Chevron osteotomy of the olecranon during the posterior approach of the elbow joint has become universally common. We modified the technique to see if it is better than the standard technique to perform, reconstruct and finally evaluate the results. A prospective study was done in 17 cases of comminuted distal humeral intercondylar fractures. A modified osteotomy was done using a Gigli saw instead of a power saw. The indications remained the same. After fixing the distal humerus fracture, the olecranon fragment was stabilised with tension band wire technique. The post-operative management was similar to that of standard AO technique. There were no per-operative difficulties with the new technique. The osteotomy was easy to do with no risk of damage to the distal humeral cartilage, as the direction of the osteotomy was away from the joint. Gigli saw produced congruent antero-posterior chevron surfaces which helped the fragment to sit well in its trough with good bony apposition. Stable reduction of the olecranon facilitated easy fixation. In this series, all osteotomies united well. There were no osteotomy-related complications. Two cases had prominent wires which were removed after the union of the osteotomy. We feel that this osteotomy is easy to perform, safe and takes less time than the standard technique, though a comparative study in a large number of cases by different surgeons needs to confirm the benefits.In this article we describe a modification of the open Latarjet technique, using sutures and cortical buttons, for the fixation of the coracoid. https://www.selleckchem.com/products/avitinib-ac0010.html The transfer of the coracoid to the anterior glenoid is a popular technique used for complex shoulder instability. The technique is proven to be effective with consistently good results but complications have been reported related to the screws used for the fixation of the coracoid. Recent studies confirm that the suture-button technique for the fixation of the coracoid is biomechanically comparable to the screw fixation. The proposed technique combines the advantages of the open approach and avoids the use of metal screws, potentially minimizing hardware-related complications.Most metatarsal neck fractures can be successfully treated non-operatively in a cast boot. Displaced metatarsal neck fractures tend to be less stable and have a propensity for the distal fragment to angulate, secondary to the strong flexor tendons, which often forces the distal fracture fragment in a plantar direction and leads to relative metatarsal shortening. Most literature is focussed on antegrade fixation of metatarsal neck fractures using pre-**** K wires or thin elastic nails. Apart from the technical challenges, this technique is limited when bones are osteoporotic as the pre-**** distal end of the K-wire may penetrate the plantar cortex of the proximal metatarsal and prevent the wire from entering the medullary canal of the metatarsal and advancing to the fracture site. Furthermore, when the medullary canal is narrow especially in Asian patients, it may be difficult to pass a **** K-wire through the isthmus of the metatarsal shaft. We describe an innovative technique of closed transverse wiring of the metatarsal head necks that has a distinct advantage in Asian population with osteoporotic bones. With percutaneous manipulation using digital pressure, closed reduction of fracture fragments of the most displaced fracture is done under fluoroscopic guidance to achieve a satisfactory alignment followed by closed transverse wiring of the metatarsal heads. With this procedure, adjacent fractures remain stable within an acceptable range because of intermetatarsal ligaments connected to the adjacent intact head. Our technique has a relatively short operating time and allows for early motion of the metatarso-phalangeal joint. This is especially useful for those with osteoporosis, narrow canal, soft tissue compromise, intra-operative failure of ante-grade pinning and in scenarios of limited surgical equipment/expertise.
Surgical antibiotic prophylaxis (SAP) has become the standard of care in orthopaedic surgery. Inappropriate usage of antibiotics (dosage, strength, and/or administration time and duration) can inadvertently result in superadded infections and antimicrobial resistance. The purpose of this study was to document and analyse the prescription patterns for SAP, and to investigate the factors associated with divergence from standard guidelines.

We conducted an online cross-sectional questionnaire-based study to collect information about the SAP practices of the members of the Indian Orthopaedic Association (IOA) using Google forms. A link to the questionnaire was sent by e-mails.

The overall response rate was 5.73%. While 97.3% respondents practised SAP routinely, the practice was not aligned with standard guidelines' recommendations. There was heterogeneity in the use of SAP in terms of choice of antibiotic(s), number of co-prescribed drugs, single- versus multiple-dose regimens, and the duration of therapy. The prescription practice patterns showed that orthopaedic surgeons almost always used broad-spectrum antibiotics for long durations, regardless of the type of surgery.

While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries.
While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries.
To evaluate the role of composite (Chitosan/Chondroitin sulphate/gelatin/nano-bioglass) scaffold in the union of critical size bone defect created in the rabbit's ulna.

The composite (Chitosan/Chondroitin sulphate/gelatin/nano-bioglass) scaffold was fabricated using the freeze-drying technique under standard laboratory conditions. The scaffold was cut into the appropriate size and transferred into the defect created (critical bone size defect 1cm) over the right ulna in the rabbit. The scaffold was not implanted on the left side thus the left side ulna served as control. Results were assessed on serial radiological examination. Rabbits were sacrificed at 20weeks for histopathological examination (Haematoxylin-Eosin staining and Mason's trichrome staining) and scanning electron microscope observation. Radiological scoring was done by Lane and Sandhu's scoring.

Among 12 rabbits, 10 could complete the follow-up. Among those 10 rabbits, 8 among the test group showed good evidence of bone formation at the gap non-union scaffold implanted site.
Chevron osteotomy of the olecranon during the posterior approach of the elbow joint has become universally common. We modified the technique to see if it is better than the standard technique to perform, reconstruct and finally evaluate the results. A prospective study was done in 17 cases of comminuted distal humeral intercondylar fractures. A modified osteotomy was done using a Gigli saw instead of a power saw. The indications remained the same. After fixing the distal humerus fracture, the olecranon fragment was stabilised with tension band wire technique. The post-operative management was similar to that of standard AO technique. There were no per-operative difficulties with the new technique. The osteotomy was easy to do with no risk of damage to the distal humeral cartilage, as the direction of the osteotomy was away from the joint. Gigli saw produced congruent antero-posterior chevron surfaces which helped the fragment to sit well in its trough with good bony apposition. Stable reduction of the olecranon facilitated easy fixation. In this series, all osteotomies united well. There were no osteotomy-related complications. Two cases had prominent wires which were removed after the union of the osteotomy. We feel that this osteotomy is easy to perform, safe and takes less time than the standard technique, though a comparative study in a large number of cases by different surgeons needs to confirm the benefits.In this article we describe a modification of the open Latarjet technique, using sutures and cortical buttons, for the fixation of the coracoid. https://www.selleckchem.com/products/avitinib-ac0010.html The transfer of the coracoid to the anterior glenoid is a popular technique used for complex shoulder instability. The technique is proven to be effective with consistently good results but complications have been reported related to the screws used for the fixation of the coracoid. Recent studies confirm that the suture-button technique for the fixation of the coracoid is biomechanically comparable to the screw fixation. The proposed technique combines the advantages of the open approach and avoids the use of metal screws, potentially minimizing hardware-related complications.Most metatarsal neck fractures can be successfully treated non-operatively in a cast boot. Displaced metatarsal neck fractures tend to be less stable and have a propensity for the distal fragment to angulate, secondary to the strong flexor tendons, which often forces the distal fracture fragment in a plantar direction and leads to relative metatarsal shortening. Most literature is focussed on antegrade fixation of metatarsal neck fractures using pre-bent K wires or thin elastic nails. Apart from the technical challenges, this technique is limited when bones are osteoporotic as the pre-bent distal end of the K-wire may penetrate the plantar cortex of the proximal metatarsal and prevent the wire from entering the medullary canal of the metatarsal and advancing to the fracture site. Furthermore, when the medullary canal is narrow especially in Asian patients, it may be difficult to pass a bent K-wire through the isthmus of the metatarsal shaft. We describe an innovative technique of closed transverse wiring of the metatarsal head necks that has a distinct advantage in Asian population with osteoporotic bones. With percutaneous manipulation using digital pressure, closed reduction of fracture fragments of the most displaced fracture is done under fluoroscopic guidance to achieve a satisfactory alignment followed by closed transverse wiring of the metatarsal heads. With this procedure, adjacent fractures remain stable within an acceptable range because of intermetatarsal ligaments connected to the adjacent intact head. Our technique has a relatively short operating time and allows for early motion of the metatarso-phalangeal joint. This is especially useful for those with osteoporosis, narrow canal, soft tissue compromise, intra-operative failure of ante-grade pinning and in scenarios of limited surgical equipment/expertise. Surgical antibiotic prophylaxis (SAP) has become the standard of care in orthopaedic surgery. Inappropriate usage of antibiotics (dosage, strength, and/or administration time and duration) can inadvertently result in superadded infections and antimicrobial resistance. The purpose of this study was to document and analyse the prescription patterns for SAP, and to investigate the factors associated with divergence from standard guidelines. We conducted an online cross-sectional questionnaire-based study to collect information about the SAP practices of the members of the Indian Orthopaedic Association (IOA) using Google forms. A link to the questionnaire was sent by e-mails. The overall response rate was 5.73%. While 97.3% respondents practised SAP routinely, the practice was not aligned with standard guidelines' recommendations. There was heterogeneity in the use of SAP in terms of choice of antibiotic(s), number of co-prescribed drugs, single- versus multiple-dose regimens, and the duration of therapy. The prescription practice patterns showed that orthopaedic surgeons almost always used broad-spectrum antibiotics for long durations, regardless of the type of surgery. While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries. While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries. To evaluate the role of composite (Chitosan/Chondroitin sulphate/gelatin/nano-bioglass) scaffold in the union of critical size bone defect created in the rabbit's ulna. The composite (Chitosan/Chondroitin sulphate/gelatin/nano-bioglass) scaffold was fabricated using the freeze-drying technique under standard laboratory conditions. The scaffold was cut into the appropriate size and transferred into the defect created (critical bone size defect 1cm) over the right ulna in the rabbit. The scaffold was not implanted on the left side thus the left side ulna served as control. Results were assessed on serial radiological examination. Rabbits were sacrificed at 20weeks for histopathological examination (Haematoxylin-Eosin staining and Mason's trichrome staining) and scanning electron microscope observation. Radiological scoring was done by Lane and Sandhu's scoring. Among 12 rabbits, 10 could complete the follow-up. Among those 10 rabbits, 8 among the test group showed good evidence of bone formation at the gap non-union scaffold implanted site.
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