Madhan Jeyaraman

WHO declared SARS-CoV-2 as a pandemic disease on 11th March 2020. Due to global lockdown and restricted social movements, there is a rising curve in the morbidity of health of non- SARS-CoV-2 orthopaedic rheumatology patients and an impairment in the functional quality of life necessitating a pandemic response protocol into action in all fields of patient care. The development of ideal strategies and recommendations for the management of orthopaedic rheumatologically predisposed population and principles to be followed in their practice is the need of the hour. We hereby give a comprehensive list of strategies that can be followed in orthopaedic rheumatology practice by encompassing the recommendations given by the European League Against Rheumatism (EULAR), The American College of Rheumatologists (ACR), and Indian Association of Orthopaedic Rheumatology - Indian Orthopaedic Association (IORA-IOA). SARS-CoV-2 pandemic has put enormous pressure on patients with Rheumatic Diseases (RD) due to their innate weakness and shared treatment protocols in management. Though RD needs a multidisciplinary approach, which remains a challenge in this pandemic scenario, these strategic recommendations would aid in their optimal care amidst the adversity of SARS-CoV-2. Keywords: Orthopaedic Rheumatology, SARSCoV2, COVID19, Rheumatic Diseases.

Background: Most acute displaced clavicular fractures conventionally have been treated non-operatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction. However, the outcome of non-operative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically. Objective: To study the clinical outcome of displaced clavicle fractures managed surgically by precontoured locking plate and screws. Materials and Methods: A prospective study was carried out between April 2015 to March 2019 in School of Medical Sciences & Research, Sharda University where 50 patients with displaced clavicle fractures were treated surgically by pre-contoured locking plate & screws. They were followed up for a minimum period of 9 months and evaluated for clinical outcome using DASH score and CONSTANT MURLEY score. Results: Out of 50 cases 42 cases had excellent results and 5 patients had good results without complications. 2 cases which were going for delayed union were treated with bone grafting and 1 case, where the plate was exposed on the medial aspect at 8 weeks follow up, plate was removed and wound was closed in layers. Conclusion: In our study of displaced clavicle fractures, which were effectively treated surgically with pre-contoured locking plate & screws, gave excellent results & to be considered the best surgical modality for displaced clavicle fracture with impending skin puncture management. Keywords: Displaced clavicle fracture, Pre contoured LCP, DASH score, Constant MURLEY score.

Introduction: WHO defined Osteoporosis as a bone mineral density (BMD) of 2.5 SD or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry. FRAX is a computer-based algorithm developed by the World Health Organization Collaborating Centre for Metabolic Bone Diseases and first released in 2008. The output of FRAX is the 10-year probability of a major osteoporotic fracture and the 10-year probability of hip fracture. Objective: To assess the outcome of combined bisphosphonate, vitamin D and calcium therapy in patients with established osteoporosis at the end of 15 months, to assess the relationship between vit D, Calcium and osteoporosis with reference to existing FRAX model and to analyze whether any correlation exists between serum Vitamin D levels and BMD as established by DEXA Scan. Materials and Methods: A prospective observational study was performed in 128 patients who underwent screening with Vitamin D levels and DEXA scan to confirm osteoporosis. DEXA scan was employed primarily to establish a case as osteoporosis according to the definition. These patients were started on treatment with combined Bisphosphonates standard dosage of alendronate 70 mgs once per week with standard instructions for 15 months, Vitamin D was administered to patients with established hypovitaminosis as standard therapy with oral sachet of 60,000 I.U administered with milk for 8 weeks. Calcium supplements were given as calcium carbonate 1G per day for 15 months. The final assessment was done by the end of 15 months by analyzing the results of BMD and Vitamin D levels to look for any improvement. Results: In our study of 128 patients we found that, there was statistically significant improvement in mean ± SD Vit D and FRAX hip score at end of study while comparing with pretreatment scores. There was a strong positive correlation between FRAX score hip and FRAX score osteoporosis. Conclusion: The combination of vitamin D3, bisphosphonate and calcium improves bone mineral density and reduces the risk of hip and other osteoporotic fractures at the end of 15 months based on FRAX model. Keywords: Osteoporosis, Bone mineral density, Z score, FRAX.

Diffuse idiopathic skeletal hyperostosis is a non inflammatory systemic disease affecting axial skeleton which results in ossification and calcification of spinal ligaments and entheses. The pathophysiology of the disease is poorly understood. The closest differential diagnosis for DISH remains ankylosing spondylitis. Further research is necessary to treat the disease and to improve the prognosis and quality of life of patients affected with DISH. This article reports a patient with DISH and its management in a tertiary care hospital. Keywords: Forestier’s disease, Diffuse idiopathic skeletal hyperostosis, Calcification, Ossification, Anterior longitudinal ligament, Candle wax, Ankylosing spondylitis, Syndesmophytes.

Introduction: Recently the idea of “Orthobiologics” leads to development of less invasive procedures and accelerated treatments which enhances functional recovery of musculoskeletal disorders. The desired therapeutic effect of autologous platelet rich plasma is facilitated by the ability of IL-1-Ra to limit the destructive inflammatory intra-articular (IA) actions of IL-1?. Objectives: To evaluate the efficacy and functional outcome of autologous PRP injection and homologous platelet lysate to reduce pain, improve joint function and enhance quality of life in patients with early knee osteoarthritis and to investigate the advantages and disadvantages of PRP and homologous platelet lysate. Material and Methods: A total of 121 cases of early osteoarthritis were equally divided into PRP and homologous platelet lysate group. Each patient in both groups has been given ultrasound guided PRP and homologous platelet lysate on day 0, at the end of 4 weeks and 8 weeks and all the patients were followed for up to one year. Treatment outcome measures were assessed at each visit using VAS and WOMAC scores. Results: A statistically significant improvement is observed with VAS and WOMAC score in knee osteoarthritis patients over 12 months with greater advantages over homologous platelet lysate. The overall reduction of pain and enhanced joint function was observed within 1 week, 3 months and 12 months after the initial injection. Conclusion: Homologous platelet lysate has the potential to offer chondroprotective and molecular approach in treating pain and functionality in patients with mild and moderate knee osteoarthritis with greater advantages over autologous platelet rich plasma. Keywords: Platelet rich plasma; Homologous platelet lysate; Osteoarthritis; VAS score; WOMAC score.