication for surgery. RESULTS: The radiologic union at the osteotomy site took place in a mean period of 5.5 weeks (range, 4.5-7 weeks). The average correction achieved by the osteotomy was 27°. There were no cases with complications of radial or ulnar nerve palsy or joint stiffness. CONCLUSION: The triple modified lateral closing wedge French osteotomy is a simple and cosmetically effective method of treating cubitus varus deformity in children. It may obviate the need for more complex procedures; at the same time, it also addresses the potential drawbacks of a simple closing wedge osteotomy.

Scapulothoracic and scapholunate dissociation in the ipsilateral upper limb of a trauma victim.

Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation. Here we describe a case of a 32-year-old male who presented with scapulothoracic dissociation associated with brachial plexus injury, along with scapholunate dissociation. We also propose an injury mechanism that might link the two injury patterns, suggesting that the association might be more than by chance. The patient was managed according to established trauma care and resuscitation protocols followed by open reduction and internal fixation of the clavicle fracture, and fixation of scapholunate dissociation and had a successful outcome at follow-up.

Neglected foreign body in contralateral limb in a traumatic transfemoral amputee---radiographs can be misleading.

Missed or neglected foreign bodies are not infrequent in surgical practice. This case report highlights the fact that thorough clinical examination and detailed evaluation of trauma patients are very necessary so that any associated injuries or foreign bodies will not be missed and any unforeseen clinical or medico-legal complications can be prevented. We present a case of a 35-year- old male patient who had traumatic transfemoral amputation of the right lower limb with a clean laceration (size 2 cm multiply 1 cm) over the medial aspect of the left thigh. Radiographs suggested a single radioopaque foreign body which proved misleading, as during surgical removal multiple radiolucent and radiopaque foreign bodies were discovered. Postoperative ultrasound was performed and showed no retained foreign bodies. A secondary closure of the right thigh amputation was done and patient was discharged. At the last follow-up, 9 months after injury, the patient had no complaints, and both the amputation stump and the wound over the left thigh were healthy. Thus in the cases of retained foreign bodies, in addition to thorough clinical examination and radiography, ultrasonograpy should be supplemented. And if required, use of CT scan as well as MRI should be also considered.

First rib fractures: not always a hallmark of severe trauma---a report of three cases.

According to medical literature, fracture of the first rib is quite rare and the bilateral condition is especially rare. This type of fracture is usually associated with severe intrathoracic trauma and other bony or neurovascular injuries, thus can be considered as a harbinger of major trauma. However here we present three cases of low velocity first rib fractures without any major trauma or multisystem injuries. All the three patients were treated conservatively and did well on simple analgesics and rest and had no early or late complications. It can be seen that not all the first rib fractures are associated with major trauma or multisystem injuries. There is a variant of first rib fracture with low velocity injuries which is not associated with any major complications in contrast to majority of first rib fractures associated with high velocity injuries. Causative factor of such injuries may be violent muscular contraction of scalenus anterior or serratus anterior, but not direct trauma.

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis.

Tuberculosis (TB) occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and internally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by antibiotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to antitubercular drug therapy (ATT), the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.

Complete palmer lunate enucleation---is proximal row carpectomy or wrist arthrodesis the only choice?

Perilunate dislocations are rare injuries of the wrist and complete dislocation of the lunate is also rare. There is controversy in literature regarding the optimal management of such injuries. Complete lunate enucleation is associated with high rate of osteonecrosis of lunate thus wrist arthrodesis or proximal row carpectomy has been advocated as primary treatment for such injuries. We report a case of transradial styloid complete palmar lunate enucleation in a 25-year-old male patient who sustained injury to the left wrist due to fall on outstretched hand. Carpal row salvage surgery initially by closed reduction and wrist distractor application followed by open reduction and internal fixation with K-wires along with ligamentous repair resulted in restoration of normal wrist anatomy and good functional outcome. As many of these injuries are missed on initial presentation and outcome is poor for missed injuries, prompt diagnosis and early surgical management to restore vascularity of lunate is recommended.

Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates.

Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

MEMS Devices-Based Hand Gesture Recognition via Wearable Computing.

Gesture recognition has found widespread applications in various fields, such as virtual reality, medical diagnosis, and robot interaction. The existing mainstream gesture-recognition methods are primarily divided into two categories: inertial-sensor-based and camera-vision-based methods. However, optical detection still has limitations such as reflection and occlusion. In this paper, we investigate static and dynamic gesture-recognition methods based on miniature inertial sensors. Hand-gesture data are obtained through a data glove and preprocessed using Butterworth low-pass filtering and normalization algorithms. Magnetometer correction is performed using ellipsoidal fitting methods. An auxiliary segmentation algorithm is employed to segment the gesture data, and a gesture dataset is constructed. For static gesture recognition, we focus on four machine learning algorithms, namely support vector machine (SVM), backpropagation neural network (BP), decision tree (DT), and random forest (RF). We evaluate the model prediction performance through cross-validation comparison. For dynamic gesture recognition, we investigate the recognition of 10 dynamic gestures using Hidden Markov Models (HMM) and Attention-Biased Mechanisms for Bidirectional Long- and Short-Term Memory Neural Network Models (Attention-BiLSTM). We analyze the differences in accuracy for complex dynamic gesture recognition with different feature datasets and compare them with the prediction results of the traditional long- and short-term memory neural network model (LSTM). Experimental results demonstrate that the random forest algorithm achieves the highest recognition accuracy and shortest recognition time for static gestures. Moreover, the addition of the attention mechanism significantly improves the recognition accuracy of the LSTM model for dynamic gestures, with a prediction accuracy of 98.3%, based on the original six-axis dataset.

Machine Learning Based Healthcare System for Investigating the Association Between Depression and Quality of Life.

New technological innovations are changing the future of healthcare system. Identification of factors that are responsible for causing depression may lead to new experiments and treatments. Because depression as a disease is becoming a leading community health concern worldwide. Using machine learning techniques this article presents a complete methodological framework to process and explore the heterogenous data and to better understand the association between factors related to quality of life and depression. Subsequently, the experimental study is mainly divided into two parts. In the first part, a data consolidation process is presented. The relationship of data is formed and to uniquely identify each relation in data the concept of the Secure Hash Algorithm is adopted. Hashing is used to locate and index the actual items in the data. The second part proposed a model using both unsupervised and supervised machine learning techniques. The consolidation approach helped in providing a base for formulation and validation of the research hypothesis. The Self organizing map provided 08 cluster solution and the classification problems were taken from the clustered data to further validate the performance of the posterior probability multi-class Support Vector Machine. The expectations of the importance sampling resulted in factors responsible for causing depression. The proposed model was adopted to improve the classification performance, and the result showed classification accuracy of 91.16%.

Osteomyelitis in Kawasaki disease.

A child who was having all symptoms of Kawasaki disease (KD) was diagnosed with osteomyelitis. Very quick response was appreciated with intravenous immunoglobulin (IVIG) infusion for all the symptoms except osteomyelitis. Long term antibiotics were required to treat it. This kind of overlap between KD and pyogenic osteomyelits due to S. aureus, further supports relationship between these two.

Use of fourteen gauge angiocatheter needle in orthopaedics.

BACKGROUNDS: Wide-bore angiocatheter is readily available in the hospital in pre-sterilized packed form. There are various uses in medical and surgical field apart from its use for transfusion. Here we are outlining its various uses in orthopaedic surgeries. METHOD: Fourteen gauge angiocatheter which internal diameter is 1.3 mm is used in fracture of patella, olecranon to pass the stainless steel (SS) wire, in scaphoid fracture fixation and hip arthroscopy and its efficacy is noted. RESULT: Surgical procedure assisted by 14 gauge angiocatheter reduces surgical time, and soft tissues damage and it also helped in scaphoid fixation and hip arthroscopy. CONCLUSION: Passing SS-wire through soft tissues and bone causes lots of trouble and time consuming. With the help of angiocatheter it overcomes these problems. So, its use in orthopaedic surgeries are rewarding.

Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures.

BACKGROUND: Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. METHODS: Twentyeight patients in age group 18-50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005-February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. RESULTS: All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. CONCLUSION: Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.