Vol. 9 | Issue 1 | January-February 2021 | Page: 56-57 | Akshay Mylarappa
Authors: Akshay Mylarappa 
 Department of Orthopaedics, IMS and SUM hospital, Siksha ‘O’ Anusandhan University, K-8, Kalinga Nagar,IMS and Sum Hospital, Bhubaneswar-751003, Odisha,India.
Address of Correspondence
Dr. Akshay Mylarappa,
Department of Orthopaedics, IMS and SUM hospital,Siksha ‘O’ Anusandhan University, K-8, Kalinga Nagar, IMS and Sum Hospital, Bhubaneswar-751003, Odisha,India.
Entrapped suction drain tube is a trivial issue but the management of which is challenging and cumbrous to both, the patient and the surgeon. Complications during its removal including pain and tearing of the drain tube increase the need for open retrieval of the fragments. A novel technique of using a Gigli saw to cut through the traversing suture intraluminally and removal of the drain tube can be performed in the ward without any extensive complications.
Keywords: Retained, Entangled, Suction drain tube, Gigli saw, Cut.
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3. Gupta R, Malhotra A, Sood M, Masih GD. Retained drain after anterior cruciate ligament surgery : A silent threat to an athlete’s career: A case report. J Orthop Case Rep 2017;7:10-2.
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|How to Cite this article: Mylarappa A Entrapped Suction Drain Tube Removal– A Novel Non-operative Technique | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 56-57.
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Vol. 9 | Issue 1 | January-February 2021 | Page: 52-55 | Atmananda Hegde, Harish Eshwarappa, Amanda Christina Pinto, Hema Kini, Prakash Saxena , Chethan Shetty
Authors: Atmananda Hegde , Harish Eshwarappa , Amanda Christina Pinto , Hema Kini , P U, Prakash Saxena , Chethan Shetty 
 Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
 Department of Oncology, Kasturba Medical College Hospital, Ambedkar circle, Mangalore, Karnataka, India.
 Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
 Department of Radiation Oncology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Address of Correspondence
Dr. Atmananda Hegde,
Associate Professor, Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education Karnataka, India.
Case Report: Here we present a very rare case of extraskeletal osteosarcoma (ESOS) in a young male abutting the scapula who underwent a limb salvaging reconstructive therapy after course of neoadjuvant chemotherapy.
Conclusion: ESOS comprises 2–5% of all osteosarcomas and less than 1% of all soft tissue sarcomas. These tumors need to be differentiated from post-traumatic myositis ossificans, soft tissue sacromas and surface osteosarcomas. The acceptable treatment for ESOS is neoadjuvant chemotherapy followed by wide resection of the tumour. In our case patient had good function of elbow and wrist with no local recurrence or metastasis at one year follow up.
Keywords: Extraskeletal osteosarcoma; Limb salvage.
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|How to Cite this article: Hegde A, Eshwarappa H, Pinto AC, Kini H, Saxena PUP, Shetty C | Limb Salvage in Extra Skeletal Osteosarcoma of Shoulder Region- A Case Report and Review of Literature| Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 52-55.
Vol. 9 | Issue 1 | January-February 2021 | Page: 49-51 | Bijai Kurian Thomas, Hemant.K. Kalyan
Authors: Bijai Kurian Thomas , Hemant.K. Kalyan 
 Departments of Trauma and Orthopaedics, Glangwili, General Hospital, Dolgwili Road, Glangwili, Carmarthen, United Kingdom.
 Departments of Orthopaedics & Sports Medicine Manipal Hospital, Bengaluru, Karnataka, India.
Address of Correspondence
Dr. Hemant. K. Kalyan,
HOD and Consultant Departments of Orthopaedics & Sports Medicine Manipal Hospital, Bengaluru, Karnataka, India.
Background: Spontaneous bilateral patellar tendon rupture is a rare condition, which is known to occur in patients with systemic illness like SLE, rheumatoid arthritis and renal failure that warrant long term systemic steroid use. It is even more exceptional in patients without such predisposing conditions. So far, only 8 other cases with neither an underlying systemic disease nor significant trauma have been reported.
Methods: We report a case of spontaneous sequential bilateral patellar tendon rupture following separate episodes of trivial trauma in an active 45 year-old male without any systemic disease known to cause patellar tendon weakening.
Results: Treating the tendon ruptures with direct surgical repair using non-absorbable synthetic sutures and reinforcement with stainless steel cerclage wires yielded satisfactory results with the patient achieving full, painless range of movements without any extensor lag in four months. This result was maintained at six years follow-up.
Conclusion: Our case is particularly remarkable for two episodes of very trivial sequential injuries leading to bilateral spontaneous patellar tendon rupture in an active individual.
Key words: Avulsion, Bilateral, Patellar, Spontaneous, Tendon.
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|How to Cite this article: Thomas BK, Kalyan HK Spontaneous Bilateral | Patellar Tendon Rupture: A Case Report | January-February 2021; 9(1): 49-51.
Vol. 9 | Issue 1 | January-February 2021 | Page: 41-48 | Rraghavendra. S. Kulkarni, Rachana A. Kulkarni, Ranjani R. Kulkarni, R. S. Deshpande, SriRam R. Kulkarni
Authors: Rraghavendra. S. Kulkarni , Rachana A. Kulkarni , Ranjani R. Kulkarni , R. S. Deshpande , SriRam R. Kulkarni 
 Medical Superintendent, SSPM Medical College & LT Hospital, Padve, Sindhudurg, Maharashtra, India.
 Jawaharlal Nehru Medical College, Belgavi, Karnataka, India.
 Medical Officer, Govt. Polyclinic, Oros, Sindhudurg, Maharashtra, India.
 Department of Anaesthesiology, SSPM Medical College & LT Hospital, Padve, Sindhudurg, Maharashtra, India.
 Govt. Medical College Miraj & Civil Hospital Sangli, Maharashtra, India.
Address of Correspondence
Dr. Raghavendra S. Kulkarni
HOD Bungalow No. 6, SSPM Medical College & Lifetime Hospital, Padve, Sindhudurg, Maharashtra, India.
Background: Yet the unresolved question of the relationship between concomitant ulnar styloid fracture and the final outcome of distal radius fracture needs further evaluation.
Methods: This study was carried out for 4672 patients of fracture distal radius, recruited in an ongoing longitudinal study to evaluate the radiological and functional outcomes treated by one surgeon at Government Hospital institute between 1986 to 2011. The right wrist was injured in 2986 (63.9%). There were 3236(69.3%) men and 1436(30.7%) women, with a mean age of 59 years (range 8 to 98 years). In intact styloid group, 1948(72.8 %) were men and 726(27.2%) women, in fractured styloid group 1386(69.4%) were men & 612(30.6%) women.
Results: 2674 (57.2%) patients had intact ulnar styloid and 1998 (42.8%) distal radius fracture with concomitant ulnar styloid fracture. This was again divided into two groups: 1426 (71.4%) had an ulnar styloid base fracture and 572 (28.6%) belong to the ulnar styloid tip fracture group.
224(8.4%) patients with intact styloid and 346(17.3%) with ulnar styloid fracture presented with ulnar side wrist pain. 264(9.9%) had acute or chronic distal radioulnar joint instability with intact styloid, as compared to 746(37.3%) with ulnar styloid fracture group. The mean volar tilt was 11.90(60 to 180) in the intact styloid and 12.60(70 to 190) in the fracture styloid group. The respective values for the base and tip group were 11.60(50 to 170), 12.40(60 to 180) at final follow-up. The mean ulnar variance was observed – 0.4 to 0.6 in the intact styloid group and 0.2 to 0.4 in the fracture styloid group at the final follow-up (p < 0.0001). The grip strength was 92.2% in the intact styloid group and 82.4% in the fracture ulnar styloid group. The hand performance was rated as excellent in 1020 (38.1%), good 1318 (49.3%), fair 204(7.6%), poor 132 (4.9%) in intact styloid group as compared to fracture ulnar styloid group, excellent 582 (29.1%), good 684 (34.2%), fair 513 (25.7%) and poor in 219 (10.9%).
Conclusion: This large sample series report concludes a very distinctly unsatisfactory final outcome uniformly, in fracture ulnar styloid group of distal radius fractures, even in spite of adequate treatment by five different modalities of treatment, which were compared very rigorously. The great influence of ulnar styloid fracture in distal radius fracture is once again well established and this study reinforced categorically the previously published articles by the same author in the past.
Keywords: Distal radius fracture; Ulnar styloid fracture outcome; Ulnar wrist pain; Distal radioulnar joint instability.
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|How to Cite this article: Kulkarni RS, Kulkarni RA, Kulkarni RR, Deshpande RS, Kulkarni SR | Presence of an Associated, Untreated Ulnar Styloid Fracture, Adversely Affect the Outcome in Distal Radius Fracture: A Paradigm Worth Pondering | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 41-48.
Vol. 9 | Issue 1 | January-February 2021 | Page: 36-40 | Prashanth Dhanraj, Eshwar patel, Harish Kodi, Lokesh Gupta, Sunkoj Krishna sai
Authors: Prashanth Dhanraj , Eshwar patel , Harish Kodi , Lokesh Gupta , Sunkoj Krishna sai 
 Department of Orthopaedics, Kamineni Institute of medical sciences, Telangana, India.
Address of Correspondence
Dr. Prashanth Dhanraj
Assistant Professor, Department of Orthopaedics, Kamineni Institute of medical sciences, Telangana, India.
Background: Fracture neck of the femur leads to significant morbidity and mortality in elderly population. Various surgical options are available for the treatment in the elderly, but the gold standard between Austin Moore’s prosthesis and bipolar prosthesis is always debated. Hence, we designed a short-term prospective study to compare the monopolar and bipolar hemiarthroplasty in the elderly having fracture neck of the femur.
Materials and Methods: We conducted a prospective study at a tertiary hospital between 2017 and 2019. In our study, we enrolled 30 patients in each group. Patients in Group A (monopolar) underwent Austin Moore’s hemiarthroplasty and in Group B (Bipolar) underwent uncemented bipolar hemiarthroplasty by standard posterolateral approach. Patients were treated by standard protocols and analyzed at regular intervals with final assessment done at the end of 1 year. Functional outcome was evaluated using Harris Hip Score.
Results: Out of total 60 patients, 51 were evaluated at the end of 1 year. Mean age of population was 66.58 ± 5.96 in monopolar and 64.68 ± 7.48 in bipolar group. Harris Hip Score was 86.58 ± 5.42 in monopolar and 88.52 ± 3.08 in bipolar group. Pain was 38.69 ± 3.58 in monopolar and 40.20 ± 1.50 in bipolar group. Functional status was 39.72 ± 3.00 in monopolar group and 39.58 ±3.45 in bipolar group. Excellent outcome was noted in 13 of monopolar and 15 of bipolar patients seven 7 complications in monopolar and six in bipolar group, respectively.
Conclusion: In our study, we had comparable functional (Harris Hip Score) results in the monopolar and bipolar prosthesis groups, though more excellent outcomes and less complications were encountered in the bipolar group than monopolar which is statistically insignificant at the end of 1 year.
Keywords: Austin Moore, Bipolar, Hemiarthroplasty, Monopolar, Neck of femur fracture, Hemireplacement.
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|How to Cite this article: Dhanraj P, Patel E, Kodi H, Gupta L, Sai SK | Functional Outcome of Unipolar (Austin Moore’s) Versus Uncemented Bipolar Hemiarthroplasty of Hip at 1-Year Follow-up | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 36-40.
Vol. 9 | Issue 1 | January-February 2021 | Page: 30-35 | Sumanth Kumar Gera, Anoop Pilar, Saji M J, Rajkumar S Amaravathi
Authors: Sumanth Kumar Gera , Anoop Pilar , Saji M J , Rajkumar S Amaravathi 
 Department of Orthopaedics, St. Johns Medical College and Hospital, Bangalore, India.
Address of Correspondence
Dr.Rajkumar S. Amaravathi
Professor and Head-Division of Arthroscopy and Sports Surgery, Department of Orthopaedics, St. Johns Medical College and Hospital, Bangalore, India.
Introduction: Anterior cruciate ligament (ACL) injuries with rapidly increasing incidence in our country are disabling to an individual both economically and monetarily, as their management is not only expensive but also has influence on the loss of number of working days of the individual. The natural history of ACL injuries which is not completely understood can have implications in treatment, management decisions, as well as patient counseling.
Materials and Methods: The objectives were to study the prevalence of ACL injuries among patients with knee injuries attending to our hospital and to assess factors associated with ACL injuries including selected demographic variables and other predisposing factors. We studied all patients (103) knee injuries seeking outpatient services at a tertiary care hospital over a period of 2 years. They were evaluated using a standardized questionnaire regarding the details of the injury followed by detailed general physical examination.
Results: We found that males in the age group of 21–30 years with normal body mass index (BMI) were most commonly affected, road traffic accident involving two wheelers being the predominant mode of injury. Majority of ACL injuries occurred on uneven surface during rainy season and they were of indirect in nature. The affected patients lead a sedentary lifestyle with highest frequency among graduates.
Conclusions: We found relatively high incidence of ACL injuries in graduate, middle-aged males with normal BMI. Most patients had poor awareness of ACL injuries and their implications. Majority of the patients had restriction in activities of daily living on self-assessment, which has significant bearing on patients economic and social well-being, we also notice consistent reporting of magnetic resonance imaging to match the clinical examination of lateral meniscal injury more than medial meniscus injury.
Keywords: Anterior cruciate ligament injuries, Epidemiology, Demography, Sex ratio, Road traffic accident, Lifestyle.
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|How to Cite this article: Gera SK, Pilar A, Saji MJ, Amaravathi RS | Epidemiology of Anterior Cruciate Ligament Injuries – A Hospital-Based Cross-Sectional Study | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 30-35.
Vol. 9 | Issue 1 | January-February 2021 | Page: 26-29 | Sunil Kumar P C, Varun Kumar N R
Authors: Sunil Kumar P C , Varun Kumar N R 
 Department of Orthoapedics, Mysore Medical College and Research Insititute Mysuru, Karnataka, India.
Address of Correspondence
Dr. Varun kumar N R,
Postgraduate Resident, Department of Orthopaedics,
Mysore medical college and research institute, Mysuru, Karnataka, India.
Objective: The objective of the study was to evaluate the functional outcome of comminuted extra-articular inferior pole fractures of patella treated with patellar encirclage and patellar tendon repair by transosseous sutures.
Materials and Methods: In this prospective study between November 2018 and January 2020, we treated 20 patients with this method for inferior pole patella fractures, 14 were male and 6 were female. Postoperatively, the knee was immobilized in a knee brace with quadriceps strengthening advised. Flexion is restricted in the first 2 weeks; then, every week, the knee flexion was increased in 20–30°/week till 6 weeks postoperatively. Later, after 6 weeks, knee flexion is increased furthermore.
Results: Results at final follow-up were assessed using Bostman scoring system. Average Bostman score was 25.6. Excellent results were seen in 65% of cases. Two patients had an episode of superficial infection. There were no reports of other complications and almost all patients returned to their pre-injury activity level.
Conclusion: Patellar encirclage and patellar tendon repair using transosseous sutures are a very effective method in the management of comminuted extra-articular inferior pole patella fractures which are not normally amenable to conventional fixation methods. It is simple and easy to perform with reproducible excellent results with no hardware-related complications. Further studies are required to validate this technique with a larger sample size and controls.
Keywords: Inferior pole patella, Comminuted, Transosseous, Patellar tendon repair.
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|How to Cite this article: Kumar PCS, Kumar NRV | Treatment of Comminuted Fracture of the Inferior Pole of Patella Using Encirclage and Patellar Tendon Repair Using Transosseous Sutures” – A Prospective Study of 20 Cases. | Journal of Karnataka Orthopaedic Association | January- February 2021; 9(1): 26-29.
Vol. 9 | Issue 1 | January-February 2021 | Page: 20-25 | Anand S R , Ravi D Narahatti
Authors: Anand S R , Ravi D Narahatti 
 Department of Orthopedics, Mysore Medical College and Research Institute, Mysore, Karnataka, India.
Address of Correspondence
Dr. Ravi D Narahatti,
Post Graduate Resident, Department of Orthopedics,
Mysore Medical College and Research Institute, Mysore, Karnataka, India.
Background: The treatment of intra-articular distal humerus fractures is subject of continuous debate in the orthopedic literature. They are uncommon, the anatomy is complex, and the bone is frequently comminuted. The treatment of distal humerus fractures has traditionally been performed through a posterior approach and an olecranon osteotomy. This study is aimed to prospectively evaluate the clinical and functional outcomes of the triceps-split approach for treating AO type C distal humerus fractures.
Methods: Twenty-two patients with distal humeral fracture AO/Orthopaedic Trauma Association type C were treated in our institution. They were treated with a triceps-splitting approach. All the fractures were managed with two-column fixation and were evaluated for functional outcome using Mayo Elbow Performance Score (MEPS).
Results: A total of 22 patients were evaluated postoperatively thoroughly for functional outcome using MEPS which showed 11 patients (50%) had excellent, 8 patients (36.36%) had good, and 3 patients (13.64%) had fair outcome. Range of motion was 113.8° (range from 85° to 135°); the elbow flexion averaged 124.5∘ (range from 112° to 135°); and the deficit of elbow extension 12.6° (range from 0° to 30°).
Conclusion: The use of a triceps-splitting approach as an alternative to olecranon osteotomy to gain access to the distal humerus provided adequate exposure to perform open reduction and internal fixation with fewer complications, avoiding the complications of reconstruction of osteotomy in the osteotomy technique when used judiciously, especially in simple intra-articular fractures (C1 and C2 type fractures) and the outcomes have been satisfactory.
Keywords: Distal humerus fracture; AO/Orthopaedic Trauma Association type C, Triceps-split approach, Mayo Elbow performance score.
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|How to Cite this article: Anand SR, Narahatti RD Evaluation | of Functional Outcome of AO Type C Distal Humerus Fractures Treated Through Triceps-Splitting Approach | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 20-25.
Vol. 9 | Issue 1 | January-February 2021 | Page: 14-19 | Shobha HP, Girisha KG, Karthik S
Authors: Shobha HP , Girisha KG , Karthik S 
 Department of Orthopedics, MMCRI Mysore, Karnataka, India.
Address of Correspondence
Dr. Girisha K G,
Post Graduate Resident, Department of Orthopedics,
Mysore Medical College and Research Institute,
Krishna Rajendra Hospital, Mysore, Karnataka, India.
Introduction: A majority of pediatric tibia fractures are treated with closed reduction and cost application in the past. Recently, there has been a shift of treatment toward operative management with flexible intramedullary nails. The aim of our study is to study the safety and efficacy of elastic stable intramedullary nails for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs).
Methods: Our study included all tibial diaphyseal fractures of the pediatric age group between 5 and 14 years admitted to the Orthopaedics Department KR Hospital, MMCRI. The study period was between February 2017 and February 2018. All patients were treated with TENs by closed manipulation under general anesthesia. Our study group included 24 cases. Postoperatively, cases were followed up to 6 months. Based on clinical and radiological parameters, the outcome was classified into excellent, satisfactory, and poor according to the Flynn classification for flexible nail fixation.
Results: In our study, all patients achieved complete healing at a mean time of 9 weeks. Complications seen in our study included malunion, skin irritation, and delayed union. Major complications such as limb length discrepancy, rotational deformity, and deep infection were not seen in any of our cases. Based on Flynn’s criteria, we had 22 cases with excellent results, 2 cases with satisfactory results, no poor results.
Conclusion: TENs for unstable pediatric tibial diaphyseal fracture is an easy and effective method of fixation that allows early mobilization, particularly in the setting of head injury, polytrauma, and compartment syndrome where closed reduction cannot be attempted.
Keywords: Tibial fracture, Pediatric, Titanium elastic nails, Elastic stable intramedullary nail, Flynn criteria.
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|How to Cite this article: Shobha HP, Girisha KG, Karthik S | Flexible Intramedullary Nails for Unstable Pediatric Tibia Fracture’s– A Prospective Study of Functional and Radiological Outcome | Journal of Karnataka Orthopaedic Association | January-February 2021; 9(1): 14-19.|
Department of Orthopaedics,
Kasturba Medical College,
Manipal-576104, Karnataka, India.