A surge in neglected shoulder dislocations and delayed surgical management due to the coronavirus disease 2019 lockdown in India

Dipit Sahu,Arun Gupta,Samarjit S. Bansal 대한견주관절의학회 2021 대한견주관절의학회지 Vol.24 No.4

Four patients with shoulder problems that were traumatic in etiology presented to us with delays in seeking care ranging from 6 to 12 weeks due to the coronavirus disease 2019 (COVID-19) lockdown. The care of three cases (a 3-month-old neglected anterior shoulder dislocation with a greater tuberosity fracture in a 30-year old man, a 3-month-old neglected anterior shoulder dislocation in a 17-year old boy, and a 2-month-old neglected greater tuberosity fracture in a 31-year old man) was delayed due to the lockdown and the ensuing travel restrictions, while that of one case (a 6-week-old fracture–dislocation of the proximal humerus in a 55-year-old woman) was delayed because the patient was undergoing treatment for COVID-19 at the time of injury. This report intends to present the exceptional circumstances around these cases. The unique treatment challenges and their outcomes are also described to advise the surgeons of the nuances and difficulties in treating these injuries.

Telehealth for consultation and shoulder rehabilitation: a preliminary study on the perspectives of 30 patients during the COVID-19 lockdown

Dipit Sahu,Vaibhavi Rathod,Ashish Phadnis,Samarjit S. Bansal 대한견주관절의학회 2021 대한견주관절의학회지 Vol.24 No.3

Background: This study aimed to determine: the perspectives of the patient cohort that underwent telehealth consultation and shoulder rehabilitation during coronavirus disease 2019 (COVID-19) and the differences in the patients’ perspectives with the two different telehealth video applications (apps) used in the study. Methods: This is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patients from the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom or WhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtual consultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained from the TUQ were the primary outcome measure. Results: The study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20–77 years). The patients who contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in the study. The average TUQ score was 13.6 (median, 14.5; range, 6–21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than the WhatsApp app (median, 8.5; average, 9.6) (p=0.004). Conclusions: Patients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth apps with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.

Comparative Study of Pinless Navigation System versus Conventional Instrumentation in Total Knee Arthroplasty

Prashant Pawar,Lokesh Naik,Dipit Sahu,Vaibhav Bagaria 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.3

Background: Optimal placement of the components and achieving a neutral mechanical axis are the main goals of total knee arthroplasty (TKA). Different computerised navigation systems are presently used for these purposes. This aim of this study was to compare the pinless navigation (PNA) TKA performed using iAssist with the conventional instrumented (CIN) TKA in terms of functional and radiological outcomes. Methods: A total of 100 knees operated for TKA by a single surgeon were studied retrospectively for a period of 2 years. Weightbearing postoperative radiographs of the knees along with scanograms of the lower limbs were used for measurements of component positioning, mechanical axis alignment, and number of outliers. Oxford knee scoring was used for functional analysis. Results: No statistically significant difference was seen in the mean mechanical axis alignment (hip-knee-ankle angle), coronal alignment (α and β angles) and sagittal alignment (γ and δ angles) of the femoral and tibial components between the two groups. Though the percentage of outliers for mechanical axis alignment was lower in the PNA-TKA group than in the CIN-TKA group, the difference was not statistically significant (p = 0.73). The number of outliers for the femoral and tibial component positioning in coronal and sagittal planes was not statistically significantly different between the two groups. No statistically significant difference (p = 0.68) was noted between the two groups with respect to the Oxford Knee Score. The mean surgical time was greater in the PNA-TKA group by 11 minutes, which was statistically significantly longer (p = 0.018). Complications were seen in 6.89% of the cases in the CIN-TKA group, while none in the PNA-TKA group. Conclusions: The accurate mechanical axis alignment and component positioning can be achieved with the conventional instrumentation, so the use of PNA system, which adds to the surgical cost, is questionable. Also, equally good short-term functional outcome can be achieved with the conventional instrumentation. The surgeon must be accustomed with the instrumentation of the PNA system, or it adds to the surgical time.

Complication Rate and Pitfalls of Temporary Bridging External Fixator in Periarticular Communited Fractures

오종건,Jin-Ho Hwang,Dipit Sahu,Seung-Hyub Jun 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.1

Background: A second staged operation using temporary bridging external fi xation (TBEF) has been widely used in patients withperiarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was toreport the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions. Methods: Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectivelycollected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactoryrestoration of length, 2) cases with deep infection caused by half pins invading the zone of defi nitive fi xation, and 3) neurovascularinjuries related to half pins. Results: Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in onecase of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femurfracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications,four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deformingforce and infection might be increased due to frequent irritation by the half pins. Conclusions: TBEF is a simple procedure with several advantages. However, complications might be observed if certain principlesare not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in thezone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular,much more caution is needed in the distal femur, which has abundant muscles surrounding it.

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Bagaria Vaibhav,Kulkarni Rajiv V.,Valavi Anisha,Choudhury Himanshu,Dhamangaonkar Anoop,Sahu Dipit 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration.Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas.The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8−14°) and 6° (3.8−11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5−10.5°) and 29° (19−43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal.The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.