T. D. Medical College

Introduction:Periprosthetic humeral fractures are rare but serious complications following shoulder arthroplasty, especially in elderly patients with osteoporosis. These fractures pose a significant management challenge due to compromised bone quality and the presence of prosthetic components. Salvage procedures such as vascularized fibular grafting offer a biologically and mechanically favorable option in complex cases with failed internal fixation.Case Report:We present the case of an 80-year-old female with systemic hypertension and osteoporosis, who sustained a periprosthetic fracture of the right humerus, which was categorized under the Wright and Cofield classification as Type B. She was initially treated with internal fixation of the fracture, and 3 weeks later, presented with implant failure following a trivial trauma. After initial stabilization and medical optimization, she underwent open reduction and internal fixation of the right humerus with vascularized fibular grafting harvested from the opposite leg. Medical management of osteoporosis was also initiated in the post-operative period. At 3 months follow-up, she had clinical and radiological healing of the fracture, restoration of full shoulder range of motion, and activities of daily living. This case highlights the complexity of managing periprosthetic humeral fractures in osteoporotic patients. Standard fixation techniques are often inadequate due to poor bone stock and fraught with high failure rates. Vascularized fibular grafting, though more commonly used in long bone non-unions, can provide durable fixation and enhance osteogenesis in selected cases.Conclusion:Vascularized fibular grafting is an effective option in managing failed fixation of periprosthetic fractures in severely osteoporotic patients. A multidisciplinary approach and individualized surgical planning are crucial for optimal outcomes.

A 54-year-old man with disseminated rhinosporidiosis presented with chronic knee swelling. Examination revealed a patellar mass, later confirmed as Rhinosporidium seeberi infection, which is likely the first such case reported in the orthopaedic literature. Diagnosing a R. seeberi infection in the patella is challenging because of its erosive nature, which can mimic chondrosarcoma. Clinicians should maintain a high degree of suspicion, as this is a highly vascular lesion that may require preoperative angioembolization.

ObjectivesThis study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status.DesignMulticentre retrospective cohort studySettingTwenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.ParticipantsAll adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data.Primary outcomesNumber of MI admissions, median O2D, D2B and D2N times.Secondary outcomes30-day outcomes including death, reinfarction and revascularisation.ResultsMI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115–428) pre-COVID-19 to 390 min (IQR 165–796) in 2020 and 304 min (IQR 135–780) in 2021. The median D2B time reduced from 225 min (IQR 120–420) in 2019 to 100 min (IQR 53–510) in 2020 and 130 min (IQR 60–704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120–840) to 35 min (IQR 25–69) and 45 min (IQR 24–75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4.25% in 2020 and 5.1% in 2021, comparable to 5.8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study.ConclusionDespite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.

Background & objectives Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes mellitus. It is usually insidious in onset, sometimes asymptomatic, predisposing to foot ulcers, muscle and joint diseases. This results in severe disability and impaired quality of life. Hence, this study undertook to estimate the prevalence of DPN among diabetic individuals aged 30 yr and above in Ettumanoor municipality and to explore association with selected factors. Methods A semi-structured interview and examination was conducted among 526 diabetic individuals aged 30 yr and above through cluster sampling. DPN was assessed using the Michigan Neuropathic Screening Instrument (MNSI). Data was coded and entered in MS Excel and analysed using IBM SPSS software version 20. Results Mean age of study participants was 62.72 +/-9.01 yr with a median duration of diabetes of seven years, with an IQR of 10 yr. Prevalence of DPN as per the MNSI Examination tool was found to be 34.2 per cent [95% confidence interval (C.I.): 30.2-38.4]. In binary logistic regression, factors found to be independent predictors of DPN were age above 60 yr, education below high school education, unemployed status, height >160 cm, insulin use, and presence of nephropathy. Interpretation & conclusions Prevalence of DPN among the study population was found to be 34.2 per cent. It was found to be associated with various sociodemographic factors, treatment-related factors, other co-morbidities, and microvascular complications. Overall, it is suggested based on the findings that community-based initiatives are necessary for the timely screening, diagnosis, and treatment of DPN.

If we can classify self-injurious behaviors without a priori assumptions about related variables, it could contribute to the nosology of self-injurious behaviors with etiological and management underpinnings. A cross-sectional study was conducted among 90 adult subjects consecutively admitted to the medical and surgical wards of a tertiary care center. In addition to socio-demographic and relevant clinical variables, intent, lethality, impulsivity, social support, and stressful life events were measured. K-means cluster analysis was used to delineate groups. Hierarchical cluster analysis followed by K-means cluster analysis yielded three groups and their characteristics. The first group consisted of older individuals with high lethality and intent, and low impulsivity. Mental illnesses such as depressive disorder and delusional disorder were more common in this group compared to the others. The second group showed some impulsivity and poor perceived social support. Their attempts were characterized by lower lethality and intent. The third group included the youngest individuals, with high impulsivity and high mean stress scores despite having high perceived social support. Both the second and third groups had a fair representation of borderline personality disorder. Adults with self-injurious behaviors could be divided into three distinct clusters, which has implications for nosology, etiological models, and management.