Publications by authors named "Jigyasa Passey"

15 Publications

  • Page 1 of 1

Mortality Predictors in Covid-19 Positive Patients with Fractures: A Systematic Review.

Bull Emerg Trauma 2021 Apr;9(2):51-59

Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India.

Objective: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data.

Methods: Keywords such as "fracture" and "COVID or COVID-19" were searched through three major databases includes PubMed, EMBASE, and Google Scholar. Selection criteria were all published reports providing the mortality related information of COVID-19 positive fracture patients. Published papers containing mortality data of COVID-19 positive fracture patients were considered for qualitative review. For meta-analysis, the presenting individual's data were considered to study the different parameters association with mortality.

Results: The rate of mean mortality in COVID-19 positive fracture patients was 34%, and 91.7% of patients had hip fractures. Older age and hip fractures had a significant association with higher mortality rates in COVID-19 positive fracture patients.

Conclusion: The mortality rates are considerably higher in COVID-19 positive patients with fractures compared to COVID-19 positive patients without fractures and to the COVID-19 negative fracture patients. Early surgical intervention should be preferred in hip fractures among COVID-19 positive patients for general stabilization and improved respiratory function. Older age and hip fractures are the main predictors of mortality in these patients.
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http://dx.doi.org/10.30476/BEAT.2021.87742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195830PMC
April 2021

Morphometric Study of the Mastoid Triangle for Sexual Dimorphism of Dry Skulls in the North Indian Population.

Cureus 2021 May 5;13(5):e14859. Epub 2021 May 5.

Department of Anatomy, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND.

The mastoid process is a conical projection from the undersurface of the temporal bone. Examination of skeletal remains by anthropologists requires sex determination. The present study proposes to determine sex from morphometry of the mastoid process. The study was conducted on 300 dried skulls with the help of a digital vernier caliper. Discriminant functional analysis was performed. The parameters measured were the mastoid triangle, which is formed by specific points the porion, mastoidale, and asterion, and the linear distances between them. All parameters were higher in male skulls with a high level of significance. The area of the mastoid triangle proved to be the best parameter for sex discrimination.
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http://dx.doi.org/10.7759/cureus.14859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177990PMC
May 2021

Morphometric variations of the lateral surface of calcaneus: Can standard plate sizes fit all?

J Clin Orthop Trauma 2021 Feb 20;13:156-162. Epub 2020 Nov 20.

Department of Anatomy, Maulana Azad Medical College, New Delhi, India.

Purpose: Displaced intraarticular fractures of the calcaneum often require plate fixation. The complex fractures are usually fixed with standard lateral plates and are approached via the extensile lateral approach which is fraught with the risk of wound complications. Oversized calcaneal plates produce tension on the wound closure site and can, thus result in wound healing problems. The current study analyses the morphometry of the lateral surface of the calcaneus for the ideal configuration of the calcaneal plates for Indian patients using a CT based analysis of intact calcanei.

Methods: Fifty CT based studies of normal calcanei were retrospectively analyzed using Horos® software version 3.3.5. The cross-section of the lateral third of calcaneum was assessed for the morphometric measurements relevant to the dimensions of the standard plating devices for calcaneum. We measured the overall plating length of calcaneum, the vertical heights at the anterior process and calcaneal tuberosity, the height of the posterior facet, the lengths of the anterior process, and the posterior facet. The inclination angles of the posterior facet, cuboid facet were also measured. The findings were compared between male and female cases.

Results: The mean plating length of the calcaneus was 60.06 ± 4.05 mm. The mean vertical height of the anterior process and the calcaneal tuberosity were 24.3 ± 2.71 mm and 39.48 ± 4.73, respectively. The length of the anterior process and the posterior facet were 21.36 ± 1.72 and 25.02 ± 4.17, respectively. The mean Gissane angle and the angle of inclination of posterior facet in relation to the plating length were 118.04 ± 5.99° and 47.3 ± 5.20°. The mean anterior slant angle of the cuboid facet was 96.64 ± 4.39°. Significant differences were observed in the measurements among male and female groups except for the angular parameters.

Conclusion: The current analysis suggests the individual morphometric variations of the lateral plating surface of the calcaneus. Although female calcanei have smaller dimensions compared to male calcanei, the angular parameters are comparable among the two groups. Considering the wide variations in the majority of the morphometric parameters, it is difficult to standardize the plate dimensions. However, a few serial increments in the plate dimensions can help in providing the best fit rather than an ideal fit. Also, the plates should be available with multiple inclination angles of the facet limbs according to the local population variations.
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http://dx.doi.org/10.1016/j.jcot.2020.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920148PMC
February 2021

CT Based Characterization of Volar Surface of Distal Radius: Can an Ideal Volar Plate for Fixation of Distal Radial Fractures be Designed?

J Hand Surg Asian Pac Vol 2021 Mar;26(1):77-83

Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.

Literature has limited evidence concerning the morphology of volar surface of distal radius. A mismatch between the plate-contour and contour of the actual volar bony surface can result in malreduction. The purpose of this study is to analyze the normal curvature morphology of volar surface of distal radius and related parameters that can help in designing of the volar plates for fixation of distal radial fractures. We retrospectively analyzed CT scans of uninjured healthy distal radii performed during a one year period (2018-2019). The mediolateral extent of the pronator quadratus line, the mediolateral curve of the pronator quadratus line, the mediolateral surface angle between intermediate column and radial column of distal radius, the curvatures and locations of their vertices for radial and intermediate columns were measured. A total of 84 CT-based studies were analyzed. The mediolateral extent of the pronator quadratus line, the mediolateral curve of the pronator quadratus line, and the mediolateral surface angle between intermediate column and radial column of the distal radius were 24.27 mm, 144.8 degrees and 163.1 degrees, respectively. The mean volar curvatures of the radial and intermediate columns were 156.5 and 151.4 degrees, respectively and distances of their vertices from the pronator-quadratus line were 10.96 mm and 14.13 mm, respectively. Considerable variations occur in curvature morphology of distal radial volar surface. A best fit rather than an anatomical fit can be considered during implant selection owing to these variations. Besides volar curvature of radial and ulnar columns, location of their vertices, mediolateral angulation and surface curvature between these columns at the level of watershed line should also be considered in plate selection. A combination of a few serial increments of the described parameters in the designs of volar fixation plates would be helpful for surgeons in the best implant selection.
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http://dx.doi.org/10.1142/S2424835521500120DOI Listing
March 2021

Radiographic Quantification of Safe Zones for Screw Placement in the Femoral Neck: A Computed Tomography-Based Analysis.

J Orthop Trauma 2021 03;35(3):136-142

Department of Radio-diagnosis, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.

Objectives: The purpose of this study is to design a radiographic map of the femoral neck showing proportion-based locations of the safe zones for screw placement with widest bony extents in anteroposterior and lateral radiographs using normal computed tomography-based data.

Methods: We analyzed computed tomography-based studies of 50 intact normal proximal femora equally from male and female subjects. Using software-developed radiographs, the proportionate locations of the maximal anteroposterior and cephalocaudal extents in both constricted zones were measured. The width of the femoral neck in the measurement zone was taken as the reference for calculation of proportions.

Results: For anteroposterior radiographs, the anteroposterior safe zones in the femoral neck are located at the gradients of 34.21% and 34.33% from the superior border in midcervical and basicervical regions, respectively. In lateral radiographs, they correlate with the visible anterior extent of femoral neck and lie at a gradient of 7.16% and 11.79% from the visible posterior border in midcervical and basicervical regions, respectively. In lateral radiographs, the calcar-based cephalocaudal safe zone was located at the gradients of 43.49% and 39.53% from the visible posterior border in midcervical and basicervical regions, respectively. In anteroposterior radiographs, cephalic limit of the calcar-based safe zone is located at the gradients of 9.63% and 17.82% from the superior border in midcervical and basicervical regions, respectively.

Conclusions: Radiographic margins cannot be reliably trusted for screw fixation of femoral neck fractures. The proportionate locations of the anteroposterior and calcar-based cephalocaudal safe zones with widest bone stock in anteroposterior and lateral fluoroscopic projections can help in the safe placement of screws for fixation of femoral neck fractures.
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http://dx.doi.org/10.1097/BOT.0000000000001914DOI Listing
March 2021

Risk of bony violation with standard triple screw configurations for fixation of femoral neck fractures: A preliminary computed tomography based analysis.

J Clin Orthop Trauma 2020 Jul 5;11(Suppl 4):S546-S552. Epub 2020 May 5.

JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.

Purpose: The reduction and fixation of femoral neck fractures is mainly an indirect one with intraoperative fluoroscopy being trusted for the safe containment of screws within the bony limits of the femoral neck. Radiologically undetected bony perforations may have an impact on the fracture stability and radiological outcomes that have not been studied previously. The purpose of this computed tomography (CT) based study is to analyze the safety of containment of triple screw configurations using standard 6.5 mm diameter screws for fixation of femoral neck fractures in the Indian population using a software-based analysis.

Methods: Data from consecutive CT scans with intact proximal femur performed over a six month period were retrospectively analyzed using iPlan® BrainLab AG, Feldkirchen, Germany. The safe containment of virtual screw trajectories placed in inverted triangular and non-inverted triangular configurations for a 6.5 mm diameter screw was analyzed in intact femoral necks.

Results: A total of 72 cases were considered for the final assessment. For 6.5 mm screws, the proportion for safe containment (without bony violation) of triple screw inverted triangular configuration was 75% with additional safety corridor to 1 mm around the screw trajectories and 31.94% for non-inverted triangular configuration. All male cases and 28% of female cases allowed safe placement of three 6.5 mm screw trajectories in an inverted triangular pattern with a safety margin of 1 mm around the screw. Replacement of one of the two superior 6.5 mm diameter screw trajectories with a 4.5 mm diameter trajectory resulted in 100% safe containment in female cases.

Conclusion: Inverted triangular configuration is a relatively safer configuration compared to the non-inverted triangular configuration. Standard triple 6.5 mm screws for fixation of femoral neck fractures carry a risk of bony violation, especially in females. A preoperative radiographic assessment to screen the cases with narrow vertical and anteroposterior extents of the femoral neck can help in reducing the risk of fluoroscopically undetected violation of the bony margins. Replacement of one of the two superior screws with a 4.5 mm diameter screw can be helpful in such cases.
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http://dx.doi.org/10.1016/j.jcot.2020.04.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394785PMC
July 2020

Reliability of relation between greater trochanter and center of rotation of femoral head in Indian population.

J Clin Orthop Trauma 2020 Jul 21;11(Suppl 4):S522-S525. Epub 2020 Apr 21.

Orthopaedics Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi, 834009, India.

Purpose: Accurate limb length restoration forms an important aspect of reconstructive surgeries around the hip joint. Among the various intraoperative methods for accurate limb length restoration, the relation between the greater trochanter and the center of the femoral head has been conventionally used owing to its simplicity and replicability. The current study aims to study the normal relation between the greater trochanter and the center of rotation of the femoral head, its population-based variation and its gender-based and contralateral differences in the Indian population.

Methods: Standard anteroposterior radiographs of normal hip joints with the proximal femur, performed over a one year period were studied. A software-based analysis was conducted to measure the difference between the levels of the greater trochanteric tip and the center of the femoral head along the longitudinal axis of the femur. The measurements among the male and female cases and the contralateral sides were compared.

Results: The greater trochanteric tip lies at a higher level than the center of rotation of the femoral head by a mean difference of 9.20 ± 5.30 mm. No significant differences were observed among male and female groups and between the contralateral hip joints. Intraobserver and Interobserver reliability were high.

Conclusions: The tip of the greater trochanter and the center of the femoral head do not lie at the same level. This differential relation should be considered during the reconstructive surgeries around the hip joint to prevent an inadvertent limb length discrepancy. Considering the wide interindividual variations, this difference cannot be generalized for all the patients and restoring it to the contralateral normal hip would be more appropriate.
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http://dx.doi.org/10.1016/j.jcot.2020.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394784PMC
July 2020

Fracture of first metacarpal head: A rare case presentation and review of literature.

J Clin Orthop Trauma 2020 Jul-Aug;11(4):672-677. Epub 2019 Jun 4.

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

Fractures around the head and neck region of first metacarpal are unusual and have not been reported in literature. We report a case of fracture of head of first metacarpal with intact articular surface, treated with open reduction and internal fixation, with a follow up period of six months. Surgical procedure, intraoperative difficulties in obtaining reduction and steps to overcome them have been described. Satisfactory functional outcomes can be achieved using stable internal fixation with minimal hardware and early mobilization in first metacarpal head fractures.
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http://dx.doi.org/10.1016/j.jcot.2019.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355070PMC
June 2019

Malleolar tips as reference points for positioning of syndesmotic screw: A preliminary CT based analysis.

J Clin Orthop Trauma 2020 May-Jun;11(3):438-441. Epub 2019 Sep 16.

Department of Anatomy, Maulana Azad Medical College, New Delhi, India.

Purpose: The risk of malpositioning of the syndesmotic screws is very high. A lack of standard radiological or physical references for accurate syndesmotic screw placement is a potential contributing factor in syndesmotic screw malpositioning. Malleolar tips are clinically as well as radiologically appreciable bony references. The purpose of this preliminary CT based study was to investigate the axial relations of the central syndesmotic axis with the malleolar tips.

Methods: CT based studies of uninjured adult ankle joints with intact syndesmosis, conducted over a six months period were analysed. The axial differences between the coronal plane along the malleolar tips and that along the central syndesmotic axis in the axial plane were measured. Gender-based variations were also analyzed.

Results: A total of 70 CT studies were analyzed, and the axial difference between the malleolar tips based coronal plane and that along the central syndesmotic axis was observed to be 3.70 ± 5.61°. The male and female measurements were comparable.

Conclusion: Being in a static relation to the syndesmosis independent of the foot position and the limb rotation, the malleolar tips can be reliably used as references for directing syndesmotic screw in the axial plane. A knowledge of this axial difference between malleolar tips and central syndesmotic axis can help surgeons in an accurate syndesmotic screw placement.
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http://dx.doi.org/10.1016/j.jcot.2019.09.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211806PMC
September 2019

Defining the "mediolateral widening of tibial plateau" as a guide for reduction in tibial plateau fractures: An Indian perspective.

J Clin Orthop Trauma 2020 Feb 7;11(Suppl 1):S66-S70. Epub 2019 Jun 7.

Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India.

Purpose: The primary aim in fixation of the tibial plateau fractures is the restoration of normal anatomy. Evaluation of the widening of the tibial plateau, which has been linked with adverse long term outcomes, still needs precise markers for quantification. The purpose of this study is to analyze the normal limits of tibial plateau widening in the Indian population in relation to the distal femur in a standardized manner to provide important radiological parameters for the same.

Methods: We retrospectively analyzed electronically archived true AP radiographs of uninjured normal knee joints during one year between 2018 and 2019. We measured the mediolateral width of the articular surface and extraarticular extent of the tibial plateau and compared them with the distal femoral articular and extra-articular extents. The measurements were compared between the male and female groups.

Results: Tibial plateau articular width was found to be 4% wider in relation to the distal femoral articular surface. The medial articular rim of distal femur matches closely to the medial articular rim of the tibial plateau. The lateral articular rim of distal femur lies medial to the lateral articular rim of tibial plateau with a mean distance of 3.49 mm.

Conclusions: Owing to individual variations in bony extents around the knee, the differential extent of tibial plateau relative to distal femur would be a more reliable parameter than absolute measurements. Medially the articular extent of distal femur matches closely with the articular extent of tibial plateau while the lateral extra-articular extent of distal femur matches closely with the lateral tibial articular extent. Gender-based differences do not significantly affect these two parameters.
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http://dx.doi.org/10.1016/j.jcot.2019.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977527PMC
February 2020

New landmarks for ideal positioning of syndesmotic screw: a computerised tomography based analysis and radiographic simulation.

Int Orthop 2020 04 20;44(4):665-675. Epub 2019 Dec 20.

Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, 110062, India.

Purpose: A lack of specific intra-operative markers for accurate positioning of the syndesmotic screw can result in its malpositioning. Knowledge of the axial orientation of the syndesmosis can help in reducing this risk of malpositioning of the syndesmotic screw. In this CT-based study, we investigated the axial relationships of intact syndesmoses with various rigid bony landmarks around the ankle joint that were independent of foot and horizontal plane.

Methods: We analyzed 126 CT-based studies of uninjured normal ankle joints and defined the following bony landmarks: posteromedial and posterolateral surface of the distal tibia, bimalleolar tips, and anterior and posterior extents of both malleoli. Axial differences between coronal plane through the central axis of syndesmosis and modified coronal planes through these bony landmarks were then measured. Software-based lateral radiographs were created with the reference coronal plane for each radiograph being kept perpendicular to the plane of the viewing screen.

Results: The mean axial differences parting the syndesmotic axis from the modified coronal planes based on distal tibial posteromedial surface, distal tibial posterolateral surface, bimalleolar tips, anterior bimalleolar extents, and posterior bimalleolar extents were - 3.15°, 13.73°, 4.10°, 11.95°, and 12.24°, respectively. With the exception of the posterolateral surface of the distal tibia, all other bony landmarks were radiologically identifiable in the majority of cases.

Conclusion: Our study attempts to provide a solution to the issues related to malpositioning of the syndesmotic screw by providing new bony landmarks that can be clinically and fluoroscopically used for syndesmotic-screw positioning. The relationships of bimalleolar tips, anterior and posterior bimalleolar extents, and the posteromedial surface can be reliably used as landmarks for directing syndesmotic screws.
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http://dx.doi.org/10.1007/s00264-019-04467-yDOI Listing
April 2020

Morphometric analysis of the anterior column of the acetabulum and safety of intramedullary screw fixation for its fractures in Indian population: a preliminary report.

Int Orthop 2020 04 14;44(4):655-664. Epub 2019 Dec 14.

JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.

Introduction: Morphometric variations of the anterior column of the acetabulum have been described in the literature for its complex structure, which can influence the safe containment of intramedullary screw for fixation of its fractures. The purpose of this CT-based study is to present a preliminary report on the morphometric variations and safety of intramedullary screw fixation of the anterior column of the acetabulum in the Indian population.

Methods: CT-based data from 102 uninjured pelves were retrospectively analyzed in iPlanⓇ BrainLab AG, Feldkirchen, Germany. Narrowest zones around acetabulum and superior pubic ramus were measured. We calculated the axis of the anterior column of the acetabulum by joining the centres of these narrowest zones. Standard screws trajectories were directed along this axis. Screw length up to the first cortical perforation, the distance of the exit point from the pubic symphysis, and the length of the anterior column up to the pubic tubercle were measured.

Results: The osseous corridor of the anterior column of acetabulum had variable cross-section along its length with two constriction zones, first in the acetabular region and second in the superior pubic ramus. Only 54% of our cases allowed safe applicability of 6.5-mm-diameter screw trajectories with safety margin of 2 mm on either side of the screw. Significant morphometric and screw applicability-related differences were observed among male and female cases with males having a wider osseous corridor in general. Elimination of safety margin results in a significant increase in the screw applicability.

Conclusion: The osseous corridor of the anterior column varies in its dimensions from individual to individual. Standard screws of 6.5-mm and 7.3-mm diameters may not be safe for intramedullary screw fixation in every patient and carry a risk of cortical violation when a 2 mm of width around the screw is considered as a safety margin. However, with a precise screw placement within the extents of the cortices of the anterior column, 6.5-mm screws can be applied in most of the female cases and 7.3-mm screws can be applied in most of the male cases for anterior column fixation.
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http://dx.doi.org/10.1007/s00264-019-04428-5DOI Listing
April 2020

Ectopic third molar tooth on the infratemporal surface of maxilla.

Ital J Anat Embryol 2016 ;121(1):96-99

Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature but the ectopic eruption into the non dentate region is rare. Diverse anatomical locations such as nasal cavity, nasal septum, mandibular condyle, coronoid process, the palate and the maxillary sinus can infrequently be non dentate sites of ectopic eruptions of teeth. While conducting an anthropometric study on 100 skulls incidental and interesting case of ectopic maxillary third molar tooth was found. The tooth was partially erupted with the unerupted part lying impacted in the posterior wall of maxilla. The case is reported and discussed for its significant clinical implications.
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January 2016
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