Shailendra Singh Bhandari

Government Medical College

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Ganesh Singh Dharmshaktu

Government Medical College

Alamgir Jhan Dar

Government Medical College

Pankaj Singh

CHI Health

Binit Singh

Employees' State Insurance Model Hospital

Ganesh Singh

Lala Lajpat Rai Memorial Medical College

Pankaj Singh

ICFAI Business School

Pankaj Kumar Singh

Central Institute of Medicinal and Aromatic Plants

Anshuman Vijay Roy

Government Medical College

Chandra Shekhar

University of Tennessee Health Science Center

Tanuja Pangtey

Government Medical College

Cooperative Institutions

Government Medical College

Creative Commons

All India Institute of Medical Sciences

National Institute of Pharmaceutical Education and Research

Chandigarh University

Lala Lajpat Rai Memorial Medical College

Sanjay Gandhi Post Graduate Institute of Medical Sciences

Guru Teg Bahadur Hospital

Medanta The Medicity

Institute of Medical Sciences

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Online validity and accuracy of references within drug promotion materials in orthopaedic out-patient department

International Journal of Orthopaedics Sciences (2017)

Ganesh Singh Dharmshaktu Alamgir Jhan Dar Binit Singh Shailendra Singh Bhandari Pankaj Singh

Background - In the era of evidence based medicine, correct and relevant information should accompany any broadcast of pharmaceutical related knowledge. A substandard piece of information has potential for negative impact on care-giver and patient at large. The claims about any pharmaceutical agent with respect to its action, complications or superiority over other ones should be based on strong level of evidence for better knowledge that is aimed at positive impact on judicious decision making and good outcome of therapy. It is thus important that periodic assessment of claims made by promotional materials should be done to ensure their validity and not rely on marketing noise. A detailed study of drug promotion materials collected in orthopaedic out-patient department within a period of four months (Oct 2015 to Jan 2016) was done with special attention to presence, quality and validity of information or claims made within it. 238 random materials were collected in a defined period, out of which 120 excluded in first and 72 in second evaluation. The remaining 46 materials with 65 references in total were part of study. The references were searched over world wide web for its validity, ease of availability and correctness. Majority (26, 56.52%) of the materials were without proper references. Most of the references were about mechanism of action followed by superiority to other drugs. There was deficiency in the presented references including lack of author name, wrong volume of journal or problem with easy identification over net in most references (32, 49.23%). Pain medication were followed by antibiotics and calcium related agents in number of references present. The wrong referencing and difficult to trace the source were leading problems noted on online assessment. The quality of promotional material should quote well substantiated evidence about mechanism of action, superiority and rationale of its use. The evidence thus garnered should be of highest level or from standard reference text book. The preferable use of digital object identifier (doi) is advisable for better search of the articles to check on internet. For ease of quick navigation through referencing articles use of technology like quick response (QR) codes may be considered in the future.

Promotion (chess)

10.22271/ortho.2017.v3.i4d.39

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PATHOLOGICAL FRACTURES IN NON-NEOPLASTIC DISORDERS: A STUDY OF ETIOLOGY, CLINICAL PROFILE AND MANAGEMENT IN A TEACHING HOSPITAL IN UTTARAKHAND

International Journal of Orthopaedics Traumatology & Surgical Sciences (2017)

Ganesh Singh Dharmshaktu Chandra Shekhar Tanuja Pangtey Pankaj Singh Shailendra Singh Bhandari

Background - Pathological fractures represent a sinister underlying cause and require its identification and management along with that of fracture for appropriate treatment and also to check complications including recurrence. Many a times, pathological fracture is the first presentation of an underlying systemic or generalized disorder. The treatment of fracture requires special attention to the abnormal physiology of native bone with subnormal structure and strength. An understanding of common pattern of these fracture subtypes and underlying causes are critical for decision making in a particular geographical area. The present study is a record of pathological fracture pattern and etiologies in Kumaon region of Uttarakhand. Methods – A retrospective evaluation of pathological fractures in cases with diagnosed pre-existing disorders other than neoplastic etiology was done during the period of July 2011 to Jan 2016. The relevant demographic details, site, affected bone and pattern of fractures along with management and outcome were key points noted. A detailed notification of already diagnosed disorder was done along with other significant clinical features. In cases of congenital or genetic condition, detailed history regarding birth and milestones, consanguinity, other sibling and investigative data was noted. Pathological fractures associated with oncological nature including both benign and malignant ones were excluded from the study. Result – A total of 34 cases were included in the study with males constituting majority 25(73.52%) of cases. The lower extremity was involved in 26 cases (76.47%) including 4 bilateral cases and femur was most common bone involved (15 cases, 44.11%). The proximal femur was most commonly involved region of femur bone (10 cases, 66.66%). Top two associated disorders were polio (8 cases, 23.52%) and osteomyelitis (7 cases, 20.58%. 5 cases of bacterial and 2 cases of tubercular osteomyelitis). The osteogenesis imperfecta, stress fracture and HIV were noted in 2 cases each. Other notable causes were thalassemia, congenital pseudoarthrosis tibia and inclusion cyst among others. Conclusion – The study was comprehensive one and evaluates fractures with associated nonneoplastic disorders. The study is important for documentation of such entity in Uttarakhand region for further research and is part of an ongoing and robust data collection preferably with multicentre collaboration. Key words: Pathological Fractures, Orthopaedic, Injury, Bone, Osteopenia, Osteoporosis, Treatment, Diagnosis

Etiology

Presentation (obstetrics)

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Fifth metatarso-phalangeal dislocation with multiple central metatarsal neck fractures in an adolescent: A rare concomitant injury

International Journal of Orthopaedics Sciences (2016)

Ganesh Singh Dharmshaktu Shailendra Singh Bhandari

Forefoot injuries are common occurrences demanding appropriate detection and treatment to ensure optimal functional outcome. Missed or mismanaged care leads to morbid sequelae complicating the management. Assessment for concomitant bony and soft tissue injuries holds due importance for uneventful recovery. Often the metatarsal fractures of central region are multiple, second to fourth, and the presence of little toe metatarso-phalangeal (MTP) dislocation with it makes it a rare injury pattern here managed successfully with appropriate management.

Concomitant

First metatarsal

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Bilateral Both Bone Leg Fracture in a Case of Hereditary Multiple Exostoses with Bilateral Proximal and Distal Tibiofibular Synostosis

Ganesh Singh Anshuman Vijay Roy Shailendra Singh Bhandari Pankaj Kumar Singh

Synostosis

Hereditary multiple exostoses

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Prevalence and pattern of cervical rib, transversomegaly and other vertebral anomalies in normal adult cervical spine in Kumaon region of Uttarakhand, India

International Journal of Research in Orthopaedics (2016)

Ganesh Singh Dharmshaktu Shailendra Singh Bhandari

Background: A supernumary rib from seventh cervical vertebra is called cervical rib and is a common anomaly. Its true prevalence is not validated as most of these are asymptomatic thus do not get diagnosed. Its incidence has been reported in several geographic regions and ethnic clusters. Most of the studies rely on radiological data collected from evaluation of chest or neck radiographs of defined numbers.Methods: A similar study to ascertain its presence and incidence, apart from sexual and morphological pattern is required for Kumaon region of Uttarakhand, India. The present study reports data extracted from study of 1500 radiographs and evaluating them for presence of cervical rib and other abnormalities. Demographic and other relevant details were noted.Results: Most of the cases were female and almost all cases of cervical rib or transversomegaly were bilateral. 0.8% and 1.4% cases were noted for cervical rib and transversomegaly respectively. Apart from it, 4 cases of vertebrae fusion and one case of hemi-vertebra leading to cervical scoliosis was also noted.Conclusions: The prevalence of cervical rib was comparable to other studies considering the sample size. The calculation of true incidence however will require multi-discipline collaboration and robust data. This study, however, is important for further work in this regard and adds value to existing literature.

Cervical rib

Vertebra

10.18203/issn.2455-4510.intjresorthop20161870

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ARE WE STILL MISDIAGNOSING CLUBFOOT? A STUDY OF NON-CLUBFOOT CASES LABELED OR REFERRED AS CLUBFOOT FROM PRIMARY CARE CENTERS IN UTTARAKHAND

Indian Journal of Child Health (2018)

Ganesh Singh Dharmshaktu Alamgir Jhan Dar Shailendra Singh Bhandari

Background: Clubfoot is a congenital disorder identifiable with the clinical assessment itself, provided the knowledge of key features is sound. Several disorders affecting the foot and lower limb that present with crooked or bent anatomy may be confused with it. Knowledge of common disorders that mimic clubfoot in a particular region is thus important to adequately distinguish, manage or refer the case to specialist opinion. Objectives: The current study attempts to provide an overview and documentation of the conditions referred and labeled as clubfoot from primary care facilities, the knowledge of which is important so that appropriate treatment is given to each. The findings will reflect lacunae in the knowledge and perception of primary healthcare workers regarding the deformity. Materials and Methods: A retrospective assessment of all cases referred to our dedicated clubfoot clinic with a diagnosis of clubfoot by peripheral health-care facility was done from September 2016 to October 2017. Relevant demographic details including that of parents, type of deformity, nature, laterality, and treatment received were noted for each case. Conditions requiring non-operative treatment and those requiring further evaluation were noted separately with a detailed description. Results: Out of total 97 cases labeled as clubfoot, 32 (33.68%) cases with 64 feet were part of the study after excluding true clubfoot cases. The common condition noted was calcaneovalgus, postural clubfoot, equinus deformity secondary to cerebral palsy, metatarsus adductus, in-toeing, and posteromedial bowing of tibia. Conclusion: The knowledge of common foot disorders in primary care settings should be strengthened by refresher practical training so that these disorders are diagnosed and managed there an appropriate referral is made thus leading to decrease the burden on higher centers.

Foot (prosody)

Congenital talipes equinovarus

10.32677/ijch.2018.v05.i04.005

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Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital

International Journal of Orthopaedics Sciences (2018)

Ganesh Singh Dharmshaktu Binit Singh Shailendra Singh Bhandari Pankaj Singh

Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and better functionality. There is also decrease in the overall burden of amputation as a result of better treatment of causative disorders and proper limb salvage techniques. Complications, however, pose challenges in regain of necessary functions and include an array of disorders related to the procedure, technique and other factors. An understanding of common and practical complications is helpful in their anticipation and relevant prohibitive measures. Apart from it, a comprehensive study that highlights pattern of amputations and related complications provides database for preventive and management strategy. A total of 69 cases of extremity amputations were included within a defined period of Jan 2011 to June 2016. Relevant demographic data were noted along with other details amputation and complications. An attempt is also made for co-morbidities associated in cases with complications. Males (88.40%) and lower extremity (66.66%) were involved more commonly than females and upper extremity. Below knee was commonest (50.72%) lower and below elbow along with digital amputations were commonest (15.94% each) upper extremity amputations. The significant complication that required increased hospital stay or additional procedures were noted in 34 (49.27%) cases. Delayed wound healing, wound dehiscence, painful neuroma, stiffness, exposed bone and phantom pain were some of major complication noted in the study. A brief notes on patient characteristics has been attributed to the nature of trauma, co-morbidities and substance abuse among the complicated cases. The early recognition of complication and prompt management goes a long way in abetment of agony and discomfort of patient affecting overall outcome.

Wound dehiscence

Neuroma

Phantom limb

Phantom pain

10.22271/ortho.2018.v4.i2d.39

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Concomitant ipsilateral metaphyseal fracture of olecranon and lateral condyle in a child - A rare case report and literature review.

Progress in Orthopedic Science (2016)

Ganesh Singh Dharmshaktu Shailendra Singh Bhandari

Elbow injuries make a sizeable burden of cases in the clinical scenario and require highly specialized care for good functional outcome. The associated injuries increase the complexities in the clinical presentation and their diagnosis. Concomitant injuries call for the appropriate management of each element separately for holistic care. The early mobilization is the aim for early and uncomplicated return to pre-injury level of activities. There are various associated injuries with olecranon metaphysis fractures but the concomitant lateral condyle fracture has been a rare reporting.

Concomitant

10.5455/pos.20151230062532

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