Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

Vol 6 | Issue 2 | July-Dec 2020 | page:2-6 | Vivek Sodhai, Meghraj Holambe, Chetan Pradhan, Atul Patil, Chetan Puram, Parag Sancheti, Ashok Shyam

Author: Vivek Sodhai [1], Meghraj Holambe [2], Chetan Pradhan [1], Atul Patil [2], Chetan Puram [2], Parag Sancheti [2], Ashok Shyam [2,3].

[1] Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[2] Department of Orthopaedics, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[3] Department of Research, Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence

Dr. Vivek Sodhai,
Lecturer, Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
E-mail: vivek.sodhai89@gmail.com


Indroduction: Cephalomedullary nailing (CMN) has become popular in treatment of extracapsular proximal femur fractures due to its mechanical advantages. This study aims to analyse the functional outcomes of the same and factors affecting it.
Material and Methods: 140 prospective cases of extracapsular proximal femur fractures were treated with CMN between October 2016 and October 2017 with a minimum follow-up period of 12 months. Patients were clinically assessed with range of motion, weight bearing status, Harris hip score (HHS) and Short form (SF)-36 score. Radiologically, fracture reduction, change in neck shaft angle (NSA) and neck length ratio in comparison to unaffected hip.
Results: 140 patients, 52 had excellent while 88 had good HHS. Patient in age group 20-40 had an average HHS of 87.79, 40-60 age group had an average HHS of 87.41, while patients in age group > 60 years had an average HHS of 87.63. Patients achieved average full weight bearing at 9.94 ± 2.76 weeks (p-value 0.578). Change in the neck shaft angle (NSA) was statistically significant in the immediate post-operative and at 1-year radiographs (p-value <0.001). Comparison of neck length ratio between affected and unaffected hip showed no statistical difference. There was no significant difference in function, range of motion and HHS in males (88.51 ± 2.72) compared with females (87.61 ± 2.98) (p-value 0.082). There was no significant association between occurrence of limp with change in NSA and neck length ratio (all p values >0.05). 6 complications occurred (1 peri-implant fracture, 2 surgical site infections and 3 cases of helical blade migration).
Conclusion: CMN gives excellent functional outcomes in all AO types A1, A2, A3 irrespective of age and sex with early mobilisation, full weight bearing and better functional range of movement. Limp occurred independant of change in NSA and neck length ratio.
Keywords: Extracapsular proximal femur fractures; Cephalomedullary nailing; Unstable intertrochanteric fractures; Reverse oblique fractures..


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How to Cite this article: Sodhai V, Holambe M, Pradhan C, Patil A, Puram C, Sancheti P, Shyam A | Outcomes of cephalomedullary nailing in the treatment of extracapsular proximal femur fractures and factors affecting it. | Trauma International | July-December 2020; 6(2): 02-06.

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From The Editor’s Desk!!

Vol 6 | Issue 2 | July-Dec 2020 | page:1 | Ashok Shyam

Author: Ashok Shyam [2,3].

[1] Indian Orthopaedic Research Group, Thane, Maharashtra, India.
[2]  Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence

Dr. Ashok Shyam
Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Email: editor.trauma.international@gmail.com

We thank authors for their contribution in the July-December 2020 issue of Trauma International. This issue contains Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures, Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic, Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19, Cervicothoracic Spine Osteoblastoma, Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOS, Removal of Elastic Stable Intramedullary Nail. We appreciate efforts of the author s and hope for more contribution in the field of orthopaedic literature in the coming years.

How to Cite this article: Shyam A. From The Editor’s Desk. Trauma International. July-December 2020;6(2):1.

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Case of Cervicothoracic Spine Osteoblastoma in a 5 Year-old Boy

Vol 6 | Issue 2 | July-December 2020 | page: 15-17 | Mohamed Hbibi, Sarra Benmiloud, Meriem Haloua, Meryem Boubbou, Moustapha Hida

Authors: Mohamed Hbibi [1], Sarra Benmiloud [2], Meriem Haloua [2], Meryem Boubbou [2], Moustapha Hida [1].

[1] Unit of Pediatric Hematology-Oncology, Department of Pediatrics, Mother- Child Hospital University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco. [2] Department of Radiology, Mother-Child Hospital, University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco.

Address of Correspondence

Dr. Mohamed Hbibi, Unit of Pediatric Hematology-Oncology, Department of Pediatrics, Mother- Child Hospital University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco. E-mail: mohamed.hbibi@usmba.ac.ma


Osteobalstoma is a benign primary bone tumor which represents 3% of all benign tumors and 1% of all bone tumors. It is localized commonly in the spine. We report the case of a 5 year-old boy with cervicothoracic spine osteoblastoma. The incidence of osteoblastoma is between de second and third decade; our case was seen in the first decade. The evaluation by computed tomography scan and magnetic resonance imaging show the lesion of posterior elements of D1 vertebrae with extension to 4 upper and underlying vertebrae. The decision of excision was taken a long time of discussion because for surgical team, the lesion was mimicking malignancy of the spine. The child had an uneventful postoperative recovery and the pain resolved after surgery. The objective of this article was to report a case of extensive osteoblastoma and to alert the clinician to avoid delay management due to differential diagnosis. Keywords: Osteoblatoma; Pediatric population; MRI; Surgical treatment.


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How to Cite this article: Hbibi M, Benmiloud S, Haloua M, Boubbou M, Hida M | Case of Cervicothoracic Spine Osteoblastoma in a 5 Year-old Boy | Trauma International | July-December 2020; 6(2): 15-17.


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Removal of Elastic Stable Intramedullary Nail

Vol 6 | Issue 2 | July-December 2020 | page: 19-21 | Vivek M. Sodhai, Sandeep A. Patwardhan, Parag K. Sancheti, Ashok K. Shyam

Authors: Vivek M. Sodhai [1], Sandeep A. Patwardhan [1], Parag K. Sancheti [1], Ashok K. Shyam [1, 2]

[1] Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.
[2] Department of Research, Indian Orthopaedic Research Group, Thane (W), Maharashtra. India.

Address of Correspondence
Dr. Vivek M. Sodhai,
Clinical fellow, Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.
E-mail: vivek.sodhai89@gmail.com


Introduction: Removal of the elastic stable intramedullary nail (ESIN) after the union is routinely performed in the pediatric population. However, ESIN removal can be lengthy and difficult due to the strong bonding between nail and bone.
Technique: We preferred keeping the nail tip tangentially flush (<5mm) to the bone to avoid skin irritation. In our technique, after incision and subcutaneous dissection, the nail tip is identified and exposed using a 6-mm osteotome, and a trough is created around it sufficient enough to pass the hollow mill over it. In cases with buried nail tip, a rectangular cortical window may be required. The nail tip is then gently bent at 90° using the hollow mill as the lever taking care not to cause an iatrogenic fracture. The nail tip is held at the bent from sideways with a plier and the nail is removed by rotatory backward motion or reverse impaction using a mallet in cases of strong bonding between nail and bone. Using this technique, ESIN removal was successful in all 28 cases using the previous incision. Of these cases, 10 were forearm (36%), 8 were tibia (28%), 7 were femur (25%) and 3 were humerus (11%). 6 cases (21%) were considered difficult due to increased thickness of the nails, deeper location of the nail tip, and increased bone growth around the tip of nails.
Conclusion: Our technique is simple, innovative, and can be easily reproduced by all Orthopaedic Surgeons. The use of this technique is recommended for all ESIN removals.
Keywords: Diaphyseal fractures; Elastic stable intramedullary nail; Hardware removal; Paediatric long bone.


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How to Cite this article: Sodhai VM, Patwardhan SA, Sancheti PK, Shyam AK | Removal of Elastic Stable Intramedullary Nail | Trauma International | July-December 2020; 6(2): 19-21.



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Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOS- A Technical Note

Vol 6 | Issue 2 | July-December 2020 | page: 15-18 | Khayas Omer Kunheen, MC Tomichan, Rajeev PB, Adarsh Krishna K Bhat

Authors: Khayas Omer Kunheen [1], MC Tomichan [1], Rajeev PB [2], Adarsh Krishna K Bhat [1]

[1] Department of Orthopaedics, Government Medical College Kottayam, Kerala, India.
[2] Caritas hospital and Institute Of Health Sciences, Thellakom, Kottayam, Kerala, India.

Address of Correspondence
Dr. Khayas Omer Kunheen,
Chelat House, P.O Olavanna,Calicut 673019, Kerala, India.
E-mail: khayasomer@gmail.com


Isolated Greater tuberosity (GT) fractures still pose a therapeutic challenge due to the wide variety of treatment options and lack of proper comparative studies on outcome. Plating still remains a valid option but has several unfavorable effects. One among them is redisplacement of tuberosity postoperatively especially in cases with comminution which may easily be missed in regular plain radiographs. Conventional techniques of fixation may remain insufficient in such scenarios. We hereby propose an adaptation of a described technique, in a 45-year-old male presenting with redisplacement of GT post plate fixation. Open double-row suture bridge construct was used to fix the displaced fragment maintaining the plate insitu and the patient had an excellent functional and radiological outcome on follow-up.
Keywords: Greater tuberosity fracture; Comminution; Double-row fixation; Suture anchor; Suture Bridge technique; PHILOS; Redisplacement.


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How to Cite this article: Kunheen KO, MC Tomichan , Rajeev PB, Bhat AKK | Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOSA Technical Note | Trauma International | July-December 2020; 6(2): 15-18.


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Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19: A Case Report and Literature Review

Vol 6 | Issue 2 | July-December 2020 | page: 11-14 | Petros Koutsogiannis, Jordan Fakhoury, Kanwarpaul Grewal, Gus Katsigiorgis

Authors: Petros Koutsogiannis [1], Jordan Fakhoury [1], Kanwarpaul Grewal [1], Gus Katsigiorgis [1]

[1] Department of Orthopaedic Surgery, Long Island Jewish Hospital- Valley Stream, Northwell Health, New York.

Address of Correspondence
Dr. Petros Koutsogiannis,
Long Island Jewish Hospital- Valley Stream, Northwell Health, New York.
E-mail: pkoutsogiann@gmail.com


This is a case report of an otherwise healthy 45-year-old male patient with a history of COVID-19, who later underwent an Anterior Cervical Spine Decompression and Fusion of level three to four for progressing neurological symptoms. The patient was readmitted eleven days postoperatively for shortness of breath and found to have a Pulmonary Embolism. The patient was at low risk for postoperative VTE, with no known current significant risk factors. He had a history of COVID-19, along with lab values and imaging that have been shown in other case series to help support the link between covid-19 and hypercoagulable state. We hope to support this hypothesis, and bring light to future larger scale studies, in order to better understand this disease and effectively create a preoperative assessment to identify such patients at risk, along with post-operative protocols for these patients having procedures in the future. To our knowledge, this is the first reported case of confirmed postoperative DVT/PE in an otherwise low-risk patient, who had a history of COVID-19 with full recovery. The rarity of this complication, along with options for how to risk-stratify these patients should be formally addressed, especially in those who require urgent spine surgery. These options are discussed, reviewed, and remarks as to where further attention and research is needed is addressed.

Keywords: Anterior Cervical Discectomy and Fusion; COVID-19; Pulmonary Embolism.


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How to Cite this article: Koutsogiannis P, Fakhoury J, Grewal K, Katsigiorgis G | Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19: A Case Report and Literature Review | Trauma International | July-December 2020; 6(2): 11-14.


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Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic: A Case Report

Vol 6 | Issue 2 | July-December 2020 | page: 7-10 | Matthew J. Partan, Peter B. White, Randy M. Cohn, Gus Katsigiorgis, Kanwarpaul Grewal

Authors: Matthew J. Partan [1, 2], Peter B. White [1, 2], Randy M. Cohn [1, 3, 4], Gus Katsigiorgis [1, 4], Kanwarpaul Grewal [1, 2, 4]

[1] Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA.
[2] Department of Orthopaedic Surgery, Huntington, Northwell Health Huntington Hospital, NY, USA.
[3] Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA. [4] Department of Orthopaedic Surgery, Long Island Jewish Valley Stream Hospital, Valley Stream, NY, USA.

Address of Correspondence

Dr. Matthew J. Partan,
Department of Orthopaedic Surgery, Plainview Hospital, 888 Old Country Road, Plainview, NY, USA.
Email: mpartan@northwell.edu


Introduction: Severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), also known as a coronavirus disease-19 (COVID-19), is a novel respiratory disease that has quickly surmounted to pandemic proportions. The purpose of this case report is to discuss the decision-making process, and resource utilization for spine cases that necessitate urgent surgical intervention in light of the COVID-19 pandemic.
Case Presentation: A twenty-five-year-old Hispanic male presented to an emergency department in Long Island, New York on March 30th, 2020 with incomplete cauda equina with altered bladder function. An MRI revealed a moderately large central disc extrusion of L4/5 with deformation at the ventral thecal sac which resulted in severe spinal stenosis. Given displacement of immediately available resources, the patient required a transfer to an affiliate hospital with readily available operating room staff.
Conclusion: From the time of initial presentation to the emergency room the patient was successfully transferred and brought to the operating room suite within eight hours. The patient underwent an L4/5 decompression and microdiscectomy for a large extruded disk herniation at L4/5 level without complications. With our healthcare system in the epicenter of the COVID-19 pandemic, we are in a unique environment exposed to the harsh characteristics of the surge. In parallel with similarly challenged organizations, our system quickly adapted and adopted various guidelines and committees to organize resource allocation. As demonstrated in this case, the displacement of immediately available resources, such as anesthesia staff, placed strain on the routine workings of surgical coordination. In normal times the decision-making in this case may seem straightforward; however, this case demonstrates the strains that the COVID-19 pandemic placed on our healthcare system especially with regards to surgical acuity, COVID-19 exposure risk and resource allocation.
Keywords: Cauda equine; Spine; Medical ethics; COVID-19.  


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How to Cite this article: Partan MJ, White PB, Cohn RM, Katsigiorgis G, Grewal K | Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic: A Case Report | Trauma International | July-December 2020; 6(2): —.



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