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Background: The literature on tuberculosis of the posterior spinal elements without involvement of the vertebral body is scarce. In this study we report our experience with twenty-four cases of neural arch tuberculosis that were treated at our center.Methods: We performed a retrospective review of the clinical and radiographic data of twenty-four consecutive patients who had tuberculosis of the posterior spinal elements with total sparing of the vertebral bodies and intervertebral disc space. We categorized the patients into two groups on the basis of the clinical and radiographic evaluation. The patients who had rapid onset weakness of the lower limbs or pyramidal signs or who showed evidence of epidural abscess underwent emergency decompressive laminectomy (Group A). Patients who had pyomyositis of the posterior spinal muscles without any neurological deficit, pyramidal signs, or epidural abscess were managed with antitubercular therapy alone (Group B).Results: The common presenting features were spastic limb weakness and back pain. The majority of the patients had involvement of the thoracic spine. Epidural abscess, erosion of lamina, and pyomyositis of posterior spinal muscles were common imaging findings. Group A consisted of nineteen patients and Group B consisted of five patients. The mean period of follow-up was 16.9 months (range, nine to sixty months). Patients in Group A had a poorer outcome than those in Group B. Thirteen of the nineteen patients in Group A improved to become independent in the activities of daily living, with complete neurological recovery in eight patients and partial recovery in five patients. Six of the nineteen patients continued to have spastic paraplegia and were wheelchair-dependent. All of the patients in Group B remained neurologically intact during the follow-up period. None of the patients had recurrence of the disease or developed anterior element involvement or kyphotic deformity during the follow-up period.Conclusions: Neural arch tuberculosis is often missed at the time of initial presentation. In association with epidural abscess, it leads to rapid neurological deterioration. This atypical picture of spinal tuberculosis showed a high rate of neurological deficit at the time of initial presentation for medical care. [ABSTRACT FROM AUTHOR]

A 25-year-old woman presented with a 5-year history of left shoulder pain, which was constant dull aching in nature, non-radiating with no relieving or aggravating factors and no seasonal variation, gradually increasing in intensity over years. There was no history of trauma or constitutional symptoms. the patient had taken anti-tubercular drugs for 6 months for this pain with no relief. There was point tenderness over the left acromion process. Local temperature was not raised. Movements of the left shoulder were not effected. All routine hematological investigations were normal. Surgical exploration of the lesion revealed a normal soft tissue periosteum and cortex. On removing the cortical bone a red colored jellified tissue was isolated and thoroughly curetted. Histopathology revealed intraosseous glomus tumor. The patient became pain free immediately postoperatively and continued to be symptom free at 24-month follow-up. Glomus tumor located within bone is rare. Only 22 cases of primary intraosseous glomus tumor have been reported in world literature. Glomus tumors are generally treated by meticulously shelling out the entire lesion. Recurrence of symptoms and the need for reoperation have been reported between 12% and 24%. Most authors assume the recurrence is due to inadequate excision, prompting some to recommend more extensive en bloc excision. Tuberculosis being endemic in this region, antituberculer chemotherapy is generally started on clinical suspicion and tissue diagnosis is only attempted in nonresponders. This case however re-emphasizes the value of tissue diagnosis especially when a lesion is at an unusual site like the acromion process. [ABSTRACT FROM AUTHOR]

This study attempts to characterize and interpret the groundwater quality (GWQ) using a GIS environment and multivariate statistical approach (MSA) for the Jakham River Basin (JRB) in Southern Rajasthan. In this paper, analysis of various statistical indicators such as the Water Quality Index (WQI) and multivariate statistical methods, i.e., principal component analysis and correspondence analysis (PCA and CA), were implemented on the pre and post-monsoon water quality datasets. All these methods help identify the most critical factor in controlling GWQ for potable water. In pre-monsoon (PRM) and post-monsoon (POM) seasons, the computed value of WQI has ranged between 28.28 to 116.74 and from 29.49 to 111.98, respectively. As per the GIS-based WQI findings, 63.42 percent of the groundwater samples during the PRM season and 42.02 percent during the POM were classed as 'good' and could be consumed for drinking. The Principal component analysis (PCA) is a suitable tool for simplification of the evaluation process in water quality analysis. The PCA correlation matrix defines the relation among the water quality parameters, which helps to detect the natural or anthropogenic influence on sub-surface water. The finding of PCA's factor analysis shows the impact of geological and human intervention, as increased levels of EC, TDS, Na+, Cl-, HCO3-, F-, and SO42- on potable water. In this study, hierarchical cluster analysis (HCA) was used to categories the WQ parameters for PRM and POR seasons using the Ward technique. The research outcomes of this study can be used as baseline data for GWQ development activities and protect human health from water-borne diseases in the southern region of Rajasthan., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gautam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Landslides are one of the most extensive and destructive geological hazards on the globe. Tripura, a northeastern hilly state of India experiences landslides almost every year during monsoon season causing casualties and huge economic losses. Hence, it is required to assess the landslide susceptibility of the area that would support short- and long-term planning and mitigation. The analytic hierarchy process (AHP) integrated with geospatial technology has been adopted for landslide susceptibility mapping in the state. Eight influencing factors such as slope, lithology, drainage density, rainfall, land use land cover, distance from rivers and roads, and soil type were selected to map the landslide susceptibility. Landslide susceptibility index (LSI) was found to vary from 6.205 during monsoon to 1.427 during post-monsoon season. The LSI values were classified into very high, high, moderate, low, and very low susceptibility. Landslide susceptibility maps for three different seasons, namely, pre-monsoon, monsoon, and post-monsoon, were prepared. The study showed that most of the areas of the state come under very low to moderate landslide susceptibility zones. Around 73.2% area of the state is found to be under low landslide-susceptible zones during the pre-monsoon season, around 62% area is prone to landslides with moderate susceptibility during the monsoon season, and 68.5% area comes under landslides with low susceptibility zones during the post-monsoon season. The results of this study may be referred to the engineers and planners for the assessment, control, and mitigation of landslides and the development of basic infrastructure in the state., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Damoh district, which is located in the central India and characterized by limestone, shales, and sandstone compact rock. The district has been facing groundwater development challenges and problems for several decades. To facilitate groundwater management, it is crucial to monitoring and planning based on geology, slope, relief, land use, geomorphology, and the types of the basaltic aquifer in the drought-groundwater deficit area. Moreover, the majority of farmers in the area are heavily dependent on groundwater for their crops. Therefore, delineation of groundwater potential zones (GPZ) is essential, which is defined based on various thematic layers, including geology, geomorphology, slope, aspect, drainage density, lineament density, topographic wetness index (TWI), topographic ruggedness index (TRI), and land use/land cover (LULC). The processing and analysis of this information were carried out using Geographic Information System (GIS) and Analytic Hierarchy Process (AHP) methods. The validity of the results was trained and tested using Receiver Operating Characteristic (ROC) curves, which showed training and testing accuracies of 0.713 and 0.701, respectively. The GPZ map was classified into five classes such as very high, high, moderate, low, and very low. The study revealed that approximately 45% of the area falls under the moderate GPZ, while only 30% of the region is classified as having a high GPZ. The area receives high rainfall but has very high surface runoff due to no proper developed soil and lack of water conservation structures. Every summer season show a declined groundwater level. In this context, results of study area are useful to maintain the groundwater under climate change and summer season. The GPZ map plays an important role in implementing artificial recharge structures (ARS), such as percolation ponds, tube wells, bore wells, cement nala bunds (CNBs), continuous contour trenching (CCTs), and others for development of ground level. This study is significant for developing sustainable groundwater management policies in semi-arid regions, that are experiencing climate change. Proper groundwater potential mapping and watershed development policies can help mitigate the effects of drought, climate change, and water scarcity, while preserving the ecosystem in the Limestone, Shales, and Sandstone compact rock region. The results of this study are essential for farmers, regional planners, policy-makers, climate change experts, and local governments, enabling them to understand the groundwater development possibilities in the study area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Desmoplastic fibromas of bone are extremely rare, slow growing, locally invasive, benign primary bone tumours, bearing close resemblance to the extra-abdominal desmoid tumours of soft tissue. They typically occur in patients around 30 years of age, and most commonly affect the mandible, pelvis and meta-diaphyseal region of long bones. En bloc or wide resection has typically been the treatment of choice to avoid recurrence, however, recent reports support curettage with bone grafting and adjuvant therapy to minimise functional loss. We report a 9-year-old child with a desmoplastic fibroma of right radius. This is an unusual age group for this bone tumor. The tumor was managed with en bloc resection and reconstruction with a non-vascularised fibula autograft. The patient had good functional outcome and no recurrence at 1-year follow-up. Level of Evidence: Level V (Therapeutic).

Organophosphate compounds (OPC) cause most selfpoisoning deaths in India due to their easy availability and lack of stringent laws., Aim: To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes., Material: This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality., Observation: Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0-3 required ventilator support, whereas 16.2% of the patients with POPS 4-7, and 100% of patients with POPS 8-11 required ventilator assistance (P < 0.0001). Similarly, the total dose of atropine required (P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality (P < 0.0001) were significantly associated with higher POPS., Conclusion: POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning., (© Journal of the Association of Physicians of India 2011.)

A purely extra-axial position of medulloblastoma in adults at cerebellopontine (CP) angle is extremely rare. To the best of our knowledge, only ten cases have been reported till date. The authors report a case of extra-axial medulloblastoma in a 30-year-old female located at right CP angle. It was surgically treated with a provisional diagnosis of meningioma. Histopathological diagnosis of desmoplastic/nodular medulloblastoma was made with the routine hematoxylin eosin (HE) stain and immunohistochemical markers. This case report highlights the fact that, although extremely rare, the possibility of an extra-axial CP angle mass being a medulloblastoma still needs to be considered in the differential diagnoses, even in adults., Competing Interests: None

Introduction: Organophosphate compounds (OPC) cause most self-poisoning deaths in India due to their easy availability and lack of stringent laws., Aim: To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes., Methods and Materials: This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality., Observations: Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0-3 required ventilator support, whereas 16.2% of the patients with POPS 4-7, and 100% of patients with POPS 8-11 required ventilator assistance ( P < 0.0001). Similarly, the total dose of atropine required ( P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality ( P < 0.0001) were significantly associated with higher POPS., Conclusion: POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Introduction: Interlocking tibia nail fixation for tibia shaft fracture treatment is one of the most commonest procedures performed in orthopedic trauma practices. We report one such case of a rare complication of anterior tibial artery (ATA) pseudo-aneurysm caused by the proximal coronal locking bolt performed by an unusual entry from lateral to medial side during shaft of tibia fracture fixation., Case Report: A 86- years old female sustained a road traffic accident and was diagnosed with a closed tibia shaft fracture of the right leg for which she underwent intramedullary interlocking nail IMIL nailing elsewhere. She presented to us three 3 weeks after primary surgery with persistent pain and swelling in the right leg proximally. We investigated and diagnosed her as having a pseudoaneurysm of the Anterior Tibial Artery on color Doppler and magnetic resonance imaging (MRI) angiography. The pseudoaneurysm of ATA was clipped without any complications. To avoid the rupture of the pseudoaneurysm during manipulation of nail and bolts, their positions were not changed as they were supporting the fracture well and the fracture was also not united at that time., Conclusion: Though Although interlocking nailing of tibia shaft fracture is a commonly performed procedure, it can lead to disastrous vascular complications if the procedure is not performed with utmost care. ATA injury by proximal locking bolts of the tibia nail mandates the need for reconsideration of the nail design with better screw hole positions. We recommend preferring standard AO manual instructions for proximal tibia locking bolt direction., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Elastic stable intramedullary nails have been commonly used to treat unstable long bone fractures in children. The nail tip at the insertion site can cause problems. The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems. If the nail tip is short, nail removal after fracture union can be difficult and may pose challenges. A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail. Few techniques have been suggested in the past for removing elastic nail with the short tip, but all these techniques need special instruments. We describe a surgical technique using a metallic suction cannula to aid elastic nail removal. This method utilizes an easily available instrument in the operating room and does not need any special equipment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Gautam et al.)

Background: A heavily loaded subsidized government run OPD at tertiary care hospital normally caters 200-300 patients daily. Constant improvement in management of OPD through new policies are essential for better patient management and for proper utilization of skill, expertises and time of senior faculty. We designed a new concept of OPD TRIAGE for the same., Material and Methods: Study was carried out on 1800 randomly selected patients, 950 each on triage & non triage interventional day.Patients were interviewed and changes in their satisfaction level were noted through a questionnaire. Senior treating faculty were also questioned about their changes in behaviour towards patient due to the intervention., Results: On triage days around 91% patients are satisfied with professional care, depth of relationship, doctor's attitude, counselling from doctor. While on non triage days, this figure is only 51%. Regarding treating doctors, around 93% percent of the time, the consultants were more happy and enthusiastic to consult patients on OPD triage days. While on non triage days it was only 32%., Conclusion: The concept of OPD Triage can very efficiently be applied for better management of patients in heavily loaded government OPD setup, which will also help in proper data maintenance, increase patients satisfaction and for efficient utilization of time, skills and expertise of the treating consultant., Competing Interests: None., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Dehalococcoides mccartyi are obligate organohalide-respiring bacteria that play an important detoxifying role in the environment. They have small genomes (~1.4 Mb) with a core region interrupted by two high plasticity regions (HPRs) containing dozens of genes encoding reductive dehalogenases involved in organohalide respiration. The genomes of eight new strains of D. mccartyi were closed from metagenomic data from a related set of enrichment cultures, bringing the total number of genomes to 24. Two of the newly sequenced strains and three previously sequenced strains contain CRISPR-Cas systems. These D. mccartyi CRISPR-Cas systems were found to primarily target prophages and genomic islands. The genomic islands were identified either as integrated into D. mccartyi genomes or as circular extrachromosomal elements. We observed active circularization of the integrated genomic island containing vcrABC operon encoding the dehalogenase (VcrA) responsible for the transformation of vinyl chloride to non-toxic ethene. We interrogated archived DNA from established enrichment cultures and found that the CRISPR array acquired three new spacers in 11 years. These data provide a glimpse into dynamic processes operating on the genomes distinct to D. mccartyi strains found in enrichment cultures and provide the first insights into possible mechanisms of lateral DNA exchange in D. mccartyi.

Purpose: Spontaneous osteonecrosis of the knee affects the medial femoral condyle in patients above 55 years of age. Many reports and studies are available from western countries. But there is a gross paucity of literature on spontaneous osteonecrosis of the knee (SPONK) in the Indian subcontinent, either it is under-reported or detected at a later stage. The aim of our study was to detect SPONK in Indian population and describe its characteristics, treatment, and outcome., Material and Method: A prospective study was conducted over a period of three years. All patients above 18 years with knee pain at rest and medial condyle tenderness without joint laxity were evaluated with plain radiographs and MRI. Further tests were done if radiological signs of osteonecrosis were present. Various parameters were recoded like Visual Analog Scale (VAS), Knee Society Score (KSS), and MRI Osteoarthritis Knee Score. Conservative treatment consisted of a combination of NSAIDs and bisphosphonates. Decompression with bone grafting was done if there was no improvement or deterioration at three month follow-up., Results: Ten patients were diagnosed with SPONK. The mean age was 50 years with male predominance (60%) with the involvement of medial femoral condyle (80%) or left knee (70%). Most cases were in Koshino stage 1. Mean VAS was 6.5 and mean KSS was 59. All clinical parameters showed improvement at one year., Discussion: A study with a bigger sample size and longer follow-up is needed to fill the lacunae of literature on this topic from the Indian subcontinent. In spite of the limitations, we did observe that in our population, males were more commonly affected than females, which is contrary to most studies on the subject. Also, the disease had an early age of onset (50 years) in Indian population as compared to Western and East Asian populations., Conclusion: Combined therapy of NSAIDs and bisphosphonates shows excellent results over a period of one year. Joint-preserving surgeries are effective even in Koshino stage 3 SPONK.

Cholesterol oxidase(ChOx) enzyme isolated from Pseudomonas aeruginosa PseA(ChOxP) and Rhodococcus erythropolis MTCC 3951(ChOxR) strains as well as a commercial variant produced by Streptomyces sp.(ChOxS) were immobilized on silane modified iron(II, III)oxide magnetic nanoparticles(MNP) by covalent coupling methods. The nanobiocatalysts in case of ChOxP, ChOxR and ChOxS, retained 71, 91 and 86% of cholesterol oxidase activity respectively, as compared to their soluble counterparts. The catalytic efficiency of the immobilized enzymes on nanoparticles was more than 2.0 times higher than the free enzyme. They also showed enhanced pH and thermal stability. After 10 cycles of operation, the MNP-bioconjugates retained 50, 52 and 51% of residual activity in case of ChOxP, ChOxR and ChOxS respectively. The presence of enzyme on nanoparticles was confirmed by FTIR, SEM and TEM. The nanobiocatalysts were used for the biotransformation of cholesterol and 7-ketocholesterol to 4-cholesten-3-one and 4-cholesten-3, 7-dione respectively, which are industrially and medically important steroid precursors., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

With only 33 cases reported so far, a purely extra-axial position of medulloblastoma at cerebellopontine (CP) angle is quite exceptional. We report a case of extra-axial medulloblastoma in a 15-year-old male child located in the CP angle that was surgically treated with a provisional diagnosis of schwannoma. Histopathological diagnosis of medulloblastoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. This case report highlights the fact that although extremely rare, the possibility of an extra-axial mass being a medulloblastoma does exist., Competing Interests: There are no conflicts of interest.

Unlabelled: Glomus tumor, originally known as an angioneuromyoma, is a benign neoplasm arising from specialized structures called glomus bodies, involved in thermoregulation. Although it has been reported at a number of sites in the body, this rare tumor is most commonly seen in the subungual areas of the digits of the hand. Only a handful of lesions have been reported in the toes. Because most foot conditions are treated by podiatrists and dermatologists, orthopaedic surgeons are generally unaccustomed to making early diagnoses. The purpose of this case report is to alert the attending surgeon regarding the possibility of glomus tumor as a cause of chronic toe pain. Also it has been observed that the behavior of this tumor varies with the site of occurrence-whether digital or extradigital. So we have extensively reviewed all similar reports in the literature to analyze the behavior of this tumor at this unusual location, apart from comparing it with the more common finger variety, to ensure it possibly is not a misclassification like the chemodectomas that were earlier thought to be glomus tumors., Levels of Evidence: Therapeutic Level IV: Case Study., (© 2015 The Author(s).)

We describe a case of xanthogranulomatous osteomyelitis (XO) of the proximal femur in a 65-year-old woman who presented with pain of 6 months' duration in the right hip. Plain radiographs showed a lytic well-defined lesion in the right peritrochanteric region suggestive of a benign neoplastic etiology. The gross and histopathologic examination of the curettage specimen was consistent with XO. Xanthogranulomatous osteomyelitis is a rare chronic inflammatory process that is characterized by the presence of a large number of lipid-containing macrophages with an admixture of lymphocytes, plasma cells, and neutrophils. Gross and radiologic examination of this entity can mimic malignancy, and differentiation should be confirmed by histopathologic evaluation. To the best of our knowledge, XO of the femur has not been reported in the English-language literature. The rarity of this condition and its resemblance to bone tumors form the basis of this case report.

Pycnodysostosis (OMIM # 265800) is an inherited lysosomal disorder due to affection of cathepsin K gene, localised to 1q21. Pycnodysostosis can present with both skeletal and extraskeletal features. The index patient presented with cardinal features of short stature, dental and digital anomalies with history of multiple fractures. He, in addition had an unreported finding of white matter hyperintensity suggesting dysmyelination on neuroimaging. Molecular analysis revealed a homozygous insertion of single nucleotide in exon 5 of the CTSK gene that produces the substitution of phenylalanine instead of leucine at position 160 of protein and a premature termination of protein synthesis due to insertion of a stop codon. This mutation (c.480&#95;481insT), (p.L160fsX173) is a novel frameshift mutation. The index case extends the phenotypic spectrum and the list of previously reported mutations in the CTSK gene.

Subacute posttraumatic ascending myelopathy is a rare disorder, unrelated to syrinx formation or mechanical instability, which may gradually emerge within the first 1-2 weeks after a spinal cord injury and may lead to diagnostic and prognostic dilemmas. We present a case of 24-year-old female with unstable wedge compression fracture of L1 vertebrae with signal changes in the upper lumbar cord causing complete paraplegia below D9 with bladder and bowel involvement. In the subsequent week, she developed a delayed progressively increasing neurological deficit with cord signal abnormality on MRI extending cephalad from the injury site to the upper dorsal cord. The patient had no initial clinical improvement initially but showed a delayed recovery over months.

Study Design: Retrospective and prospective case series., Purpose: The aim of this study was to assess the results of reconstruction of anterior column, fusion and complications related to cages., Overview of Literature: Literature shows that corpectomy has become a common surgical procedure for spinal infection, trauma, deformity, instability and metastasis. Also the use of reconstructive spinal cages is common after corpectomy., Methods: Study was carried out in patients with dorsolumbar traumatic and Koch's spine. We assessed 25 patients (13 traumatic/12 tuberculous) who were treated with cages with/without any other instrumentation. Radiographs were obtained before and after the surgery. A preoperative magnetic resonance imaging was obtained in every patient., Results: Fourteen patients underwent 1 level of corpectomy, 9 patients underwent 2 levels and 2 patients underwent 3 levels of corpectomy. Anterior reconstruction alone was performed in 8 patients; 360° reconstruction was performed in 17 patients and 2 of them underwent reconstruction through single posterior approach only. The mean kyphotic angulation improved from 21.2° preoperatively to 9.3° postoperatively and to 12° at final follow up. 8 patients with neurological deficits had improvement by at least one or more Frankel grade. No migration/displacement of cage was seen in any patients., Conclusions: The present study demonstrates that the vertebral body replacement after corpectomy by reconstructive cages provides a reconstruction of the anterior column, good correction of the mean kyphotic angle, and a correction maintained with cage without any cage related complication at long term follow up. The fusion can be achieved with reconstructive cage plus bone graft with or without posterior instrumentation.

A 40-year-old woman from India presented with a mass in the front of her left knee which had been present for 8 months. Local examination revealed a globular mass of approximate size 5 cm × 4 cm × 4 cm in front of the lower pole of left patella. The patient was investigated with imaging studies and laboratory tests. Plain radiograph of the chest was normal. In addition, contrast enhanced Magnetic Resonance Imaging (MRI) of the left knee was performed. Based on the history, physical examination, laboratory and imaging studies, what is the differential diagnosis?

A 15-year-old male presented with progressive weakness of both lower limbs with urinary incontinence. Magnetic resonance imaging revealed a spinal intramedullary mass at D7-D8 level. The child was operated with a preliminary diagnosis of an intramedullary tumor. Atypical ependymoma and astrocytoma were considered in the differential diagnosis. Per- and post-operative histopathological examination reported the case as transitional meningioma (WHO Grade I). Spinal intramedullary meningiomas being a rare entity may be confused with other common intramedullary tumors. Though, rare still the possibility of an intramedullary spinal mass of being a meningioma does exist and therefore should be considered in the differential diagnosis of intramedullary tumors.

Neurilemmomas constitute one of the most common tumors of peripheral nerves. Rarer amongst them is their occurrence in median nerve in the region of arm. A sixteen-year-old female presented with painless mass in right arm which was non-tender on palpation with positive Tinel's sign and no motor or sensory deficit in the affected arm. Ultrasound examination revealed an eccentrically arising mass of size 19 × 11 mm along median nerve. MRI study revealed a mass homogenously isointense on T1 weighted images and hyperintense in T2 weighted images placed eccentrically in relation to median nerve in arm. Excisional biopsy under loupe magnification was carried out which revealed the mass to be neurilemmoma. This slowly growing benign tumor of peripheral nerves with an incidence of 5% with 14% involvement of Median nerve can be enucleated from the nerve with little or no damage. In spite of advanced imaging studies the mass cannot be differentiated preoperatively from another peripheral nerve sheath tumor neurofibroma. Both these tumors although bearing some clinical and imaging resemblance carry different intraoperative findings, histopathological features and post-operative results.

Background/aims: A little information is available in the orthopaedic literature on the clinical bedside assessment of the coronal plane deformities of the knee. We aim to explain the 'knee flexion test' to make it useful for the clinicians and the students learning the art of orthopaedics., Methods and Results: We describe the principle, pre-requisites, fallacy, and modification of the 'knee flexion test' along with the illustrative case description that had genu valgum deformity of the left knee of tibial origin., Conclusion: The 'knee flexion test' should be a part of clinical bedside assessment of the coronal plane deformities of the knee.

Background: Total knee arthroplasty is associated with significant perioperative blood loss which may necessitate blood transfusion. In this prospective randomised case control study we analysed the efficacy and safety of tranexamic acid in reducing perioperative blood loss and requirement of blood transfusion in total knee arthroplasty., Methods: Fourteen patients (group A) undergoing total knee replacement were given intravenous tranexamic acid twice, once ten minutes before tourniquet deflation and once after four hours. Thirteen patients (group B) were observed as a separate group without the administration of the drug. Total perioperative blood loss, need of blood transfusion and D-dimer assay were analysed subsequently., Results: The average blood loss in the first group was 266.2 ml and in the second group was 667.5 ml (p < 0.001). average requirement of transfusion in both the groups were 0.54 and 1.6 units of blood respectively (p < 0.001). There was no case of deep vein thrombosis or any other untoward effects., Conclusion: Hence from these evidences it was concluded that administration of tranexamic acid during total knee replacement helps to reduce blood loss without increasing the risk of deep vein thrombosis.

Summary: This study evaluated the parameters of bone mineral homeostasis including 25(OH)D and PTH in 90 Indian patients with hip fracture and 90 controls. Hypovitaminosis D, secondary hyperparathyroidism, and biochemical osteomalacia was present in 77, 69, and 50 % patients, respectively, significantly higher compared to controls. Vitamin D deficiency is an important risk factor for hip fracture., Introduction: The prevalence of vitamin D deficiency is not well known in hip fracture patients from India. Therefore, the present study was conducted to evaluate the parameters of bone mineral homeostasis including 25(OH)D and intact PTH in hip fracture from North India., Methods: Ninety consecutive patients with hip fracture and similar number of age- and sex-matched controls were enrolled in the study. The fasting venous samples were analyzed for 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. Vitamin D deficiency was defined as serum 25-OHD of <20 ng/dl., Results: The mean age of hip fracture subjects was 65.9 ± 12.6 which was comparable in men and women. Majority of study subjects were women (70 women and 20 men). The serum 25(OH)D and calcium levels were significantly lower, whereas the intact PTH and ALP levels were significantly higher in patients compared to controls. There was significant negative correlation between serum 25(OH)D and PTH. In the hip fracture group, 76.7 % of the subjects had vitamin D deficiency, and 68.9 % had secondary hyperparathyroidism. In the control group, vitamin D deficiency and elevated PTH levels were seen in 32.3 and 42.2 %, respectively., Conclusion: About three fourths of hip fracture patients have vitamin D deficiency, and two thirds have secondary hyperparathyroidism. Therefore, the serum 25-OHD level may be a useful index for the assessment of risk of hip fracture in India.

Unlabelled: This case-control study was performed to evaluate 25-hydroxyvitamin D [25(OH)D] deficiency and its correlation with hand grip strength in 95 Indian hip fracture subjects and 95 controls. 25(OH)D deficiency was found in 88.4 % of hip fracture subjects that was significantly higher as compared to controls. Hand grip strength as measured by hand held dynamometer was significantly lower in patients, and there was a significant positive correlation between 25(OH)D and hand grip strength., Purpose: The present study was conducted to assess correlation between 25(OH) D and hand grip strength in hip fracture subjects residing in North India., Methods: Ninety-five patients with hip fracture and similar number of controls were enrolled in the study. Fasting venous samples were analyzed for 25(OH)D, intact parathyroid hormone (PTH), alkaline phosphatase, calcium, and phosphate. Hand grip strength of study subjects was measured using Jamar dynamometer. Correlation between vitamin D levels and hand grip strength was analyzed in study population., Results: The mean age of hip fracture subjects was 61.4 ± 12.6 years which was comparable in men and women. Out of 95 subjects, 57 were men and 38 were women. Mean 25(OH)D levels were significantly lower whereas intact PTH levels were significantly higher in patient group compared controls (10.29 ± 6.53 vs 13.6 ± 4.01 ng/ml; 62.6 ± 59.3 vs 37.7 ± 28.8 pg/ml, respectively). The number of subjects with 25(OH)D deficiency and secondary hyperparathyroidism was significantly higher in hip fracture group. The mean hand grip strength among hip fracture subjects was significantly lower compared to that of controls (16.57 ± 5.74 vs 26.74 ± 5.23 kg). There was a significant positive correlation between 25(OH)D and hand grip strength ( r = 0.482, p value <0.01) in hip fracture population., Conclusion: Majority of hip fracture patients in India have vitamin D deficiency, secondary hyperparathyroidism, and lower hand grip strength compared to controls. Further, there is significant positive correlation between 25(OH)D and hand grip strength.

We report late presentation of caudal regression syndrome in a 9 year old presenting with a scoliotic deformity. She in addition had an asymptomatic cervical syrinx and vitiligo. We discuss the reasons for this unusual constellation of symptomatology present in our case.