Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism, osteoporosis, stress fracture and kidney failure. Isolated bilateral traumatic fracture of patella following an unusual mode of injury is seldomly reported in the literature. We reported such a case following a road traffic accident without any associated injuries or co-morbid condition. The patella on the right side had transverse open fracture which was fixed with two Kirschner wires following tension band principle, and that on the left side sustained upper pole comminution which was treated by partial patellectomy. The patient achieved good outcome: at 6 months he was able to squat and sit cross legged; at one year he obtained nearly normal muscle strength and full range of motion. We discussed the injury mechanism, management and rehabilitation in such a case and reviewed the available literature regarding such a presentation.
Bone Wires ; Fracture Fixation, Internal ; Fractures, Bone ; Fractures, Comminuted ; Humans ; Knee Injuries ; Patella ; injuries

Type 2 diabetes (T2D) is rapidly spreading throughout the world. It's an insidious disease and still treated in an indirect manner without having specific drug target. In majority cases T2D is treated with drugs that address type 1 diabetes, majority of drugs aim to increase insulin release although the root cause for T2D is not the dearth of insulin release, it occurs in the later stage of disease development. T2D silently progressed in the patient; it begins with insulin resistance that takes place due to the loss of insulin sensitivity. Though insulin resistance is the centre of pathogenesis, our treatment of the disease has not yet addressed it. It is now a fact that insulin resistance is manifested by lipid and fatty acids (FAs) play a critical role in blunting insulin sensitivity. Our understanding is still poor in deciphering how lipid impose insulin insensitivity, majority of workers suggest it is because of insulin signaling defects which implements insulin function in inhibiting glucose to the cell from circulation. Number of long chain saturated FA has been shown to produce insulin signaling defects. However, we really need further investigation to find specific target(s) for FA induced damage. In addition to these information, a new dimension of T2D is getting attractive is fetuin-A/alpha2-Heremans-Schmid Glycoprotein, a secretary protein from liver. Its gene locus has been identified as T2D susceptible. Fetuin-A's excess expression occurs by FA and it disrupts adipocyte function. It has been shown to be associated with T2D especially in obesity. In this review, we briefly discuss the present status on the mechanistic understanding of lipid induced insulin resistance that leads to T2D. More we understand the mechanism; opportunity to fight the battle with T2D will be increasing. Since, this field is now vast; we covered a few major events.
Adipocytes ; alpha-2-HS-Glycoprotein ; Fatty Acids ; Glucose ; Glycoproteins ; Hypogonadism ; Insulin ; Insulin Resistance ; Liver ; Mitochondrial Diseases ; Obesity ; Ophthalmoplegia

STUDY DESIGN: Prospective cohort study. PURPOSE: Evaluation of the clinico-radiological outcome and complications of limited laminectomy and restorative spinoplasty in spinal canal stenosis. OVERVIEW OF LITERATURE: It is critical to achieve adequate spinal decompression, while maintaining spinal stability. METHODS: Forty-four patients with degenerative lumbar canal stenosis underwent limited laminectomy and restorative spinoplasty at our centre from July 2008 to December 2010. Four patients were lost to follow-up leaving a total of 40 patients at an average final follow-up of 32 months (range, 24-41 months). There were 26 females and 14 males. The mean+/-standard deviation (SD) of the age was 64.7+/-7.6 years (range, 55-88 years). The final outcome was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: At the time of the final follow-up, all patients recorded marked improvement in their symptoms, with only 2 patients complaining of occasional mild back pain and 1 patient complaining of occasional mild leg pain. The mean+/-SD for the preoperative claudication distance was 95.2+/-62.5 m, which improved to 582+/-147.7 m after the operation, and the preoperative anterio-posterior canal diameter as measured on the computed tomography scan was 8.3+/-2.1 mm, which improved to 13.2+/-1.8 mm postoperatively. The JOA score improved from a mean+/-SD of 13.3+/-4.1 to 22.9+/-4.1 at the time of the final follow-up. As for complications, dural tears occurred in 2 patients, for which repair was performed with no additional treatment needed. CONCLUSIONS: Limited laminectomy and restorative spinoplasty is an efficient surgical procedure which relieves neurogenic claudication by achieving sufficient decompression of the cord with maintenance of spinal stability.
Asian Continental Ancestry Group ; Back Pain ; Cohort Studies ; Constriction, Pathologic* ; Decompression ; Female ; Follow-Up Studies ; Humans ; Laminectomy* ; Leg ; Lost to Follow-Up ; Male ; Prospective Studies ; Spinal Canal*