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Study Design Systematic Review and Meta-analysis Objectives This systematic review and meta-analysis is aimed to assess effectiveness, safety, clinical, functional and radiological outcome of either combined anteroposterior or posterior-only approach in the surgical management of active tubercular disease of paediatric thoracolumbar spine. Methods A systematic literature search through PubMed, Scopus, Web of Science and Cochrane Library database was performed. Data extraction was undertaken following methodological quality assessment. Results 9 out of the 182 publications identified, were included for analysis. A total of 247 patients were analysed. Two amongst the 9 studies were retrospective comparative studies evaluating posterior approach with combined anteroposterior approach and were considered for comparative meta-analysis. Blood loss and duration of surgery was significantly higher in the anteroposterior group, as compared to the posterior-only group. There was no significant difference between the 2 groups in terms of post-operative kyphosis angles, final kyphosis angles, number of complications, functional outcome and spinal fusion time. However, all the included studies were non-randomised and retrospective. Only 2 of them had a control group with a high heterogeneity amongst these 2 studies. Conclusion The inference from the studies included in this review suggests that equivalent results can be achieved with posterior-only approach for thoracolumbar tuberculosis in children as compared to anteroposterior approach, with much lower complexity, reduced blood loss and shorter surgical time. However, due to the high risk of bias and considerable heterogeneity among the studies included, we cannot conclude whether one approach is better than the other.

Study Design: Retrospective cohort. Objective: ( a) To compare the recommendations of Lenke and Peking Union Medical College (PUMC) classifications in choosing distal fusion levels in Lenke 1 adolescent idiopathic scoliosis (AIS) curves and ( b) to analyze whether the variability in distal fusion levels influences treatment outcomes. Methods: Hospital records of Lenke 1 AIS patients operated for single stage, posterior-only deformity correction were analyzed. Distal fusion levels recommended by Lenke and PUMC classifications were calculated and were compared with the actual distal fusion levels. The study population was divided based on whether the actual distal fusion levels were in agreement, shorter or longer than those recommended by Lenke classification. Subgroup analysis of Lenke 1C curves was done. The groups were compared with regard to the following outcome measures: Cobb angle correction, postoperative sagittal vertical axis, postoperative C7 offset, and Scoliosis Research Society–22r (SRS-22r) score at 24 months. Results: The distal fusion levels recommended by the 2 classifications were in agreement in 92 of 104 cases. In all the cases with disparity, Lenke classification recommended shorter fusions than the PUMC classification. No statistically significant difference was observed in the outcome measures—whether the actual distal fusion levels were in agreement, shorter, or longer than those recommended by the Lenke classification or whether or not the recommendations for selective fusion of any of these classifications were adhered to. Conclusion: Lenke classification can save fusion levels without compromising on treatment outcomes when compared with PUMC classification. Variability in choice of distal fusion levels is not clinically significant at 24-month follow-up.

Purpose. To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation. Methods. 80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre- and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and self-evaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire). Results. Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy. Conclusions. Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training.

Large femoral neck defects are frequently associated with neglected femoral neck fractures, sequelae of infection, and failed fixation devices. The AIIMS box technique of neck reconstruction has the objectives of femoral head preservation and restoration of hip function in such cases. 32 patients (age range 20–56, average 38 years) with large femoral neck defects were treated from January 1990 to May 1997 and were followed up for a minimum of 10 years (range 10 to 17 years). The neck defect was converted into a box using osteal flaps (base from greater trochanter, anterior wall from head, quadratus femoris muscle pedicle graft posteriorly), which was filled with cancellous bone autograft, and stabilized with cancellous screws. Union occurred in all patients in a mean time of 16 weeks (range 12–20 weeks). One patient developed avascular necrosis (AVN) of femoral head. 8 out of 32 results were classified as excellent, 22 good and 2 fair. Good functional mobility was seen in all but two patients. Complications included coxa vara in two patients, and fixation problems in four patients. Large femoral neck defects can be managed successfully by this technique with preservation of the viability of the femoral head, and therefore the procedure should be considered in appropriate cases, particularly in young adults.

This work discusses the biomechanical testing of 3 elbow bones, namely the humerus, ulna, and radius. There is a need to identify the mechanical properties of the bones at the organ level. The following tests were performed: 3-point bending, fracture toughness, and axial compression. Six sets of whole-bone samples of human male cadaveric humerus, ulna, and radius (age of donor: 35 to 56 years) were tested. The results were analyzed for statistical significance by 2-stage, repeated-measure analysis of variance (ANOVA). The difference between the bending strength of the humerus, ulna, and radius was statistically significant ( P = .001) when compared to one another. However, the fracture toughness and compressive strength were observed to be similar for the 3 bones. The knowledge of mechanical properties of elbow bones can aid in the design of elbow implants and upper limb protection systems, and also allow us to identify criteria for injury. Further, knowledge of the mechanical properties of the elbow bones can aid in calibrating simulations through finite elements analysis.

Purpose. To review outcomes of 106 patients after complete excision of the giant cell tumour of the tendon sheath of the hand, with or without postoperative radiotherapy. Methods. Records of 77 women and 29 men aged 11 to 61 (mean, 31) years who underwent excision of giant cell tumours of the tendon sheath of the hand were reviewed. All patients presented with gradually progressive swelling; only 3 of them also presented with pain. The lesions were located on the dorsal aspect (n=11), the palmar aspect (n=66), both aspects (n=10), or circumferentially (n=14). No patient had multiple lesions. Five patients had bony erosion and 3 had neurovascular bundle involvement. Results. The mean follow-up period was 12 (range, 4–22) years. 56 patients with well-encapsulated giant cell tumour in the palmer and/or dorsal aspects were classified as at low risk of recurrence. The remaining 50 patients were classified as at high risk of recurrence and underwent postoperative radiotherapy. None of the patients at low risk had any recurrence; 4 of those at high risk had recurrence despite radiotherapy. No complication was attributable to the irradiation, except that 3 patients had some dark pigmentation around the wound scar. Conclusion. Postoperative radiotherapy may have a role in reducing recurrence of the giant cell tumour of the tendon sheath of the hand.

Eosinophilic granuloma is the most common and benign form of a rare proliferative disorder—Langerhans' cell histiocytosis. Spinal involvement is rare and only 15 adult cases have been reported. We present an unusual variant of eosinophilic granuloma in a 25-year-old woman with radiological evidence of vertebra plana. Plain radiography, magnetic resonance imaging, bone scan, and blood tests were carried out, and a specimen was taken from L4 using computed tomography–guided biopsy. Gram staining, acid fast bacillus smear, bacterial and fungal cultures were negative. Histological examination of the biopsy showed features of eosinophilic granuloma with aggregates of Langerhans histiocytes. The patient was treated with low-grade radiotherapy at 150 cGy per day for 7 days. She was asymptomatic at one-year follow-up although the radiological picture was unchanged.

Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of upper limb. In advanced stage of CTS, nerve conduction studies demonstrate undetectable compound muscle action potentials of the abductor pollicis brevis (APB-CMAP) following stimulation of the median nerve at the wrist. Opponensplasty is a surgical option for patients with severe CTS. Should single-stage opponensplasty be added at the time of release for severe carpal tunnel syndrome? Methods: We prospectively evaluated patients following carpal tunnel release to observe correlation between clinical and electrophysiological recovery and to determine the necessity for single-stage opponensplasty. Subjects were prospectively collected 22 hands from 22 carpal tunnel syndrome patients, with APB-CMAP of 2 mV or less and evaluated preoperatively and postoperatively for clinical and electrophysiological recovery. Results: All 3 components of pulp pinch strength (PPS)—that is, tip-tip, lateral, 3 point; grip strength; and thumb opposition—showed statistical significant improvement after 6 months. There was statistical significant improvement in APB-CMAP postoperatively after 6 months. Functional outcome was assessed with Mayo wrist score and showed statistical significant improvement postoperatively. Conclusion: We conclude that all patients had good clinical and electrophysiological recovery at 6 months; therefore, single-stage opponensplasty may not be necessary for such patients.

Aims and Objectives: Our study aims to outline and investigate the role of wrist arthroscopy as both a diagnostic and a therapeutic tool in patients with chronic wrist pain. Materials and Methods: Between April 2014 and June 2015, 33 patients with chronic wrist pain undiagnosed with routine x-rays and with clinical suspicion of ligament injuries of the wrist underwent arthroscopic examinations. Both radiocarpal and midcarpal joint spaces were visualized using standard arthroscopic portals. The surgeries were carried out as day care procedures under general anesthesia. Therapeutic interventions as deemed necessary were done in the same sitting. The arthroscopic findings were further correlated with radiological and clinical findings. Results: In the 33 wrists that were arthroscopically examined, 17 lesions of the triangular fibrocartilage complex (TFCC) were found—10 (58.8%) were central perforations which were arthroscopically debrided whereas 7 (41.2%) were tears of the TFCC at its peripheral attachment and were repaired. The treated patients at a mean follow-up period of 7.1 months displayed an improvement in their Mayo wrist scores. A total of 13 scapholunate tears and 7 lunotriquetral tears were seen—which were graded arthroscopically. Partial tears (60%) were treated by thermal shrinkage and ablation while complete tears (40%) underwent open reconstruction. Cartilage defects of varying degrees were also noted in 6 patients. One patient was found to have extensive cartilage damage and was advised wrist fusion. No complications were noted in the follow-up period. Conclusions: Wrist arthroscopy is a potent diagnostic tool and tends to pick up lesions of intrinsic carpal ligaments and the TFCC which are often missed by advanced imaging techniques. It aids in staging of the lesions, thereby guiding their treatment, and provides a host of therapeutic offerings. It may be recommended in cases of chronic wrist pain where the clinical suspicion is strong and the operating team is well-versed with the technique.