EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION.

Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant. Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

Introdução: O fechamento adequado da ferida é um passo importante no manejo da fratura distal do fêmur a fim de evitar infecção e permitir uma rápida reabilitação. Suturas farpadas sem nós podem poupar tempo e distribuir uniformemente a tensão da ferida. Entretanto, seu papel em termos de resultado funcional, tempo de fechamento e complicações pós-operatórias não tem sido analisado em casos de fratura distal do fêmur. Material e métodos: Um total de 47 pacientes com mais de 18 anos de idade com fratura distal do fêmur tratados com placa de fixação distal do fêmur foram aleatorizados em grupos de sutura farpada ou tradicional. No grupo de farpados, o fechamento da ferida capsular foi feito com suturas sem nós farpados bidirecionais 2-0 (Quill SRS® PDO, Angiotech, Vancouver, BC, Canadá). Em pacientes designados para o grupo B, o fechamento capsular foi feito com Vicryl®1-0 (Ethicon inc. Somerville, NJ) e Ethibond® 5-0 respectivamente. Resultados: A flexão média na articulação do joelho foi de 105,7±15,6 graus no grupo de estudo e 110,4±13,7 no grupo controle (p= 0,2133). O tempo médio estimado de fechamento foi significativamente menor no grupo de estudo em comparação com o grupo controle (p<0,05). Os casos de ferimento por perfuração da agulha foram maiores no grupo de sutura tradicional. Os pacientes desenvolveram abscesso de pontos e infecção superficial em ambos os grupos. Entretanto, a diferença na incidência entre os dois não foi estatisticamente significative. Conclusão: A sutura farpada é um método eficiente para o fechamento de feridas. Ele reduz o tempo de fechamento das feridas com uma taxa de complicação semelhante à utilização de suturas convencionais. Evidência Nível II; Ensaio Clínico Randomizado.

Efficacy and safety of knotless barbed sutures in capsular closure following distal femur fracture fixation / Eficácia e segurança das suturas farpadas sem nós no fechamento capsular após fixação de fratura distal do fêmur

ABSTRACT Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

RESUMO Introdução: O fechamento adequado da ferida é um passo importante no manejo da fratura distal do fêmur a fim de evitar infecção e permitir uma rápida reabilitação. Suturas farpadas sem nós podem poupar tempo e distribuir uniformemente a tensão da ferida. Entretanto, seu papel em termos de resultado funcional, tempo de fechamento e complicações pós-operatórias não tem sido analisado em casos de fratura distal do fêmur. Material e métodos: Um total de 47 pacientes com mais de 18 anos de idade com fratura distal do fêmur tratados com placa de fixação distal do fêmur foram aleatorizados em grupos de sutura farpada ou tradicional. No grupo de farpados, o fechamento da ferida capsular foi feito com suturas sem nós farpados bidirecionais 2-0 (Quill SRS® PDO, Angiotech, Vancouver, BC, Canadá). Em pacientes designados para o grupo B, o fechamento capsular foi feito com Vicryl®1-0 (Ethicon inc. Somerville, NJ) e Ethibond® 5-0 respectivamente. Resultados: A flexão média na articulação do joelho foi de 105,7±15,6 graus no grupo de estudo e 110,4±13,7 no grupo controle (p= 0,2133). O tempo médio estimado de fechamento foi significativamente menor no grupo de estudo em comparação com o grupo controle (p<0,05). Os casos de ferimento por perfuração da agulha foram maiores no grupo de sutura tradicional. Os pacientes desenvolveram abscesso de pontos e infecção superficial em ambos os grupos. Entretanto, a diferença na incidência entre os dois não foi estatisticamente significative Conclusão: A sutura farpada é um método eficiente para o fechamento de feridas. Ele reduz o tempo de fechamento das feridas com uma taxa de complicação semelhante à utilização de suturas convencionais. Evidência Nível II; Ensaio Clínico Randomizado.

Validation and Cross-Cultural Adaptation of the Hindi Version of the Oxford Knee Score in Patients With Knee Osteoarthritis.

INTRODUCTION: Cases of knee osteoarthritis are on the rise in India with an increasingly ageing population. A large number among them shall undergo total knee replacement, so there is a requirement for validated patient-reported outcome measures in the Hindi language. Oxford Knee Score (OKS) is one of the most commonly used patient-reported outcome measure scoring systems. The current study was designed to test and validate cross-cultural adaptation and translate the Hindi version of the Oxford Knee Score (OKS-H).  Material and Methods: The OKS-H was formulated as per recommendations for cross-cultural adaptation and translation. The OKS was tested on 162 patients with knee osteoarthritis who underwent a total knee replacement. Reliability of the OKS-H was tested using the intraclass correlation coefficient (ICC) and internal consistency was assessed using Cronbach's alpha. The construct validity was assessed using OKS-H, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form Survey (SF-36) questionnaire.  Results: The translation was performed with no major difficulty. The OKS was completed by 158 (97.5%) and 157 (96.9%) patients at test and retest, respectively, after one week. With an ICC of 0.87, OKS had shown good reliability. The construct validity obtained against the WOMAC and SF-36 scores was strong (ICC between 0.49 to 0.86). CONCLUSION: The translated OKS-H is a reliable and valid instrument for patient-reported outcome measures in cases of knee osteoarthritis opting for total knee arthroplasty.

Comparison Between Vancomycin and Gentamicin for Intraoperative Presoaking of Hamstring Graft in Primary Anterior Cruciate Ligament Reconstruction.

Introduction Postoperative infection is an uncommon complication with grave consequences following anterior cruciate ligament reconstruction (ACLR). Presoaking of the hamstring graft with antibiotics results in a lower rate of infection. The purpose of the current study was to compare the efficacy of two commonly used antibiotics, vancomycin and gentamicin, in reducing infection rates following anterior cruciate ligament reconstruction. Methods The retrospective study included a total of 578 patients who underwent arthroscopic anterior cruciate ligament reconstruction between June 2015 and October 2021. The timeline was categorized as the period between June 2015 to October 2018 (Vancomycin presoaking of hamstring graft) and November 2018 to October 2021 (Gentamicin presoaking of hamstring graft). All patients were examined for the development of infection, causative organism, and treatment received. Patients with intravenous drug abuse, alcoholism, steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Fisher's exact test was used for comparison of categorical data, and Poisson regression analysis was carried out to calculate incidence rate ratios after adjusting for confounding variables. Results Presoaking of hamstring grafts with vancomycin was carried out in 224 patients, and gentamicin was used in 354 patients. In total, three patients in the vancomycin and four patients in the gentamicin groups developed an intraarticular infection, and the difference in infection rate between the two groups was not statistically significant (p=0.919). Coagulase-negative Staphylococcus aureus was isolated in four cases, Enterobacter cloacae in one, and no organism was seen in two cases. The groups were comparable in terms of age (p=0.563), smoking (p=0.84), sex (p=0.359), and operative time (p=0.09). Conclusion Presoaking of hamstring autografts with gentamicin intraoperatively is a good alternative to vancomycin in the prevention of infection following arthroscopic anterior cruciate ligament reconstruction.

Data on the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians.

Grade II furcation defect has a great potential for regeneration. Attempts have been made to regenerate lost periodontium in furcation defects through variety of approaches. A total of 22 patients with Grade II furcation defect were examined. The patients were sequentially grouped into three groups namely, (Group A) subepithelial connective tissue graft as a barrier membrane, (Group B) bovine bone graft material Bio-OssTM and (Group C) with the combination of the two. The treatment modalities show that there was a strong improvement in the resolution of the grade II furcation defects. The reduction in horizontal furcation defect measurement was 20.63% for group A. The change was found to be moderate (p=0.023*). The % change is 20.97% for group B and it is statistically significance (p = 0.001**). The % change was 20.78% in Group C with a good statistical significance (p=0.003**). Complete obliteration of the defect clinically and radio-graphically was observed for grade II furcation defect. Thus, the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians is documented in this report.

Data on inter-locking nail in humeral shaft fractures among Indian patients.

Humeral shaft fractures are commonly seen orthopaedics injuries. Open reduction with internal fixation (ORIF) with plating is a gold standard procedure despite various issues such as infection, radial nerve palsy and no-nunion. Close reduction with interlocking nails (ILN) is not a very popular procedure. Therefore, it is of interest to collect data on the significance of interlocking nail in different pattern of humerus shaft fracture. 30 patients with closed humeral shaft fracture participated in this study. The fractures were classified according to their descriptive location as proximal, middle and distal. All surgeries were performed by a single surgeon familiar with the ILN procedure. All patients had appropriate clinical, radiological and pre and postoperative assessment. Data on patients were collected at 2, 6weeks, 12weeks, 18 weeks and 6 months. 19 cases with middle third and distal third fractures were united within 10-14 weeks. 6 cases of proximal shaft fracture were united in 14-18 weeks. According to Rodri ´guez-Merchant criteria - Middle shaft fracture has shown good results (n=9, 75%) followed by distal third shaft fracture (n=6, 60%) and proximal third fracture (n=1, 12.5%). Though there is decrease in mean ASES score in all three groups of fractures but the Mid shaft fracture has shown significant decline in ASES score suggesting improvement in pain and ROM after 6 months. Thus, ILN of humerus is a simple and a safe procedure for treating fractures of middle and distal third shaft humerus. However, this study does not support ILN for the management of proximal third humerus fracture.

Known data on applied regenerative medicine in tendon healing.

Tendons and ligaments are important structures in the musculoskeletal system. Ligaments connect various bones and provide stability in complex movements of joints in the knee. Tendon is made of dense connective tissue and transmits the force of contraction from muscle to bone. They are injured due to direct trauma in sports or roadside accidents. Tendon healing after repair is often poor due to the formation of fibro vascular scar tissues with low mechanical property. Regenerative techniques such as PRP (platelet-rich plasma), stem cells, scaffolds, gene therapy, cell sheets, and scaffolds help augment repair and regenerate tissue in this context. Therefore, it is of interest to document known data (repair process, tissue regeneration, mechanical strength, and clinical outcome) on applied regenerative medicine in tendon healing.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

OBJECTIVE: Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure. MATERIAL AND METHODS: We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria. RESULT: Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient. CONCLUSION: Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Linking periodontal disease with obesity and blood glucose.

It is of interest to evaluate the association of obesity and blood glucose level with periodontitis. Patients (150 with age range 26-68 years) were included based on WHO obesity criteria, undiagnosed for periodontitis, with Body Mass Index (BMI) ≥ 30 and systemically healthy. These patients underwent periodontal examination followed by blood analysis for lipid profile and blood sugar level. The periodontal status was determined using parameters such as Plaque index (PI), gingival index (GI), Probing depth (PPD) and Clinical attachment loss (CAL). 103 (68.7%) patients had >190 of triglyceride values. Data shows that periodontitis has no statistical significance with total cholesterol, HDL, LDL and moderate significance with VLDL, triglycerides. Glycemic control of the patients is assessed using postprandial blood sugar (PPBS) and Fasting Blood Sugar (FBS). Data shows that 129(86.6%) had FBS (mg/dl) <100 and 21 (14.0%) had FBS (mg/dl) >100. So the number of patients with FBS (mg/dl) < 100 were more i.e., 129 (86.6%). The PPBS values were in 136 (90.7%) had PPBS (mg/dl) <140 and only 14(9.3%) had PPBS (mg/dl) >140 group of patients were said have glucose intolerance. Thus, there is no change in lipid profile with established periodontitis in obese individuals. However, altered glycemic control is observed.

Corona Virus (COVID-19) and its Impact on Health Care Workers.

Pandemics always come up with various life-threatening issues. COVID-19 outbreak came up with the same issues along with certain other problems involving public, administrative and healthcare sector concerns. It resembled the SARS outbreak but posed such challenges against the world that are uneasy to handle. The disease which started from Wuhan, China has now affected almost every country in a ruthless manner. Healthcare workers are working day and night just to protect the citizens despite being at high-risk exposure and they are being aimed by the virus due to shortage of Personal Protection Equipment kits. Not only this, but they are being brutally harassed by the patients themselves. Social, economic, psychiatric and many other factors are responsible for deteriorating the health of these frontline healthcare workers who are now being allegedly regarded as "Healthcare Warriors".

Corona virus (Covid-19) - ITS implications in pediatric orthopedic care.

The recent spread of severe acute respiratory syndrome coronavirus (SARS-CoV2) and its associated coronavirus disease has gripped the entire international community and has caused widespread public health concerns due to the unavailability of treatment to this deadly disease. The COVID -19 has affected healthcare workers badly in the world with front line health care providers has a mortality rate of 1.4%. But in countries like Italy, it has gone up to 9%. To this date, there are no universal guidelines for musculoskeletal (MSK) care in the face of the coronavirus pandemic. Health care professionals, including orthopedic surgeons may encounter patients with suspected or confirmed COVID -19 infections and will have to act diligently not only to provide care but at the same time to prevent the spread of infection. During the lockdown period in INDIA we collected data of patients who came to an emergency in our hospital. Out of 81 patients, 40 patients were of pediatric trauma with a percentage of 49% making it highly significant. Thus, in this article, we tried to summarize current recommendations and our institutional guidelines for diagnosing and managing a pediatric orthopedic patient in the COVID-19 pandemic.

Outcome of rail fixator system in reconstructing bone gap.

BACKGROUND: Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps. MATERIALS AND METHODS: 20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator. RESULT: We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score. CONCLUSION: All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.

Efficient waveguide-coupling of metal-clad nanolaser cavities.

Many remarkable semiconductor-based nanolaser cavities using metal have been reported in past few years. However, the efficient coupling of these small cavities to waveguides still remains a large challenge. Here, we show highly efficient coupling of a semiconductor-based metal-clad nanolaser cavity operating in the fundamental dielectric cavity mode to a silicon-on-insulator waveguide. By engineering the effective refractive index and the field distribution of the cavity mode, a coupling efficiency as high as 78% can be achieved for a metal-clad nanolaser with a modal volume of 0.28 (λ/n)³ while maintaining a high optical quality factor of > 600.

Plasmonic crystal defect nanolaser.

Surface plasmons are widely interesting due to their ability to probe nanoscale dimensions. To create coherent plasmons, we demonstrate a nanolaser based on a plasmonic bandgap defect state inside a surface plasmonic crystal. A one-dimensional semiconductor-based plasmonic crystal is engineered to have stopbands in which surface plasmons are prohibited from travelling in the crystalline structure. We then confine surface plasmons using a three-hole defect in the periodic structure. Using conventional III-V semiconductors, we achieve lasing in mode volumes as small as V(eff) = 0.3(λ0/n)³ at λ0 = 1342 nm, which is 10 times smaller than similar modes in photonic crystals of the same size. This demonstration should pave the way for achieving engineered nanolasers with deep-subwavelength mode volumes and attractive nanophotonics integration capabilities while enabling the use of plasmonic crystals as an attractive platform for designing plasmons.

Radiation engineering of optical antennas for maximum field enhancement.

Optical antennas have generated much interest in recent years due to their ability to focus optical energy beyond the diffraction limit, benefiting a broad range of applications such as sensitive photodetection, magnetic storage, and surface-enhanced Raman spectroscopy. To achieve the maximum field enhancement for an optical antenna, parameters such as the antenna dimensions, loading conditions, and coupling efficiency have been previously studied. Here, we present a framework, based on coupled-mode theory, to achieve maximum field enhancement in optical antennas through optimization of optical antennas' radiation characteristics. We demonstrate that the optimum condition is achieved when the radiation quality factor (Q(rad)) of optical antennas is matched to their absorption quality factor (Q(abs)). We achieve this condition experimentally by fabricating the optical antennas on a dielectric (SiO(2)) coated ground plane (metal substrate) and controlling the antenna radiation through optimizing the dielectric thickness. The dielectric thickness at which the matching condition occurs is approximately half of the quarter-wavelength thickness, typically used to achieve constructive interference, and leads to ∼20% higher field enhancement relative to a quarter-wavelength thick dielectric layer.

Subwavelength metal-optic semiconductor nanopatch lasers.

We report on near infrared semiconductor nanopatch lasers with subwavelength-scale physical dimensions (0.019 cubic wavelengths) and effective mode volumes (0.0017 cubic wavelengths). We observe lasing in the two most fundamental optical modes which resemble oscillating electrical and magnetic dipoles. The ultra-small laser volume is achieved with the presence of nanoscale metal patches which suppress electromagnetic radiation into free-space and convert a leaky cavity into a highly-confined subwavelength optical resonator. Such ultra-small lasers with metallodielectric cavities will enable broad applications in data storage, biological sensing, and on-chip optical communication.

Enhanced modulation bandwidth of nanocavity light emitting devices.

We show that the direct modulation bandwidth of nano-cavity light emitting devices (nLEDs) can greatly exceed that of any laser. By performing a detailed analysis, we show that the modulation bandwidth can be increased by the Purcell effect, but that this enhancement occurs only when the device is biased below the lasing threshold. The maximum bandwidth is shown to be inversely proportional to the square root of the modal volume, with sub-wavelength cavities necessary to exceed conventional laser speeds.