A rare case of Osteoblastoma of the Calcaneum – A Case Report

Volume 6 | Issue 2 | May – Aug 2018 | Page: 42-44| Jose Austine, Atmananda Hegde, Deepa Adiga.

Authors: Jose Austine [1], Atmananda Hegde [1], Deepa Adiga [2].

[1] Department of Orthopaedic Surgery, Kasturba Medical College, Mangalore Manipal Academy of Higher Education (MAHE), Karnataka, India.

[2] Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Karnataka, India.

Address of Correspondence
Dr. Jose Austine,

Department of Orthopaedic Surgery,

K.M.C. Hospital Attavar, Attavar, Mangalore – 575 001, Karnataka, India.

Email: joseaustine10@gmail.com


Introduction: Osteoblastoma is a benign tumor which constitutes around 1% of primary bone tumors. The incidence of an osteblastoma of the calcaneum is <0.8% among all.

Case Report: We report a 17-year-old boy who presented with unremitting heel pain of 4 months’ duration associated with a swelling which was clinically and radiologically diagnosed as either an aneurysmal bone cyst or giant-cell tumor. The patient was treated with an extended curettage and cementing of cavity. The final diagnosis of an osteoblastoma of calcaneum was established post-operatively following histopathological examination of biopsy.

Discussion: The prevalence and behavior of calcaneal osteoblastomas are yet to be reported in the Indian population. Lack of clinician familiarity and a rare incidence translate into a delay in the diagnosis of tumors and tumor-like lesions of the calcaneum, as seen in our case. Their recognition is imperative to avoid mistaking the condition for an aneurysmal bone cyst, giant-cell tumor, or even an osteogenic sarcoma and be managed more aggressively than required.

Conclusion: An adolescent presenting with chronic unremitting heel pain should undergo early and detailed radiographic evaluation. A high index of suspicion is needed to diagnose this condition early. Outcome largely depends on early diagnosis and prompt surgical intervention.

Keywords: Osteoblastoma, Calcaneum, Heel pain.


1. E. Santini-Araujo. Ricardo KK, Franco B, editors. Tumors and Tumor-Like Lesions of Bone: For Surgical Pathologists, Orthopedic Surgeons and Radiologists. London: © Springer-Verlag; 2015.

2. Khan Z, Hussain S, Carter SR. Tumours of the foot and ankle. Foot (Edinb) 2015;25:164-72.

3. Lichtenstein L. Benign osteoblastoma. A category of osteoid and bone forming tumor other than classical osteoid osteoma, which may be mistaken for giant cell tumor or osteogenic sarcoma. Cancer 1956;9:1044-52.

How to Cite this article: Austine J, Hegde A, Adiga D. A rare case of Osteoblastoma of the Calcaneum – A Case Report. J Kar Orth Assoc. May-Aug 2018; 6(2): 42-44.

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Intimal Injury of Abdominal Aorta Following Traumatic Spondylolisthesis in a Polytrauma Patient – A Case Report

Volume 6 | Issue 2 | May – Aug 2018 | Page: 35-37 | Nataraj A R, Raghavendra S, Murali Poduval Sreenivas T.

Authors: Nataraj A R [1], Raghavendra S [2], Murali Poduval [2], Sreenivas T [3].

[1] Dept of Orthopaedics ESIC PGIMSR, Bengaluru, Karnataka

[2] Dept of Orthopaedics JIPMER, Puducherry

[3] Dept of Orthopaedics, Kannur medical college, Kannur, Kerala

Address of Correspondence
Dr. Nataraj AR,

Department of Orthopaedics, ESIC MC & PGIMSR,

Rajajinagar Bengaluru 560072

E mail: natadoc@rediffmail.com


Traumatic spondylolisthesis can involve lamina, pedicle, or facet fracture, but usually spares pars interarticularis. Traumatic listhesis causing cord injuries has been reported. Traumatic spondylolisthesis of L4 and L5 vertebra with spontaneous reduction causing intimal tear of abdominalaorta in a case of polytrauma patient is very rare and has been never reported. In this case report, we are presenting one such case which eventually led to gangrene of both lower limbs and death due to sepsis and acute renal failure.

Keywords: Spondylolisthesis, abdominal aorta, intimal tear, polytrauma.


1. Sedrick JA, Ho J, Stern JA, McDaniel AT, Mahoney CR. Post-totalknee-arthroplasty popliteal artery intimal tear repaired with endoluminal balloon angioplasty. Am J Orthop (Belle Mead NJ) 2009;38:E31-3.

2. Lim CT, Hee HT, Liu G. Traumatic spondylolisthesis of the lumbar spine: A report of three cases. J OrthopSurg (Hong Kong) 2009;17:361-5.

3. Deniz FE, Zileli M, Cağli S, Kanyilmaz H. Traumatic L4-L5 spondylolisthesis: Case report. Eur Spine J 2008;17 Suppl 2:S2325.

4. Miyamoto H,Sumi M,Kataoka O,Doita M,Kurosaka M,Yoshiya S. Traumatic spondylolisthesis of the lumbosacral spine with multiple fractures of the posterior elements.J Bone Joint Surg Br2004;86:115-8.
5. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma 2000;48:613-21.

6. Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J PediatrOrthop 1996;16:621-6.

7. Lloyd S. Carotid artery dissection following minimal postural trauma in a firefighter. Occup Med (Lond) 2004;54:430-1.

8. Zack PM, Ischinger T. Late progression of an asymptomatic intimal tear to occlusive coronary artery dissection following angioplasty. CathetCardiovascDiagn 1985;11:41-8.

9. Ihaya A, Takamori A, Morioka K, Sasaki M, Yamada N, Tanabe S. Popliteal artery disruption following complete dislocation of the knee. Chirurgia 2006;19:219-21.

How to Cite this article: Nataraj A R, Raghavendra S, Poduval M, Sreenivas T. Intimal Injury of Abdominal Aorta Following Traumatic Spondylolisthesis in a Polytrauma Patient – A Case Report. J Kar Orth Assoc. May-Aug 2018; 6(2): 35-37.

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Parsonage-Turner Syndrome Masquerading as Shoulder Septic Arthritis: A Curious Case of the Subluxed Shoulder – A Diagnostic Dilemma

Volume 6 | Issue 2 | May-Aug 2018 | Page: 38-41 | Naveen Mathai, Sashi Aier, Abhijith S, Kiran Acharya, Vivek Pandey.

Authors: Naveen Mathai [1], Sashi Aier [1], Abhijith S [1], Kiran Acharya [1], Vivek Pandey [1].

[1] Department Of Orthopaedics, Kasturba Medical College, MAHE, Manipal, Karnataka

Address of Correspondence
Dr. Vivek Pandey,

Associate Professor,

Department Of Orthopaedics, Kasturba Medical College,

MAHE, Manipal, Karnataka India- 576104

Email: vivekortho@gmail.com


Introduction: Idiopathic brachial neuritis, also known as Parsonage-Turner syndrome, is a disorder of unknown etiology, with asymmetric involvement of the brachial plexus [1, 2]. It occurs in all age groups but is more common between the third and seventh decade. Men are affected more often than women. Inciting events occurring days before the onset has been reported in 28–83% of the cases in various series [3, 4]. Upper respiratory infection, flu-like illness, immunization, surgery, and emotional stress have been the common triggers. Some incidents occur without a triggering factor. We report a rare case of a middle-aged female with brachial neuritis which masqueraded as septic arthritis of the shoulder.

Keywords: Brachial Neuritis, Parsonage Turner syndrome, Subluxed shoulder


1. Parsonage MJ, Turner JW. Neuralgic amyotrophy; the shouldergirdle syndrome. Lancet 1948;1:973-8.

2. Rachid AB, Lacerda D, Seitenfus JL. Síndrome de ParsonageTurner em paciente HIV positivo. Rev Bras Reumatol 2005;45:3942.

3. Sathasivam S, Lecky B, Manohar R, Selvan A. Neuralgic amyotrophy. J Bone Joint Surg Br 2008;90:550-3.

4. Bagheri F, Ebrahimzadeh MH, Sharifi SR, Ahmadzadeh-Chabok H, Khajah-Mozaffari J, Fattahi AS. Pathologic dislocation of the shoulder secondary to septic arthritis: A case report. Cases J 2009;2:9131.

5. Gompels BM, Darlington LG. Septic arthritis in rheumatoid disease causing bilateral shoulder dislocation: Diagnosis and treatment assisted by grey scale ultrasonography. Ann Rheum Dis 1981;40:609-1.

6. Van Alfen N, Van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain 2006;129:438-50.

7. Fransz DP, Schonhuth CP, Postma TJ, van Royen BJ. ParsonageTurner syndrome following post-exposure prophylaxis. BMC Musculoskelet Disord 2014;15:265.

8. Misamore GW, Lehman DE. Parsonage-Turner syndrome (acute brachial neuritis). J Bone Joint Surg Am 1996;78:1405-8.

9. Tjoumakaris FP, Anakwenze OA, Kancherla V, Pulos N. Neuralgic amyotrophy (Parsonage-Turner syndrome). J Am Acad Orthop Surg 2012;20:443-9.

10. Dartevel A, Colombe B, Bosseray A, Larrat S, Sarrot-Reynauld F, Belbezier A, et al. Hepatitis E and neuralgic amyotrophy: Five cases and review of literature. J Clin Virol 2015;69:156-64.

11. Moriguchi K, Miyamoto K, Takada K, Kusunoki S. Four cases of anti-ganglioside antibody-positive neuralgic amyotrophy with good response to intravenous immunoglobulin infusion therapy. J Neuroimmunol 2011;238:107-9.

12. Stich O, Glos D, Brendle M, Dersch R, Rauer S. Cerebrospinal fluid profile and seroprevalence of antiganglioside reactivity in patients with neuralgic amyotrophy. J Peripher Nerv Syst 2016;21:27-32.
13. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015; 2015:CD008242. 14. Nishikawa N, Nomoto M. Management of neuropathic pain. J Gen Fam Med 2017;18:56-60.

15. Van Alfen N, Van Engelen BG, Hughes RA. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev 2009; 2009:CD006976.

16. Van Alfen N. Clinical and pathophysiological concepts of neuralgic amyotrophy. Nat Rev Neurol 2011;7:315-22.

17. Tsairis P, Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol 1972;27:109-17.

18. Van Eijk JJ, Van Alfen N, Berrevoets M, Van der Wilt GJ, Pillen S, Van Engelen BG. Evaluation of prednisolone treatment in the acute phase of neuralgic amyotrophy: An observational study. J Neurol Neurosurg Psychiatry 2009;80:1120-4.

19. Naito KS, Fukushima K, Suzuki S, Kuwahara M, Morita H, Kusunoki S, et al. Intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy for motor impairment of neuralgic amyotrophy: Clinical observations in 10 cases. Intern Med 2012;51:1493-500.

20. Van Eijk JJ, Van Alfen N, Tio-Gillen AP, Maas M, Herbrink P, Portier RP, et al. Screening for antecedent Campylobacter jejuni infections and anti-ganglioside antibodies in idiopathic neuralgic amyotrophy. J Peripher Nerv Syst 2011;16:153-6.

21. Host C, Skov L. Idiopathic neuralgic amyotrophy in children. Case report, 4 year follow up and review of the literature. Eur J Paediatr Neurol 2010;14:467-73.

22. Hussey AJ, O’Brien CP, Regan PJ. Parsonage-Turner syndromecase report and literature review. Hand (NY) 2007;2:218-21.

23. Cup EH, Ijspeert J, Janssen RJ, Bussemaker-Beumer C, Jacobs J, Pieterse AJ, et al. Residual complaints after neuralgic amyotrophy. Arch Phys Med Rehabil 2013;94:67-73.

24. Van Alfen N, Van der Werf SP, Van Engelen BG. Long-term pain, fatigue, and impairment in neuralgic amyotrophy. Arch Phys Med Rehabil 2009;90:435-9.

How to Cite this article: Mathai N, Aier S, Abhijith S, Acharya K, Pandey V.Parsonage-Turner Syndrome Masquerading as Shoulder Septic Arthritis: A Curious Case of the Subluxed Shoulder – A Diagnostic Dilemma. J Kar Orth Assoc. May-Aug 2018; 6(2):38-41.

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Outcome Analysis of Osteosynthesis of Complex Fractures of Both Bones of Forearm

Volume 6 | Issue 2 | May-Aug 2018 | Page: 21-28 | Darshan Kumar A. Jain, Rahul P, Aubrey Conrad, Franco.

Authors: Mahesh Suresh Kulkarni [1], Sheik Mohammad Fahim [1], Monappa Naik, Sandeep Vijayan [1], Sourab Shetty [1], Sharath K Rao [1].

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Sciences Manipal, India.

Address of Correspondence
Dr. Monappa Naik Aroor,

Department of Orthopaedics,

Kasturba Medical College,

Manipal Academy of Higher Sciences Manipal, India.

Email: naikortho@gmail.com


Background: Diaphyseal forearm fractures are virtually considered as equivalent to intra articular fractures. Open Reduction with internal fixation (ORIF) with plate Osteosynthesis has been considered as the gold standard for both bone fractures. AO ‘C’ type of the fractures are of special interest because they represent complex fractures of the both bones of the forearm which includes segmental and / or comminuted fractures in the diaphyseal region. There are not many studies in the English literature which focus upon this complex fracture management and their functional outcome. We are describing the clinical, radiological and functional outcome of complex both bone forearm diaphyseal fractures treated with ORIF with LCP Osteosynthesis in skeletally mature patients who have minimum follow up of one year.

Materials and Methods: We retrospectively reviewed adult patients who were treated for complex diaphyseal both bone forearm fractures by ORIF with LCP plate Osteosynthesis between 2006 to 2016 with minimum follow up period of one year. Skeletally immature patients, nonosteoporotic pathological fractures, intact single bone, open injuries who required soft tissue coverage, injuries with dislocations of either or both of proximal and distal joints in forearm and patients with neurovascular injuries were excluded from the study. Patients were assessed for union time, complications and functional evaluation was done by Andersons criteria and Disabilities of the arm, Shoulder and Hand (DASH) scores.

Results: Of the 24 patients who were operated 20 were available for the follow up.(16 male,4 females)with mean age of 42.35 years ( range 20 to 70 years). There were 17 bifocal 16 unifocal and 7 irregular fractures.Mean follow up was 49.1 months (Range 14 to 111months). Mean union time was 7.2 months (±4.6 months). There were, 2 nonunions 2neuroproxia. As per the Anderson criteria we had 11 excellent 6 satisfactory 1 usatisfactory and 2 as failures. Mean DASH score was 18.8 (±12.42).

Conclusion: Judicious use of LCP in complex forearm fractures with early mobilization will lead to the good functional outcome with minimal complications. But there is a tendency for the delay in fracture consolidation and union.

Key words: complex fractures; Forearm Fractures; LCP osteosynthesis; both bone fractures; AO 22 C fractures; segmental fractures; diaphyseal fractures; nonunion ; radius and ulna fractures; complex fractures


1. Browner BD, Levine AM, Jupiter JB, Trafton PG, Krettek C. Skeletal Trauma: 2-Volume Set. Saint Louis: Elsevier Health Sciences; 2008.

2. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg 2014;22:437-46.

3. Goldberg HD, Young JW, Reiner BI, Resnik CS, Gillespie TE. Double injuries of the forearm: A common occurrence. Radiology 1992;185:223-227.

4. Müller ME, Koch P, Nazarian S, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin, Heidelberg: Springer Berlin Heidelberg; 1990.

5. Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions. Injury 2007;38:S11-8.

6. Tzioupis C, Giannoudis PV. Prevalence of long-bone nonunions. Injury 2007;38:S3-9.

7. Anderson L, Sisk D, Tooms R, Park W. Compression plate fixation in acute diaphyseal fxs of radius and ulna. J Bone Joint Surg Am 1975;57-A(3):287-97.

8. Niemeyer P, Sudkamp NP. Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech 2006;73:221-8.

9. Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am 1992;74:1068-78.

10. Matthews LS, Kaufer H, Garver DF, Sonstegard DA. The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm. J Bone Joint Surg Am 1982;64:14-7.

11. Wu CC, Chen WJ. Healing of 56 segmental femoral shaft fractures after locked nailing: Poor results of dynamization. Acta Orthop Scand 1997;68:537-40.

12. Grace TG, Eversmann WW. Forearm fractures treatment by rigid fixation with early motion. J Bone Joint Surg 1980;62A(3):433-7.

13. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am 2008;90:1891-8.

14. Hong G, Cong-Feng L, Chang-Qing Z, Hui-Peng S, Cun-Yi F, Bing-Fang Z. Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail: Short-term results in eighteen patients. J Orthop Trauma 2005;19:384-91.

15. Saikia K, Bhattacharya T, Jitesh P, Bhuyan S, Borgohain M, Ahmed F. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian J Orthop 2011;45:417.

16. Stevens CT, Dus HJT. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg 2008;74:180-3.

17. Henle P, Ortlieb K, Kuminack K, Mueller CA, Suedkamp NP. Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compression plate. Arch Orthop Trauma Surg 2011;131:85-91.

18. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: Choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110.

19. Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: The biomechanical effect of number of screws and plate length. J Orthop Trauma 2002;16:166-71.

20. Iacobellis C, Biz C. Plating in diaphyseal fractures of the forearm. Acta Bio Med Atenei Parmensis 2014;84:202-11.

21. Goldfarb CA, Ricci WM, Tull F, Ray D, Borrelli J. Functional outcome after fracture of both bones of the forearm. Bone Joint J 2005;87:374-9.

22. Leung F, Chow SP. Locking compression plate in the treatment of forearm fractures: A prospective study. J Orthop Surg 2006;14:291-4.

23. Droll KP, Perna P, Potter J, Harniman E, Schemitsch EH, McKee MD. Outcomes following plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am 2007;89:2619-24.

24. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res 1983;175:25-9.

25. Mih AD, Cooney WP, Idler RS, Lewallen DG. Long-term follow-up of forearm bone diaphyseal plating. Clin Orthop Relat Res 1994;299:256-8.

How to Cite this article: Kulkarni M S, Fahim S M, Naik M, Vijayan S, Shetty S, Rao S K. Outcome Analysis of Osteosynthesis of Complex Fractures of Both Bones of Forearm. J Kar Orth Assoc. MayAug 2018; 6(2):

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Treatment of distal humerus extra-articular fractures using a single 3.5mm precontoured locking compression plate

Volume 6 | Issue 2 | May-Aug 2018 | Page 7-11 | Darshan Kumar A. Jain, Rahul P, Aubrey Conrad, Franco.

Authors: Darshan Kumar A. Jain [1], Rahul P [1], Aubrey Conrad [1], Franco [1].

[1]Department of Orthopaedics, Ramaiah Medical College & Hospital, Bangalore.

Address of Correspondence
Dr. Darshan Kumar A. Jain,

Department of Orthopaedics,

Ramaiah Medical College & Hospital, Bangalore.

Email: jaindarshan81@gmail.com


Background: Extra-articular distal humerus fractures are relatively rare,and optimal surgical fixation is a quandary for orthopedic surgeons. The introduction of the extra-articular distal humerus locking plates has provided a viable option,and in our study, we have retrospectively analyzed 17 patients with extra-articular distal radius fracture surgically treated using the 3.5mm extra-articular distal humerus locking plate through the paratricipital approach.

Materials and Methods: A total of 17 patients with closed extra-articular fractures of the distal humerus presenting within 3weeks of injury were operated between June 2015 and July 2017 using the 3.5mm distal humerus extra-articular plate through the paratricipital approach. All patients were followed up for a minimum of 10months,and radiological and functional outcome were accessed. The Mayo Elbow performance score (MEPS)and the disabilities of arm, shoulder,and hand (DASH)questionnaire were employed.

Results: The mean age of patients was 40.6 years (range 18–60 years) with 9 females and 8 males. All fractures united with a mean time to union of 16.94 weeks (range 14–20 weeks). The mean follow-up period was 12.5 months(range 10–15 months). Preoperatively two patients had radial nerve palsy andpostoperatively one patient developed radial nerve palsy, all had neuropraxia and recovered completely. 15 patients had excellent results,and two patients had good results using MEPS,and the mean DASH score was 14.6 ± 5.4.

Conclusion: Extra-articular distal humerus fractures can be treated successfully by a single precontoured extra-articular distal humerus locking compression plate with minimal soft tissue injury and good functional outcome.

Keywords: Distal humerus fracture, extra-articular, locking plate.


1. Webb LX. Fractures of the distal humerus. In: Bucholz RW, Heckwan JD, editors. Rockwood and Green’s Fractures in Adults. Philadelphia: Lippincott Williams and Williams; 2001. p. 953-72.

2. Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphy- seal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 2006;88:2343-7.

3. Scolaro JA, Hsu JE, Svach DJ, Mehta S. Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants. Injury 2014;45:2040-4.

4. Fjalestad T, Strømsøe K, Salvesen P, Rostad B. Functional results of braced humeral diaphyseal fractures: Why do 38% lose external rotation of the shoulder? Arch Orthop Trauma Surg 2000;120:2815.

5. Zimmerman MC, Waite AM, Deehan M, Tovey J, Oppenheim W. A biomechanical analysis of four humeral fracture fixation systems. J Orthop Trauma 1994;8:233-9.

6. Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 2005;19:43-7.

7. Spitzer AB, Davidovitch RI, Egol KA. Use of a “hybrid” locking plate for complex metaphyseal fractures and non- unions about the humerus. Injury 2009;40:240-4.

8. Saragaglia D, Rouchy RC, Mercier N. Fractures of the distal humerus operated on using the Lambda® plate: Report of 75 cases at 9.5 years follow-up. OrthopTraumatolSurg Res 2013;99:707-12.

9. Tejwani NC, Murthy A, Park J, McLaurin TM, Egol KA, Kummer FJ. Fixation of extra- articular distal humerus fractures using one locking plate versus two reconstruction plates: A laboratory study. J Trauma 2009;66:795-9.

10. Paris H, Tropiano P, ClouetD’orval B, Chaudet H, Poitout DG. Fractures of the shaft of the humerus: Systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev ChirOrthopReparatriceAppar Mot 2000;86:346-59.

11. Qing Y, Fang W, Qiugen W, Wei G, Jianhua H, Wu X, et al. Surgical treatment of adult extra- articular distal humeral diaphyseal fractures using an oblique metaphyseal locking compression plate via a posterior approach. Med PrincPract 2012;21:40-45.

12. Meloy GM, Mormino MA, Siska PA, Tarkin IS. A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: Single-column plating. Injury 2013;44:1620-4.

13. Capo JT, Debkowska MP, Liporace F, Beutel BG, Melamed E. Outcomes of distal humerus diaphyseal injuries fixed with a singlecolumn anatomic plate. IntOrthop 2014;38:1037-43.

14. Fawi H, Lewis J, Rao P, Parfitt D, Mohanty K, Ghandour A. Distal third humeri fractures treated using the SynthesTM 3.5-mm extraarticular distal humeral locking compression plate: Clinical, radiographic and patient outcome scores. Shoulder Elbow 2015;7:104-9.

15. Jain D, Goyal GS, Garg R, Mahindra P, Yamin M, Selhi HS. Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures. Indian J Orthop 2017;51:86-92.

How to Cite this article: Jain D A, Rahul P, Conrad A, Franco. Treatment of distal humerus extra-articular fractures using a single 3.5mm precontoured locking compression plate. J Kar Orth Assoc. May-Aug 2018; 6(2): 7-11.

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Comparative Study of Efficacy of Single Injection of Platelet-rich Plasma with Steroid Injection in Treatment of Plantar Fasciitis

Volume 6 | Issue 2 | May-Aug 2018 | Page: 29-34 | Vanamali B Seetharam, B Sunil, K B Srinath Reddy, Narayan Naik

Authors: Vanamali B Seetharam [1], B Sunil [1], K B Srinath Reddy [1], Narayan Naik [1].

[1] Department of Orthopaedics, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. B Sunil,

Department of Orthopaedics, K.R Road, Fort,

Bangalore Medical College and Research Institute,

Bengaluru – 560 002, Karnataka, India.

E-mail: comsunil_bee@yahoo.co.in


Background: Plantar fasciitis (PF) is a degenerative condition which can be painful and debilitating with well-recognized clinical presentation. Although most patients with this condition eventually have satisfactory outcomes with nonsurgical treatment, sometimes PF can be a difficult problem to treat. For patients who do not improve after initial treatment, corticosteroid injection or dexamethasone iontophoresis may provide short-term benefit. However, these therapies do not improve long-term outcomes and may cause plantar fascia rupture. Recent studies have indicated platelet-rich plasma (PRP) might be promising treatment modality in chronic cases of PF.

Materials and Methods: Prospective study conducted at tertiary care research institute comparing the efficacy of single injection of PRP with a steroid. A total of 80 patients with PF of more than 3 months were subjected to routine blood investigation, X-rays of the foot with ankle and were categorized into two groups. The first group received local infiltration of 1 ml of autologous PRP and the second group received 1 ml Triamcinolone  injection. After injection, all patients were prescribed combination of paracetamol and tramadol orally for pain relief and were advised plantar fascia stretching exercises, soft footwear. Visual analog scale and foot and ankle outcome scores were recorded on day 0, at 12 and 24 weeks.

Results: The results were analyzed using nonparametric tests such as Chi-square and Fisher Exact tests. The pain relief at 3 months was comparable in both groups, but at 6 months pain relief was greater in the PRP group, and the difference was statistically significant (P <0.001). The complications in steroid group were hypopigmentation with subdermal atrophy, and no complications were reported in PRP group.

Conclusion: Efficacy of single injection of PRP to relieve the pain of PF is better than triamcinolone over a short-term follow-up period. However, more multicenter studies are required to evaluate the efficacy of PRP over the long term.

Keywords: Plantar fasciitis, platelet-rich plasma, steroid, visual analog scale score, foot and ankle outcome score.


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17. Buckbinder R. Plantar fasciitis. N Engl J Med 2004;350:2159-66.
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23. Say F, Gürler D, İnkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc 2014;48:667-72.
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corticosteroid injection for the treatment of plantar fasciitis. J Foot Ankle Surg

27. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1998;19:91-7.
28. Mcmillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB.
Ultrasound guided corticosteroid injection for plantar fasciitis: Randomised controlled trial. BMJ 2012;344:1-12.
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30. Kane D, Greaney T, Shanahan M, Duffy G, Bresnihan B, Gibney R, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford) 2001;40:1002-8.
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32. Gidumal R, Evanski P. Calcaneal osteomyelitis following steroid injection: A case report. Foot Ankle 1985;6:44-6.
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How to Cite this article: Kulkarni M S, Fahim S M, Naik M, Vijayan S, Shetty S, Rao S K. Outcome Analysis of Osteosynthesis of Complex Fractures of Both Bones of Forearm. J Kar Orth Assoc. MayAug 2018; 6(2): 29-34.

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A Study to Assess the Functional Outcome After Laminotomy and Microdiscectomy in Lower Lumbar Disc Prolapse

Volume 6 | Issue 2 | May-Aug 2018 | Page 12-15 | Deepak Hegde, Arjun Ballal, Hishanil Rasheed

Authors: Deepak Hegde [1], Arjun Ballal [2], Hishanil Rasheed [1].

[1] Department of Orthopaedics, K.S Hegde Medical Academy, Mangalore – 575 018, Karnataka, India,

[2] Department of Orthopaedics, Consultant Orthopaedic Surgeon, Ballal Healthcare, Udupi – 576 105, Karnataka, India.

Address of Correspondence
Dr. Deepak Hegde,

Department of Orthopaedics, K.S Hegde Charitable Hospital,

Medical sciences Complex, Deralkatte, Mangalore – 575 018, Karnataka, India.

E-mail: arjchess_lp@rediffmail.com


Background: Advances in technology with better surgical techniques and instrumentation have proved time and again to reduce the incidence of complications and cosmetic morbidities caused by the traditional techniques in the management of intervertebral disc prolapse of the lumbar spine. By limiting the width of the surgical corridor the risk of muscle crush, exposure of soft tissues for infection and post-operative morbidity and complications can be minimized by great amounts.

Aims and Objectives: The aim of the study was to assess the functional outcome of the spine after laminotomy and microdiscectomy in cases of lower lumbar intervertebral disc prolapse.

Materials and Methods: A prospective study was conducted in the department of orthopedics of a teaching hospital in Southern India. A total of 28 diagnosed cases of intervertebral disc prolapse at L5-S1 levels were included in the study. The preoperative functional status was assessed as per the modified oswestry disability index (ODI) and visual analog scale (VAS). All of them underwent laminotomy of L5 vertebra and microdiscectomy at L5-S1 level. The patients were reviewed at postoperative weeks 6, 12, and 24 and the functional status of the spine was assessed and tabulated using the modified ODI and VAS. All results were tabulated and calculated with repeated measures ANOVA using SPSS software version 20.0.

Results: It was noted that the modified ODI scores preoperatively had a mean of 75 ± 11.85% which improved to 55 ± 9.18% at 6 weeks, 45 ± 9.37% at 12 weeks, and 36 ± 8.65% at 24 weeks. The VAS scores were noted to have a mean of 8 ± 0.93 mm preoperatively. It was noted to have improved to 6 ± 0.93 mm at 6 weeks, 5 ± 0.74 mm at 12 weeks, and then to 5 ± 0.73 mm at 24 weeks. This showed that there was an improvement in the back function after surgery in all the cases. No complications were noted in any of the cases.

Conclusion: Laminotomy and microdiscectomy level is an excellent technique of management of intervertebral disc prolapsed of L5-S1 with minimal complication rate.

Keywords:  Visual analogue scale, Oswestry Disability Index, lumbar spine, laminotomy, microdiscectomy.


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15. Lønne G, Solberg TK, Sjaavik K, Nygaard ØP. Recovery of muscle strength after microdiscectomy for lumbar disc herniation: A prospective cohort study with 1-year follow-up. Eur Spine J 2012;21:655-9.

How to Cite this article: Kulkarni M S, Fahim S M, Naik M, Vijayan S, Shetty S, Rao S K. Outcome Analysis of Osteosynthesis of Complex Fractures of Both Bones of Forearm. J Kar Orth Assoc. MayAug 2018; 6(2):12-15.

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Long Head of Biceps Tendon: Current Concepts and Controversie

Volume 6 | Issue 2 | May-Aug 2018 | Page 3-6 | Sandesh Madi S, Vivek Pandey, Kiran Acharya, Prajwal Mane.

Authors: Sandesh Madi S [1], Vivek Pandey [1], Kiran Acharya [1], Prajwal Mane [1].

[1] Department of Orthopaedics, Kasturba Hospital, Manipal Academy of Higher Education, Manipal.

Address of Correspondence
Dr. Sandesh Madi S,

Department of Orthopaedics,

Kasturba Hospital, Manipal Academy of Higher Education, Manipal.

Email: sandesh.madi@gmail.com


The peculiar anatomical location of the long head of the biceps tendon (LHBT) and pathological changes with or without rotator cuff pathology has generated much interest for a long time which has subsequently resulted in contradictory results and controversies. This review highlights the evolution of changing concepts in understanding the role of LHBT in normal function, its pathology, clinical presentation,and management. The scope for future clinical studies in Biceps pathology is also briefly outlined.

Keywords: Biceps, tenotomy, tenodesis, shoulder, arthroscopy.


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2. Khazzam M, George MS, Churchill RS, Kuhn JE. Disorders of the long head of biceps tendon. J Shoulder Elbow Surg 2012;21:13645.

3. Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 2007;89:1001-9.

4. Cheng NM, Pan WR, Vally F, Le Roux CM, Richardson MD. The arterial supply of the long head of biceps tendon: Anatomical study with implications for tendon rupture. Clin Anat 2010;23:683-92.

5. Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton SB. Long head of the biceps tendon pain: Differential diagnosis and treatment. J Orthop Sports Phys Ther 2009;39:55-70.

6. Ryu JH, Pedowitz RA. Rehabilitation of biceps tendon disorders in athletes. Clin Sports Med 2010;29:229-46, vii-viii.

7. Pandey V, van Laarhoven SN, Arora G, Rao S. Bifurcated intraarticular long head of biceps tendon. Indian J Orthop 2014;48:432-4.

8. Dierickx C, Ceccarelli E, Conti M, Vanlommel J, Castagna A. Variations of the intra-articular portion of the long head of the biceps tendon: A classification of embryologically explained variations. J Shoulder Elbow Surg 2009;18:556-65.

9. Lippman RK. Bicipital tenosynovitis. N Y State J M 1944:2235-41.

10. Kumar VP, Satku K, Balasubramaniam P. The role of the long head of biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res 1989;244:172-5.

11. Pandey V, Vijayan S, Hafiz N, Deepika N, Acharya K. Does congenital absence of the long head of biceps tendon render shoulder unstable leading to bony bankart and posterior labral tear: A case report and review of the literature. J Musculoskelet Res 2016;19:1672001.

12. Abboud JA, Bartolozzi AR, Widmer BJ, DeMola PM. Bicipital groove morphology on MRI has no correlation to intra-articular biceps tendon pathology. J Shoulder Elbow Surg 2010;19:790-4.

13. Takahashi N, Sugaya H, Matsumoto M, Miyauchi H, Matsuki K, Tokai M, et al. Progression of degenerative changes of the biceps tendon after successful rotator cuff repair. J Shoulder Elbow Surg 2017;26:424-9.

14. Holtby R, Razmjou H. Accuracy of the speed’s and yergason’s tests in detecting biceps pathology and SLAP lesions: Comparison with arthroscopic findings. Arthroscopy 2004;20:231-6.

15. Hedtmann A, Fett H. Ultrasound diagnosis of the rotator cuff. Orthopade 2002;31:236-46.

16. Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B. Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: A new classification based on arthroscopic observations. Arthroscopy 2007;23:73-80.

17. Dubrow SA, Streit JJ, Shishani Y, Robbin MR, Gobezie R. Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI. Open Access J Sports Med 2014;5:81-7.

18. Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, et al. The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elbow Surg 2006;15:7-11.

19. Creech MJ, Yeung M, Denkers M, Simunovic N, Athwal GS, Ayeni OR, et al. Surgical indications for long head biceps tenodesis: A systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24:2156-66.

20. Patte D, Walch G, Boileau P. Luxation de la longue portion du biceps et rapture de la cauffe des rotateurs. Revue de Chirurgie Orthopedique 1990;76:95.

21. Bradbury T, Dunn WR, Kuhn JE. Preventing the popeye deformity after release of the long head of the biceps tendon: An alternative technique and biomechanical evaluation. Arthroscopy 2008;24:1099-102.

22. Kane P, Hsaio P, Tucker B, Freedman KB. Open subpectoral biceps tenodesis: Reliable treatment for all biceps tendon pathology. Orthopedics 2015;38:37-41.

23. Werner BC, Brockmeier SF, Gwathmey FW. Trends in long head biceps tenodesis. Am J Sports Med 2015;43:570-8.

24. Abraham VT, Tan BH, Kumar VP. Systematic review of biceps tenodesis: Arthroscopic versus open. Arthroscopy 2016;32:365-71.

25. Gialanella B, Grossetti F, Mazza M, Danna L, Comini L. Functional recovery after rotator cuff repair: The role of biceps surgery. J Sport Rehabil 2018;27:83-93.

26. Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma 2005;58:1189-93.

27. Peltz CD, Hsu JE, Zgonis MH, Trasolini NA, Glaser DL, Soslowsky LJ, et al. Biceps tendon properties worsen initially but improve over time following rotator cuff tears in a rat model. J Orthop Res 2011;29:874-9.

28. Moon YL, Ha SH, Lee YK, Park YK. Comparative studies of platelet-rich plasma (PRP) and prolotherapy for proximal biceps tendinitis. Clin Shoulder Elbow 2011;14:153-8.

How to Cite this article: Madi S S, Pandey V, Acharya K, Mane P. Long Head of Biceps Tendon: Current Concepts and Controversies. J Kar Orth Assoc. May-Aug 2018; 6(2): 3-6.

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Our Experience with Modified Lateral Approach for Total Hip Replacement – A Midterm Study

Volume 6 | Issue 2 | May-Aug 2018 | Page:16-20 | Madhuchandra P, Raju K P, Arun K M

Authors: Madhuchandra P [1], Raju K P [1], Arun K.N [1], Pawan Kumar K M [1].

[1] Department of Orthopaedics, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. P Madhuchandra,

Department of Orthopaedics,

BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.

Email: drmadhuchandrap@gmail.com


Background: Numerous approaches have been described in the literature for total hip replacement surgeries. Each of the approach has got its own merits and demerits. Modified lateral approach gives the best visualization and orientation of both acetabular cup and femur; furthermore, rates of dislocation are very less. However, damage to abductor mechanism is a major disadvantage. We have evaluated the clinical and functional outcomes of modified lateral approach in this midterm study.

Materials and Methods: The study was conducted in a tertiary institute in a prospective and retrospective manner. The study period was from January 2007 to December 2012 for 6 years. The study sample was 119 patients who underwent total hip replacements for different indications. 7 patients were lost to follow up for reasons unknown, so a total of 112 patients were included in the study who were in regular follow-up. All the patients were evaluated for clinical and functional outcomes using modified Harris hip score, and abductor mechanism was evaluated by electrophysiological studies and Trendelenburg test.

Results: Functional outcome was evaluated using modified Harris hip score. We had excellent results in 44 (39.2%) hips, good in 62 (55.5%) hips, and fair in 6 (5.5%) hips. There were no cases with poor outcomes. 92 patients (82.2%) had negative modified Trendelenburg test, whereas 20 patients (17.8%) had positive modified Trendelenburg test. Electrophysiological studies were done in 58 patients, which showed that there were no injuries to superior gluteal nerve in any of our cases.

Conclusion: Modified direct lateral approach is a wonderful approach for the total hip replacement surgeries. It gives better visualization and orientation of the components with lesser incidence of dislocations and good abductor strength is retained provided careful dissection is done taking care not to injure superior gluteal nerve.

Keywords: Lateral approach, total hip replacement, Harris hip score, Trendelenburg test.


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10. Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement: A clinical and electrophysiological study. J Bone Joint Surg [Br] 1996;78-B:899-902.

11. Brooker AF, Bowerman JW, Robinson RA, Riley LM. Ectopic ossification following THR. J Bone Joint Surg 1973;44:1629-35.

12. Kelmanovich D, Parks ML. Surgical approaches to total hip arthroplasty. J South Orthop Assoc 2003;12:90-4.

13. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br 1982;64:17-9.

14. Mulliken BD, Rorabeck CH, Bourne RB, Nayak N. A modified direct lateral approach in total hip arthroplasty. J Arthroplast 1998;13:737-47.

15. Harkess JW, Crockarell JR Jr. Arthroplasty of the Hip. Philadelphia, PA: Mosby; 2008. p. 312-482.

16. Charnley J. Total hip replacement by low friction arthroplasty. Clin Orthop 1970;72:7-21.

17. Pai VS. A modified direct lateral approach in total hip. Arthroplast J Orthop Surg 2002;10:35-9.

18. Baker AS, Bitounis VC. Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg Br 1989;71:47-50.

19. Dudda M, Gueleryuez A, Gautier E, Busato A, Roeder C. Risk factors for early dislocation after total hip arthroplasty: A matched case-control study. J Orthop Surg (Hong Kong) 2010;18:179-83.

20. Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW. Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 2001;72:215-20.

21. Minns RJ, Crawford RJ, Porter ML, Hardinge K. Muscle strength following total hip arthroplasty. A comparison of trochanteric osteotomy and the direct lateral approach. J Arthroplasty 1993;8:625-7.

How to Cite this article: Madhuchandra P, Raju K P, Arun K.N, Pawankumar K M. Our Experience with Modified Lateral Approach for Total Hip Replacement – A Midterm Study. J Kar Orth Assoc. MayAug 2018; 6(2):16-20.

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Implant Free Repair of Pediatric Patella Sleeve Avulsion Fracture

Volume 6 | Issue 2 | May-Aug 2018 | Page 45-47 | Sathya Vignes, Santhosh Sahanand, David Rajan.

Authors: G Sathya Vignes [1], Santhosh Sahanand [1], David V Rajan [1].

[1] Department of Orthopaedics, Ortho One Orthopaedic Speciality Hospital, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. G. Sathya Vignes,

Sri Athi Sathya Hospital,

Perundurai Road, Erode.

Email: sathyavg88@gmail.com


Introduction: Sleeve avulsion fractures of the patella are rare fractures that occur more commonly in children and adolescents. The diagnosis is difficult both clinically and radiologically since the distal bony fragment may be too small to be detectable by radiography. A high-riding patella and hemarthrosis are important signs of sleeve fractures.

Case Report: A 10-year-old boy was admitted to our ER after having felt a severe pain in his Right knee on kicking the ground while playing foot-ball two days earlier. Knee swelling, haemarthrosis and periarticular tenderness were noted. On physical examination, an extension lag of 15 was observed. The active range of motion of the injured knee was 45-60° of flexion. Radiography showed an avulsion fracture of the lower pole of the patella and a high-riding patella. We performed open reduction and internal fixation surgery with Transosseous Tunneling and Suture Pull Through using a multi-strand, long chain ultra-high molecular weight polyethylene (UHMWPE) wire. At 6 weeks after surgery, there was no extension lag, and the active range of motion of the injured knee was 0-140° of flexion. Callus formation over the fracture site and bone union was confirmed.

Conclusion: Although sleeve fractures in children are uncommon, it should be considered a possibility in children with complaints of pain around the knee postinjury. This technique of Implant Free ORIF was effective in the treatment of sleeve fracture of the patella and alleviates the need for a resurgery for implant removal.

Key words: Sleeve fracture patella, open reduction and implant free fixation.


1. Hunt DM, Somashekar NA. Review of sleeve fractures of the patella in children. Knee 2005;12:3-7.

2. Xie L, Xu H, Zhang L, Xu R, Guo Y. Sleeve fracture of the adult patella case report and review of the literature. Medicine (Baltimore) 2017;96:e7096.

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How to Cite this article: Vignes GS, Sahanand S, Rajan DV. Comparative Study of Efficacy of Single Injection of Platelet-rich Plasma with Steroid Injection in Treatment of Plantar Fasciitis. J Kar Orth Assoc. May-Aug 2018; 6(2):45-47.

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