Rakesh John1, Ankit Khurana2, Nirmal G Raj3, Pradeep Aggarwal4, Ravi Kanojia4, Varsha Chayapathi5. 1. Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India. 2. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. 3. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. 4. Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. 5. Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi, India.
Abstract
BACKGROUND: Once an exceedingly rare entity, multiple cases of forgotten rubber band syndrome or the so-called 'dhaaga' syndrome have now been reported in the literature. OBJECTIVES: To conduct a thorough and systematic review of the literature for all articles reporting a chronic type of rubber band syndrome and to present an additional similar case as an illustration. STUDY DESIGN: Systematic review and case report. METHODOLOGY: PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20th June 2017. All articles reporting cases of chronic rubber band syndrome with a discharging sinus were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed. RESULTS: A total of 15 cases have been reported in the literature so far and all cases are from India. Thirteen of these have been reported in the wrist region. Median duration of presentation is 7.6 months after the application of elastic band. Characteristic clinical signs are a circumferential linear scar with discharging sinus (multiple sinuses noted in around one-fourth of the cases). 'Soft tissue constriction sign' on plain radiograph is pathognomonic for this condition. Rate of missed/misdiagnosis is very high (46.7%) and it has been confused with tubercular osteomyelitis which is endemic in India. All cases responded to surgical debridement of circumferential fibrous tissue and foreign body removal with good functional outcomes. CONCLUSIONS: A high index of suspicion must be maintained for this 'syndrome' in chronic osteomyelitis cases presenting with a linear, circumferential scar and discharging sinus in India. Soft tissue constriction sign on plain radiographs are pathognomonic.
BACKGROUND: Once an exceedingly rare entity, multiple cases of forgotten rubber band syndrome or the so-called 'dhaaga' syndrome have now been reported in the literature. OBJECTIVES: To conduct a thorough and systematic review of the literature for all articles reporting a chronic type of rubber band syndrome and to present an additional similar case as an illustration. STUDY DESIGN: Systematic review and case report. METHODOLOGY: PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20th June 2017. All articles reporting cases of chronic rubber band syndrome with a discharging sinus were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed. RESULTS: A total of 15 cases have been reported in the literature so far and all cases are from India. Thirteen of these have been reported in the wrist region. Median duration of presentation is 7.6 months after the application of elastic band. Characteristic clinical signs are a circumferential linear scar with discharging sinus (multiple sinuses noted in around one-fourth of the cases). 'Soft tissue constriction sign' on plain radiograph is pathognomonic for this condition. Rate of missed/misdiagnosis is very high (46.7%) and it has been confused with tubercular osteomyelitis which is endemic in India. All cases responded to surgical debridement of circumferential fibrous tissue and foreign body removal with good functional outcomes. CONCLUSIONS: A high index of suspicion must be maintained for this 'syndrome' in chronic osteomyelitis cases presenting with a linear, circumferential scar and discharging sinus in India. Soft tissue constriction sign on plain radiographs are pathognomonic.
Entities:
Keywords:
Constriction band syndrome; Dhaaga syndrome; Elastic band syndrome; Rubber band syndrome
Authors: Alessandro Liberati; Douglas G Altman; Jennifer Tetzlaff; Cynthia Mulrow; Peter C Gøtzsche; John P A Ioannidis; Mike Clarke; P J Devereaux; Jos Kleijnen; David Moher Journal: BMJ Date: 2009-07-21