Journal of Orthopedic Education

 The aim of this short communication was to highlight the evidence informed from randomized controlled trials on multidisciplinary rehabilitation of people with chronic low back pain (CLBP). From the reviewed randomized controlled trials, there is moderate evidence for efficacy of an individualized comprehensive multidisciplinary biopsychosocial rehabilitation program on people with CLBP. However the efficacy was provider­dependent and time­dependent, as demonstrated by lack of efficacy when treatments were delivered by non­trained professionals, and the length of the follow­up on change in outcome measures.

Keywords: Multidisciplinary Rehabilitation; Biopsychosocial Model; Chronic Low Back Pain; Orthopedic Rehabilitation.

 This short communication was aimed to highlight the application of clinical prediction rules (CPR) or clinical diagnostic rules (CDR) for knee and patellofemoral pain in the field of clinical orthopaedics. There were two CPRs found on radiographic examination, one each for foot orthoses, patellar taping, hip mobilization, lumbopelvic manipulation and nonarthroplasty surgery. The identified CPRs would enable an evidenceinformed orthopaedic clinical decision making in evaluation and management of patients with knee and/or patellofemoral pain.

Keywords: Clinical Examination; Lower Extremity; Clinical Prediction Rule; Clinical Orthopaedics.

 Bone Cement Implantation Syndrome (BCIS) is a highly under­reported rare fatal complication of cementation, characterized by hypoxia, hypotension, cardiac arrhythmias, and cardiac arrest. Such intraoperative deaths are usually not reported. We report such a rare adverse complication of cementation in a 65 years old female who had fracture neck of femer and sustained a fatal cardiac arrest while performing cemented hemiarthroplasty, with aim to alert surgeons about rare, but serious harm due to BCIS and review the available literature, with aim to educate the them regarding risk, clinical features, preventive measures and management.

Keywords: Bone Cement; Cement Implantation Syndrome; Hemiarthroplasty

 Hand is very uncommon site for primary malignant bony tumors. Chondrosarcoma, which can form de novo as a primary lesion or secondarily from malignant transformation of a pre­existing benign lesion, like enchondroma, is common in pelvis, proximal femur and proximal humerus and rarely occurs in hand. Biologic behaviour of chondrosarcomas in hand whether primary or secondary, which have similar histologic features as chondrosarcomas located elsewhere is not known, but they are locally aggressive lesion, rarely metastasises and had relatively favorable prognosis. We report here such a rare case of third metacarpal chondrosarcoma, suspected to be a secondary chondrosarcoma due to malignant transformation of a benign lesion, which was successfully treated with ray excision. As pre conversion stages are benign, can be differentiated from malignant lesion on clinic­radiologically features and are amenable to salvage surgery, thus regular follow­up are suggested to prevent conversion of benign lesion to malignant lesion.

Keywords: Chondrosarcoma; Hand; Metacarpal; Tumor

 Internal fixation for long bone tumors is still a debatable topic. Approximately 75% of children present with pathological fracture in case of unicameral bone cyst and osteoid osteoma. We report a case of unicameral bone cyst of neck of femur and another case of osteoid osteoma at distal end of fibula wherein both the cases underwent bone curettage and prophylactic internal fixation. After 3 months of follow up both the patients are having full range of movements of the affected joint and are walking full weight bearing, Five year follow up, No recurrance, Prophylactic internal fixation showed good results and can prevent pathological fracture in future in bone tumors.

Keywords: Unicameral Bone Cyst; Osteoid Osteoma; Prophylactic Internal Fixation; Pathological Fracture.

 The objective of this review paper was to provide an evidence informed overview on the anatomical, mechanical and clinical basis for straight leg raise (SLR) as a neurodynamic test in the evaluation and treatment of neuroorthopaedic disorders. There were four anatomical studies that measured nerve­specific strain and excursion during different movement combinations of SLR, four mechanical studies that evaluated responses to structural differentiation in asymptomatic participants, and seven clinical studies that reported interlimb differences, measurements using ultrasonography and handheld inclinometer, and psychometric properties in people with lumbar disc herniation, lumbar radiculopathy and/or sciatica. There is scope for further research using modified SLR techniques for common peroneal, sural and saphenous nerves.

Keywords: Straight Leg Raise; Physical Examination; Neurodynamic Testing; Clinical Orthopaedics.

 Introduction: It is the present day trend to use external fixator as a temporary measure till soft tissue heals up and switch over to definitive mode of internal fixation. In our study we tried to continue the fixator as a definitive treatment and augment the bony healing by bone grafting by phemister techniquein cases with delayed union. Materials and Method: 31 opentibial fractures (Gustilo type II and III) including 5 segmental fractures, presenting 24 hours after injury were treated between 2013­ 2014 with unilateral uniplanar tubular external fixatorsand were followed up for bony union. 10 patients with delayed union (at 3 months) without pin track infection and pin loosening were operated with bone grafting by phemister technique. The graft materials harvested from autogenous Iliac crest by standard phemister technique were applied to denuded surface of the cortex across the fracture site, without disturbing the fibrous union without removing fixator. Results: 24 male and 7 female patients with open tibial fractures were included in this study with average age of 34.03 years.2 patients were lost to follow up and 4 patients had implant failure during the course of the study.Bone healing time ranged from 24­28 weeks with mean of 26.67 weeks in patients with external fixator without bone grafting.Bone healing time in patients with phemister bone grafting for delayed union ranged from 30­36 weeks with mean of 32.3 weeks. Conclusion: The results were very encouraging in our study which can be considered particularly important in our country with economically poor patients who face considerable hardship to afford for the 1st operation with external fixator and it becomes difficult for them to undergo another major operation with instrumentation.In situations where external fixators serve its purpose of stability without loosening and pin track infection and where patient compliance is good,these can be continued till there is bony union.If there is evidence of delayed union at 3 months,bone grafting by phemister technique is the gold standard proceduregiving satisfactory outcome which helps in conversion of fibrous union to osseous union.

Keywords: Phemister; Delayedunion; External Fixation; Bone Grafting; Open Fractures.