John Mukhopadhaya’s research while affiliated with Huntington Medical Research Institutes and other places

Pilon fractures of the distal tibia are associated with several complications. Late presentations are also not uncommon and together they present many challenges in the management. This review article looks at many of the problems they may present with, and the options available in their treatment with illustrative cases that we have treated over a number of years.

The study focuses on the successful management of late-presenting proximal humerus non-union (PHN) through osteosynthesis using an intra-medullary strut fibular autograft with a proximal humerus internal locking system (PHILOS) and cancellous bone grafting. The study included six cases of PHN that were presented more than 5 years after the original injury, and achieved satisfactory outcomes with improved shoulder function based on the constant score and disabilities of the arm, shoulder, and hand (DASH) score during the final follow-up. The study utilized a paired sample t-test to compare the difference in mean of the pre-operative and post-operative scores for each patient, and found a significant improvement in shoulder function postoperatively. The demographic data of the patients in the study showed a mean age of 54.3 years, with a female-predominant population, and the mean constant score improved from 26.33 to 71.83 postoperatively. The study concluded that symptomatic PHN can be effectively managed operatively, even in cases where it presents very late, and recommended further research through a prospective, multicentric study to enhance the reliability and efficacy of the findings.

Background Most of the commercially available TKR implants are designed for western populations, which are known to have larger build and stature compared to Asian counterparts often leading to mismatch between resected bony surfaces and implant components. There is paucity of morphometric data of distal femur and proximal tibia in the Indian population. Thus, it becomes important to obtain anthropometric data to achieve the best stability and long-term success of implant.Materials and Methods Intraoperative morphological measurements of 100 knees (59 female and 41 males) were done using vernier calliper during TKR. The anteroposterior (AP) and mediolateral (ML) dimensions of cross-section of the femur and tibia were noted before bony resection. The aspect ratios were calculated and compared with that of implant used (DePuy, Stryker, Maxx).ResultsWe have found that Indian males have larger dimensions of distal femur as well as proximal tibia than females. There exists some degree of mismatch in patients’ dimensions and the sizes of all the three commercially available implant system as well their aspect ratios.Conclusion Specific designing of implants with dimensions in accordance with the morphometric measurements of Indian population should be done. Also gender specific implant designing should be done.

Providing higher education is a dream of every Indian parent. Every Indian student goes through many hurdles while pursuing their career. During the 80s and 90s, a career in medicine was very rewarding for students and parents. The interest in pursuing medical education has slowly declined due to the many problems faced by the parents and their kin. Reasons might be many but initial hiccoughs are difficulty in getting admission into medical college. The second hurdle is securing a postgraduate seat. The current scenario of medical practice is entirely different than it was in the 60s and 70s when an MBBS medical graduation was enough to practice. Globalization has changed the current scenario and expectations of patient-doctor relations where a patient is looking for a specialist with in-depth knowledge about the problem and advanced care and treatment methods. Postgraduate education in orthopedics is divided into two main streams after MBBS. M.S. Orthopaedics where training is done at teaching hospitals and Diplomate of National Board (DNB) orthopedics where training is undergone at corporate hospitals usually, where the surgeons may be interested in teaching but not necessarily in a teaching faculty post. This has led to a debate about the equivalence of DNB and MS degrees, whether acquired from the government or private medical colleges or institutions. We know that DNB is a "centralized postgraduate degree" awarded directly by National Board of Examination (NBE), an autonomous body under the Union Ministry of Health and Family Welfare. It is believed that DNB is equivalent degree to MD/MS and is more recognized abroad as there is no room for manipulation of admission through centralized examination nor during exit examination as the examination center is usually away from the institution. Hence, many postgraduates appear for DNB examinations after passing MS/MD. Quality of DNB trainee depends mainly on the following factors: The number of beds in a hospital, existing infrastructure, and the presence of the experienced faculty-all these matters when a student chooses the institute to pursue the postgraduate course. After all the hurdles, the pass percentage of the DNB candidates is very low, and in spite of this, the number of eligible candidates wanting to pursue DNB courses of their choice is increasing every year but the number of seats, however, is not increasing. Recently, all postgraduate courses be it M.S. (Master of Surgery), DNB, or diploma have been clubbed together through National Eligibility and Entrance Test, which gives a higher chance to a candidate to get the specialty of his/her choice, but DNB Ortho won't be the first choice as the pass percentage is very low compared to the M.S Ortho candidate. We wish to summarize the problems faced by a DNB trainee and the reasons for the low pass percentage and how to improve the pass percentage of the DNB trainee. b. Change in the pattern of question paper a. Candidature capacity versus responsibility of the course provider c. Inequalities in the evaluation of answers d. What are the reasons behind these and how to solve these issues?

Femoral head fractures, also known as Pipkins fractures, are more common in young and are usually caused by high-energy trauma. Controversies in the management of Pipkins fracture still exist between excision, osteosynthesis, and arthroplasty. For internal fixation, multiple implants have been tried including Smillie pins, Kirschner wires, screws including mini- or small-fragment cortical screws (2.0–3.5 mm) with countersinking of the head, headless screws like the Herbert screw, and bioabsorbable pins. Fixation can be challenging and may be best done through a safe surgical dislocation using a trochanteric flip osteotomy or through an anterior modified Smith-Peterson approach. Total hip arthroplasty as well as hemiarthroplasty are also advocated for these fractures in certain situation.

Femoral head fractures, also known as Pipkins fractures, are more common in young and are usually caused by high-energy trauma. Controversies in the management of Pipkins fracture still exist between excision, osteosynthesis, and arthroplasty. For internal fixation, multiple implants have been tried including Smillie pins, Kirschner wires, screws including mini- or small-fragment cortical screws (2.0–3.5 mm) with countersinking of the head, headless screws like the Herbert screw, and bioabsorbable pins. Fixation can be challenging and may be best done through a safe surgical dislocation using a trochanteric flip osteotomy or through an anterior modified Smith-Peterson approach. Total hip arthroplasty as well as hemiarthroplasty are also advocated for these fractures in certain situation.

Background Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. Materials and methods A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer's scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Results Stable union was accomplished in all. There was a significant improvement in the average Neer's score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Conclusion Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Clinical significance Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union. How to cite this article Mukhopadhaya J, Ranjan R, Sinha AK, et al. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022;17(3):137–143.