Publications by authors named "Himanshu Kanwat"

8 Publications

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Relationship between height and osteosarcoma at the time of diagnosis in the Indian population: A retrospective study.

J Clin Orthop Trauma 2021 Mar 18;14:162-166. Epub 2020 Apr 18.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Background: It has been indicated in several instances that tall stature is also an important risk factor in the development of osteosarcoma. This relationship between height and osteosarcoma is substantiated even more by the increasing evidences being put forth in the recent literature on dependence of certain tumors on the growth factors and their receptors, acting through autocrine or paracrine mechanisms. There has been no study on the Indian population that attempts to define such a relationship.

Purpose: The primary objective of this study was to define relationship between height of patients and osteosarcoma at the time of diagnosis in the Indian population.

Materials/methods: Retrospective data was collected from the old hospital records. Height of patients at the time of diagnosis was compared with expected height of patients of the same age with reference to the standardized growth charts provided by the Indian Academy of Paediatrics.

Results: Out of 98 patients, there were 65 male and 33 female patients with M: F ratio being 1.97:1. The mean age at diagnosis was 17 (SD = 8) years with range of 5-55 years (median = 17 years). Height of the patients at the time of diagnosis was 155.18 (SD = 15.47) cm with range of 115 cm-184 cm (median = 159 cm). Overall, patients with Osteosarcoma were found to be shorter than the expected height deduced from the national growth charts. When patients were divided into two groups of those who were of growing age and those who had completed growth, results were similar.

Conclusion: The observation that majority of patients with osteosarcoma in our study were stunted, is an important finding. It could be deduced from this observation that these patients are unable to mount the usual biological response to the overstimulated growth as part of tumorigenesis in osteosarcoma. This could point to a different scenario in the Indian population and more studies need to be carried out with larger number of patients to further elaborate on this observation.
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http://dx.doi.org/10.1016/j.jcot.2020.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919943PMC
March 2021

Conjoined twins presenting with foot deformities: insights to management and challenges.

BMJ Case Rep 2019 Dec 10;12(12). Epub 2019 Dec 10.

Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Conjoined twins are a rare outcome of conception associated with numerous anomalies involving multiple organ systems. Musculoskeletal abnormalities like vertebral anomalies, sacral agenesis, foot deformities and hip dysplasia have been described in literature. We describe two cases of pyopagus twins with congenital talipes equinovarus and congenital vertical talus deformity which have not been described previously in this type of conjoined twins. The orthopaedist should look actively for such deformities in this patient population and be wary of the difficulties associated with their management.
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http://dx.doi.org/10.1136/bcr-2019-231247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936551PMC
December 2019

Unusual Bilateral Neck of Femur Stress Fracture in a Healthy, Non-athletic Individual - ACase Report and Literature Review.

J Orthop Case Rep 2019 ;9(2):90-93

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Stress fractures of the neck of femur are a rare injury mostly seen in athletes, military recruits, elderly patients, and patients with metabolic bone diseases. Such injury patterns are rare in otherwise healthy and non-athletic individuals. Bilateral presentation in such population is even rarer.

Case Report: We present a case of bilateral neck of femur stress fracture (compression type) in a healthy 50-year-old housewife treated with osteosynthesis with three cannulated screws on one side and total hip replacement on other sides. Follow-up at 1 year revealed optimum results.

Conclusion: This report highlights the importance of diagnosis and early intervention in such cases to prevent complications and morbidity.
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http://dx.doi.org/10.13107/jocr.2250-0685.1388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727459PMC
January 2019

Neglected medial swivel dislocation of talonavicular joint with calcaneus, cuboid and 5th metatarsal fractures - A case report.

J Clin Orthop Trauma 2021 Apr 13;15:168-171. Epub 2019 Aug 13.

Dept. of Orthopaedics, JPNATC, AIIMS, Room 406, 4th Floor, JPNATC, Raj Nagar, 110029, New Delhi, India.

Talonavicular dislocation is a rare injury. Isolated medial or lateral talonavicular dislocations without disruption of subtalar joint are known as medial or lateral swivel dislocations respectively, both being extremely rare. We describe a rare case of neglected medial swivel dislocation with concomitant calcaneus, cuboid and 5th metatarsal fracture, which was managed with open reduction and fixation of talonavicular joint with k-wires and an external distractor. At 1 year follow up the patient was mobilizing full weight bearing without any pain or deformity, the radiographs showing well located talonavicular joint and healed calcaneus, cuboid and 5th metatarsal fractures. This is the first reported case of medial swivel talonavicular dislocation with associated calcaneum, cuboid and 5th metatarsal fracture to the best of our knowledge. This case report highlights the importance of maintaining high level of suspicion for diagnosing midfoot injuries in a polytraumatized patient as well as need of accurate and timely reduction of dislocation for good functional outcome.

Level Of Clinical Evidence: Level 4.
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http://dx.doi.org/10.1016/j.jcot.2019.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920153PMC
April 2021

Multiple Platelet-Rich Plasma Injections Versus Single Platelet-Rich Plasma Injection in Early Osteoarthritis of the Knee: An Experimental Study in a Guinea Pig Model of Early Knee Osteoarthritis.

Am J Sports Med 2019 08 3;47(10):2300-2307. Epub 2019 Jul 3.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options for early osteoarthritis (OA) of the knee. However, no consensus is available regarding optimum dosing schedules.

Purpose: To determine whether multiple injections of PRP (3 injections) provide better short-term and long-term results than a single injection of PRP in a guinea pig model of knee OA.

Study Design: Controlled laboratory study.

Methods: 36 Dunkin-Hartley guinea pigs (weighing ~600-800 g) were chosen for this study. The animals were assigned to group DC (disease control group), group G1 (single-PRP group), and group G2 (multiple-PRP group) containing 10, 10, and 12 animals, respectively. Another 4 animals were used for preparation of allogenic PRP. Groups G1 and G2 received 1 and 3 injections of PRP, respectively, at weekly intervals in the intervention knee while the contralateral knee was injected with normal saline. Group DC received no intervention in either knee. Half of the animals from each group (subgroups DC.3, G1.3, and G2.3) were sacrificed at 3 months, and the remaining half (subgroups DC.6, G1.6, and G2.6) were sacrificed at 6 months after intervention. Both knee joints were harvested for histological assessment of articular cartilage and synovium.

Results: The mean synovial scores for groups G1 and G2 were significantly better than those for group DC at 3 months. No difference was found between groups G1 and G2 at 3 months. At 6 months, group G2 had significantly better mean synovial scores than group G1 and group DC. The mean articular cartilage scores in group G2 were significantly better than those in group DC at 3 months. However, at 6 months, no significant difference was found among any of the groups in terms of mean articular scores.

Conclusion: Both single and multiple injections of PRP exert similar anti-inflammatory effects on the synovium in the short term. However, this effect is sustained in the long term only for multiple injections. Multiple injections of PRP exert a chondroprotective effect, but only in the short term. This effect is not seen with a single injection of PRP.

Clinical Relevance: This study provides insight into the histological basis for the superiority of multiple injections of PRP.
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http://dx.doi.org/10.1177/0363546519856605DOI Listing
August 2019

Risk Factors Associated With Cephalomedullary Nail Cutout in the Treatment of Trochanteric Hip Fractures.

J Orthop Trauma 2018 09;32(9):e385-e386

Department of Orthopaedics, AIIMS, New Delhi, India.

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http://dx.doi.org/10.1097/BOT.0000000000001272DOI Listing
September 2018

The effect of intra-articular allogenic platelet rich plasma in Dunkin-Hartley guinea pig model of knee osteoarthritis.

Muscles Ligaments Tendons J 2017 Jul-Sep;7(3):426-434. Epub 2018 Jan 10.

Postgraduate Institute of medical education and research, Chandigarh, India.

Objectives: To investigate the pathway for disease modifying effect of the PRP in osteoarthritis of knee.

Design: Two experimental models (group I and II) of Twelve Dunkin-Hartley guinea pigs each were enrolled as a part of a prospective controlled experimental study. One knee was enrolled for intervention and the other knee of the same animal used as control, the intervention being three intra-articular allogenic PRP injections given at a weekly interval. Equal volume of isotonic saline injection were given simultaneously in the control knees. Six animals from each model (subgroup IA, IIA) were euthanized at three months and the remaining six (subgroup IB, IIB) at six months post intervention. Samples of synovial fluid were collected from each knee joint for COMP level analysis by ELISA and bilateral knee joints were harvested for histopathological assessment of articular cartilage and synovium at the time of euthanasia.

Results: Mean synovial fluid COMP concentration was significantly lower in PRP treated knees (p<0.05) at three months. On histological examination mean synovitis scores and synovial vascularity were significantly lower in PRP treated knees as compared to controls at both three and six months (p < 0.05). Additionally mean articular cartilage degeneration was significantly lower in PRP treated knees in group 1 only (p<0.05).

Conclusion: Our preliminary data from the study has shown some evidence of positive influence of PRP in knee OA, possibly due to its anti-inflammatory effect and disease modifying effect, shown by short-term chondro-protective effect in PRP injected knees.

Level Of Evidence: V.
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http://dx.doi.org/10.11138/mltj/2017.7.3.426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774915PMC
January 2018

Surgical Retrieval of an Impaled Tapestry Needle from the True Pelvic Cavity of a Child-An Unusual Case Report.

J Orthop Case Rep 2017 Sep-Oct;7(5):24-28

Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India.

Introduction: Impalement injuries of pelvis have been reported in children but are uncommon. Impalement could be associated with injuries to deep organs, wound contamination, crush injuries, and in certain instances, can even be fatal.

Case Report: We present a bizarre case of a 2-year-old female child who presented to us with a tapestry needle embedded in the true pelvic cavity after a history of fall on the buttock while playing at home. The impaled needle was eventually successfully extracted surgically using the modified Stoppa's approach and the post-operative period was uneventful. We also briefly review the literature surrounding such unusual injuries and discuss tips and tricks regarding the surgical technique in such cases.

Conclusions: In impalement injuries, adequate analgesia, tetanus prophylaxis, antibiotics, and immobilization must be given initially followed by meticulous pre-operative planning in the form of radiographs and computed tomography(CT) scans. Minimally invasive CT-guided extraction of needle can be attempted by an experienced interventional radiologist when there is no significant risk of damaging neighboring vital organs or neurovascular structures. The surgical approach if an open approachis decided must be chosen wisely; backup may be needed from an abdominal surgeon, urologist, or gynecologist in certain cases.
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http://dx.doi.org/10.13107/jocr.2250-0685.882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727993PMC
December 2017