The Effect of Timing of Debridement and Surgical Intervention in Open Fractures on the Rate of Infection and Surgical Outcomes: A Prospective Study in a Tertiary Care Setup.

Introduction Open fractures remain one of the true orthopedic emergencies. Despite recent advances in orthopedic surgery, the management of compound fractures is still a challenge to an orthopedic surgeon. Open fractures are a result of high-speed injuries and are associated with several complications such as infections, non-unions, or sometimes an eventual amputation. Infection is the major problem associated with open fractures due to soft tissue damage, contamination, and neurovascular compromise. Presently, management of open fractures requires early aggressive debridement followed by limb salvage by definitive reconstruction or amputation, depending upon the extent and location of the injury. Early aggressive debridement of open fractures has always been the rule. However, it has been observed that open fractures managed even after six hours of injury fare well, and there are no definite guidelines available to decide the safe period of debridement following open fractures so as to prevent infection. The "six-hour rule" is a hotly debated topic with fervent perseverance of this dogma despite a gross lack of support from the literature. Objective The objective of this study was to analyze the relationship between the timing of operation/debridement on infection rates in open fractures, particularly if surgery is performed after six hours. Methods This is a prospective study of 124 patients (R=5-75 years) presenting with open fractures to the outpatient department (OPD) and emergency section of a tertiary care hospital from January 2019 to November 2020. Patients were divided into four groups based on the time to operation/debridement: groups A, B, C, and D, with patients operated within six hours, six to 12 hours, 12-24 hours, and 24-72 hours after injury, respectively. Infection rates were obtained based on the above data. ANOVA was applied using SPSS 20 software (IBM Inc., Armonk, New York). Results This study concludes that the infection rate for fractures treated in less than six hours was 18.75%; in the six to 12 hours group, it was 18.50%, and in the 12-24 hours group, it was 14.28%. The infection rate increased to 38.8% if surgery was performed after 24 hours of injury. On statistical analysis, the time to debridement was not found to be a significant factor. The infection rate in Gustilo-Anderson classification compound grade I was 2.7%, grade II 9.8%, grade IIIA 45%, and grade IIIB 61%. Also, in this study, the union rate in grade I was 97.22%, grade II 96.07%, grade IIIA 85%, and grade IIIB 66.66%. Thus, the degree of wound contamination and compounding gives a prognostic indication regarding the final outcome of the compound fracture. Conclusion Time to debridement is not a significant factor in the management of compound fractures, and these fractures can be safely debrided up to 24 hours after injury. Gustilo and Anderson's classification provides a prognostic indicator of the outcome of a compound fracture. Infection rates and non-union rates increase with increasing grades of compound fractures.

Nonunion of an Isolated Medial Condyle of a Femur Hoffa Fracture in a 21-Year-Old Male: A Case Report.

Isolated Hoffa fractures of the femur are often missed on initial radiographic evaluations. Routine CT scans for intraarticular fractures in suburban populations are not routinely done. Nonunion of medial condyle Hoffa fracture of the distal femur is a rare finding and presents late with pain in weight-bearing and painful flexion. This is a case report of a 21-year-old male who sustained trauma as a result of a motorcycle-car collision and was managed elsewhere conservatively on an above-knee slab. He presented after five months to our side with a limited range of movement at the knee and pain during ambulation. After radiological work diagnosis of isolated non-union of medal condyle Hoffa fracture of the distal femur was made, the patient was managed by freshening of fracture followed by rigid fixation with cancellous screws and reconstruction plate. At postoperative six weeks, the patient had a painless full range of motion at the knee joint.

Recent advances in sustainable nature-based functional materials for biomedical sensor technologies.

The lightweight, low-density, and low-cost natural polymers like cellulose, chitosan, and silk have good chemical and biodegradable properties due to their individually unique structural and functional elements. However, the mechanical properties of these polymers differ from each other. In this scenario, chitosan lacks good mechanical properties than cellulose and silk. The synthesis of nano natural polymer and reinforcement with suitable chemical compounds as the development of nanocomposite gives them promising multidisciplinary applications. Many kinds of research are already published with innovative bio-derived polymeric functional materials (Bd-PFM) applications. Most research interest is carried out on health concerns. Lots of attention has been paid to biomedical applications of Bd-PFM as biosensors. This review aims to provide a glimpse of the nanostructures Bd-PFM biosensors.

Anatomical Variations in the Posterior Tibial Slope in the North Indian Population: A Hospital-Based Study.

BACKGROUND: The measurement of the posterior tibial slope (PTS) angle is crucial for various knee surgeries such as total knee replacement, high tibial osteotomy, and anterior cruciate ligament reconstruction. This hospital-based study aimed to determine the average PTS angle in the knee joints of the North Indian population and provided valuable data to aid knee surgeries in this region. METHODS: An analysis of 200 plain X-ray films, specifically the true lateral view of both knees in 20-degree flexion, was conducted on participants who exhibited skeletal maturity with no arthritis, tumours, or previous knee surgeries. The PTS measurements were performed manually. The data were analyzed statistically by matching them with variables such as gender, age, laterality, and body mass index (BMI). RESULTS: The study revealed the following findings for the posterior tibial slope in a section of the North Indian population: there was no significant laterality difference (right knee: 12.76±2.35°, left knee: 12.55±2.46°); no notable sexual dimorphism (males: right knee - 12.79±2.65°, left knee - 12.25±2.65°, females: right knee - 12.73±2.11°, left knee - 12.77±2.30°). However, as age advanced, there were significant differences observed (PTS: 14.27±1.28° and 13.84±1.80° in the 18-40 years age group, 11.36±1.76° and 11.31±1.97° in the 41-60 years age group, 10.32±2.82° and 10.56±3.04° in the >60 years age group for the right and left knee, respectively). No significant correlation was found with BMI (PTS: 13.12±3.13° and 12.59±3.14° for BMI <25, 12.88±2.15° and 12.80±2.34° for BMI 25-30, 12.00±2.09° and 11.66±2.99° for BMI >30 in the right and left knee, respectively). CONCLUSIONS: The study demonstrated significant variations in the posterior tibial slope based on age, emphasizing the need for individualized treatment in knee surgeries. The research provided valuable insights into normal PTS values specific to the North Indian population, offering regional data to inform knee surgery procedures.

Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction.

Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects of intra-articular corticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.

A Comparative Study of the Modified Baumann's Angle Between the Dominant and Non-Dominant Sides in a North Indian Pediatric Population.

Background The literature points towards the fact that paediatric elbow fractures happen more frequently and have greater variability when contrasted with adults. Between 65%-75% of pediatric fractures involve the upper extremity, and supracondylar humerus is the most common of them all. To know the exact site of injury and to estimate the degree of reduction after manipulation, the modified Baumann's angle, the Baumann's angle, the Humero-condylar angle, the Anterior humeral line, and the Radio-capitellar line are the parameters most commonly used. This study was carried out to compare the modified Baumann's angle between both upper limbs in the paediatric population. Methodology This cross-sectional study was conducted in a tertiary health care centre in Northern India for one year from September 1, 2021, to August 31, 2022. We included pediatric patients in the age group of 3-16 years. Age, sex, weight, height, BMI, secondary sexual characters, and handedness were noted in all the children enrolled in our study. In both the dominant and non-dominant sides, the mean arm length, the forearm length, the inter-epicondylar distance, the clinical carrying angle, the radiological carrying angle, and the modified Baumann's angle were calculated.  Results A total of 113 children were enrolled in the study. The majority of children (71.7%) had dominance on the right side. In both the dominant side and non-dominant side, mean arm length, forearm length, inter-epicondylar distance, clinical carrying angle, radiological carrying angle, and modified Baumann's angle values were calculated. On evaluating the data statistically, a significant difference between the two sides was observed for all the parameters (p<0.05), except forearm length (p-value -0.954). Multivariate analysis showed that only BMI was significantly negatively associated with modified Baumann's angle (p=0.016), and only age (0.019) and BMI (<0.001) were found to be significantly associated with the difference in modified Baumann's angle. Conclusions The findings of this study will be helpful in the management of elbow disorders and their reconstruction following trauma. A significant difference was found in the modified Baumann's angle between dominant and non-dominant sides, and it also showed a negative significant correlation with arm length, forearm length, and the presence of secondary sexual characteristics. The equations derived in this study will be helpful in the simple derivation of the modified Baumann's angle and its difference from simple measurements of the upper limb parameters.

Application of tele-ophthalmology in remote diagnosis and management of adnexal and orbital diseases.

PURPOSE: To assess the feasibility of making a diagnosis of adnexal and orbital diseases by Tele-ophthalmological means. MATERIALS AND METHODS: Tele-consultation for eye diseases was done for 3497 patients from remote areas of Tamilnadu as part of the rural tele-ophthalmology project of a tertiary eye care hospital during a period of nine months from October 2004 to June 2005. These patients were comprehensively examined on-site by optometrists. Using digitized images sent by store and forward technique and videoconferencing, the ophthalmologist made a diagnosis and advised treatment. RESULTS: Adnexal or orbital diseases were detected in 101 out of 3497 patients (2.88%). Medical treatment was advised to 13 of 101 patients (12.8%). Surgery was advised in 62 of 101 patients (61.28%) whereas 18 of 101 patients (17.8%) required further investigations at a tertiary center. CONCLUSION: It was feasible to apply the satellite based tele-ophthalmology set-up for making a presumptive diagnosis and planning further management of adnexal and orbital diseases based on live interaction and digital still images of the patients.

Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses.

AIM: To study the indications, technique and diagnostic utility of helical computed tomographic dacryocystography (CTDCG). MATERIALS AND METHODS: Retrospective analysis of 13 patients who underwent CTDCG with subsequent surgical intervention, during the period January 2003 to December 2005, was done. Axial plain computed tomography (CT) scan was performed, followed by administration of water-soluble contrast in the conjunctival cul de sac or by cannulation of the lacrimal passages. Thin-slice helical CT with two-dimensional (2D) and three-dimensional (3D) coronal and sagittal reformation was done. RESULTS: Four patients were males and 9 were females. Age range was 5 to 62 years. Seven patients presented with watering and 6 patients with a medial canthal mass. Three patients had history of trauma. CTDCG was performed by instillation technique in 10 patients and by cannulation in 3 patients. CTDCG showed mass lesion displacing the sac in 5 cases, nasolacrimal duct obstruction in 6 cases and mucocele in 2 cases. Based on the findings on CTDCG, 5 patients underwent mass excision, 7 underwent dacryocystorhinostomy and 1 patient underwent primary silicone tube intubation. CONCLUSION: Helical CTDCG is a safe and useful diagnostic tool for the lacrimal surgeon. Instillation technique is a physiological and convenient method, and cannulation is needed only in cases where adequate visualization is not achieved.

Adult onset Langerhans cell histiocytosis of the orbit--a case report.

PURPOSE: To report an interesting case of adult onset Langerhans cell histiocytosis in a 41-year-old male with clinicopathological correlation. DESIGN: Interventional case report. MATERIALS AND METHODS: A 41-year-old male presented with an ill-defined mass occupying the temporal quadrant of the left orbit. Computerized tomography revealed an ill-defined extraconal mass involving the superolateral aspect of the left orbit with areas of osteolysis involving the lateral and superior orbital walls. The mass excised at orbitotomy showed microscopic features consistent with Langerhans cell histiocytosis. Immunohistochemistry with CD-68 macrophage marker and S-100 was positive, confirming the diagnosis. Treatment included oral steroids and radiotherapy. At 6 months follow-up, he developed a punched-out lytic lesion in the left parietal calvarium. He again received external beam radiotherapy. At 14 months follow-up, he is doing well with no recurrences. CONCLUSIONS: Adult onset Langerhans cell histiocytosis, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient.