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.

Parosteal Lipoma of the Proximal Phalanx of Hand.

Parosteal lipomas are rare benign tumors accounting for less than 0.1% of all primary bone tumors. Only 3 cases of parosteal lipoma have been previously described affecting the distal and middle phalanges. We describe a case of parosteal lipoma in a 45-year-old man involving the proximal phalanx of the right middle finger. The tumor was marginally excised with the osseous attachment. There was no clinical or radiological recurrence at a follow-up of 2 years, with full range of movement at the proximal interphalangeal joint.

Primary Total Knee Replacement in a Case of Lateral Tibial Condyle Delayed Union with Severe Grade 4 Osteoarthritis Knee - A Case Report.

INTRODUCTION: Tibial plateau fractures are not uncommon. These fractures occur in bimodal age distribution consisting of 8% of all geriatric fractures. They usually occur as a result of low-energy trauma in the elderly. The management options include closed/open reduction and internal fixation (ORIF) using screws and plates. The osteosynthetic treatment options cause malreduction, non-union, implant failure in elderly patients due to osteoporosis and this may lead to post-traumatic arthritis, requiring total knee replacement (TKR) as a secondary procedure later. CASE REPORT: A 76-year-old male patient presented with pain and swelling in the left knee with a history of trauma to the left knee. X-ray of the left knee showed the split fracture of the left lateral tibial condyle with severe Grade 4 osteoarthritis. On examination, tenderness was present over the lateral tibial condyle. We managed with cemented primary TKR using stemmed tibial component. Postoperatively, the patient is having good knee range of motion and having no difficulty in walking and weight-bearing. Functional outcome is good as per Oxford knee score. CONCLUSION: Primary TKR is a viable alternative treatment option compared to ORIF in elderly patients with preexisting osteoarthritis with tibial condyle fractures. It helps in early mobilization, weight-bearing and avoids secondary surgical procedures.

Tuberculosis of Calcaneus - A Case Report and Review of Literature.

INTRODUCTION: Osteoarticular tuberculosis (TB) constitutes 1-3 % of cases and about 10% of osteoarticular TB affects the foot and ankle. In foot, TB calcaneus is the most commonly affected bone. CASE REPORT: A 21-year-old male presented with pain, swelling in the right heel for 5 months and difficulty in walking for 2 months. Plain X-ray (axial) view of calcaneus showed a lytic lesion in calcaneus. Biopsy was done under local anaesthesia and histologic examination revealed a characteristic granuloma, caseous necrosis, and Langhans giant cells which confirmed our diagnosis. The patient was treated with anti-TB chemotherapy for 12 months. Radiographs at 18 months follow-up showed a healed lesion. At present, the patient is comfortable with no complaints. DISCUSSION AND CONCLUSION: TB calcaneus is rare condition and a high index of clinical suspicion along with imaging studies helps in diagnosis. Conservative management with anti-TB chemotherapy for adequate duration helps in complete resolution of the infection with good functional results.

Primary hyperparathyroidism with extensive brown tumours and distal humerus fracture-A case report.

INTRODUCTION: A brown tumour is benign bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. In this report, we present a case of 25-year-old woman with multiple swelling and bone pain. Plain radiographs of the affected bones revealed multiple erosive bone tumours, which were diagnosed as brown tumours associated with primary hyperparathyroidism. CASE REPORT: A 25 year old female presented with swelling in left elbow since 1 month along with multiple swelling in body. Patient had pain in left elbow after trivial fall. X-ray showed lytic lesion of left elbow with pathological fracture. Biopsy was suggestive of brown tumour of distal humerus. DISCUSSION: We managed this case with reconstruction of defect with fibula grafting and plating. CONCLUSION: Pathological fracture in young adult should always be properly investigated. A high index of suspicion is necessary to diagnose unusual presentation of Primary Hyperparathyroidism.

Management of Forearm Deformity by Limb Reconstruction System in Children with Multiple Exostosis - A case Report.

INTRODUCTION: Osteochondroma is the group of benign bone tumours, which are composed of spongy bone covered by a cartilaginous cap. Patients with distal ulnar osteochondromas frequently cause forearm deformities with relative ulnar shortening, wrist joint deviation, and varus bowing. Surgical ulnar lengthening is necessary to restore the carpal balance. CASE REPORT: We report the case of multiple exostosis in a 13-year-old male with the right distal ulna osteochondroma with long-standing and progressive ulnar shortening and radial bowing treated with a limb reconstruction system. Our case is Type I Masada managed with excision of distal ulna osteochondroma and gradual ulnar lengthening without osteotomy of the radius. CONCLUSION: Progressive ulna deformity can lead to increasing pain, joint instability, limited motion, and functional decline. For Type I, Masada ulnar lengthening is necessary, but over correction is inadvisable due to possible ulnocarpal impaction syndrome. As significant remodeling effects on the radius were observed, simultaneous radial correction can be delayed.

Ceramic liner fracture in ceramic on ceramic Total hip arthoplasty: A case report.

INTRODUCTION: Revision rates of total hip arthoplasty have decreased after introducing total hip arthroplasty using ceramic component due to reduce wear and osteolysis. CASE REPORT: 29 year old male case of bilateral hip avascular necrosis operated for bilateral hip THA presented 30 months after with complaint of squeaking, x-ray showing left ceramic liner fracture without any history of trauma. Revision of ceramic liner and head with ceramic on polyethylene was done. DISCUSSION AND CONCLUSION: Ceramic on ceramic articulation has the lowest wear rate among various articulations. However, there is a concern about ceramic implant fracture; therefore ceramic with polyethylene bearing could be a good choice.