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PURPOSE: To report outcomes of Debridement, Antibiotic therapy and Implant Retention (DAIR) for periprosthetic knee joint infections (PJI) in the Indian population and to study factors influencing outcomes. METHODS: This was a Retrospective study of 80 cases of acute PJI after total knee arthroplasty who were treated by DAIR, within 2 weeks of onset of infection. A standardised institutional management protocol was applied to all cases. Patients were followed up for a minimum 1 year. Outcomes of DAIR were classified as successful or unsuccessful based on resolution or persistence of infection, and subsequent requirement of revision surgery. Influence of factors, like comorbidities, culture status and microbiological characteristics of causative organism, on outcomes was assessed. RESULTS: Overall 55 patients (68.75%) had successful eradication of infection after DAIR. 27 (33.7%) patients were culture negative and 53 (66.2%) patients grew organisms on culture. There was no statistically significant difference in outcomes (p = 0.082) between culture-positive cases (69.8% success rate) and (66.7% success rate) in culture negative cases. Furthermore, no difference in outcomes was observed in culture-positive patients between those who grew Gram-positive organisms versus Gram-negative organisms (p = 0.398) Similarly, patient comorbidities did not significantly alter the outcomes after DAIR (p = 0.732). CONCLUSION: Our study demonstrates that early DAIR within 2 weeks of onset of infection using a standard protocol during surgery and postoperatively can result in good outcomes. Patient comorbidities, culture status (positive versus negative), Gram staining characteristics of organisms and the identity of pathogenic bacteria did not influence outcomes of DAIR for acute PJI.

Background The COVID-19 outbreak reached pandemic proportions in March 2020, and the government of India declared a nationwide lockdown on 24th March, 2020. All vehicular movement, construction work, industries, national highways, etc. remained closed during lockdown. The aim of this study was to assess the impact of lockdown on the case load and epidemiology of orthopaedic trauma cases in the state of Telangana. Methods This study was a multi-centre, retrospective observational study. Data were collected from 8 teaching hospitals, 8 corporate hospitals, 1 dedicated industrial trauma, and hand injury center and 56 consultants with individual practice. Data were collected in two groups, pre-lockdown period (23rd Feb to 24th March) and lockdown period (25th march to 25th April). Patient demographics, type of injury, and cause of injury were collected. This was done using an online survey form and retrieval of case data from health records. Results There was a significant decrease in total trauma numbers during lockdown by 1266 cases (pre-lockdown n = 2020 and lockdown n = 754), amounting to a decrease by 62.7% (p

BACKGROUND: Heterotopic ossification (HO) is a concern after elbow trauma and is associated with significant limitation of movement. Although complete restoration of elbow movement is seldom possible even by surgical resection, it improves functional range of movement and quality of life. Surgical excision of HO requires meticulous preoperative planning to minimize complications such as inadequate resection, and neurovascular complications. Life size models printed with three-dimensional (3D) printing technology help in understanding the complex HO mass and its relation to neurovascular structures, thereby helping in better preoperative planning. AIM: The aim is to study the usefulness of 3D-printed patient-specific models in resection of heterotrophic ossification around elbow MATERIALS AND METHODS: The 3D models are printed using computed tomography scans by FDM technology. Surgical approaches were planned based on the dimensions and extent of the HO mass in the 3D model. Resection was performed as planned and the sterilized 3D model was also used during surgery as anatomical reference. All patients had a minimum follow-up of 1 year. They were evaluated for improvement in elbow range of motion and complications. RESULTS: Six patients underwent surgical excision of HO of the elbow, with preoperative planning using 3D-printed models. A functional range of movement was achieved in all patients. There were neurovascular complications in this case series. CONCLUSION: 3D-printed models are accurate and provide a replica of the patient-specific abnormal heterotopic ossification. 3D models provide excellent anatomical reference in planning excision by providing good orientation of the mass, dimensions, extent, and relation to neurovascular structures.

We present a rare case of a previously healthy 16-year-old boy who sustained simultaneous bilateral femoral neck fractures after a single first-time seizure episode. He was diagnosed to have severe vitamin D deficiency and secondary hyperparathyroidism. Symptomatic hypocalcemia was the cause of seizures. Both fractures were treated surgically and united at 3 months. Bilateral femoral neck fractures after seizures are very rare, especially in children. Severe vitamin D deficiency may cause seizures and also weakening of bone, predisposing to fractures without significant trauma. We recommend that paediatric cases of femoral neck fractures after seizures should be investigated for underlying metabolic disease.

Glomus tumours are benign neoplastic lesions of glomus body, a thermoregulatory apparatus of cutaneous microvasculature. These tumours can arise at any location of the body but most commonly seen in subungual region of fingers. Bilateral solitary glomus tumour of hand is a rare entity. We report a case of 54-year-old female who presented with complaints of pain in the right thumb since three years and left thumb pain since 20 years. Clinical examination revealed acute tenderness of both the thumbs. Love’s pin test and Hildreth’s test were positive. MRI revealed characteristic features of glomus tumour. Excision of both the lesions was done and proceeds forwarded to histopathology which confirmed diagnosis. Patient was symptom free immediately following surgery. No nail deformities were noticed and there was no recurrence of symptoms in one year follow up. Glomus tumours of the hand are a rare entity and often missed.