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Background: Lockdown and quarantine strategies due to COVID-19 scare have made routine health facility inaccessible to patients across the country To combat this issue, tele-consultation was identified as an interim solution where patients could avail the benefit of routine health check-up Materials and methods: We at AIIMS, Mangalagiri, started two e-consultation designs to tide over the crisis of lockdown and reach out to our patients These were call-based (group I) and app-based (group II) The patient response to these two modalities was compared over a period of 6 weeks

Context: Covid-19 pandemic and lockdown scenario has forced to shut down the Outpatient consultation in hospitals and clinics. It was challenging to help out the patient population who were routine health care seekers for maintenance and follow-up.Aims: To tackle the prevailing routine Orthopaedic health care issue due to Covid-19 lockdown strategy through Tele-consultation and to delineate the spectrum of Orthopaedic disorders that were amenable to treatment by e-Consultation.Methods and Material: We executed two Tele consultation designs (Call based and App based) for our institution to reach out to the patients. The Orthopaedic patient characteristics and disease management was documented and analyzed.Results: A total of 468 consultations with diverse Orthopaedic disorders including Congenital lesions, Developmental and Metabolic disorders, Infective disorders, inflammatory disorders, Traumatic disorders, Tumours, Degenerative disorders and Repetitive Strain Injuries were addressed.Conclusions: Clinical decision making through Tele-consultation in Orthopaedics is demanding. However, majority of routine Orthopaedic disorders are amenable to management.

INTRODUCTION: The commonly recognized causes of post-operative neurological deterioration in spinal tuberculosis are inadequate decompression, damage to vascular supply of the spinal cord, and multi-drug resistant organisms. There are no known cases of syringomyelia developing after surgical decompression of spinal tuberculosis. CASE PRESENTATION: A teenage girl presented with rapid onset quadriparesis secondary to a tubercular epidural abscess extending from C4-T8. The neurological status deteriorated to quadriplegia immediately following decompression by hemilaminectomy at C7 and T7 levels. Investigations into the cause of neurological deterioration revealed syrinx formation at T5–9 levels. The patient had partial motor and sensory recovery in the first 3 weeks post-operatively. Tubercular infection was treated with a 1-year course of multi-drug anti-tubercular therapy. However, there was no further neurological improvement at 2 years follow-up. DISCUSSION: Syringomyelia in tuberculosis has been associated with tubercular meningitis, intradural tuberculomas, and post-surgical vascular insult. None of these were implicated as the cause of syrinx formation in this case. We hypothesize that the rapid evolution of epidural abscess in an intact vertebral column led to an acute “epidural compartment syndrome”, which caused ischemic damage to the spinal cord. Compression caused by the epidural abscess was relieved by surgical decompression, allowing the central canal to dilate and expand into the softened spinal parenchyma, hence leading to syrinx formation.

Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.

Aim: Early tendon transfer has shown good outcomes in peripheral nerve injuries of upper limb. However, there is lack of knowledge on early tendon transfer for peripheral nerve palsy in lower limb. This study has been designed to study the functional outcomes of early tendon transfer in the lower limb, particularly for foot drop. Patients and Methods: We enrolled 30 cases of foot drop due to traumatic sciatic/common peroneal nerve (CPN) palsy between September 2012 and March 2016. We performed nerve exploration with repair and early tendon transfer in all patients. All patients were followed up for a minimum period of 24 months. Functional evaluation was carried out using Stanmore assessment questionnaire. Results: At the end of 24 months postoperatively, the Stanmore assessment questionnaire score showed a significant improvement from a mean preoperative score of 17.5 to mean postoperative score of 86.2. All patients were free of ankle–foot orthosis (AFO). All patients were subjectively satisfied. Time to return to original job was 5.2 months on an average. Ankle dorsiflexion of the operated limb was comparable to the normal limb in cases where there was nerve recovery. Planovalgus foot, a known complication of this procedure, was noted in 24 patients. However, it was not disabling to any patient. Conclusion: Early tendon transfer in CPN palsy/sciatic nerve palsy has a definite place in the management of the injured patient. The transfer, if appropriately carried out, acts as a helper, an internal splint, a substitute, or perhaps all of the three at varying times in the rehabilitative phase of the patient. Dorsiflexor clearance in swing phase of locomotion was quickly restored in all patients, obviating the need for AFO.

BACKGROUND: Indiscriminate use of intra-operative fluoroscopy can incur harm both to the patient as well as the surgeons. Orthopedic surgeons seldom do in skin marking prior to cleaning and draping of the operative site. This study aims to study the feasibility and utility of pre-operative skin marking with henna in conjunction with marker radiograph.METHODS: Out of 54 patients undergoing spine surgery, vertebral level localization was done by fluoroscopy in 26 patients. In the rest of the 28 patients, preoperative marker radiograph with steel wires was taken in conjunction with henna line markings on the skin. These were correlated for vertebral level localization. Difference in time taken for vertebral localization by these two methods, and the difference in the number of fluoroscopic images required was observed and recorded.RESULTS: Approximately 4 minutes were needed for level localization via fluoroscopic technique, whereas the henna marking technique did this in approximately 30 seconds. No adverse effects of henna application were observed during the study.CONCLUSIONS: The use of preoperative skin marking with henna along with the appropriate marker radiograph can reduce the surgical time and radiation exposure without increasing the chances of a wrong level surgery in the spine.

Background: Spontaneous epidural haematoma is a rare clinical presentation and may be associated with coagulation disorders. These hematomas present usually with rapidly developing paraparesis and any delay in diagnosis may be disastrous.Methods: We included five patients of spontaneous epidural hematomas in hemophilia A with neurological deficit. They were treated non-operatively with factor VIII replacement therapy with oral tranexamic acid and intravenous dexamethasone as per protocol. All patients were followed up for 6 months and assessed for signs of neurological recovery and radiological resolution of hematoma.Results: All patients had complete motor recovery within 3 months of initiating treatment and showed resolution of hematoma on MRI. Conclusions: Prognosis following early initiation of correction of factor deficiency is good.

Wilson's disease (WD) is a rare inherited disorder of copper metabolism. It chiefly has hepatic, neurological and ophthalmic manifestations. Although osteoporosis, rickets and early arthritis are common features of WD, they are under-recognized. Musculoskeletal manifestations very rarely lead to diagnosis of the disease. Here we present a case of a 12-year-old girl who presented with a 3-month-old pathological fracture of neck of femur. WD was diagnosed on investigating the cause of the pathological fracture, which was managed by performing a conventional McMurray's intertrochanteric osteotomy. At 6 months follow up, fracture had united and patient was able to ambulate with support. WD can be a rare cause of pathological fracture. A high index of suspicion must be maintained in patients of pathological fracture presenting with associated neuropsychiatric or hepatic manifestations.