OrthoTV: Broadcasting Orthopedics around the World.

OrthoTV has emerged as a pioneering platform in the field of orthopedic education, leveraging technology to create a comprehensive and accessible knowledge repository. Originating from the vision of the Indian Orthopedic Research Group in 2013, OrthoTV has evolved into a global educational hub, streaming thousands of hours of surgical videos, webinars, and podcasts. It provides a dynamic learning environment through live interactive sessions, fostering real-time engagement with experts and facilitating a global exchange of knowledge. OrthoTV's expansion during the COVID-19 pandemic underscored its vital role in continuing medical education amidst travel restrictions. The platform extends beyond educational resources to include career support, collaborative research initiatives, and even virtual fellowships, embodying a multifaceted approach to professional development. With the introduction of OrthoAI, OrthoTV integrates advanced artificial intelligence to offer personalized, evidence-based responses to queries, setting a new standard in digital medical education. This narrative review highlights OrthoTV's foundational principles, its significant impact on orthopedic education and practice, and its commitment to democratizing knowledge across the globe. OrthoTV's innovative use of technology bridges geographical barriers enriches learning experiences, and fosters a vibrant community of orthopedic professionals, marking a significant advance in the field of medical education.

Co-existing Ankylosing Spondylitis and Rheumatoid Arthritis in a Patient Undergoing Total Knee Arthroplasty Under Peripheral Nerve Blocks.

Introduction: While laboratory tests and clinical criteria are well-defined, simultaneous presence of concomitant symptoms can lead to a misdiagnosis and delay in initiation of appropriate pharmacotherapy. Similarly, natural joint disease progression may also vary and present with atypical presentations. Case Report: Here we report a case of Ankylosing Spondylitis (AS) with Rheumatoid Arthritis (RA) proven clinically, radiologically, as well as serologically, in whom multiple joint replacement procedures were performed. The association between these two conditions with overlapping features and laboratory markers constitutes an interesting phenomenon and can pose a diagnostic dilemma, thus, increasing the importance of awareness and early diagnosis of this co-existence. We report the case of a 63 year-old gentleman who was a known case of ankylosing spondylitis since the age of 38. The patient had undergone a staged bilateral total hip arthroplasty 18 years ago and presented to us with knee arthritis necessitating Total Knee Arthroplasty. The patient was subsequently diagnosed to have coexisting Rheumatoid Arthritis. After a failed attempt for spinal anaesthesia, a para-sacral sciatic block in the lateral position and an infra-inguinal femoral nerve block and obturator nerve block in the supine position were given under ultrasound guidance. The total knee replacement was performed successfully without any intra-operative complications. Conclusion: This combined entity requires accurate assessment or can be easily misleading. No definite conclusion is possible with regards to the etiopathogenesis of these conditions coexisting but this association with overlapping features and laboratory markers constitutes an interesting phenomenon and can pose a diagnostic dilemma.

Adult Hip Manifestations in Klippel-Trenaunay Syndrome.

Introduction: Klippel-Trenaunay syndrome (KTS) is rare and sporadic disorder. Clinical manifestation of KTS is heterogenous. KTS patients often suffer degenerative joint disease at an early age. Arthroplasty performed in extremities with KTS is challenging due to vascular malformations and increased risk of intraoperative and post-operative complications. Case Report: We report two patients of KTS with varied musculoskeletal manifestations with one patient treated operatively and one patient managed conservatively, both predominantly affecting the hip joint. We present this report due to rarity of presentation and to discuss varied articular manifestations in two patients with KTS. Both patients fulfilled the criteria and were diagnosed to have KTS. The first patient was a 36 year-old woman who presented with left hip pain since 3 years which was progressively worsening. As this patient did not have any vascular malformations around the hip, a left total hip arthroplasty was planned and successfully executed. The second patient was a 42-year-old gentleman who had polyarticular involvement, mainly affecting the hip and knee. Due to the severe presentation of a subluxated hip, vascular malformations, gross knee laxity, and the patient's occupational demands; it was decided to opt for conservative management in this patient. Conclusion: KTS often presents a challenging scenario due to the rarity of the condition, multiple systems involved and varied manifestations from patient to patient which makes it essential to individualize treatment goals based on the severity, functional demands, and associated complications.

Non-Vascularized Fibular Cortical Strut Graft with Intramedullary Nailing for Fibrous Dysplasia of the Proximal Radius - A Case Report.

Introduction: Fibrous dysplasia (FD) is a skeletal developmental abnormality commonly affecting the ribs, femur, tibia, skull, pelvis, spine, and shoulder. FD of the proximal radius is extremely rare and very few cases have been reported. In addition, monostotic lesions of FD in the upper extremity go unnoticed as they are usually asymptomatic. Symptomatic lesions warrant surgical intervention. Here, we present a rare case of FD of the proximal radius treated with curettage and non-vascularized fibular cortical strut graft with intramedullary elastic nailing. We believe that this is the first report in the literature wherein this treatment modality has been undertaken. Case Report: A 27-year-old woman presented with excruciating pain and swelling in her right elbow for 4 weeks, with no inciting event or trauma leading to the pain. Plain radiographs revealed a well-circumscribed radiolucent lesion in the proximal radius with cortical thinning at the metaphysis and a rim of epiphyseal bone. Clinically, the patient had restricted supination (50°) and limited elbow range of motion (ROM) (20-130°), mostly because of the pain but had full pronation. With these radiographic and clinical features, FD and giant cell tumor were kept as differential diagnoses and surgical treatment was planned. The lesion was excised leaving the normal epiphysis of the radius intact and samples were sent for histopathological examination. A non-vascularized fibular cortical strut graft was harvested from the same side and was fluted into the radial shaft. Final stabilization was done using a 2.5 mm intramedullary elastic nail. The arm was immobilized in an above-elbow slab. Histopathology confirmed our diagnosis of FD. The slab was removed after 6 weeks, and a gentle ROM was started in the form of active-assisted ROM. At the end of 1 year, complete union and almost full ROM were achieved and the patient was completely pain-free. Conclusion: Non-vascularized fibular strut grafting with intramedullary nailing provides a comparatively quicker, cost-effective way of treating this lesion with a minimum insult of the bony cortex and quicker rehabilitation.

Robotics in Joint Replacement Surgery.

Today, the total knee replacement (TKR) is considered as one of the most successful orthopedics surgeries. The effective long-term pain relief, deformity correction, and restoration of function that it provides have resulted in a large number of these procedures being performed worldwide. It has been observed that 15-20% of patients are not satisfied even after successful TKR surgery. Various attempts such as careful patient selection, pre-operative education, optimization of patients before the surgery, expeditious and precise surgery, aggressive pain control, early return to home, and rehabilitation have been made to improve outcomes and satisfaction among patients. There are also attempts at designing newer implants and introducing smart technology like navigation and Robotics to improve the precision of surgery. In this letter, we look at the pros and cons of the rapid introduction of Robotics in the practice of total knee arthroplasty.

Chronic Recurrent Osteomyelitis of Ribs Due to Bamboo Stick Injury in an Adult Man: A Case Report.

Introduction: Chronic osteomyelitis of the ribs in adolescents and adults is a rare condition. Current understanding of its diagnosis and management is primarily derived from case reports and small series studies. Here, we present a case of chronic rib osteomyelitis initially managed conservatively with antibiotics, followed by debridement, sequestrectomy, and continued antibiotic therapy. However, due to recurrence, rib excision was ultimately chosen as the definitive management approach. Case Report: A 18-year-old male presents with a discharging sinus from the chest persisting for 6 months, with no history of fever, shivering, or weight loss. He sustained a blunt injury to the chest with a bamboo stick 9 months ago. Initially, the patient was treated with antibiotics, but there was no relief. He was later operated on with debridement, sequestrectomy, and antibiotics. Six weeks later, he again presented to us with a discharging sinus. Due to recurrence, he underwent re-operation with partial resection of the 6th rib. At the 1-year follow-up after rib excision, the patient is doing well, with all blood parameters within the normal range and without any systemic or local complications. Conclusion: Rib osteomyelitis is a rare complication of blunt chest trauma. Surgical management is indicated in cases of persistent infection. Sequestrectomy and antibiotics, though standard procedures in chronic osteomyelitis, may encounter failure due to various factors. Moreover, due to limited literature on chronic osteomyelitis of ribs, the standard approach to its management is not available. Partial excision of the rib with appropriate antibiotics in our case provided complete cure for the patient.

Comparison between effects of instrument-assisted soft tissue mobilization and manual myofascial release on pain, range of motion and function in myofascial pain syndrome of upper trapezius - A randomized controlled trial.

Background: Myofascial pain syndrome (MPS) is a muscle pain disorder characterized by the presence of Myofascial Trigger Point (MTrP) within a taut band, local tenderness, referral of pain to a distant site, restricted range of motion, and autonomic phenomena. The upper trapezius is the muscle most often affected by MTrPs. Manual myofascial release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are techniques of soft tissue release that are used to resolve MPS. Fifty six percent of physiotherapists complain of pain in multiple areas due to the massage and manual therapy that they have to perform. Objective: The objective of this study is to find whether IASTM is better than manual MFR in treating patients with MPS in upper trapezius. Methods: This study was a single-blinded randomized controlled trial that included 31 participants, both males and females between the age groups of 18-50 years. Participants were randomly divided into two groups. Three sessions were given over a period of one week for both groups. Group A received IASTM along with conventional treatment and Group B received Manual MFR along with the conventional treatment. The outcome measures evaluated were pain, cervical range of motion, pain pressure threshold (PPT) of trigger points, and the neck disability index. Pre- and post-measurements were taken and the analysis was done. Results: Both the treatment methods significantly reduced pain, improved PPT, range of motion, and function. The effects between the groups showed that IASTM was significantly better than manual MFR to reduce pain. The improvement in PPT, range of motion and function were equal in both the groups. Conclusion: IASTM and manual MFR both are effective individually as treatment procedures for pain, PPT, range of motion, and function. Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.

Minimally invasive treatment for idiopathic chondrolysis of the hip: analysis of forty-one cases.

PURPOSE: Idiopathic chondrolysis of the hip is characterized by the loss of the articular cartilage of the hip joint with spectrum ranging from full recovery to fibrous ankylosis. Study assessed outcomes following intra-articular steroid injections, joint manipulation and traction immobilization. METHODS: Retrospective (2012-2021) review of 41 cases treated for idiopathic chondrolysis of hip, assessed pre-operatively and post-operatively (minimum 2-year follow-up) using Children's Hospital Oakland Hip Evaluation Score (CHOHES), visual analogue scale (VAS) and range of motion measurements. RESULTS: Twenty-five patients (62%) achieved painless mobility, 6 (14%) had hip stiffness without pain and 10 (24%) had painful and stiff hips at final follow-up. They had a mean age of 12.49 ± 2.4 years and a mean follow-up duration of 33.15 ± 13.1 months. Range of motion improved significantly (p < 0.05). VAS improved to 3.93 ± 1.3 from 7.8 ± 0.7. CHOHES improved from 29.12 ± 9.9 to 56.37 ± 17.6. CONCLUSION: Intra-articular steroid injection, manipulation and traction immobilization may effectively treat idiopathic chondrolysis of the hip by enhancing patient function and reducing the need for further surgical intervention.