The New Normal for Orthopaedic Surgeons

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 1 | Anil k. Bhat [1][2]

Authors: Anil k. Bhat [1][2].

[1] Editor in chief, Journal of Karnataka Orthopaedic Association
[2] Department of Orthopaedics, Kasturba Medical College, Manipal,
Karnataka, India

Address of Correspondence
Dr Anil .K Bhat ,
Associate Dean, Professor, Unit of Hand and Microsurgery,
Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
Manipal Academy of Higher education

The New Normal for Orthopaedic Surgeons

As things stand now, India is in third place in the world with more than 25 lakh cases of coronavirus infection with more than 50,000 deaths [1]. The good news is that we have a lower mortality rate compared to many other countries with respect to our population. This itself encourages us to come out of the shackles of lockdown to restart our lives with all the standard precautions and guidelines as prescribed by the Government and health authorities.

The role of Orthopaedic Surgeons in this situation has changed from speciality services to a front line worker. Injuries due to trauma had not stopped even in the lockdown period and Orthopaedic Surgeons had continued to render their services. With the increasing cases, they are now called to be part of the front line care, being deployed for COVID duties along with their peers in ICUs and COVID hospitals. This will be the new norm for many months to come.

The Indian scenario of health care services comprising medical institutions, corporate hospitals, smaller private setups and individual practice has thrown many challenges in health care delivery for patients with COVID infections and associated Orthopaedic pathologies. Each health care service has to create their protocols based on the infrastructure, man-power and expertise available. At the same time, restarting elective surgeries also is challenging for these establishments in their unique ways [2]. The requirements of COVID testing before surgery, the post-operative care and follow up of these patients with options for teleconsultations will be a part of a new practice system which have to be incorporated in our routine workflow. The guidelines are changing constantly as newer epidemiological, public health and health care delivery challenges emerge.
On the academic front, virtual conferences and Webinars are being undertaken with huge enthusiasm and we have to wait and see how much of these practices will hold good in the future. Postgraduates and Undergraduates teaching has entered a new paradigm of online classes but may not completely compensate for bedside teaching.
Rather than accepting the present situation as new normal and not processing the ravage of coronavirus, we need to look at the present situation as a new paradigm and take everyone along this process to emerge with minimal scars once this is pandemic is over.
The present volume of Journal comes in these tough times with dedicated teamwork at the Editorial office. We thank the Karnataka Orthopaedic Association office bearers & the KOA members for their constant support.

Dr Anil .K Bhat
Chief Editor, JKOA
Associate Dean
Professor, Unit of Hand and Microsurgery
Department of Orthopaedics, KMC, Manipal academy of Higher education
Manipal, Karnataka, India.


2. Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic Guidelines Developed by the International Consensus Group (ICM), Parvizi, al, The Journal of Bone and Joint Surgery: July 15, 2020 – Volume 102 – Issue 14 – p 1205-1212 DOI: 10.2106/JBJS.20.00844.

How to Cite this article: Bhat A K. The New Normal for Orthopaedic Surgeons. Journal of Karnataka Orthopaedic Association. Aug-Sep 2020;8(2): 1.

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Evaluation of Functional Outcome of Arthroscopic Meniscal Repair of Knee Joint

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 28-33 | Darshan C K, Neelanagowda V Patil, Manohar Rao H R, Manjunath D N

Authors: Darshan C K [1], Neelanagowda V Patil [1], Manohar Rao H R [1], Manjunath D N [1]

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

Address of Correspondence

Dr. Manohar Rao H R,
Mysore Medical College and Research Institute, Mysore, Karnataka, India .


Background: Knee joint is the largest and complex weight-bearing joint of the human body. The meniscus is a crescent-shaped fibrocartilaginous tissue in the knee joint. Meniscal tears are the most frequently encountered and treated injuries in the knee joint. This study aimed to evaluate the clinical and functional outcomes for a series of patients who underwent meniscal repair using all-inside technique for meniscal injuries.
Materials and Methods: All patients attended to the Department of Orthopaedics, Mysore Medical College and Research Institute, with peripheral meniscal tear operated by arthroscopic meniscal repair by all-inside technique and were evaluated for functional outcome using Lysholm score. Twenty-three cases of knee trauma diagnosed by clinical evaluation and magnetic resonance imaging were recruited for the study.
Results: A total of 23 subjects were included in the final analysis. The mean age was 32.39 ± 9.24 years in the study population. A significant portion (47.8%) of the study population belonged to 30–39 years age group. About 82.6% of the study participants were male. Among the study population, 11 (47.8%) participants had good functional outcome, and 12 (52.2%) participants had excellent functional outcome at 12 months. Among the 23 subjects, 8 (34.80%) had isolated meniscal tear, and 15 (65.20%) had either anterior cruciate ligament (ACL) or posterior cruciate ligament plus meniscal injury.
Conclusion: The study concluded that arthroscopic meniscal repair is a very effective method of treating meniscal injuries. It gave painless functional knee postoperatively with a good range of movements and increased quality of life. Patients with simultaneous ACL reconstruction had a better outcome than an isolated meniscal repair. However, the comparative statistical analysis could not be made with isolated meniscal repair due to a small study group. Our results were comparable with the various studies with respect to the Lysholm scoring and the outcome.
Keywords: Knee joint, Meniscal injuries, Arthroscopic meniscal repair.


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8. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am 2004;86:1139-45.
9. Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the lysholm knee score and tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006;88:698-705.
10. Paxton EW, Fithian DC, Stone ML, Silva P. The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation outcomes. Am J Sports Med 2003;31:487-92.
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19. Johnson MJ, Lucas GL, Dusek JK, Henning CE. Isolated arthroscopic meniscal repair: A long-term outcome study (more than 10 years). Am J Sports Med 1999;27:44-9.
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21. Nakayama H, Kanto R, Kambara S, Kurosaka K, Onishi S, Yoshiya S, et al. Clinical outcome of meniscus repair for isolated meniscus tear in athletes. Asia Pac J Sports Med Arthrosc Rehabil Technol 2017;10:4-7.
22. Pujol N, Tardy N, Boisrenoult P, Beaufils P. Long-term outcomes of all-inside meniscal repair. Knee Surg Sports Traumatol Arthrosc 2015;23:219-24.
23. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 2010;38:1542-8.
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How to Cite this article: Darshan CK, Patil NV, Rao HRM, Manjunath DN | Evaluation of Functional Outcome of Arthroscopic Meniscal Repair of Knee Joint | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 28-33.

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Fractures of the Scapula: A Narrative Review on Diagnosis and Management

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 53-59 | Sujayendra Murali, Sandesh Madi, Raghuraj Kundangar, Monappa Naik, Anika Sait

Authors: Sujayendra Murali [1], Sandesh Madi [1], Raghuraj Kundangar [1], Monappa Naik [1], Anika Sait [1]

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal

Address of Correspondence
Dr.Sujayendra Murali
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal -576104


Scapula fractures are relatively rare when compared to fractures of the other bones of the shoulder region. High-velocity injuries encountered in road traffic accidents are responsible for the increased incidence of these fractures. Intra-thoracic and cervical spine injuries can be associated with these fractures and warrants a thorough clinical examination. In an acute setting of patient resuscitation, the initial diagnosis of these fractures is frequently missed or delayed. Radiological assessment should include dedicated shoulder trauma X-ray series and computed tomography scans with three-dimensional reconstruction. Being suspended by the dense muscles of the shoulder complex, the union of these fractures is rarely a concern. However, with a better understanding of the biomechanics, the management of these fractures is gradually evolving. Only in recent times, the criteria for surgical intervention for these fractures have been defined. This narrative review aims to provide a brief overview of the recent advances and the changing concepts of these uncommon fractures.
Key words: Trauma; Scapula; Fracture classification; glenoid; algorithm.


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6. DeFranco MJ, Patterson BM. The floating shoulder. J Am Acad Orthop Surg 2006;14:499-509.
7. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: A marker for concomitant injury? A retrospective review of data in the national trauma database. J Trauma 2008;65:430-5.
8. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res 1998;347:122-30.
9. Anavian J, Conflitti JM, Khanna G, Guthrie ST, Cole, PA. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res 2011;469:3371-8.
10. Koh KH, Han, KY, Yoon YC, Lee SW, Yoo JC. True anteroposterior (Grashey) view as a screening radiograph for further imaging study in rotator cuff tear. J Shoulder Elbow Surg 2013;22:901-7.
11. Tuček M, Naňka O, Malík J, Bartoníček J. The scapular glenopolar angle: Standard values and side differences. Skeletal Radiol 2014;43:1583-7.
12. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma 2002;16:7-11.
13. Bartoníček J, Frič V. Scapular body fractures: Results of operative treatment. Int Orthop 2011;35:747-53.
14. Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 2009;91:2222-8.
15. Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Multiple-region scapular fractures had more severe chest injury than single-region fractures: A prospective study of 107 blunt trauma patients. J Trauma 2007;63:889-93.
16. Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir 2018;97:67-76.
17. Nau T, Petras N, Vécsei V. Fractures of the scapula-classification and treatment principles. Osteosynth Trauma Care 2004;12:174-9.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26:41-5.
19. Woolnough T, Shah A, Sheean AJ, Lesniak BP, Wong I, Sa D. Postage stamp fractures: A systematic review of patient and suture anchor profiles causing anterior glenoid rim fractures after bankart repair. Arthroscopy 2019;35:2501-8.e2.
20. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res 1991;269:174-80.
21. Romero J, Schai P, Imhoff AB. Scapular neck fracture-the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg 2001;121:313-6.
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23. Dimitroulias A, Molinero KG, Krenk DE, Muffly MT, Altman DT, Altman GT. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res 2011;469:1459-65.
24. Jones CB, Sietsema DL. Analysis of operative versus nonoperative treatment of displaced scapular fractures. Clin Orthop Relat Res 2011;469:3379-89.
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How to Cite this article: Murali S, Madi S, Kundangar R, Naik M, Sait A | Fractures of the Scapula: A Narrative Review on Diagnosis and Management | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 53-59.

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A Study to Know Short Term Outcome of Tricolumnar Plating in Complex Tibial Plateau Fractures

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 2-6 | S. B Kamareddy, Pradeep Kumar Natikar, Mujtaba Hussain Patel

Authors: S. B Kamareddy [1], Pradeep Kumar Natikar [2], Mujtaba Hussain Patel [1,2]

[1] Kamareddy Ortho and Trauma Care Centre, Kalaburagi, Gulbarga, Karnataka, India.
[2] Department of Orthopaedics, KBNIMS Kalaburagi, Gulbarga, Karnataka, India.

Address of Correspondence
Dr. Pradeep Kumar Natikar,
KBNIMS Kalaburagi, Gulbarga, Karnataka, India.


Background: Tricolumnar plate fixation in comminuted proximal tibial fractures remains a new concept to have a rigid construct and to improve the functional outcome with dual incision. We performed a retrospective study to evaluate the functional outcome of proximal tibial fracture fixation using tricolumn plating.
Objective: The objective of the study was to study the clinical outcome of internal fixation with tricolumnar plating for the treatment of complex tibial plateau fractures.
Materials and Methods: The study was conducted in tertiary care center, Kalaburagi, over a period of 2 years from June 2017 to June 2019. Twenty patients with complex tibial plateau fractures were treated with tricolumnar plating through posteromedial and anterolateral approaches. There were 12 males and 8 females, with an average age of 45.2 years old (ranged, 32–60 years old). Fourteen patients had injuries in the left side and 6 patients had injuries in the right side. According to Schatzker classification, 14 patients were type V and 6 patients were type VI.
According to the three-column classification, all the patients had injuries of lateral, medial, and posterior columns. All the patients were evaluated using the Oxford Knee Score at 6-month and 1-year follow-up.
Results: The mean interval from injury to operation was 9.4 days (ranged, 6–15 days). The bone union time ranged from 4 to 10 months after operation. According to the results of Oxford Knee Score, 14 patients got an excellent result, 3 good, and 3 moderate.
Conclusion: Tricolumnar plate fixation for the treatment of complex tibial plateau fractures is effective to achieve anatomic reduction, rigid internal fixation, and good functional outcome. Careful soft-tissue handling and employing minimally invasive techniques minimize soft-tissue complications.
Key words: Tricolumnar plating, Schatzker classification, Oxford Knee Score.


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6. Weil YA, Gardner MJ, Boraiah SB, Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma. 2008;22: 357–62.
7. Barei DP, O’Mara TJ, Taitsman LA, Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;22:176–82.
8. Luo CF, Jiang R, Hu CF, Medial double-plating for fracture dislocations involving the proximal tibia. Knee. 2006;13:389–94
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11. Schatzker J, Tile M. The Rationale of Operative Fracture Care, 2nd ed.Berlin: Springer-Verlag; 1996:390–391.
12. Macarini L, Murrone M, Marini S, et al. Tibial plateau fractures:evaluation with multidetector-CT. Radiol Med. 2004;108:503–514.
13. Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19: 305–310.
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15. Su EP, Westrich GH, Rana AJ, Kapoor K, Helfet DL. Operative treatment of tibial plateau fractures in patients older than 55years. Clin Orthop Relat Res 2004;421: 240‑8
16. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, BenirschkeSK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006;88: 1713‑21
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How to Cite this article: Kamareddy SB, Natikar PK, Patel MH | A Study to Know Short Term Outcome of Tricolumnar Plating in Complex Tibial Plateau Fractures | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 2-6.

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Study of Functional Outcome in Midshaft Clavicle Fracture Treated With Titanium Elastic Nailing System

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 22-27 | Sreejith Thampy J, Arun H S, Prabhu E, Hariprasad S

Authors: Sreejith Thampy J [1], Arun H S [1], Prabhu E [1], Hariprasad S [1]

[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.

Address of Correspondence
Dr. Arun H S,
Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.


Purpose: Conservative methods were commonly used for midshaft clavicle fracture treatment, but with complications such as non-union, malunion, and shoulder asymmetry. Early surgical treatment for midshaft clavicular fractures could greatly reduce the same. Open reduction and internal fixation with plate and intramedullary fixation are the commonly used surgical techniques. Plating was considered as the gold standard in view of firm fixation and early rehabilitation, but with larger incision and soft-tissue exposure. Intramedullary fixation has been favored for its small incision, less periosteal striping, faster union, and less operating time. Here, we assess the functional outcome following titanium elastic nailing system (TENS) application.
Methodology: It is a prospective cohort study (evidence level II), 60 patients fitting as per inclusion and exclusion criteria presenting to our orthopedic department from July 2017 to May 2019 are included in the study after obtaining informed consent.
Results: Among 60 patients treated with TENS, excellent functional outcome was seen in 50 patients (83.3%) by the 3rd month and 54 (90%) by the 6th month using Constant and Murley scoring system. In our study, 66.6% of cases had union by the 3rd month and rest all by 6 months.
Conclusion: TENS should be considered as primary option for midshaft clavicle fracture with mild-to-moderate comminution.
Keywords: Midshaft clavicle fracture, Locking compression plate, Titanium elastic nailing system, Intramedullary nailing, Closed reduction and nailing, Mini-open incision.


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18. Mueller M, Rangger C, Striepens N, Burger C. Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. J Trauma 2008;64:1528-34.
19. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36:78-85.
20. Zhang B, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y. Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures. Scand J Trauma Resusc Emerg Med 2015;23:27.
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How to Cite this article: Thampy JS, Arun H S, Prabhu E, Hariprasad S | Study of Functional Outcome in Midshaft Clavicle Fracture Treated With Titanium Elastic Nailing System | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 22-27.

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Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 49-52 | Manoh Shanmugam, Snolin Shiromi Antonyrajan

Authors: Manoh Shanmugam [1], Snolin Shiromi Antonyrajan [2]

[1] Consultant, Nallan Speciality Hospital, Madurai, Tamil Nadu.
[2] Department of Orthopaedics, Velammal Medical College Hospital and Research Institute

Address of Correspondence
Dr. Snolin Shiromi,
5, state bank officer’s I colony, S S Colony, Madurai, Tamil Nadu 625016, India


A case of necrotizing fasciitis (NF) of the right upper limb caused by the fungi Apophysomyces elegans in an immunocompetent adult following polytrauma is reported. The probable portal of entry is abrasion with the environment being the source. Once clinically stable, the patient underwent surgical stabilization of fracture humerus and fracture clavicle. As the patient developed signs of NF in the right upper limb on the 14th post-operative day, empirical antibiotics were administered. Wound debridement was performed, and appropriate antibiotics were administered based on culture sensitivity. Since there was no clinical improvement, multiple wound debridements were performed. Amphotericin B was initiated empirically before the fungal culture report. As the wound was progressingly involving the whole limb, the patient ultimately required shoulder disarticulation. Containment of the infection with early initiation of amphotericin B and extensive wound debridements gave a positive outcome in our case. Mucormycosis should be considered a possibility in cases of NF with the progressive course and inadequate response to antibiotics.
Keywords: Necrotizing fasciitis, Amphotericin B, Mucormycosis, mucorales, Immunocompetent.


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How to Cite this article: Shanmugam M, Antonyrajan SS | Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 49-52.

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Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 16-21 | Mohan N S, Shankaragouda R Patil, Avinash Parthasarathy

Authors: Mohan N S [1], Shankaragouda R Patil [1], Avinash Parthasarathy [1]

[1] Department of Spine, Sanjay Gandhi institute of Trauma and Orthopaedics, Jayanagar East, Bangalore, India.

Address of Correspondence
Dr. Avinash Parthasarathy,
Dept. of Orthopaedics, Sanjay Gandhi institute of Trauma and Orthopaedics,
Jayanagar East, Bangalore 560011,Karnataka,India.


Objectives: Clinical outcome of thoracolumbar unstable fracture treated by short-segment transpedicular fixation with and without intermediate screw fixation assessed by modified Macnab criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) and to compare the radiological outcome using Cobb angle, Beck index, and kyphotic deformation.
Methods: A prospective study of 60 patients with unstable thoracolumbar fracture was treated with posterior transpedicular screw fixation at Spine injury Centre, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, from December 2016 to July 2019. Clinical assessment was done using Macnab criteria, ODI, and VAS scoring system and radiological assessment was done using Cobb angle, becks index, and segmental kyphotic deformation. The patients were divided into two groups according to the surgical method used. In Group A, 28 patients underwent surgery with a posterior approach through transpedicular screw instrumentation with an additional screw at the fractured vertebrae. In Group B, 32 patients were received a traditional short-segment fixation (1 level above and 1 level below the fractured level). Clinical and radiologic parameters were evaluated before surgery and at 3 and 6 months and 1 year after surgery.
Results: Our study showed predominant male population (80%) of working age group (21–40 years), who had unstable thoracolumbar fractures. The most common mode of injury was fall from height (60%). Majority of the patients had L1 vertebra fracture of about 48% and 28% of T12 vertebra fracture. According to modified Macnab criteria, majority have good results at 3, 6, and 12 months of follow-up, at the end of 12 months, both groups have 50% and 68% good result and 50% and 28% of excellent results, respectively, but non-significant. Mean ODI after 1 year of follow-up shows 6.93 and 8.53 and VAS score at the end of 12th month of follow-up is 1.21 and 1.22, respectively. Both groups have better Cobb angle correction from 18.39° to 10.29° in Group A and 19.25° to 11.38° in Group B. Loss of Cobb angle correction is 2.97 Group A and 2.91 in Group B. Our study shows that there is no statistically significant improvement in Beck index in both groups from 0.64 to 0.78 in Group A and in Group B from 0.62 to 0.78. Both groups have better kyphotic deformation correction from 15.71° to 7.93° in Group A and 15.22° to 8.41° in Group B and it shows that Group A has more correction of kyphotic deformation.
Conclusions: Pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar is safe and feasible. Pre-operative evaluation of pedicle dimension would be useful for the placement into fractured vertebra. Short-term benefits of placing pedicle screw into fractured vertebra are restoration of vertebral body height and kyphotic angle and indirect canal decompression.
Keywords: Thoracolumbar fracture, Short segment, Cobb angle, Transpedicular fixation, Kyphotic deformation, Additional screw, Burst fracture.


1. Ravikanth M, Babu TV, Chandrasekaran A. Comparison between short and long segment transpedicular fixation of thoracolumbar burst fractures. J Evid Based Med Healthc 2016;3:996-1001.
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12. Yang M, Wang X, Li J, Xiong G, Lu C, Lu G. Implanting pedicle screw in fractured vertebra results in no adverse effect on bone healing in thoracic or lumbar burst fracture. Turk Neurosurg 2013;23:778-82.
13. Eno JJ, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health 2012;71:19-22.
14. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine 1993;18:977-82.
15. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 2009;22:417-21.
16. Defino HL, Scarparo P. Fractures of thoracolumbar spine: Monosegmental fixation. Injury 2005;36 Suppl 2:B90-7.
17. Lehman RA Jr., Lenke LG, Keeker KA, Kim YJ, Cheh G. Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine 2007;32:2679-84.
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19. Ye C, Luo Z, Yu X, Liu H, Zhang B, Dai M. Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures. Medicine (Baltimore) 2017;96:e7893.
20. Huang W, Luo T. Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures. Exp Ther Med 2013;5:678-82.
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How to Cite this article: Mohan N S, Patil SR, Parthasarathy A | Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 16-21.

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Acute Paraparesis Secondary to Epidural Hematoma Caused by Spinal Anesthesia Given for Lower Segment Caesarean Section

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 46-48 | Uday Kumar Guled

Authors: Uday Kumar Guled [1]

[1] Department of Orthopaedics, S Nijalingappa Medical College ,Bagalkot, Karnataka, India.

Address of Correspondence
Dr. Udaykumar Guled
Assistant professor , S Nijalingappa Medical College ,Bagalkot, Karnataka, India.


Spinal anesthesia is one of the most common anesthetic procedure performed in operative cases . Neurological deficit is an uncommon but catastrophic complication of spinal anesthesia. Epidural hematoma is the most common cause of such neurological deficit. Unidentified bleeding and clotting disorders increase the risk. On detection such complications need close monitoring. Though many cases can be managed conservatively, progressive deficit warrants quick decompression of spinal canal.
Keywords: Epidural hematoma, Paraparesis, Spinal anesthesia, Laminectomy.


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How to Cite this article: Guled U K| Acute Paraparesis Secondary to Epidural Hematoma Caused by Spinal Anesthesia Given for Lower Segment Caesarean Section | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 46-48.

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Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 7-15 | Mrinal B Shetty, Vinayak Venugopal, Jabez Gnany

Authors: Mrinal B Shetty [1], Vinayak Venugopal [1], Jabez Gnany [1]

[1] Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka

Address of Correspondence
Dr. Vinayak Venugopal,
Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka


Purpose: The treatment of fracture-dislocations and unstable fractures of the thoracic and lumbar spine has been controversial. Many authors have advised conservative treatment which was labor intensive and associated with complications, increased bed occupancy, increased cost of therapy, increased hospital stay hours, and care by trained personnel. Early surgical indirect decompression with instrumentation reduces the duration of hospital stay, facilitates early recovery, and prevents prolonged morbidity, so there is an urgent need for possibilities of surgical stabilization, early mobilization, and rehabilitation of patients. The surgical decompression can be done anteriorly, posteriorly, or anteroposteriorly. With advent of pedicle screws, more and more fractures are treated with posterior based surgeries with long-segment (LS) fixation which regains spinal alignment and provides adequate stability. Short-segment pedicle screw fixations of thoracolumbar fractures excluding screw fixation at the fractured vertebrae do not provide the necessary stability; hence, additional fixation point with screws in the fractured vertebrae is useful and a safe technique in the treatment of thoracolumbar fractures.
This prospective study aims at comparing the clinical, radiological, and neurological outcomes after surgical decompression and instrumentation by posterior and transpedicular approach in thoracolumbar spinal fractures postoperatively at 1month, 6 months, and 1 year follow-up periods.
Materials and Methods: Adult patients with acute thoracolumbar injuries admitted to Spine Surgery unit, Father Muller Medical Hospital, Mangalore, were taken for this study after obtaining their informed, valid written consent. This is a prospective study from September 2016 to August 2018.
Results: In our study, 50% of population belong to the age group of 31–50 years, 28% belong to the age below 30 years, and 22% belong to the age above 50 years and 92% of population were male and the rest 8% were female. Twenty-nine of them sustained L1 flexion distraction injury which accounts to about 58% of the fracture, the second most common being six patients with D12 flexion distraction injury which accountsfor10% of cases. Three cases each of D11, L2, and L3 flexion distraction injury which accounts for 6% of fracture. One each case of D11 unstable burst fracture, D12 chance fracture, D12 unstable burst fracture,L1 unstable burst fracture, L1 chance fracture, and L3 unstable burst fracture which accounts for 2% of total fractures. Thirty-eight patients had no neurological deficits and categorized under the American Spine Injury Association (ASIA)-E which accounts for 76% of the cases. Seven had neurological deficits, incomplete categorized under ASIA-C which accounts for14% of the cases. Five were categorized under ASIA-D which accounts for 10% of total cases. Preoperatively, an average of 40.09% of vertebral body height was lost which improved in immediate post-operative period to 70.25% and maintained at 70.38% at the end of 1 year. Degree of segmental kyphosis preoperatively was 15.32°, which improved to 6.62° at the end of 1 year. Percentage of canal compromise measurement preoperatively showed an average of 30.38% of spinal canal encroachment. Immediate post-operative assessment showed decompression of canal to 12.64% and 10.00% at the end of 1 year. Preoperatively, an average Oswestry Disability Index score was 44.28% which improved inimmediate post-operative period to 32.52% and15.71% at the end of 1 year which is mildlevel of disability. Preoperatively, average visual analog score was 7 which shows moderate-to-severe pain which improved to 2.92, indicating minimal or no pain at the end of follow-up.
Conclusion: The technique of short-segment pedicle screw fixation with screws in fractured vertebrae is safe as our study did not show worsening of the pre-operative neurological status in any patients with ASIA-C and above. There was adequate indirect decompression of the spinal canal using smaller incision, resulting in lesser operative time, and blood loss. The vertebral body height was satisfactorily reconstructed, kyphotic angle reduced, and the spinal alignment was maintained. The final outcome in terms of improvement of ASIA impairment scale was determined by the initial injury. Incomplete injuries improved by at least one scale as per ASIA. Hence, this is an effective and safe technique which retains the biomechanical stability as compared to the LS fixation while requiring smaller incision, lesser operative time, and less blood loss.
Keywords: Short-segment pedicle screw fixation, Thoracolumbar fracture, Tanspedicular instrumentation.


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How to Cite this article: Shetty MB, Venugopal V, Gnany J | Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 7-15.

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A Comprehensive Assessment of the Coracoid Process Dimensions in the South Indian Population Using 3D Computer Tomographic Reconstruction

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 37- 46 | Sandesh Madi S, Muthiah Muthu Magesh, Sujayendra DM, Vivek Pandey, Kiran K V Acharya

Authors: Sandesh Madi S [1], Muthiah Muthu Magesh [1], Sujayendra DM [1], Vivek Pandey [1], Kiran K V Acharya [1]

[1] Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

Address of Correspondence
Dr. Sandesh Madi S,
Kasturba Medical College, Manipal Academy of Higher
Education, Manipal, India.


Background: Awareness of the accurate dimensions of the coracoid is essential for (i) coracoclavicular ligament reconstructions and (ii) coracoid transfer procedures (e.g. Latarjet) for shoulder instability. The morphometric assessment of the coracoid process using three-dimensional computer tomography (3-D CT) in the Indian population has not been previously undertaken.
Materials and Methods: The study was aimed to conduct the morphometric assessment of coracoid process using 3-D CT reconstruction in the South Indian population and to compare the gender and side differences. In addition, we compared the dimensions of the coracoid process with the findings in the previous studies performed in different races and ethnicities. We also compared the results of our study with other morphometric studies conducted in India using dry bones. From the records, the 3D CT images of the shoulder (age between 20 and 60 years) were assessed. Fractures of the coracoid or previous history of surgery involving the coracoid were excluded from the study. The dimensions of coracoid were measured on the same final images by two observers using digital calipers, and an average of their measurements was recorded. A two-tailed independent t-test was used to measure the statistical significance.
Results: A total of 187 shoulders (120 males and 67 females), 3D CT images were assessed. The average age of the study population was 30.66 ± 7.21 years. The average length of coracoid was 40.11 ± 1.36 mm. Overall dimensions of tip of coracoid was 20.56 ± 1.67 mm (length), 13.01 ± 0.97 mm (width), and 9.24 ± 1.05mm (height). Overall dimensions of base of coracoid were 20.45 ± 2.26 mm (length) and 14.5 ± 0.86 mm (height). All the measurements were larger in males (P < 0.05). The side difference for all measurements was not statistically significant. The mean coracoid width was significantly larger than the mean coracoid thickness (P < 0.00001).
Conclusion: This study provides a comprehensive baseline data on the morphometry of the coracoid process in the South Indian population that will be valuable in pre-operative planning for the shoulder surgeons.
Keywords: Coracoid, Three-dimensional computer tomography scan, Tip, Base, Scapula, Shoulder.


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How to Cite this article: Madi SS, Magesh MM, Sujayendra DM, Pandey V, Acharya KKV | A Comprehensive Assessment of the Coracoid Process Dimensions in the South Indian Population Using 3D Computer Tomographic Reconstruction | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 37-45.

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