47 results on '"S Dhillon"'
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2. Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis
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Babina Rani, Abhijit Paul, Anil Chauhan, Pranita Pradhan, and Mandeep S. Dhillon
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Orthopedics and Sports Medicine - Published
- 2023
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3. Autonomic Denervation Dermatitis: A Relatively Undocumented ‘ADD’itional Complication of Total Knee Replacements and Other Surgeries Around the Knee
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Karan Jindal, Rajesh Kumar Rajnish, Mandeep S Dhillon, Vijay Shetty, and Prasoon Kumar
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Denervation ,medicine.medical_specialty ,business.industry ,Review Article ,Rash ,Surgery ,Saphenous nerve ,Patient satisfaction ,Orthopedic surgery ,Fracture fixation ,medicine ,Orthopedics and Sports Medicine ,Patella ,medicine.symptom ,business ,Complication - Abstract
BACKGROUND: Infrapatellar branch of the saphenous nerve lies subcutaneously and supplies the anterolateral aspect of knee below the patella. It is extremely susceptible to iatrogenic injuries during the surgeries around the knee, mainly total knee replacements (TKRs). Post operatively the patients present with localised area of numbness and in some instances a traumatic eczematous reaction termed autonomous denervation dermatitis (ADD) is witnessed, leading to skin manifestations that range from a simple rash to extensive lesions. METHODOLOGY: A review of literature was conducted with search of relevant articles from Medline (PubMed), Embase, and Scopus which discussed eczematous skin lesions secondary to total knee replacements. Additionally, we noted studies which described these lesions in other surgeries around the knee like arthroscopies and fracture fixations. RESULTS: Eight studies including atleast one case after TKR were reviewed. There was only one cohort study while the remaining included case reports and small case series. There were 69 cases of ADD appearing after TKR. The appearance of the skin lesions was lateral to the incision in 30/34 operated knees and on both sides of the incision in four knees after TKRs. Bilateral lesions were seen in only six patients of TKRs. There was no functional limitation caused by these lesions and they resolved either spontaneously or after using topical steroids. CONCLUSION: ADD is a relatively uncommonly reported complication of TKRs, which can reduce patient satisfaction and increase surgeon apprehension. Although all cases of nerve damage do not manifest as cutaneous lesions, steps to minimise the damage to the nerve intra operatively should be taken. The diagnosis requires a high index of suspicion, and should not be dispelled as a simple allergic reaction without adequate investigations. Patients should be counselled to alleviate unnecessary fear and apprehensions.
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- 2021
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4. The Increased Burden of SARS-CoV-2 Infection in Orthopaedic Trauma Patients: Comparison of Demographics of Both the Waves of the Pandemic—An Indian Tertiary Center Experience
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Siddhartha Sharma, Vishal Kumar, Sameer Aggarwal, Mandeep S Dhillon, Shahnawaz Khan, and Sandeep Patel
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medicine.medical_specialty ,Demographics ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,SARS-CoV-2 infection ,COVID-19 pandemic ,Trauma registry ,Asymptomatic ,Trauma ,Orthopedics ,Orthopedic surgery ,Pandemic ,Emergency medicine ,Health care ,medicine ,Orthopedics and Sports Medicine ,Original Article ,medicine.symptom ,Orthopaedic trauma ,business - Abstract
Background The second wave of SARS-CoV-2 pandemic has posed new challenges in the management of Orthopedic trauma patients due to the overburdened healthcare facilities and we aim to present the differences in demographics between the first wave and the initial part of the second wave. Methodology This study was a retrospective cross-sectional study of our trauma registry from June 19, 2020 to October 13, 2020 (1st study period) and from April 1, 2021 to the first week of May 2021 (2nd study period). We looked into differences in the following three parameters: (1) infection rate among Orthopaedic patients in the first and second study period of SARS-CoV-2 pandemic, (2) infection rate among the Health Care Workers and (3) hospital-acquired SARS-CoV-2 infections in admitted Orthopaedic trauma patients. Results 35 out of 852 patients (4.1%) were positive for SARS-CoV-2 infection in 1st study period as compared to 48 out of 262 patients (18.3%) in the 2nd study period (p
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- 2021
5. Changes in the Management of Clubfoot Cases During COVID-19 Pandemic—A Survey Among Orthopaedic Specialists
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Mandeep S Dhillon, Rujuta Mehta, Nirmal Raj Gopinathan, Prateek Behera, Karthick Rangasamy, and Alaric Aroojis
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Clubfoot ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Tenotomy ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Orthopedics and Sports Medicine ,General anaesthesia ,Congenital talipes equinovarus ,Casting ,030222 orthopedics ,business.industry ,COVID-19 ,030229 sport sciences ,medicine.disease ,Orthopedic surgery ,Physical therapy ,Original Article ,Achilles tenotomy ,business ,Ponseti - Abstract
Purpose The on-going COVID-19 pandemic has curtailed the established practice norms of many ailments including clubfoot. We conducted a survey to study the changes in the clubfoot treatment practices, Achilles tenotomy methods, and the role along with the possible impact of teleconsultation during this pandemic. Methods A web-based survey was conducted using a questionnaire prepared on Google forms. The link for this questionnaire was sent to Indian Orthopaedic specialists with a special interest in clubfoot management via a social messaging platform. Results 127 eligible responses were analysed. Of them, 67% respondents were in practice for more than 10 years. During the study period, 30.7% of doctors did not perform any casting; 66.9% performed casting in 1–5 cases per week and only 2.4% performed casting in more than five cases per week. A statistically significant difference was noted in the number of doctors who performed casting in less than five cases per week and the doctors who performed casting in more than five cases per week, before and during the COVID-19 pandemic. 30.7% of doctors deferred doing Achilles tenotomy during the study period, and among those who performed one, a significant number of them avoided tenotomy under general anaesthesia. Conclusion The COVID-19 pandemic has significantly impacted clubfoot treatment practices during the lockdown period in India. Significant reductions in the number of cases, and a reduction with changes in Achilles tenotomy practices were noted too. However, whether this had any adverse influence on the eventual outcome in these feet is yet to be determined. Electronic supplementary material The online version of this article (10.1007/s43465-020-00277-2) contains supplementary material, which is available to authorized users.
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- 2020
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6. Orthopedic Residency in a Tertiary Care Hospital of India: Positives, Negatives and Perspectives for Change
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Mandeep S Dhillon, Akshay Shetty, Deepak Neradi, Deepak Kumar, Pulak Vatsya, and Aman Hooda
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030222 orthopedics ,medicine.medical_specialty ,Medical education ,Standardization ,business.industry ,International standard ,education ,Mindset ,030229 sport sciences ,03 medical and health sciences ,0302 clinical medicine ,Mentorship ,Work (electrical) ,Orthopedic surgery ,medicine ,Original Article ,Orthopedics and Sports Medicine ,business ,Logbook ,Graduation - Abstract
BACKGROUND: Orthopaedic residency training is a 3-year period of preparation that converts a raw medical student into a proficient orthopaedic surgeon. Due to wide variations at different centers in India, the program in a tertiary hospital is presented, in an attempt to improve the overall levels of training. MATERIALS AND METHODS: PGIMER has produced many good surgeons who are well settled across the country and the world. A survey of the postgraduates of the last 30 years was done to highlight the perceptions about the program. An overview of the program was also added to the narrative to highlight the positive aspects of the training. RESULTS: 132 Orthopaedic passed-out residents from PGIMER could be contacted. 97% of them rated their residency experience as excellent or good, and stated that they would recommend this program to new residents. Key points highlighted by them were the readiness of trainees for any surgical contingency after graduation, continuation of the mindset for research, and their prompt acceptability into their subsequent places of work due to their place of graduation. DISCUSSION: Converting an orthopaedic resident into a competent surgeon involves knowledge upgrades and impartation of skills; these are not limited to the theory of orthopaedics, but involve the thought processes and the planning as a surgeon, the attitude towards patient management, and a continuously inquisitive scientific mind. The shortcomings and strengths of the residency program in PGIMER are discussed; international standard methodology limited to this institute like formal log books, mentorship program, hands-on skill development through courses, etc. is something that is recommended to be mandatory in all residency programs. CONCLUSION: The PGIMER Orthopaedic residency program could act as a basic model for other Indian medical schools, with any appropriate modifications. Standardization of Orthopaedic residency programs could allow upgrading to International levels.
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- 2020
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7. COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons
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Rajesh Malhotra, Swapnil M. Keny, Harvinder Singh Chhabra, Vaibhav Bagaraia, Kalyan Kumar Varma Kalidindi, Mandeep S Dhillon, Abhinandan Reddy Mallepally, and Shanmuganathan Rajasekharan
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medicine.medical_specialty ,Telemedicine ,Best practice ,Review Article ,Orthopaedics ,Guideline ,Disease cluster ,03 medical and health sciences ,0302 clinical medicine ,Surgical procedures ,Health care ,Pandemic ,Medicine ,Infection control ,Orthopedics and Sports Medicine ,030222 orthopedics ,SARS-CoV-2 ,business.industry ,COVID-19 ,Outpatient ,030229 sport sciences ,medicine.disease ,Operative ,Orthopedic surgery ,Medical emergency ,business - Abstract
Background A mysterious cluster outbreak of pneumonia in Wuhan, China in December 2019 was traced to Severe Acute Respiratory Syndrome Coronavirus 2 and declared a Pandemic by WHO on 11th March 2020. The pandemic has spread rapidly causing widespread devastation globally. Purpose This review provides a brief understanding of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge as well as best practices for orthopaedic surgeons. These are likely to change as knowledge and evidence is gained. Results Orthopaedic surgeons, like other front-line workers, carry the risk of getting infected during their practice, which as such is already substantially affected. Implementation of infection prevention and control as well as other safety measures for health care workers assumes great importance. All patients/visitors and staff visiting the hospital should be screened. Conservative treatment should be the first line of treatment except for those requiring urgent/emergent care. During lockdown all elective surgeries are to be withheld. All attempts should be made to reduce hospital visits and telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned authorities. All patients being admitted to the hospital in and around containment zones should be tested for COVID-19. There are special considerations for anaesthesia with preference for regional anaesthesia. A separate Operation room with specific workflow should be dedicated for COVID-19 positive cases. Conclusions Despite the magnitude of challenge, the pandemic offers significant lessons for the orthopaedic surgeon who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai. Electronic supplementary material The online version of this article (10.1007/s43465-020-00135-1) contains supplementary material, which is available to authorized users.
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- 2020
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8. The Success of ‘e-knee school’ for Knee Osteoarthritis During COVID 19; a Game- Changing Modality for the Future
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Archit Chalana, Mandeep S Dhillon, Sandeep Negi, Amarjeet Singh, Meenakshi Sharma, and Bibek Adhya
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Modality (human–computer interaction) ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Osteoarthritis ,medicine.disease ,Orthopedic surgery ,Commentary ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,business - Published
- 2020
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9. Letter to the Editor Regarding Sukhsathein et al.: 'Cup Alignment Change After Screw Fixation in Total Hip Arthroplasty'
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Sandeep Patel, Mandeep S Dhillon, and Himanshu Bhayana
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Orthodontics ,medicine.medical_specialty ,Letter to the editor ,business.industry ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,business ,Letter to the Editor ,Total hip arthroplasty ,Screw fixation - Published
- 2020
10. Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature
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Vijay Shetty, Mandeep S Dhillon, Ankush Verma, Yuvarajan Palanisamy, Prasoon Kumar, and Lalit Maini
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musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,General surgery ,Psychological intervention ,Context (language use) ,030229 sport sciences ,Review Article ,medicine.disease ,Slow growth ,Questionnaire based survey ,03 medical and health sciences ,0302 clinical medicine ,Orthopedic surgery ,Respondent ,medicine ,Orthopedics and Sports Medicine ,Hip arthroscopy ,business ,Femoroacetabular impingement - Abstract
BACKGROUND: Hip arthroscopy is a minimally invasive technology for diagnostic and therapeutic interventions in various hip disorders. Over the past decade or so, the technology and understanding related to this surgery have improved by leaps and bounds; however, in India the overall pace has been limited. The present review highlights the status of hip arthroscopy in the Indian context. METHODOLOGY: A small survey with five questions related to practice of hip arthroscopy among Indian orthopaedic surgeons was conducted. Additionally a PubMed database search was conducted to recognise and assess studies pertaining to hip arthroscopy originating from India. RESULTS: Forty-two responses were received for the questionnaire, out of which 38 surgeons performed hip arthroscopy in their practice; the overall numbers were very low with only one respondent performing more than 50 surgeries in a year. For 84.2% of the respondents, the practice was limited to less than ten surgeries per year. 63.2% of the surgeons affirmed that there has been no change in their practice of hip arthroscopies over the past 5 years, signifying the slow growth and limited application of the technique. Only nine studies pertaining to the topic were available in the literature search, out of which five were case reports. The most common indication was removal of intraarticular foreign bodies, followed by joint debridement and lavage, synovial biopsies and femoroacetabular impingement (FAI). The outcomes in all the studies were satisfactory. CONCLUSION: Hip arthroscopy is in its nascent stages in India and much is still needed to be done for better implementation of the technique on a wider scale. Adequate training and continued medical education programme, with exposure to the experts in the field, will go a long way in better utilisation of the surgery in India.
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- 2020
11. Changing Pattern of Orthopaedic Trauma Admissions During COVID-19 Pandemic: Experience at a Tertiary Trauma Centre in India
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Nirmal Raj Gopinathan, Mandeep S Dhillon, Deepak Kumar, Sameer Aggarwal, Uttam Chand Saini, and Himanshu Bhayana
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030222 orthopedics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Psychological intervention ,COVID-19 ,Orthopaedic emergency ,030229 sport sciences ,Disease ,Coronavirus ,03 medical and health sciences ,0302 clinical medicine ,Trauma demographics ,Amputation ,Orthopedic surgery ,Pandemic ,Emergency medicine ,medicine ,Trauma centre ,Original Article ,Orthopedics and Sports Medicine ,business ,Orthopaedic trauma - Abstract
Introduction COVID-19 has emerged as a medical threat to mankind, with a serious disruption of lifestyle in 2020. This has not only changed the way we live and work but has also changed the pattern of hospital admissions and medical care. To see if there was significant change in the pattern and management of trauma in our region, we evaluated data from our centre for the lockdown period and compared it with data from the previous year, and also with some available international data. Methods We collated data from our Tertiary care hospital for two periods, i.e. from 25th March 2020 to 3rd May 2020 signifying strict lockdown and then from 4th May to 31st May during which some conditional relaxations were given. This was compared to data from similar periods in 2019. We looked at patient demographics, fracture types, injury mechanisms, and even changes in treatment protocols. Results Significant reductions in caseloads were noted; open injuries were less, road accidents were infrequent, but cases due to falls, especially children and the elderly were still seen, although slightly reduced. The plan to minimize operative interventions could not be fully implemented due to complex nature of trauma seen by us. Only one case of bilateral amputation turned out to be positive, with no infectious consequences to the treating staff. Conclusions COVID-19 pandemic led to significant reductions in trauma caseload and change in injury patterns. Doctor responses and patient management needs significant alteration to prevent spread of disease.
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- 2020
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12. Application of 3D Printing in Hip and Knee Arthroplasty: A Narrative Review
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Mandeep S Dhillon, Pulak Vatsya, Prasoon Kumar, Rajesh Kumar Rajnish, and Aman Hooda
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030222 orthopedics ,medicine.medical_specialty ,Preoperative planning ,business.industry ,medicine.medical_treatment ,3D printing ,030229 sport sciences ,Review Article ,Femoral stem ,Arthroplasty ,03 medical and health sciences ,0302 clinical medicine ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Narrative review ,Medical physics ,Instrumentation (computer programming) ,business ,Patient education - Abstract
INTRODUCTION: Ideal surgical positioning and placement of implants during arthroplasty are crucial for long-term survival and optimal functional outcomes. Inadequate bone stock or defects, and anatomical variations can influence the outcomes. Three-dimensional printing (3DP) is an evolving technology that could provide patient-specific instrumentation and implants for arthroplasty, taking into account anatomical variations and defects. However, its application in this field is still not adequately studied and described. The present review was conceptualised to assess the practicality, the pros and cons and the current status of usage of 3DP in the field of hip and knee arthroplasties and joint reconstruction surgeries. METHODS: A PubMed database search was conducted and a total number of 135 hits were obtained, out of which only 30 articles were relevant. These 30 studies were assessed to obtain the qualitative evidence of the applicability and the current status of 3D printing in arthroplasty. RESULTS: Currently, 3DP is used for preoperative planning with 3D models, to assess bone defects and anatomy, to determine the appropriate cuts and to develop patient-specific instrumentation and implants (cages, liners, tibial base plates, femoral stem). Its models can be used for teaching and training young surgeons, as well as patient education regarding the surgical complexities. The outcomes of using customised instrumentations and implants have been promising and 3D printing can evolve into routine practice in the years to come. CONCLUSION: 3D printing in arthroplasty is an evolving field with promising results; however, current evidence is insufficient to determine significant advantages that can be termed cost effective and readily available.
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- 2020
13. Olympics in the Time of a Pandemic
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Mandeep S Dhillon
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030222 orthopedics ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,biology ,Coronavirus disease 2019 (COVID-19) ,Athletes ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,education ,MEDLINE ,030229 sport sciences ,biology.organism_classification ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Editorial ,Family medicine ,Pandemic ,Medicine ,Orthopedics and Sports Medicine ,business ,Coronavirus - Abstract
An editorial is presented on Olympics in the time of a Coronavirus Pandemic Topics discussed include International contributors have added to the knowledge pool which maybe relevant to Orthopods and other medical practitioners;and understand the genetic make-up of the athlete, and this can be used in a good sense to train some athletes with specific genes into specific sports
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- 2020
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14. Kinetic and Kinematic Analysis of Gait in Type IV Osteogenesis Imperfecta Patients: A Comparative Study
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Mandeep S Dhillon, Sandip R Dhole, Vandana Dhiman, Jitendra Prasad, A. D. Jayal, Subham Badhyal, and Nirmal Raj Gopinathan
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medicine.medical_specialty ,medicine.medical_treatment ,Kinematics ,osteogenesis imperfecta ,03 medical and health sciences ,0302 clinical medicine ,Gait (human) ,Physical medicine and rehabilitation ,lcsh:Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Brittle bone disease ,030222 orthopedics ,Rehabilitation ,business.industry ,030229 sport sciences ,medicine.disease ,Preferred walking speed ,lcsh:RD701-811 ,medicine.anatomical_structure ,Osteogenesis imperfecta ,kinematics ,kinetics ,Gait analysis ,Orthopedic surgery ,gait analysis ,Original Article ,Ankle ,business - Abstract
Background: Osteogenesis imperfecta (OI) is a genetic connective tissue disorder characterized by skeletal deformity and increased risk of fracture. Independent mobility is of concern for OI patients as it is associated with the quality of life. The present study investigates the variation of kinetic and kinematic gait parameters of type IV OI subjects and compares them with age-matched healthy subjects. Materials and Methods: Gait analysis is performed on five type IV OI patients and six age-matched normal subjects. Spatiotemporal, kinematic, and kinetic data are obtained using Helen Hayes marker placement protocol. Results: The results indicate an imprecise double-humped profile for vertical ground reaction force (GRF) with reduced ankle push off power and walking speed for OI subjects. Moreover, a comparison of vertical GRFs in OI subjects with that of healthy subjects suggests lower values for the former. The results encourage and motivate for further investigation with a bigger set of subjects. Conclusion: This information may be useful in developing a better understanding of pathological gait in type IV OI subjects, which ultimately helps the design of subject-specific implants, surgical preplanning, and rehabilitation.
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- 2019
15. The 'Open-Envelope' Approach: A Limited Open Approach for Calcaneal Fracture Fixation
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Mandeep S Dhillon, Rakesh John, Ankit Khurana, and Sharad Prabhakar
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medicine.medical_specialty ,Heel ,Symposium - Hindfoot and Ankle Trauma ,03 medical and health sciences ,mesh: minimally invasive surgical procedures ,0302 clinical medicine ,Calcaneal fracture ,lcsh:Orthopedic surgery ,Fracture fixation ,medicine ,internal ,minimally invasive surgical procedures ,Orthopedics and Sports Medicine ,minimally invasive surgery ,Valgus deformity ,030222 orthopedics ,business.industry ,American Orthopaedic Foot and Ankle Score ,open-envelope approach MeSH terms: Calcaneus ,fracture fixation ,Soft tissue ,calcaneum fracture ,mesh: Calcaneus ,030229 sport sciences ,medicine.disease ,Surgery ,open-envelope approach ,mesh: internal ,lcsh:RD701-811 ,medicine.anatomical_structure ,mesh: fracture fixation ,Orthopedic surgery ,displaced intraarticular calcaneal fractures ,Calcaneus ,Ankle ,business - Abstract
Background: Minimally invasive surgery (MIS) has a significant and evolving role in the treatment of displaced intra articular calcaneal fractures (DIACFs), but there is limited literature on this subject. The objective was hence to assess the clinicoradiological outcomes of DIACFs fixed with an innovative open-envelope MIS technique. Materials and Methods: 42 closed Sanders Type 2 and 3; DIACFs were included in this study. The Open-envelope approach was developed, which is essentially a limited open, dual incision, modified posterior longitudinal approach allowing excellent visualisation and direct fragment manipulation. The main outcome measures were American Orthopaedic Foot and Ankle Score (AOFAS) hindfoot score and preoperative and postoperative radiological angles. Results: The Bohler angle improved from a preoperative mean of 14.3° (range 0°–28°) to a postoperative mean of 32.46° (range 22°–42°). The Gissane angle improved from a preoperative mean of 135.83° to a postoperative mean of 128.33°. The postoperative improvement in Bohler and Gissane angles was highly significant (P < 0.001). The AOFAS scores at 6 months were excellent in nine patients, good in 15 patients, and fair in six patients. Three patients had residual valgus deformity of the heel. Conclusions: Open-envelope technique minimized soft tissue complications and achieved acceptable radiological reductions with good clinical outcomes.
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- 2018
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16. Evidence-Based Medicine: Hype or Reality?
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Mandeep S Dhillon
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lcsh:RD701-811 ,medicine.medical_specialty ,Editorial ,lcsh:Orthopedic surgery ,business.industry ,Family medicine ,MEDLINE ,Medicine ,Orthopedics and Sports Medicine ,Evidence-based medicine ,business - Published
- 2019
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17. Crush fractures of the anterior end of calcaneum
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Sharad Prabhakar, Siddharth Sharma, Mandeep S Dhillon, and Ankit Khurana
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mesh: Tarsal joint ,medicine.medical_specialty ,medicine.medical_treatment ,calcaneal fracture ,Symposium - Hindfoot and Ankle Trauma ,030218 nuclear medicine & medical imaging ,midfoot abduction injury ,03 medical and health sciences ,0302 clinical medicine ,Calcaneal fracture ,lcsh:Orthopedic surgery ,mesh: calcaneus ,Fracture fixation ,medicine ,Orthopedics and Sports Medicine ,midfoot abduction injury MeSH terms: Tarsal joint ,fracture fixation ,calcaneus ,Reduction (orthopedic surgery) ,Orthodontics ,030222 orthopedics ,Stress fractures ,Anterior process of calcaneum ,business.industry ,Tarsal Joint ,medicine.disease ,lcsh:RD701-811 ,medicine.anatomical_structure ,mesh: fracture fixation ,Orthopedic surgery ,Calcaneus ,Ankle ,business ,lateral column foot injury - Abstract
The anterior end of calcaneum fractures can present as inversion injuries, stress fractures or as a part of displaced intraarticular calcaneum fracture. Rarely, these may occur due to abduction injury from a laterally directed force that crushes the anterior calcaneum instead of the cuboid, and has associated medial column injuries which are unrecognized. Compression fractures of the anterior calcaneum are actually lateral column shortening injuries with poor outcomes in the few published reports. We describe three patients with compression fractures of the anterior end of calcaneum resulting from foot abduction injury which were managed by reduction and column length restoration via distraction by external fixator. All three fractures showed good to excellent outcomes using the American Orthopedic Foot and Ankle Society midfoot score at followup >1 year. Awareness of this injury pattern is important, and appropriate measures to reduce and maintain the fracture reduction are needed to avoid long term disability.
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- 2018
18. Current Concepts in Sports Injury Rehabilitation
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Himmat Dhillon, Mandeep S Dhillon, and Sidak Dhillon
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sports injury ,medicine.medical_specialty ,Sports injury ,medicine.medical_treatment ,media_common.quotation_subject ,education ,Psychological intervention ,Context (language use) ,sports rehabilitation MeSH terms: Athletic injuries ,recovery of function ,Phase (combat) ,return to sports ,rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Injury prevention ,Medicine ,Orthopedics and Sports Medicine ,physiotherapy ,sports injuries ,media_common ,030222 orthopedics ,Medical education ,Teamwork ,Rehabilitation ,biology ,Athletes ,business.industry ,030229 sport sciences ,biology.organism_classification ,lcsh:RD701-811 ,Physical therapy ,Erratum ,business ,human activities ,Conditioning - Abstract
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.
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- 2017
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19. Response to Letter to the Editor: COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons
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Abhinandan Reddy Mallepally, Kalyan Kumar Varma Kalidindi, Swapnil M. Keny, Rajesh Malhotra, Vaibhav Bagaria, Shanmuganathan Rajasekharan, Mandeep S Dhillon, and Harvinder Singh Chhabra
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2019-20 coronavirus outbreak ,Letter to the editor ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Best practice ,medicine ,MEDLINE ,Orthopedics and Sports Medicine ,Medical emergency ,medicine.disease ,business ,Letter to the Editor - Published
- 2020
20. Focused Amputee Clinics: The need of the hour
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Mandeep S Dhillon, Aman Hooda, and Uttam Chand Saini
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medicine.medical_specialty ,business.industry ,MEDLINE ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,business ,Letter to the Editor - Published
- 2020
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21. Short-Termism in Sport and Medicine: The Dilemma of Painkillers
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John Orchard and Mandeep S Dhillon
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Dilemma ,business.industry ,Invited Commentary ,MEDLINE ,Medicine ,Orthopedics and Sports Medicine ,Engineering ethics ,Short termism ,business - Published
- 2020
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22. Patterns and Trends of Foot and Ankle Injuries in Olympic Athletes: A Systematic Review and Meta-analysis
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Rajesh Kumar Rajnish, Siddhartha Sharma, Mandeep S Dhillon, and Prasoon Kumar
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030222 orthopedics ,medicine.medical_specialty ,Stress fractures ,biology ,Athletes ,business.industry ,Incidence (epidemiology) ,030229 sport sciences ,Review Article ,biology.organism_classification ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Meta-analysis ,Injury prevention ,Orthopedic surgery ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Ankle ,business ,Foot (unit) - Abstract
INTRODUCTION: Foot and ankle injuries in elite athletes can result in decreased performance, absence from sport and prolonged morbidity. There is paucity of data on foot and ankle injuries in Olympics athletes. METHODS: We conducted a systematic review of the PubMed and EMBASE databases. Studies in English language that reported the incidence and/or prevalence of foot and ankle injuries in during Olympics games (summer, winter and youth Olympics) were included. Studies in languages other than English, those that looked at injuries other than foot and ankle injuries, studies looking at injuries in non-Olympics events and those looking at Olympics trials were excluded. We determined the injury rates and burden of foot and ankle injuries. We also looked at the patterns and trends of foot and ankle injuries. RESULTS: A total of 399 foot and ankle injuries from 25 publications were included in the review. Foot and ankle injury rates ranged from 0.09 to 0.42 injuries per athlete-years for summer Olympics and 0.02–0.35 injuries per athlete-years for winter Olympics. Quantitative analysis revealed that foot and ankle injuries contributed to 16.9% of all injuries (95% CI 8.1–31.9%) for summer Olympics and 5.1% of all injuries (95% CI 1.9–12.6%) for winter Olympics; however, a high statistical heterogeneity was noted. The three most common injuries were tendon injuries, ligament injuries and stress fractures. The rates and burden of foot and ankle injuries showed a declining trend. CONCLUSIONS: Foot and ankle injuries are an important cause of morbidity amongst Olympics athletes. The declining trend amongst these injuries notwithstanding, there is a need for a global electronic database for reporting of injuries in Olympics athletes.
- Published
- 2020
23. Epidemiology of lower limb musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India
- Author
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Balaji Saibaba, Siva Swaminathan Santhanam, Nirmal Raj Gopinathan, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,mesh:traumatology ,Epidemiology ,medicine.medical_treatment ,Poison control ,Traumatology ,mesh:arteries ,mesh:trauma centres ,arteries ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,vascular trauma ,Injury prevention ,medicine ,trauma centres ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,traumatology ,mesh:Epidemiology ,030222 orthopedics ,business.industry ,Head injury ,Trauma center ,medicine.disease ,Surgery ,mesh:lower extremity ,tertiary trauma care center ,lcsh:RD701-811 ,Amputation ,Blunt trauma ,Orthopedic surgery ,lower extremity ,Original Article ,vascular trauma MeSH terms: Epidemiology ,business - Abstract
Background: Vascular trauma associated with bony injuries is an orthopaedic emergency. Lack of timely intervention can lead to loss of limb or even life. Inspite of the rising incidence of high speed road traffic accidents in India, there is paucity of literature regarding the demographic pattern, clinical morbidity, management strategies and outcome of arterial injuries associated with lower limb trauma. The aim of this study is to describe the epidemiology and outcome of lower extremity musculoskeletal trauma with associated vascular injuries in a tertiary care institute in India. Materials and Methods: All individuals who presented to our tertiary care trauma center from July 2013 to December 2014 with lower extremity vascular injury associated with lower limb fractures were identified from a retrospective trauma database for this descriptive study. For the 17 months, there were 82 lower extremity vascular trauma cases admitted in our trauma center, of which 50 cases were included in the study. 32 patients with crush injuries, traumatic amputations, and those with head injury and blunt trauma to chest or abdomen were excluded from the study. Results: Out of the 50 cases of lower extremity vascular injury with associated lower limb fractures, 19 limbs were salvaged, 28 amputated, and three patients expired. Young males in the age group of 20–39 years were frequently injured. Motor vehicle accident (MVA) (82%) was found to be the most common cause followed by pedestrian injury. Popliteal artery (62%) was the most common vessel injured, followed by femoral artery (28%). The salvageability percentage was much higher (64%) in the femoral artery injury group when compared to popliteal artery injury group (25%). There were 32 open fractures, with amputation rates (60%) being higher and all three cases of death falling in this group. In addition, the limb salvageability percentage was 43.2% when the patient presented within 12 h of injury and this decreased to a mere 16.7% when the patient had presented more than 24 h after injury. Conclusion: MVAs are the leading cause of vascular injuries in India. Road safety measures and prevention programs are the need of the hour to prevent these kinds of injuries in the future.
- Published
- 2017
24. Complex Hindfoot and Ankle Trauma: The Management Status in 2018
- Author
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Mandeep S Dhillon
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,MEDLINE ,030229 sport sciences ,lcsh:RD701-811 ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Orthopedic surgery ,Physical therapy ,medicine ,Orthopedics and Sports Medicine ,Guest Editorial ,Ankle ,business - Published
- 2018
25. Legends of Indian Orthopedics
- Author
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Mandeep S Dhillon
- Subjects
lcsh:RD701-811 ,lcsh:Orthopedic surgery ,business.industry ,Medicine ,Library science ,Profile ,Orthopedics and Sports Medicine ,business - Published
- 2018
- Full Text
- View/download PDF
26. Misconceptions about the three point bony relationship of the elbow
- Author
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Vishal Kumar, Nirmal Raj Gopinathan, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,mesh:observation ,observation ,Elbow surface markings ,Elbow ,Equilateral triangle ,lcsh:Orthopedic surgery ,three bony point relationship ,Isosceles triangle ,Key words: Elbow surface markings ,medicine ,Orthopedics and Sports Medicine ,Scalene triangle ,Confusion ,mesh:dislocation ,Orthodontics ,dislocation ,Point (typography) ,business.industry ,Anatomy ,Clinical Practice ,lcsh:RD701-811 ,medicine.anatomical_structure ,mesh:Elbow joint ,elbow triangle ,three bony point relationship MeSH terms: Elbow joint ,Orthopedic surgery ,Original Article ,medicine.symptom ,business - Abstract
Introduction: The 3 bony point relationship of the elbow is an important surface evaluation done in all cases of elbow pathology; its importance is highlighted by the fact that significant emphasis is also laid on this during the specialty board examinations. Confusion about the exact inter relationship exists even in the standard orthopaedic books, with various authors labeling it as isosceles, equilateral or a different triangle, without any citation to back this statement. Materials and Methods: The knowledge of the three bony points relationship in elbow was verified after a survey of orthopaedic surgeons undertaken by the senior author, produced disparate answers. Most (63%) classified this as an isosceles triangle. To clarify this further, 200 elbows were prospectively evaluated to measure the distances between these points and the angles were calculated. Conclusion: Our observations indicate that this triangle is neither isosceles, nor equilateral, but a scalene triangle of unequal sides. There may even be a minimal difference in the 2 sides of the same individual, which has the potential to complicate routine comparison of the two elbows during examination. Results: The analysis of data revealed that all surgeons were aware of the three bony points relationship; however 21 of the 179 (mostly senior surgeons) did not give too much importance to this evaluation in daily clinical practice. Nine surgeons were not sure what type of triangle was formed, 17 thought it was an equilateral triangle, 40 thought it was some other type of triangle while 113 (63%) thought these points formed an isosceles triangle. This is a reflection of the disparity in the perception about this triangle in the orthopaedic community in general.
- Published
- 2014
27. Orthobiologics and platelet rich plasma
- Author
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Mandeep S Dhillon, Vijay Shetty, Sandeep Patel, and Prateek Behera
- Subjects
orthobiologics ,medicine.medical_specialty ,business.industry ,Cartilage ,Regeneration (biology) ,Review Article ,Bioinformatics ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,ligament repair ,Ligament repair ,lcsh:Orthopedic surgery ,Platelet-rich plasma ,Orthopedic surgery ,medicine ,tendon healing ,Orthopedics and Sports Medicine ,Bone formation ,Stem cell ,Platelet rich plasma ,business ,Tendon healing - Abstract
Orthobiologics have evolved to the extent that they significantly influence modern orthopedic surgical practice. A better understanding of the role of various growth factors and cells in the process of tendon healing, ligament repair, cartilage regeneration and bone formation has stimulated focused research in many chronic musculoskeletal ailments. Investigators have published results of laboratory as well as clinical studies, using orthobiologics like platelet rich plasma, stem cells, autologous conditioned serum etc., with variable results. However, a clear consensus over the best orthobiologic substance and the method of preparation and usage of these substances is lacking. Much of the confusion is due to the fact that studies ranging from RCTs to case reports present variable results, and the interpretations are wide-ranging. We have reviewed the available orthobiologics related data with a focus on platelet rich plasma in orthopedic conditions.
- Published
- 2014
28. Surgical treatment of sanders type 2 calcaneal fractures using a sinus tarsi approach
- Author
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Ankit Khurana and Mandeep S Dhillon
- Subjects
lcsh:RD701-811 ,lcsh:Orthopedic surgery - Published
- 2018
29. Tuberculosis of the foot: An osteolytic variety
- Author
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Sharad Prabhakar, Vikas Bachhal, Sameer Aggarwal, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,Tuberculosis ,Osteolysis ,medicine.diagnostic_test ,business.industry ,medicine.disease ,infection ,Surgery ,Lesion ,lcsh:RD701-811 ,Calcaneus ,lcsh:Orthopedic surgery ,osteolytic ,tuberculosis ,foot ,Orthopedic surgery ,Biopsy ,medicine ,Deformity ,Original Article ,Orthopedics and Sports Medicine ,medicine.symptom ,business ,Foot (unit) - Abstract
Background: Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis. Materials and Methods: We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges) out of 92 foot TB cases collected over last 20 years. There were 16 adults and eight children. Tissue diagnosis was established in 23 of 24 cases based on PCR AFB staining, culture, and histopathology. Surgical intervention was reserved for patients with either a juxtaarticular focus threatening to involve a joint or an impending collapse of a midfoot bone with cystic destruction. Results: Fifteen cases had an osteolytic lesion on the radiographs resembling a space-occupying lesion, five had patchy osteolysis, while four showed coke like sequestra; one patient had a lesion in two bones. Antitubercular chemotherapy after biopsy was sufficient to heal the lesion in 19 cases, while in five cases surgical debridement needed to be done. The lesions healed eventually. At an average followup of 8.3 years, (range 2-15 years) there were no recurrences and all patients were free from pain, with no restriction of movements. Six patients complained of occasional pain during walking on uneven ground. Conclusion: When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability.
- Published
- 2012
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30. Tuberculosis of the elbow: A clinicoradiological analysis
- Author
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Akshay Goel, Vikas Bachhal, Sharad Prabhakar, Mandeep S Dhillon, and Sameer Aggarwal
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Tuberculosis ,business.industry ,Olecranon ,medicine.medical_treatment ,Elbow ,Synovectomy ,medicine.disease ,musculoskeletal system ,Condyle ,infection ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,tuberculosis ,Radiological weapon ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Original Article ,Stage (cooking) ,business - Abstract
Background: The incidence of Tuberculosis (TB) of elbow is 2-5% of all skeletal locations. Most reports of TB elbow have focused attention on the diagnosis. The management options and classification has been missing. We present a retrospective clinicoradiological analysis of 38 cases (40 elbows) of TB of elbow joint. Materials and Methods: The patients presented with pain, swelling and loss of motion. Two cases had bilateral involvement. The average delay between onset of symptoms and presentation was 8 months. The elbows were classified according to modified Martini's radiological classification, which distinguishes between osseous lesions close to joint line (e.g. coronoid, condyles) and lesions away from the joint line (e.g. epicondyles, olecranon). We modified the classification to subdivide into para-articular bony lesions that had invaded the joint and those that were threatening to invade joint. All patients received antitubercular chemotherapy and immobilization in above-elbow plaster slab for 4-8 weeks. Twenty patients underwent surgical interventions (synovectomy, intraarticular debridement). Results: The average followup period was 5.3 years (range 1.5-14.2 years). The range of movement at final followup averaged 107° for stage 2, 90° for stage 3A, 47° for stage 3B and 32° for stage 4. Range of supination and pronation was less satisfactory as compared to flexion and extension and all elbows with bony involvement had less than 90° arc of supination and pronation. Conclusion: Surgical intervention could appreciably alter the outcome especially in patients with extra-articular involvement close to the joint. We have classified this subgroup separately.
- Published
- 2012
31. Functional outcome of neglected perilunate dislocations treated with open reduction and internal fixation
- Author
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Vishal Kumar, Devendra K. Chouhan, Sharad Prabhakar, Mandeep S Dhillon, and Kamal Bali
- Subjects
medicine.medical_specialty ,Scoring system ,Perilunate dislocation ,business.industry ,medicine.medical_treatment ,Carpal ,Avascular necrosis ,Wrist ,medicine.disease ,neglected ,perilunate dislocation ,Surgery ,Lunate ,lcsh:RD701-811 ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,open reduction internal fixation ,Orthopedic surgery ,medicine ,Internal fixation ,Original Article ,Orthopedics and Sports Medicine ,business ,Reduction (orthopedic surgery) - Abstract
Introduction: Management of neglected perilunate dislocations is controversial. The various procedures such as open reduction and internal fixation (ORIF), proximal row carpectomy, lunate excision, and wrist arthrodesis have been advocated. The aim of our study was to evaluate the functional outcome of neglected perilunate dislocations managed by ORIF. Materials and Methods: Over a period of 10 years (1996 to 2006), 14 patients with neglected perilunate dislocations (undiagnosed or untreated for 6 weeks or more) were managed by ORIF. Six patients had dorsal trans-scaphoid perilunate dislocation, 6 patients had volar lunate dislocation while the remaining two had a dorsal perilunate dislocation The results were evaluated by clinical scoring system of Cooney et al. Results: The average followup was 4.1 years (range 2-12 years). All except one of the patients operated earlier than 5 months had good results. Of the four patients operated after 5 months, two had a fair result while two had a poor outcome. Chondral damage to the capitate was noted intraoperatively in both the cases with poor outcomes. The two patients were found to have avascular necrosis (AVN) of the lunate; however, functional outcome was fair in both, and both were able to return to their profession. Conclusion: We observed favorable functional results of ORIF in neglected perilunate dislocations up to 5 months after injury. The development of AVN or midcarpal arthritis was not a major disabling factor as long as stability of wrist has been restored. Beyond 5 months, an alternative surgical procedure such as proximal row carpectomy should be contemplated as results of ORIF have not been good uniformly.
- Published
- 2011
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32. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage
- Author
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Sharad Prabhakar, Kamal Bali, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,Antifibrinolytic ,Blood transfusion ,medicine.drug_class ,medicine.medical_treatment ,knee arthroplasty ,tranexamic acid ,lcsh:Orthopedic surgery ,Medicine ,Orthopedics and Sports Medicine ,blood loss ,Tourniquet ,Red Cell ,business.industry ,Case-control study ,hemoglobin ,Surgery ,lcsh:RD701-811 ,Anesthesia ,Orthopedic surgery ,Original Article ,Hemoglobin ,business ,Tranexamic acid ,medicine.drug - Abstract
Background: Tranexamic acid (TEA) reduces blood loss and red cell transfusions in patients undergoing unilateral total knee arthroplasty (TKA). However, there is not much literature regarding the use of TEA in patients undergoing bilateral TKA in a single stage and the protocols for administration of TEA in such patients are ill-defined. Materials and Methods: We carried out a case control study evaluating the effect of TEA on postoperative hemoglobin (Hb), total drain output, and number of blood units transfused in 52 patients undergoing bilateral TKA in a single stage, and compared it with 56 matched controls who did not receive TEA. Two doses of TEA were administered in doses of 10 mg / kg each (slow intravenous (IV) infusion), with the first dose given just before tourniquet release of the first knee and the second dose three hours after the first one. Results: A statistically significant reduction in the total drain output and requirement of allogenic blood transfusion in cases who received TEA, as compared to the controls was observed. The postoperative Hb and Hb at the time of discharge were found to be lower in the control group, and this result was found to be statistically significant. Conclusion: TEA administered in patients undergoing single stage bilateral TKA helped reduce total blood loss and decreased allogenic blood transfusion requirements. This might be particularly relevant, where facilities such as autologous reinfusion might not be available.
- Published
- 2011
33. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction
- Author
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Sharad Prabhakar, Kamal Bali, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,reconstruction ,Anterior cruciate ligament reconstruction ,Anterior cruciate ligament ,medicine.medical_treatment ,proprioception ,Review Article ,Knee Joint ,Physical medicine and rehabilitation ,lcsh:Orthopedic surgery ,Medicine ,Orthopedics and Sports Medicine ,mechanoreceptors ,Proprioception ,business.industry ,Soft tissue ,Functional recovery ,musculoskeletal system ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,surgical procedures, operative ,Orthopedic surgery ,Ligament ,business ,human activities - Abstract
Injury to the anterior cruciate ligament (ACL) not only causes mechanical instability but also leads to a functional deficit in the form of diminished proprioception of the knee joint. "Functional" recovery is often incomplete even after "anatomic" arthroscopic ACL reconstruction, as some patients with a clinically satisfactory repair and good ligament tension continue to complain of a feeling of instability and giving way, although the knee does not sublux on clinical testing. Factors that may play a role could be proprioceptive elements, as the intact ACL has been shown to have significant receptors. Significant data have come to light demonstrating proprioceptive differences between normal and injured knees, and often between injured and reconstructed knees. ACL remnants have been shown to have proprioceptive fibers that could enhance functional recovery if they adhere to or grow into the reconstructed ligament. Conventionally the torn remnants are shaved off from the knee before graft insertion; modern surgical techniques, with remnant sparing methods have shown better outcomes and functional recovery, and this could be an avenue for future research and development. This article analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability. The types of mechanoreceptors, their distribution and presence in ACL remnants is reviewed, and suggestions are made to minimize soft tissue shaving during ACL reconstruction to ensure a better functional outcome in the reconstructed knee.
- Published
- 2011
34. Erratum: Current Concepts in Sports Injury Rehabilitation
- Author
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Mandeep S Dhillon, Sidak Dhilllon, and Himmat Dhillon
- Subjects
sports injury ,030222 orthopedics ,Medical education ,Sports injury ,Rehabilitation ,business.industry ,medicine.medical_treatment ,education ,Section (typography) ,mesh: sports injuries ,030229 sport sciences ,return to sports ,mesh: rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,sports rehabilitation ,Medicine ,Symposium - Sports Injury ,mesh: Athletic injuries ,Orthopedics and Sports Medicine ,mesh: recovery of function ,business ,human activities ,physiotherapy ,Conditioning - Abstract
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.
- Published
- 2017
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35. The three-minute appraisal of a randomized trial
- Author
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Mandeep S Dhillon, Mohit Bhandari, and Katelyn Godin
- Subjects
lcsh:RD701-811 ,medicine.medical_specialty ,lcsh:Orthopedic surgery ,Randomized controlled trial ,business.industry ,law ,Physical therapy ,MEDLINE ,Medicine ,Orthopedics and Sports Medicine ,EBM Tips ,business ,law.invention - Published
- 2011
- Full Text
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36. Peripheral primitive neuroectodermal tumor causing cauda equina syndrome with destruction of L5 vertebra
- Author
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Mandeep S Dhillon, Tarun Goyal, Sujit Kumar Tripathy, Vanyambadi Jagadeesh, and Sarvdeep Singh Dhatt
- Subjects
musculoskeletal diseases ,business.industry ,Peripheral Primitive Neuroectodermal Tumor ,Cauda equina ,Case Report ,Cauda equina syndrome ,Anatomy ,medicine.disease ,Vertebra ,Lateral recess ,lcsh:RD701-811 ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Primitive neuroectodermal tumor ,medicine ,spinal tumor ,Orthopedics and Sports Medicine ,Thecal sac ,L5 Vertebra ,business ,primitive neuro-ectodermal tumor - Abstract
A 24-year-old male patient presented with cauda equina lesion symptoms. His clinicoradiological examination including X-rays, CT scan and MRI revealed destruction of L 5 vertebral body, pedicle and a mass extending to lateral recess and left intervertebral foramina causing pressure over the thecal sac. A CT guided FNAC was inconclusive. Open biopsy and hemilaminectomy of L 5 vertebra was performed. Histopathology and immunocytochemical analysis revealed it to be primitive neuroectodermal tumor. Patient was given chemotherapy and radiation therapy. His lower limb power improved by grade I post operatively and at 2 years follow-up bowel/bladder recovery was noticed. Patient died after 2.5 years of surgery because of pulmonary metastasis.
- Published
- 2010
- Full Text
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37. Neglected irreducible posterolateral knee dislocation
- Author
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Aditya Krishna Mootha, Vijay Goni, Raghav Saini, and Mandeep S Dhillon
- Subjects
Orthodontics ,musculoskeletal diseases ,medicine.medical_specialty ,Rehabilitation ,business.industry ,Knee Dislocation ,medicine.medical_treatment ,Posterior Cruciate Ligament Reconstruction ,Case Report ,musculoskeletal system ,knee dislocation ,Orthopedic surgery ,Medicine ,Orthopedics and Sports Medicine ,Posterolateral knee ,Good outcome ,Dislocation ,business ,Irreducible knee dislocation ,neglected posterolateral knee dislocation ,human activities ,Reduction (orthopedic surgery) - Abstract
Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and isolated posterior cruciate ligament reconstruction followed by gradual rehabilitation with good outcome at 3 years followup.
- Published
- 2010
38. Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage
- Author
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Mandeep S, Dhillon, Kamal, Bali, and Sharad, Prabhakar
- Subjects
Letters to Editor - Published
- 2011
39. Preliminary experience with biodegradable implants for fracture fixation
- Author
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Sharad Prabhakar, Mandeep S Dhillon, and Chandiralingam Prasanna
- Subjects
medicine.medical_specialty ,External fixator ,business.industry ,medicine.medical_treatment ,Biodegradable implants ,Long bone ,Dentistry ,fractures ,surgeon confidence ,Surgery ,lcsh:RD701-811 ,Fixation (surgical) ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Mechanical strength ,Fracture fixation ,medicine ,Internal fixation ,Orthopedics and Sports Medicine ,Original Article ,Fibula ,business - Abstract
Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures) were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum), were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.
- Published
- 2009
40. Authors’ reply
- Author
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Mandeep S. Dhillon, Kamal Bali, and Sharad Prabhakar
- Subjects
Orthopedics and Sports Medicine - Published
- 2011
- Full Text
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41. Femoral neck fractures
- Author
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Mandeep S Dhillon, Anil K Jain, and Hardas Singh Sandhu
- Subjects
medicine.medical_specialty ,Text mining ,Editorial ,business.industry ,Medicine ,Orthopedics and Sports Medicine ,business ,Femoral Neck Fractures ,Surgery - Published
- 2008
42. Multicentric giant cell tumor involving the same foot: A case report and review of literature
- Author
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Prabhudev Prasad A, Mandeep Singh Virk, Sameer Aggarwal, and Mandeep S Dhillon
- Subjects
medicine.medical_specialty ,Foot ,business.industry ,multicentric ,Surgery ,Giant cell ,Symposium - Giant Cell Tumor ,medicine ,Orthopedics and Sports Medicine ,Histopathology ,Calcaneus ,Local disease ,business ,Whole body ,giant cell tumor ,Foot (unit) - Abstract
Multicentric giant cell tumour (GCT) is extremely rare; no case has been previously reported where two lesions occurred in the same foot at different sites. We report a case involving the calcaneus and subsequently the 3 rd toe of the same foot and review the reported literature. In established cases of multicentricity, the histopathology has to be properly reviewed and the patient has to be followed up for a longer time with serial whole body assessment to pick up any subsquent lesions. The treatment of the local disease does not differ from a standard GCT.
- Published
- 2007
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43. Gorham′s Disease -A case report
- Author
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Deepali Jain, Mandeep S Dhillon, Mandeep Singh Virk, Rakesh Kumar Vasishta, and Vijay Kumar
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Orthopedics and Sports Medicine ,Gorham's disease ,business ,medicine.disease ,Dermatology - Published
- 2006
- Full Text
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44. Epidemiology of golf related musculo-skeletal injuries
- Author
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Sanjay Singh, Jaspal S Sandhu, Himmat Dhillon, and Mandeep S Dhillon
- Subjects
Dorsum ,medicine.medical_specialty ,education.field_of_study ,Physical conditioning ,business.industry ,Incidence (epidemiology) ,Population ,Epidemiology ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Prospective cohort study ,education ,business ,human activities ,Amateur ,Stretching exercises - Abstract
Background : Golfing has become an increasingly popular sport enjoyed by both men and women. Although the game is not viewed as hazardous, golfers do sustain injuries connected with the game. However, golf injuries have received little attention in the literature and there is no study from Asia. Methods : A prospective study was undertaken to analyze the incidence, cause and type of injury among amateur golfers. Open ended questionnaires were sent to 1000 golfers; 240 responded (Av age 51 years, 200 males and 40 females). The respondents played an average of 2 rounds per week. Results : One hundered and ten (46%) responders had sustained one or more orthopaedic injuries. Both among men and women, the lower back was the most common site of injury followed by shoulder and dorsal spine. There was a difference in the injury pattern in skilled and relatively unskilled players. Lack of warm up, excessive practice and improper swing mechanics were the most common causes. Conclusion : Golf injuries perhaps could be prevented or reduced by proper technique, controlled practice routines, physical conditioning and pre-play stretching exercises. The most important factor in this playing population seems to be prevention.
- Published
- 2006
- Full Text
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45. Genetics and the Elite Athlete: Our Understanding in 2020.
- Author
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John R, Dhillon MS, and Dhillon S
- Abstract
Modern competitive sport has evolved so much that athletes would go to great extremes to develop themselves into champions; medicine has also evolved to the point that many genetic elements have been identified to be associated with specific athletic traits, and genetic alterations are also possible. The current review examines the published literature and looks at three important factors: genetic polymorphism influencing sporting ability, gene doping and genetic tendency to injury. The ACTN3 gene has an influence on type II muscle fibres, with the R allele being advantageous to power sports like sprinting and the XX genotype being associated with lower muscle strength and sprinting ability. The ACE gene polymorphisms are associated with cardio-respiratory efficiency and could influence endurance athletes. Many other genes are being looked at, with specific focus on those that are potentially related to enhancement of athletic ability. Recognition of these specific gene polymorphisms brings into play the concept of genetic engineering in athletes, which constitutes gene doping and is outlawed. This has the potential to develop into the next big threat in elite sports; gene doping could have dangerous and even fatal outcomes, as the knowledge of gene therapy is still in its infancy. Genetic predisposition to injury is also being identified; recent publications have increased the awareness of gene polymorphisms predisposing to injuries of ligaments and tendons due to influence on collagen structure and extracellular matrix. Ongoing work is looking at identifying the same genes from different races and different sexes to see if there are quantitative racial or sexual differences. All of the above have led to serious ethical concerns; in the twenty-first century some sports associations and some countries are looking at genetic testing for their players. Unfortunately, the science is still developing, and the experience of its application is limited worldwide. Nevertheless, this field has caught the imagination of both the public and the sportsperson, and hence the concerned doctors should be aware of the potential problems and current issues involved in understanding genetic traits and polymorphisms, genetic testing and genetic engineering., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Indian Orthopaedics Association 2020.)
- Published
- 2020
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46. Rowing Injuries in Elite Athletes: A Review of Incidence with Risk Factors and the Role of Biomechanics in Its Management.
- Author
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Arumugam S, Ayyadurai P, Perumal S, Janani G, Dhillon S, and Thiagarajan KA
- Abstract
Background: Rowing is an Olympic sport gaining popularity in India and injuries are common in these athletes. Determinants of performance, injury risk and training are all interrelated in rowing. Injuries result from various risk factors including fitness issues and improper techniques. Rowers should have adequate leg extension strength and lumbo-pelvic coordination to produce and transmit power from the legs to the oar handle. Biomechanical analysis of the rowing stroke can help in preventing injuries and optimise technique for best performance. It involves a detailed and systematic observation of movement patterns to establish the quality of the movement and provide feedback to the rower about the key variables affecting performance and injury risk. Kinetics such as foot forces and kinematics such as key joint angles can be accurately measured by instrumented foot stretcher and three-dimensional motion capture., Aim: To do a detailed review of literature regarding the incidence and risk factors for rowing injuries and to get an insight on the role of biomechanics in its management., Materials and Methods: Literature review was carried out with standard academic search engines and databases including Science Direct, PubMed and Google Scholar using keywords of relevance. A total number of 38 articles were analysed and results were collated to compile this review report., Results: Lumbar spine is most commonly injured (up to 53%), followed by rib cage (9-10%) and shoulder and other anatomical areas. Rowers with a trunk-driven rowing action will have a lower hip:trunk score and carry a high injury risk. A player with lumbar injury will take a minimum of 3-4 months to recover., Conclusion: Rowing injuries are common. Regular screening of the rowing athletes by comprehensive fitness and biomechanics assessment will help in prevention of injuries. Rowers need to be tested for pain, strength, flexibility, reproducibility of rowing action with modified mechanics, coordination, fatigue level, explosive power, aerobic and anaerobic endurance. Early recognition of risk factors and timely intervention is the key aspect of a successful return to play., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Indian Orthopaedics Association 2020.)
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- 2020
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47. Current Concepts in Sports Injury Rehabilitation.
- Author
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Dhillon H, Dhillon S, and Dhillon MS
- Abstract
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world., Competing Interests: There are no conflicts of interest.
- Published
- 2017
- Full Text
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