Biomedical subjects

O N Nagi

Publications and source records attributed to O N Nagi.

At least 19 recordsLinked to original sources

PubMed2005

Revascularization of diaphyseal bone segments by vascular bundle implantation.

Vascularized bone transfer is an effective, established treatment for avascular necrosis and atrophic or infected nonunions. However, limited donor sites and technical difficulty limit its application. Vascular bundle transplantation may provide an alternative. However, even if vascular ingrowth is presumed to occur in such situations, its extent in aiding revascularization for ultimate graft incorporation is not well understood. A rabbit tibia model was used to study and compare vascularized, segmental, diaphyseal, nonvascularized conventional, and vascular bundle-implanted grafts with a combination of angiographic, radiographic, histopathologic, and bone scanning techniques. Complete graft incorporation in conventional grafts was observed at 6 months, whereas it was 8 to 12 weeks with either of the vascularized grafts. The pattern of radionuclide uptake and the duration of graft incorporation between vascular segmental bone grafts (with intact endosteal blood supply) and vascular bundle-implanted segmental grafts were similar. A vascular bundle implanted in the recipient bone was found to anastomose extensively with the intraosseous circulation at 6 weeks. Effective revascularization of bone could be seen when a simple vascular bundle was introduced into a segment of bone deprived of its normal blood supply. This simple technique offers promise for improvement of bone graft survival in clinical circumstances.

Animals↗

PubMed2005

Technetium-99m ciprofloxacin imaging in the diagnosis of postsurgical bony infection and evaluation of the response to antibiotic therapy: A case report.

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTC ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTC methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTC ciprofloxacin, indicating a good response. Therefore, 99mTC ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTC methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.

Adult↗

PubMed2005

Comminuted refracture of the distal femur and condyles in patients with an intramedullary nail: a report of 5 cases.

Patients with in situ intramedullary nails sustaining a second distal femoral fracture following high-velocity trauma are infrequently reported in the literature. We report 5 such patients who sustained a second injury after 6 to 24 months, resulting in another fracture at the nail-tip level. These second fractures severely comminuted the femoral condyles. These patients required removal of the intramedullary nail, reconstruction of the comminuted femoral condyles, and stabilisation using an angled or buttress plate. Four of the 5 patients were followed up for a mean period of 36 months and were evaluated for knee status and outcome using Judet's criteria. Postoperative knee stiffness was common, and further interventions such as manipulation, hardware removal, arthrolysis, and quadricepsplasty were needed. One patient was lost to follow-up. The final results of the knees were good, with more than 100 degrees range of movement. It is important to adhere to established internal fixation protocols in the treatment of these complex nail tip fractures.

Accidents, Traffic↗

PubMed2004

Traumatic bowing of the forearm bones in roller machine injuries.

Slow bending forces created by rollers of rotating machines and acting on forearm bones can result in traumatic bowing even in adults. Four patients having this peculiar injury pattern in industrial accidents have been reported in this paper. Three of these had concomitant fractures of ipsilateral humerus. There were problems in appropriate reduction of the deformity due to the presence of associated overlying soft tissue injury. The literature has also been reviewed for this injury and 13 reports defining the injury profile, problems in realigning forearm bones and their subsequent maintenance have been described. The eventual outcome of such machine injuries has not been good due to persistence of some degrees of bowing and associated restriction of forearm rotation.

Accidents, Occupational↗

PubMed2004

Open reduction and internal fixation of volar Barton's fractures: a prospective study.

PURPOSE: To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist. METHODS: From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks. RESULTS: All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0-65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases. CONCLUSION: Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function.

Accidental Falls↗

PubMed2003

Posterior cruciate ligament avulsion from the tibia: fixation by a posteromedial approach.

The authors present their experience with a posteromedial approach for fixation of posterior cruciate ligament avulsion from the tibia. The approach is easy, safe and demands no great technical prowess or instruments. Some minor modifications and technical tips for a safer exposure and a better fixation are highlighted. This is a reproducible method for achieving good stability in these avulsion fractures, where early intervention prevents significant late disability. Even in cases delayed up to 3 months we advocate fixation after gradual intra-operative traction and multiple longitudinal stab incidisons, if the ligament with the attached bony fragment has retracted proximally. A single 4-mm screw gives sufficient initial stabilisation to allow supervised mobilisation. A high index of suspicion should be maintained in all dash-board injuries presenting with femoral shaft fractures, especially when the patella is also fractured. The diagnosis may be missed in the acute setting if the bony avulsion is not adequately appreciated; routine MRI in this situation is a good option.

Adolescent↗

PubMed2001

Tuberculosis of the sternoclavicular joints.

From May 1991 to December 1997, we treated 9 patients with tubercular arthritis in 10 sternoclavicular joints. The patients presented with a painful swelling (7 joints), painless swelling (2 joints) and a painless (?) discharging sinus (1 joint) having a mean duration of symptoms of 13 (6-32) months. The diagnosis was made with fine-needle aspiration or open biopsy. In 1 patient debridement of the joint was combined with open biopsy. All patients were initially put on a 4-drug regimen of antitubercular therapy (ATT). 2 joints not responding to closed treatment were surgically debrided after 2-3 months of ATT. Total duration of ATT was 14-18 months. At final follow-up after average 4.5 (1.5-7.5) years, all lesions had healed. 3 patients had mild limitation of shoulder motion, with no pain, and 2 patients had a cosmetically ugly scar at the site of the sinus or biopsy.

Adolescent↗

PubMed2000

Bilateral sternoclavicular joint tuberculosis.

A unique case of bilateral sternoclavicular tuberculosis is presented, with discussion of the possible mechanism of infection. Early diagnosis is mandatory for good results, and with a world-wide resurgence of this disease, a high index of suspicion is mandatory (especially in immunocompromised patients and migrant populations). Computed tomography and magnetic resonance imaging are helpful for defining the exact extent of the disease.

Adult↗

PubMed2000

Fractures of the medial humeral condyle in adults.

BACKGROUND/AIM OF STUDY: Fractures of the medial condyle of humerus are uncommon in adults. The aims of this study were (i) to highlight the rarity of this injury, (ii) to focus on the problems in management of cases which present late, and (iii) to compare the results of surgical excision of medial condyle with those of internal fixation. METHODS: Seven adult medial humeral condyle fractures were seen over a 10-year period. Four cases were surgically fixed within three weeks of the injury; one case refused operation. Two cases which presented late, one with an isolated trochlear fracture, and another Milch type I fracture comminution and compounding, were treated by excision of the condyle and supervised post excision physiotherapy. RESULTS: All six operated cases regained good function. The two patients with excised condyle had no significant instability and had good range of movements. The results were comparable to those managed by open reduction and internal fixation. CONCLUSIONS: Medial condyle fractures presenting early (within 3 weeks), should be managed by accurate open reduction and rigid fixation: non operative management leads to relatively poor results. In late/neglected cases, or those with extensive comminution, open reduction and fixation may lead to stiff and painful elbow, whereas excision of the condylar fragment does not lead to instability.

Adult↗

PubMed1999

Inferomedial (subsustentacular) dislocation of the navicular: a case report.

A unique case of subsustentacular dislocation of the navicular is presented. The authors propose that such a severe displacement cannot occur until there is complete instability across the whole midfoot. The mechanism of injury and the treatment options are discussed. In the present case, there was late collapse of the foot into abduction because the lateral column was not primarily stabilized. Avascular necrosis is a common complication which leads to navicular collapse. A midfoot arthrodesis gave a good result in our patient.

Arthrodesis↗

PubMed1999

Total dislocations of the navicular: are they ever isolated injuries?

Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed subluxation and deformity of the midfoot because of inadequate stabilisation of the lateral column, and there was one patient with ischaemic necrosis. We believe that the navicular cannot dislocate in isolation because of the rigid bony supports around it; there has to be significant disruption of both longitudinal columns of the foot. Most commonly, an abduction/pronation injury causes a midtarsal dislocation, and on spontaneous reduction the navicular may dislocate medially. This mechanism is similar to a perilunate dislocation. Stabilisation of both medial and lateral columns of the foot may sometimes be essential for isolated dislocations. In spite of our low incidence of ischaemic necrosis, there is always a likelihood of this complication.

Adult↗

PubMed1999

Does the piriformis compress the sciatic nerve during limb length equalization?

BACKGROUND: Correction of limb length inequality during reconstruction procedures at the hip has the inherent danger of sciatic nerve injury. Among others, we think that constriction by a tightened Piriformis tendon may be a significant cause during longitudinal traction at the time of surgery. PATIENTS: A specific protocol involving the use of staged surgical release at the time of intraoperative traction/limb length equalization gave only partial nerve compromise in one out of 11 cases; three other patients treated without this protocol developed sciatic nerve problems. CONCLUSION: The authors feel that prior to the application of longitudinal traction, routine sectioning of the contracted piriformis tendon is important to prevent this complication; it is suggested that further investigations like intra operative nerve conduction studies during traction may perhaps substantiate these findings.

Adolescent↗

PubMed1998

Tuberculosis of the patella.

A rare case of tuberculosis of the patella is presented. Diagnostic features include an osteolytic lesion in the patella with flaky sequestrum, associated with typical clinical features. Treatment should be urgent and should include a regimen of surgical debridement along with four antitubercular drugs. Once the joint is involved, the end results become less satisfactory.

Adolescent↗

PubMed1998

Fracture epiphyseal separation of the distal humerus.

Seven patients seen with fracture separation of the distal humerus epiphysis have been analysed for the problems linked with the radiological diagnosis of this injury. Peculiar male predominance, exclusive left-side involvement, consistent postero-medial displacement of the epiphyseal fragment and ability to achieve near anatomic reduction by closed manipulation in fresh cases have been some of the other features observed. The literature has been briefly reviewed for this infrequent and usually misdiagnosed injury.

Child↗

PubMed1998

Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck.

Neglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed. We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.

Adolescent↗

PubMed1997

Comparison of formalin preserved bone allograft in the form of a paste and as bone chips in fresh femoral shaft fractures with comminution.

Femoral shaft fractures with comminution are indicators for primary bone grafting. Problems related to autograft use have led us to evolve methods using allografts preserved in formalin. This method is cheap, easy, reliable and is readily available in the poorer countries. Comparison of 20 cases using allograft paste with 20 cases using allograft chips slivers in similar femoral shaft fractures was done. In both cases, the fusion time was slightly delayed as compared to cases using autograft. The infection rates were comparable, but it was noticed that bone paste got resorbed in 2 cases, leading to plate bending and malunion. The theoretical advantage of the bone paste in filling up the defects and crevices in the comminuted fractures was offset by the practical disadvantage of having no osteoconductive scaffolding, which was provided by the bone chips. It is thus recommended that formalin preserved bone allograft paste may be better suited for use in bony cavities and joint replacements, while formalin preserved bone chips are a good alternative to bone autografts, especially in polytrauma cases. Formalin preserved allografts are a viable alternative method for use in third world countries.

Adolescent↗

PubMed1994

Primary bone tumors of the talus.

A review of 12 cases of bony tumors involving the talus is presented. Giant cell tumor was the most common tumor. Malignant tumors should be treated by surgical ablation followed by chemotherapy. There are good results after excision or curettage and bone grafting in the treatment of benign neoplasms. Giant cell tumors, if diagnosed early, can be treated by curettage and bone grafting, but if there is talar collapse, a talectomy can be performed.

Adolescent↗

PubMed1994

Role of formalin-preserved allograft in fresh fractures with comminution.

The use of bone grafting in polytrauma patients is associated with significant problems. Additional surgical time is required for the use of cancellous autografts, and there may be a significant incidence of donor site morbidity. Various types of allografts used in western countries are expensive to obtain and store, and the technical know-how required for their use may not be available in Third World countries. A series is reported in which formalin-preserved allograft (FPA) was used for the management of comminuted fractures in 22 polytrauma cases. This type of allograft is inexpensive, easy to prepare and store, and has been shown in experimental and clinical studies to be nonantigenic and sterile. The complication rate and time to union were comparable with a control series of autografted cases and previously reported series in the literature. Based on the results in this series of patients, the use of FPA is recommended for the grafting of multiple fractures, especially when other forms of allograft are not available because of technical or financial limitations.

Adolescent↗