Publications by authors named "Sandeep Vijayan"

24 Publications

  • Page 1 of 1

Monophasic spindle cell myxoid synovial sarcoma of the hand: promising results with marginal resection.

BMJ Case Rep 2021 Jan 28;14(1). Epub 2021 Jan 28.

Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Synovial sarcomas are deep-seated, genetically distinct, malignant neoplasms seen in young adults, with a male preponderance. They have unusual clinical and pathological presentation and mimic many other sarcomas and carcinomas, making the diagnosis quite challenging. Although four variants are identified, occurrence in the hand is extremely rare and leads to significant morbidity. There is a high incidence of local recurrence and distant metastasis within the first 2 years. We report the case of an elderly woman with monophasic spindle cell synovial sarcoma who presented with painless swelling in her palm and underwent local excision of the neoplasm. At 2-year follow-up, she remains totally asymptomatic with normal function of the hand. We also attempt to give an overview about monophasic spindle cell synovial sarcoma with the differentials, which would help surgeons in prompt diagnosis and appropriate management.
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http://dx.doi.org/10.1136/bcr-2020-238366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845715PMC
January 2021

Functional outcome and patients' perceived benefits after total knee arthroplasty: A cross-sectional study.

Int J Orthop Trauma Nurs 2020 Nov 12;39:100791. Epub 2020 May 12.

Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi District, Karnataka, 576104, India. Electronic address:

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http://dx.doi.org/10.1016/j.ijotn.2020.100791DOI Listing
November 2020

Suprapatellar nailing in proximal third tibial fractures - Clinicoradiological outcome.

Injury 2020 Aug 18;51(8):1879-1886. Epub 2020 May 18.

Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE University), Manipal, Udupi, Karnataka 576104, India.

Aims And Objectives: To evaluate the clinical and radiological outcome of proximal third tibia fractures managed by suprapatellar nailing with a minimum follow-up of 12 months.

Methodology: In our retrospective cohort study of 43 consecutive proximal third tibia fractures from January 2015 to September 2018 treated with intramedullary nailing through suprapatellar approach in semiextended knee position were included. The patients were followed up regularly at 6 weeks, 3 months, 4.5 months, 6 months, 12 months and every 6 months thereafter. At each visit patients were assessed for union, shortening and rotational alignment. The clinical outcome was analysed using Lower Extremity Functional Scale (LEFS) and anterior knee pain. The radiological outcomes are analysed by evaluating the radiographs for progression of fracture union and tibial alignments.

Results: After fulfilling the exclusion and inclusion criteria, 43 out of 60 consecutive proximal third tibia fracture were included in the study with an average age of 38.4 years (20-71 years), follow up of 20.4 months (12-45 months) after the index procedure. The radiological union was achieved in 7.3 months (4-13 months). At the end of 1 year follow up, the average LEFS was 89.4% (60%-95%). 4 patients had Malunion - with 1 valgus and 3 anterior angulations, 8 delayed unions and 1 non-union (with bone loss- which required bone grafting). All the fractures united eventually. No incidence of anterior knee pain.

Conclusion: We recommend suprapatellar nailing in proximal third tibial fractures when meticulously performed using the current surgical principles and techniques with proper implant selection. It results in excellent clinical and radiological outcomes with minimal complications when compared to other modalities of management. Suprapatellar nailing is a viable option for proximal third tibia fractures due to its inherent advantages of positioning, perfect nail entry and placement. Additionally, noteworthy absence of anterior knee pain is an additional benefit of this technique.
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http://dx.doi.org/10.1016/j.injury.2020.05.008DOI Listing
August 2020

First responder's care package on management of road traffic accident victims of Udupi: Study protocol.

J Adv Nurs 2020 Jul 14;76(7):1812-1822. Epub 2020 Apr 14.

Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India.

Aim: To evaluate the effectiveness of 'first responder's care package' on knowledge and skill on the management of road traffic accident (RTA) victims. The outcomes relate to the quality of first responder's care by autorickshaw drivers.

Methods: Autorickshaw drivers (N = 1,040) will be assessed to identify the impediments and knowledge to provide the first responder's care to RTA victims following which, 150 autorickshaw drivers will be selected based on a cut-off knowledge score to train half of them using workshops. Drivers below 55 years and willing to participate will be recruited and drivers with serious health issues, homophobia and who cannot read English or Kannada will be excluded. Randomized controlled trial with repeated measures design will be adopted. Funding for the research is by the Indian Council of Medical Research and it is registered in the Clinical Trial Registry of India.

Discussion: Road traffic accidents are responsible for 85% of the total global mortality and 90% of the 'Disability Adjusted Life Years' in the developing countries amounting to an annual loss of $65 billion to $100 billion. India's rate of RTA deaths is high and postcrash care is not addressed efficiently by any agencies in India. Autorickshaw drivers could be ideal candidates for teaching the first responder's care package in India as they are a constant presence on the roads and reach all the main roads and small lanes of the country.

Impact: The research will add to knowledge on quality of first responder's care provided to accident victims. If the intervention is found to be fruitful for the accident victims of the locality, it can be recommended to be implemented all over the state.
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http://dx.doi.org/10.1111/jan.14368DOI Listing
July 2020

Osteoid osteoma of the calcaneus misdiagnosed as subtalar sprain.

Indian J Cancer 2019 Oct-Dec;56(4):350-353

Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Osteoid osteoma of foot and ankle account for ten percent of benign bone tumors and commonly involve the talus and metatarsals. Its occurrence in calcaneus is extremely rare and can mimic ankle instability, subtalar arthritis, osteochondritis or plantar fasciitis leading to delay in diagnosis. We present the case of a 17 year old boy with periarticular osteoid osteoma in the calcaneum, who presented following an ankle sprain. He was successfully treated with CT guided percutaneous radiofrequency ablation and we feel that it is a safe, precise and effective treatment option for even periarticular osteoid osteoma in the foot and ankle region.
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http://dx.doi.org/10.4103/ijc.IJC_146_18DOI Listing
February 2020

Anterior elbow dislocation without fracture in an adult: a rare injury pattern.

BMJ Case Rep 2019 Sep 30;12(9). Epub 2019 Sep 30.

Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Anterior elbow dislocation without periarticular fracture (simple dislocation) is an extremely rare injury and is usually caused by distraction or torsional forces. It is important to look for associated ligamentous and musculotendinous injuries in this pattern. We report an elderly patient who sustained simple anterior dislocation of the elbow and in whom successful closed reduction could be achieved. Reduction by closed method is possible if we know the exact mechanism of elbow injury. Despite the presence of medial collateral ligament injury, he was managed non-operatively and had full functional recovery. Checking for joint stability and collateral ligaments after reduction and getting additional radiological investigations help in better treatment planning. Early protected active mobilisation should be initiated to achieve better functional results.
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http://dx.doi.org/10.1136/bcr-2019-230115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768362PMC
September 2019

Variables affecting functional outcome in floating knee injuries.

Injury 2018 Aug 1;49(8):1594-1601. Epub 2018 Jun 1.

Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka, 576104, India.

Background: The surgical outcome of floating knee injuries is difficult to predict. The high-velocity nature of the injury, complex fracture pattern and associated soft tissue/visceral injuries may have some impact on the functional outcome. The present study evaluates the variables affecting the clinical and radiological outcomes of floating knee injuries.

Materials And Methods: The clinical, radiological and functional outcome (Karlstrom and Olegrud criteria) of 89 patients with 90 floating knee injuries were evaluated at the end of one year who were managed in our level 1 trauma center between January 2013 and December 2016. The details of the injury, fracture pattern, management and complications were collected retrospectively from their records.

Results: There were 81 (91.1%) males and 8 (8.9%) females with mean age of 34.34 ± 12.28 years. The mean time for tibia and femur union was 9.52 (±6.6) and 10.5 (±7.37) months. There was significant delay (p < 0.005) in time taken for union in segmental femur fractures (14.3 ± 9.6 months) compared to nonsegmental femur fractures (8.68 ± 5.18 months). Such significant difference in time taken for union was not seen in tibial segmental (10.6 ± 4.62 months) and nonsegmental fractures (9.05 ± 7.27 months). As per the Karlstrom and Olegrud criteria, there were 22 (24.4%) excellent, 26 (28.9%) good, 24 (26.7%) fair and 11 (12.2%) poor outcome. There were 15 patients with malunited tibia, 6 with malunited femur, 10 with limb length discrepancy and 39 with knee stiffness. 28 (33.3%) patients underwent major additional procedures such as bone grafting, re-fixation or bone transport or tendon transfer. It was observed that open tibia fracture, segmental fracture, intra-articular fracture, additional surgical procedures, initial external-fixator (ex-fix) application were significantly associated with development of knee stiffness, limb shortening, malalignment and unsatisfactory (Karlstrom and Olegrud fair to poor) functional outcome.

Conclusion: Open tibial fractures, segmental fractures, intraarticular involvement, additional surgical procedures and initial external fixator application are the poor prognostic indicators of floating knee injuries.
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http://dx.doi.org/10.1016/j.injury.2018.05.019DOI Listing
August 2018

Fracture neck of femur in Factor XIII deficiency: Was better outcome possible?

J Family Med Prim Care 2017 Jul-Sep;6(3):651-653

Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka, India.

The fracture in a Factor XIII deficiency patient is being reported for the first time in the literature. We report a displaced fracture neck of femur in a 17-year-old boy with Factor XIII deficiency. Open reduction and internal fixation was done 8 days after the following the initial injury. Two units each of fresh frozen plasma and cryoprecipitate were given perioperatively to prevent excessive bleeding. No perioperative bleeding complications were encountered. At 18-months follow-up, the fracture had united with evidence of avascular necrosis. The fracture neck of femur in a child or young adult needs to be reduced and stabilized at the earliest to prevent devastating complications. Its occurrence in a patient with Factor XIII deficiency is to be managed like in a normal patient, but with extra perioperative care. Undue delay in fixation as happened in this case should be avoided for a better outcome.
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http://dx.doi.org/10.4103/2249-4863.222011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787972PMC
February 2018

Longitudinal Midline Sacral Split Fracture - A Rare Entity.

BMJ Case Rep 2017 Jul 28;2017. Epub 2017 Jul 28.

Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal - Udupi, Karnataka, India.

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.
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http://dx.doi.org/10.1136/bcr-2017-220397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614253PMC
July 2017

A rare tumour of hand: angioleiomyoma.

BMJ Case Rep 2017 Apr 28;2017. Epub 2017 Apr 28.

Department of Orthopaedics, Kasturba Medical College Manipal, Manipal University, Manipal, India.

Angioleiomyoma is a benign tumour composed of smooth muscle and vascular tissue. Because of the paucity of smooth muscles in the hand other than tunica media of the blood vessels, its occurrence is quite rare in the hand and only few cases are reported in the English literature. We present the case of a 49-year-old man with benign painless swelling on the dorsum of hand. Differential diagnosis of ganglion cyst and tendon sheath tumour were considered. However, excision biopsy revealed angioleiomyoma. At 2-year follow-up, the patient remained asymptomatic with no evidence of recurrence.
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http://dx.doi.org/10.1136/bcr-2017-220005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534928PMC
April 2017

Multiple solitary extramedullary anaplastic plasmacytomas.

Indian J Med Paediatr Oncol 2016 Oct-Dec;37(4):303-304

Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

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http://dx.doi.org/10.4103/0971-5851.195727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234171PMC
February 2017

Simultaneous, Isolated Traumatic Bilateral Patella Fractures.

Trauma Mon 2016 Feb 6;21(1):e20244. Epub 2016 Feb 6.

Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, India.

Introduction: Isolated traumatic fractures of both Patellae, occurring at the same time, in an otherwise healthy person, are very rare. The Patella, as a subcutaneous and a cancellous bone, is vulnerable to injury. However, simultaneous injury to both Patellae without the involvement of any other bony injuries occurs infrequently, and only a few cases have been reported in the literature.

Case Presentation: We report a rare case of isolated, traumatic bilateral Patella fracture with unusual fracture patterns and briefly review the literature.

Conclusions: In simultaneous bilateral Patella fractures, good functional outcome can be expected following a stable surgical fixation and a structured rehabilitation regime. However, personality of the fracture determines salvage versus sacrifice of the Patella.
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http://dx.doi.org/10.5812/traumamon.20244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869419PMC
February 2016

Giant cell rich osteosarcoma of the cuneiforms.

J Cancer Res Ther 2015 Oct-Dec;11(4):989-92

Department of Orthopedics, Kasturba Medical College, Manipal, Manipal University, Karnataka, India.

Osteosarcoma is the commonest primary malignant bone tumor in children and adolescents. Giant cell rich osteosarcoma is a rare subtype of conventional osteosarcoma. Osteosarcomas commonly involve the metaphysis and meta-diaphysis of long bones. We report a 19-year-old girl with giant cell rich osteosarcoma of the medial and intermediate cuneiform bones. Even though, giant cell rich osteosarcoma is frequently mistaken for osteoclastoma of the bone; age of onset, location of lesion, radiological features, and histological characteristics on a high power field helps to differentiate the two conditions. Appropriate and early diagnosis of this variant possibly averts severe morbidity and mortality to the patient. Nonmetastatic osteosarcomas in the foot have better prognosis and are amenable to limb salvage surgeries.
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http://dx.doi.org/10.4103/0973-1482.157318DOI Listing
November 2016

An isolated case of first metatarsal tuberculosis.

Oxf Med Case Reports 2015 Mar 23;2015(3):241-3. Epub 2015 Mar 23.

Department of Orthopaedics , Kasturba Medical College, Manipal University , Udupi, Karnataka , India.

An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year. All serological parameters were within normal limits. X-ray picture revealed an expansile osteolytic lesion of first metatarsal. Tissue biopsy and PCR confirmed it be of tubercular etiology. The incidence of isolated occurrence of metatarsal tuberculosis is very rare and the diagnostic dilemma it brings about is briefly discussed in the following report.
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http://dx.doi.org/10.1093/omcr/omv021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664920PMC
March 2015

Chondroblastoma of the scaphoid: A case report.

J Cancer Res Ther 2015 Jul-Sep;11(3):669

Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

Benign Chondroblastoma generally occur in the epiphysis of long bones and rarely arise in carpal bones. We report a young male with chondroblastoma of scaphoid treated with curettage, bone grafting and K-wire fixation. At the last follow-up, 4 years after surgery, the patient was asymptomatic without recurrence.
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http://dx.doi.org/10.4103/0973-1482.151938DOI Listing
August 2016

Three floating metatarsals and a half-floating cuneiform.

BMJ Case Rep 2015 Oct 8;2015. Epub 2015 Oct 8.

Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

Floating metatarsals are rare and complex injury patterns in the world of foot trauma. The injury is typically characterised by concomitant dislocations of the metatarsals from both articular ends ('bipolar dislocations'). Fascination arises from the fact that there have been only 15 cases reported in the English literature from 1964 to date. The first metatarsal has been more frequently reported than the lesser metatarsals. More than one floating metatarsal is also extremely uncommon. Inter-cuneiform diastasis is another rare entity seen in low velocity injuries and sports injuries; this condition is very difficult to diagnose clinically and radiologically. The occurrence of these two injury patterns in isolation is itself rare, making their combination even more unique.
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http://dx.doi.org/10.1136/bcr-2015-212360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600804PMC
October 2015

Extensive subcutaneous emphysema complicating a percutaneous Mumford procedure.

Knee Surg Sports Traumatol Arthrosc 2016 Jun 25;24(6):1907-10. Epub 2014 Jul 25.

Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.

Subcutaneous emphysema may be a part of a life-threatening pneumomediastinum or pneumothorax and usually does not occur alone. A case of a 75-year-old lady who underwent a percutaneous Mumford procedure for acromioclavicular osteoarthrosis has been reported. She developed extensive subcutaneous emphysema of the neck, chest, bilateral shoulders, and upper arms, in the absence of pneumomediastinum or pneumothorax, during the procedure. Isolated subcutaneous emphysema as a complication of a percutaneous Mumford procedure has not been reported so far in the English literature. The possible mechanism of this complication is discussed. Understanding the mechanism is essential in avoiding this preventable complication.
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http://dx.doi.org/10.1007/s00167-014-3183-2DOI Listing
June 2016

A child with Erysipelothrix arthritis-beware of the little known.

Asian Pac J Trop Biomed 2012 Jun;2(6):503-4

Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India-576104.

Erysipelothrix rhusiopathiae is an established animal pathogen while the zoonotic infections in humans are rarely reported. Infections occur after exposure to animals or animal products that are mostly occupational in adults. Here we report in a child for the first time septic arthritis and osteomyelitis without an identifiable risk factor. A 5-year-old male child was admitted with pain in the left hip joint and inability to bear weight on the limb. Clinical examination followed by radiological and magnetic resonance imaging was suggestive of septic arthritis. Erysipelothrix rhusiopathiae grew from peroperative joint specimen. The infection was resolved following arthrotomy, joint lavage and antibiotic therapy.
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http://dx.doi.org/10.1016/S2221-1691(12)60085-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609334PMC
June 2012

Bilateral stress fractures of femoral neck in non-athletes: a report of four cases.

Chin J Traumatol 2013 ;16(2):113-7

Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.

Femoral neck stress fractures (FNSFs) are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers without underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and subtrochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular necrosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in patients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.
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June 2014

Multicentric osteosarcoma.

Singapore Med J 2012 Oct;53(10):e214-7

Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.

Multicentric osteosarcoma is a rare type of osteosarcoma with a poor prognosis. It is usually described as the occurrence of tumorous lesions in more than one bone, but without pulmonary metastasis. It may be of a synchronous or metachronous variety. We report the case of a 12-year-old boy with a synchronous variety of multicentric osteosarcoma, although he did not have any risk factors for the disease. We also discuss the current debate on whether multicentric osteosarcoma represents multiple primary tumours or metastatic disease.
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October 2012

Analysis of the WISP3 gene in Indian families with progressive pseudorheumatoid dysplasia.

Am J Med Genet A 2012 Nov 17;158A(11):2820-8. Epub 2012 Sep 17.

Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Andhra Pradesh, India.

Progressive pseudorheumatoid dysplasia (PPD) is a progressive skeletal syndrome characterized by stiffness, swelling and pain in multiple joints with associated osteoporosis in affected patients. Radiographically, the predominant features resemble a spondyloepiphyseal dysplasia. Mutations in the WISP3 gene are known to cause this autosomal recessive condition. To date, only a limited number of studies have looked into the spectrum of mutations causing PPD. We report on clinical features and WISP3 mutations in a large series of Indian patients with this rare skeletal dysplasia. Families with at least one member showing clinical and radiologic features of PPD were recruited for the study. Symptoms, signs and radiographic findings were documented in 35 patients from 25 unrelated families. Swelling of small joints of hands and contractures are the most common presenting features. Mutation analysis was carried out by bidirectional sequencing of the WISP3 gene in all 35 patients. We summarize the clinical features of 35 patients with PPD and report on 11 different homozygous mutations and one instance of compound heterozygosity. Eight (c.233G>A, c.340T>C, c.348C>A, c.433T>C, c.682T>C, c.802T>G, c.947_951delAATTT, and c.1010G>A) are novel mutations and three (c.156C>A, c.248G>A, and c.739_740delTG) have been reported previously. One missense mutation (c.1010G>A; p.Cys337Tyr) appears to be the most common in our population being seen in 10 unrelated families. This is the largest cohort of patients with PPD in the literature and the first report from India on mutation analysis of WISP3. We also review all the mutations reported in WISP3 till date.
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http://dx.doi.org/10.1002/ajmg.a.35620DOI Listing
November 2012

Slipped Capital Femoral Epiphysis in a Child with Pycnodysostosis: A Case Report.

JBJS Case Connect 2012 Jul-Sep;2(3):e33

Pediatric Orthopaedic Service, Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, 576104, India. E-mail address for S. Vijayan: E-mail address for H. Shah: E-mail address for B. Joseph:

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http://dx.doi.org/10.2106/JBJS.CC.K.00070DOI Listing
December 2017

The fate of the joint space in Legg-Calvé-Perthes' disease.

Skeletal Radiol 2013 Mar 20;42(3):341-5. Epub 2012 Jun 20.

Paediatric Orthopaedic Service, Kasturba Medical College, Manipal University, Manipal, Karnataka State, India.

Objective: This study was undertaken to identify variations in the hip joint space in patients with healed Legg-Calvé-Perthes' disease (LCPD) and to correlate these changes with the radiological outcome of treatment.

Methods: The width of the joint space was measured on radiographs of 121 skeletally mature individuals with healed LCPD. The joint space width at the stage of healing in 79 patients was compared with the joint space at skeletal maturity. The hips were graded by the Stulberg classification and the femoral head radius was measured. Associations between the joint space width, the Stulberg class and the femoral head radius were tested. The reproducibility of measurement was tested by measuring 30 radiographs twice and computing the intra-class correlation coefficient (ICC). The joint space width was measured on radiographs of 25 patients taken both while recumbent and standing, to determine if the joint space alters on weight-bearing.

Results: The reproducibility of measurements was satisfactory; no difference was noted in the joint space in recumbent and weight-bearing films. Increased joint space was noted both at healing of the disease and at skeletal maturity; the width was minimally increased in Stulberg Class I hips and considerably increased in Class III, IV and V hips. There was a significant correlation between the increase in joint space and enlargement of the femoral head.

Conclusions: An increase in joint space width occurs quite frequently following LCPD; the increase is most evident in hips with a poor outcome. The implications of this observation need to be elucidated.
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http://dx.doi.org/10.1007/s00256-012-1474-6DOI Listing
March 2013

Second report of slipped capital femoral epiphysis in Rubinstein-Taybi syndrome.

Clin Dysmorphol 2011 Jan;20(1):55-7

Paediatric Orthopaedic Service, Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.

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http://dx.doi.org/10.1097/MCD.0b013e32833f000bDOI Listing
January 2011