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International Journal of Research in Orthopaedics
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2455-4510
Published by Medip Academy Homepage  [12 journals]
  • Version reckoning of variant glenoid levels: a radiological study on dry
           human scapulae

    • Authors: Amr Elshahhat, Aya Mohammed Abdel Aziz, Yehia Basyoni, Khaled Ayman Nour
      Pages: 613 - 618
      Abstract: Background: Preoperative glenoid version measurement can guide base plate implantation and directing screws positioning. Glenoid vault depth affects guide-wire insertion with accurate inclinations towards maximum bone stock. No consensus exists regards the precise glenoid level for version assessment, whether at midaxial or coracoid tip level, and if those values are identical or not. Additionally, there is not much data in literature concerning the deepest point of glenoid vault and its proximity to anterior and inferior glenoid surfaces. Thus, we aimed in this study to report glenoid version values at all levels utilizing two different methodologies (Freidman method, vault version method). Additionally, detecting deepest vault point and how much distant from anterior and inferior glenoid aspects.Methods: Sixty dry, unpaired scapulae were scanned with 1.25mm-thick slices. Version was measured at all levels and compared. Axial and coronal slices with greatest vault depth was determined and distance from anterior and inferior glenoid rims were determined.Results: Version method showed significant difference in version at coracoid tip and midaxial levels (p<0.001). Mean versions were 18.2±10.6º and 8.9±6.8º respectively. Also, significant difference was noted between version of upper, middle, and lower thirds, except between middle and lower thirds. A significant difference was evident between both methodologies on comparing version at coracoid tip level (p<0.001).Conclusions: Glenoid version at coracoid tip and midaxial levels are not the same. Correlation of preoperative version values with intraoperative situations might be studied in future studies.  
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222697
      Issue No: Vol. 8, No. 6 (2022)
       
  • Study of outcomes of suprapatellar approach for tibia intramedullary
           nailing in patients coming to rural medical college, Loni

    • Authors: Nevish H. Patel, Prafulla G. Herode, Het R. Patel
      Pages: 619 - 622
      Abstract: Background: Tibia shaft fractures are most common lower limb long bone fractures. In approximately 80% of patients, tibia fracture occurs in diaphysis region. The procedure of intramedullary interlocking nailing is done by positioning the injured extremity at minimum of 90 degree of flexion in the knee joint to achieve optimal exposure of correct entry point. The tension of quadriceps tendon causes a typical apex anterior angulation of proximal fragment. Supra patellar nailing is done with knee in semi extended position, reducing the anterior angulation. The aim of this study is to study outcomes of supra patellar access of intramedullary nailing for tibia fractures.Methods: It is a descriptive longitudinal study which was carried out from October 2019 to September 2021 in Dr. Balasaheb Vikhe Patil rural medical college, Loni, Ahmednagar. In this study 60 case of closed shaft tibia fractures were treated by supra-patellar nailing technique.Results: In our study we selected, 60 patients with tibia fracture admitting in our institute. All patients underwent operative procedure in the form of intramedullary interlocking tibia nail which was done with suprapatellar approach. Out of all the 60 patients treated with suprapatellar approach, excellent results with good range of movements with excellent lower extremity functional scale score.Conclusions: Supra-patellar approach was found to provide excellent outcome for proximal 1/3rd of tibia fracture.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222377
      Issue No: Vol. 8, No. 6 (2022)
       
  • Comparison of functional outcomes and complications of conservative
           management verses surgical fixation with a locking compression plate in
           the treatment of displaced middle third clavicular fracture

    • Authors: Nilesh S. Sakharkar, Vikas A. Atram, Chandan A. Arora, Rohit K. Bhurre, Akshay J. Atilkar, Kuber Sakhare
      Pages: 623 - 627
      Abstract: Background: About 3 to 5 percent of all fractures are clavicle fractures, which account for 45 percent of fractures at the shoulder. While fractures of the lateral and medial thirds of the clavicle account for 15% and 5% of all clavicle fractures, respectively, middle third fractures account for 80% of all clavicle fractures.Methods: patients were divided into two groups at random. Patients selected for conservative treatment with figure of eight Clavicle Brace and arm sling/pouch were treated with the brace immediately and for surgical intervention with locking plating. Constant and Murley's scoring system was used to check for signs of healing and functional improvementResults: The 40 patients in the current study include 20 with a new fracture of the mid-third clavicle who underwent surgical treatment with clavicular locking compression plate and screws and 20 who underwent conservative treatment with a figure-eight clavicle brace and arm pouch/sling. There was a statistically significant difference in the Constant and Murley score between the surgical group and the conservative group.Conclusions: According to the present study, patients with a displaced mid-third clavicle fracture may benefit more from surgery than from conservative treatment. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222698
      Issue No: Vol. 8, No. 6 (2022)
       
  • Prospective study of surgical outcomes of cervical myelopathy based on its
           etiology, duration of affection and radiological patterns of compression

    • Authors: Rajdeepsinh P. Jadeja, Nishat M. Goda
      Pages: 628 - 635
      Abstract: Background: Cervical spondylotic myelopathy (CSM) is considered the commonest cause of spinal cord dysfunction in individuals above 55 years of age and if left untreated, permanent cord damage may occur. This could contribute to increased dependence and reduced quality of life in older individuals. A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria.Methods: A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria. Total 30 patients included in study. patients were operated according to patterns of compression. Anterior/posterior decompression SOS instrumentation was done according to POC. Pre-op and post-op Nurick’s grading, pre-op and post-op modified Japanese orthopaedics association (mJOA) scores were used for comparison. Patients were followed up for period of 1 year from surgical intervention. Recovery rate calculated using preop and post op mJOA scores.Results: Overall satisfactory surgical outcome found in patients of cervical myelopathy, out of 30 patients, 9 patients of pattern of compression I (POC I) had  recovery rate (RR) of (91.6±7.8) , 8 patients of POC II had RR of (78.4±14.8), 6 patients of POC III had RR of (73.5±11.1), 4 patients of POC IV had RR of (74.9±29.2), 3 patients of POC IVv had RR of (80.4±4.1).the assessment of the final outcome was done using mJOA scoring system  and Nurick’s grading system.Conclusions: Anterior cervical discectomy and fusion (ACDF) for POC I (one- or two-level anterior cord compression) and POC II (one or two levels of anterior and posterior cord compression) give good surgical outcome. Cervical laminectomy and SOS instrumentation is recommended for POC III (3 levels of anterior cord compression), IV (3 or more levels of anterior compression and development of narrow canal with multiple posterior compression) and IV variant (similar to POC IV with one or two levels, being more significant than the others).earlier diagnosis, prompt radiological investigations, individualizing surgical protocol, proper surgical techniques and proper follow-up evaluation are key in management of patients of cervical myelopathy.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222699
      Issue No: Vol. 8, No. 6 (2022)
       
  • Is antegrade K-wire pinning better than retrograde pinning for distal
           radius fracture' A comparative study

    • Authors: Nischay Kenjige Keshava, Prashant N. Gedam, Sahil Mhaisane, Ketan Naik, Shubham Dakhode
      Pages: 636 - 641
      Abstract: Background: The treatment of distal end radius has undergone tremendous changes over the years due to better understanding of the fracture anatomy, mechanism of injury and development of newer techniques and implants. The objective of treatment of distal end radius fracture is to restore the anatomy and to obtain early function. Percutaneous pinning is a minimally invasive technique to maintain the reduction and prevent re-displacement of the fracture fragments. Sato et al. introduced a technique of fixation for the unstable extra-articular distal radial fractures by manual reduction and antegrade intra-medullary pinning.Methods: A retrospective study with a sample size of 30, where 15 of the selected patients had undergone antegrade fixation and the rest 15 had undergone retrograde fixation.Results: Patients were evaluated for functional and radiological outcomes after a mean follow up of one year. No statistically significant difference was found between the two methods.Conclusions: Both the procedures were effective in managing the distal radius fracture with preservation of fracture hematoma. However soft tissue complications were less in antegrade pinning as compared to retrograde. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222700
      Issue No: Vol. 8, No. 6 (2022)
       
  • Comparison of treatment outcome of transforaminal and caudal epidural
           steroid injections for radiating low back pain

    • Authors: Sorabh Garg, Jagdeep Singh, Chandanpreet Kaur, Rajdeep Singh, Azhar Pookunju
      Pages: 642 - 648
      Abstract: Background: Low back pain is a common disorder. Nearly everyone is affected by it at some time during one’s life time. Corticosteroid injections showed early and moderate but unsustained improvements versus placebo in certain outcomes for lumbar radiculitis. Hence; the present study was undertaken for assessing and comparing the efficacy of transforaminal and caudal epidural steroid injections outcome for the treatment of lumbar radiculitis.Methods: The study was conducted prospectively on 60 patients (30 each) from 20-75 years of age. All the patients were divided into two groups; Group A included patients in which Transforaminal route was used while Group B included patients in which caudal route was used. Pain relief was assessed after the epidural steroid injection using visual analogue scale (VAS) and Oswestry disability index (ODI).Results: Mean VAS and mean ODI score for the patients of Group A was significantly lower in comparison to the patients of group B at post-last injection, 15 days post-last injection, 1-month post-last injection and 3 months post-last injection time interval.Conclusions: Transforaminal approach exhibited superior efficacy and should be performed with increasing frequency. Transforaminal epidural steroid injection also gave better quality of life.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222701
      Issue No: Vol. 8, No. 6 (2022)
       
  • Awake spinal fusion: a retrospective analysis of minimal invasive single
           level transforaminal lumbar interbody fusion done under spinal anaesthesia
           in 150 cases

    • Authors: Ameya Rangnekar, Mani K. Anand, Praveen Goparaju, Amit Chugh, Abhijith Shetty, Saijyot Raut, Vishal Kundnani
      Pages: 649 - 654
      Abstract: Background: Spinal anaesthesia carries the advantage of having rapid onset, lesser blood loss, early recovery and hospital stay as compared to general anaesthesia. The present study evaluated outcomes of awake spinal fusion i.e., minimal invasive single level transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anaesthesia. Current study is a retrospective analysis of prospectively collected data carried to assess patient related outcome benefits for a single level transforaminal lumbar interbody fusion done under spinal anaesthesia.Methods: Patients who fit deemed criteria not responding to 6 weeks of conservative treatment to lumbar degenerative pathologies underwent MIS-TLIF. The demographic data, visual analogue pain scale (VAS), Oswestry disability index (ODI), blood loss, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in post anaesthesia care unit (PACU), duration of surgery, nausea/vomiting, urinary retention, requirement of analgesics, duration of stay in hospital, peri-operative complications, fusion rate and satisfaction score were compiled and assessed.Results: 150 patients were operated with MISTLIF under spinal anaesthesia. VAS and ODI score improved significantly at final follow up (p<0.05). The mean duration of surgery was 148±18.24 minutes and blood loss were 109.64±110.45 ml. The average time from entering OT to incision and bandaging to exit was respectively 27.32±8.44 and 6.43±3.28 minutes. Mean PACU time was 36.74±6.32 minutes while duration of stay averaged 1.58±0.67 days. Post operative analgesia requirement was in 10.6% patients and radiographic fusion was observed in 96.6% patients. 90.6% patients were fully satisfied with spinal anaesthesia.Conclusions: Awake spinal fusion should be considered as a novel surgical approach with newer minimal invasive surgical techniques and regional anaesthesia to improve patient satisfaction and overall surgical outcome.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222702
      Issue No: Vol. 8, No. 6 (2022)
       
  • Comparative evaluation of pre and post operative functional outcomes
           determined by Lysholm knee score of patients undergoing arthroscopic
           anterior cruciate ligament reconstruction

    • Authors: Rajat Kapoor, Ashutosh Verma, Atul Kumar Saroj
      Pages: 655 - 659
      Abstract: Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee joint and prevents the knee against anterior translation. After ACL tears, most patients experience recurrent episodes of instability (give way), pain and decreased function. Purpose of our study was to comparative evaluation of functional outcomes of pre and post operative patients after arthroscopic ACL reconstruction by using Lysholm knee score and its complications.Methods: This is a prospective interventional study which were included total 45 patients undergoing arthroscopic ACL reconstruction by using hamstring autograft. Postoperatively patients were followed up at 6, 9 and 12 months for functional assessment by using Lysholm knee score.Results: After ACL reconstruction increment in mean Lysholm knee score during follow up from 69.33 to 96.03 at final followup (p<0.001) which indicate that significant improvement in functional status of patients.Conclusions: Reconstruction of ACL leads the patient to return to a normal activity level and prevent the occurrence of associate meniscal injury and post-traumatic osteoarthritis. A regular followup based and well-organized rehabilitation program provide a key role in functional outcome of knee after ACL reconstruction.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222703
      Issue No: Vol. 8, No. 6 (2022)
       
  • Relevance of posterior malleolar fracture fixation to ankle syndesmotic
           reduction, a comparative study

    • Authors: Amr Elshahhat, Khaled Youssef, Mohammed Elkasaby, Osama Samir Gaarour
      Pages: 660 - 667
      Abstract: Background: Appropriate distal tibiofibular syndesmotic reduction is crucial to restore ankle stability, guard against future arthrosis with worse functional outcome. Optimal technique for syndesmotic reduction has been a matter of debate. This study aimed at radiological evaluation of syndesmotic integrity following two methods of reduction (posterior malleolar fixation and trans-syndesmotic screw fixation), additionally, correlating the posterior malleolus size to the radiological results of both techniques.Methods: Syndesmotic integrity was compared after each technique as per translational and rotational fibular positions. Utilizing, preoperative and postoperative computed tomography scans of injured ankle, the fibular antero-posterior and Medio-lateral translation distances were measured. Additionally, the fibular rotation angle was calibrated. Incidence of inadequate reduction in each group was reported. Preoperative and postoperative radiological findings were compared and correlated to posterior malleolus size in relation to tibial articular distance.Results: A significant difference between both techniques was noted in term of fibular rotation. In patients with PM ˂ 10% of tibial articular surface, a significant difference was obvious in postoperative AP-translational and rotational findings between both techniques. Overall malreduction incidence rate of 68.9% was reported in this study, with 84.7% rate in patients managed with SS-fixation, whilst 51.2% rate in those managed via PM-fixation.Conclusions: Posterior malleolar fixation could limit syndesmotic malreduction risk whatsoever it’s size. Approaching CT reference values for syndesmotic reduction might benefit preoperative planning and detect intraoperative malreduction. Further future clinical studies correlating these findings to clinical outcome would be more helpful.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222704
      Issue No: Vol. 8, No. 6 (2022)
       
  • Correlation between clinical findings and magnetic resonance imaging
           findings in meniscal and anterior cruciate ligament injuries

    • Authors: Sharath Balemane, Jassim Usman, Humam Ahmad, Jithin Jebbar
      Pages: 668 - 673
      Abstract: Background: This study aims to compare the correlation between clinical findings and magnetic resonance imaging with arthroscopic findings in meniscal and anterior cruciate ligament (ACL) injuries.Methods: This was a prospective study of 60 patients with ACL and meniscal injuries of the knee who were admitted between October 2020 and October 2021, who underwent clinical examination, MRI, and arthroscopy of the knee.Results: In our study of 60 cases, there were 44 male and 16 female patients ranging from 18 to 45 years, with the majority of patients between the ages of 25 and 35. The clinical examination had a sensitivity of 88%, specificity of 100%, and accuracy of 90% for ACL, the sensitivity of 80%, specificity of 100%, and accuracy of 90% for medial meniscus, and sensitivity of 50%, specificity of 100%, and accuracy of 83.33% for lateral meniscus. Magnetic resonance imaging (MRI) had a sensitivity of 100%, specificity of 100%, and accuracy of 100% for ACL, the sensitivity of 100%, specificity of 66.67%, and accuracy of 83.33% for medial meniscus, and sensitivity of 100%, specificity of 85%, and accuracy of 90% for lateral meniscus.Conclusions: In conclusion, the current investigation emphasizes the importance of clinical diagnosis, as the positive predictive value (PPV) for all lesions is high. An MRI provides an additional diagnostic tool for ligament and meniscal injuries of the knee. The diagnostic accuracy of all lesions was in the 90th percentile. Because the negative predictive value (NPV) for all lesions is substantial, MRI is utilized to confirm the diagnosis and rule out pathology.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222705
      Issue No: Vol. 8, No. 6 (2022)
       
  • Determine the functional and radiological outcome of T3 proximal femur
           nail in the treatment of intertrochanteric fracture of femur

    • Authors: Manan B. Paneliya, Sunil H. Shetty, Kumar Abhineet Chand, Vidur Sharma
      Pages: 674 - 680
      Abstract: Background: T3 is the new generation nail used for fixation of intertrochanteric fractures. The lag screw is designed to transfer the load of the femoral head into the nail shaft by bridging the fracture line to allow fast and secure fracture healing. The load carrying thread design of the T3 lag screw provides large surface contact to the cancellous bone, this provides high resistance against cut out.Methods: 30 subjects attending the study were operated with T3 proximal femur nail in the treatment of intertrochanteric fracture of femur. Prospective, randomised case-controlled study done over period of 1 year.Results: Significant results were obtained while comparing the mean RUSH score and mean Harris hip score at different postoperative follow-up time intervals with good to excellent outcome and less operative time and low complications rate.Conclusions: T3 is the new generation nail used for fixation of intertrochanteric fractures and is a dependable implant for the fixation. It has good to excellent outcomes and takes less operative time with low complication rates. The anatomical shape of the nail is universal for all indications involving the treatment of intertrochanteric fractures. The load carrying thread design of the T3 lag screw provides large surface contact to the cancellous bone, thus providing high resistance against cut out. The set screw prevents rotation of the lag screw. The T3 has a single screw passing into the neck of the femur and its Set Screw that is passed into the proximal part of the femoral nail sits into the groove of the Lag screw, thus providing rotational stability.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222706
      Issue No: Vol. 8, No. 6 (2022)
       
  • Midterm outcome of proximal fibular osteotomy for medial compartment
           osteoarthritis- a prospective study

    • Authors: Ajeet Singh
      Pages: 681 - 685
      Abstract: Background: Primary osteoarthritis of knee is one of the most common degenerative conditions associated with disability. With more of varus knee medial compartment osteoarthritis is most common and early presentation. High tibial osteotomy (HTO) is technically demanding and associated with major complication like neurovascular injury, iatrogenic fracture, nonunion. Practically HTO is associated with longer bed immobilization and difficult to take bilateral condition.Methods: We treated 38 patients 54 knees with proximal fibular osteotomy for primary medial compartment osteoarthritis excluding other condition like secondary and inflammatory from January 2017 to December 2017. Pre operative assessment of patients done on standing antero-posterior (AP) X-ray and knee injury and osteoarthritis outcome score (KOOS). Post operative assessment done on opening of medial joint line space on standing AP X-ray and KOOS score.Results: Patients treated with PFO, there was change in the weight bearing axis, opening of the medial joint space, improvement in pain, functional outcome assesses with improvement in KOOS score. 8 patients experienced some catchy knee pain and swelling and deterioration of KOOS score.Conclusions: PFO is simple, cost effective and can be surgical treatment option for primary medial compartment Osteoarthritis irrespective of age, though a greater number of patients with longer follow is needed, initial results are very promising in majority of patients and few patients shows deterioration in comparison to initial results but overall patient’s satisfaction index is good.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222707
      Issue No: Vol. 8, No. 6 (2022)
       
  • A comparative study of intertan nail versus proximal femoral nail
           antirotation in the treatment of peritrochanteric fractures

    • Authors: Pranav Kothiyal, Kunal Vij, Puneet Gupta, Shashank Sharma
      Pages: 686 - 693
      Abstract: Background: Over the past decades the incidence of intertrochanteric fractures has increased and there is a universal agreement about the intramedullary nail being the preferred implant of fixation for these fractures.Methods: In this study we have attempted to assess and compare the results and immediate as well as long term outcome of fractures managed by proximal femoral nail anti rotation and the intertan nail. We included 102 patients in our study, half in the group managed by proximal femoral nail anti rotation group and half in the group managed by intertan nail. Over a period of almost one and half years we evaluated the patients in immediate and late post op period for the union of the fracture, functional outcomes and the short- and long-term complications.Results: The results were evaluated in the terms of intraoperative variables like fluoroscopy time, mean blood loss and reduction achieved and postoperatively in terms of superficial wound infections and Harris hip score and mobility score of paper and palmer which were comparable for both groups of patients with slight differences in some variables.Conclusions: We concluded that the intertan nail is a good option for fracture fixation in patients with unstable intertrochanteric fractures and though associated with a steeper learning curve it has lesser complications and slightly better functional outcomes as compared to the proximal femoral nail anti rotation.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222708
      Issue No: Vol. 8, No. 6 (2022)
       
  • New classification of S1 pedicle morphometry impacting pedicle screw
           insertion technique

    • Authors: Atit Tiwari, Sandeep V. Sonone, Nishant P. Jaiswal
      Pages: 694 - 700
      Abstract: Background: The conventional entry point for the S1 pedicle screw insertion has been described as ‘at the base of and lateral to the superior S1 superior facet’. However, many orthopaedic surgeons complain that this technique is extremely demanding and is faced with many challenges in execution. Therefore, alternative entry points and modifications of existing techniques are explored for a greater convenience.Methods: We conducted a survey amongst 136 spine surgeons on the technical difficulties faced during insertion of the S1 pedicle screw. We also classified the S1 pedicles based by measuring their geometric parameters on 100 random computed tomography (CT) images.Results: The S1 pedicle entry technique was considered to be the most difficult and challenging by the orthopaedic surgeons in our survey due to an inadequate medial angulation due to paraspinal muscle mass tension and an overhanging iliac crest. This could be explained by the hourglass shaped pedicle (type 3) with a desired medial angle more 50 degrees (type III) observed as the most common S1 pedicle in the study population. To overcome this limitation, most of them preferred a tri-corticate approach.Conclusions: A more lateral entry point and a longer screw might be considered as solutions for a better and safer S1 pedicle entry. Also, the use of pre-operative CT can be considered to visualize the type of S1 pedicle and hence, decide on the most appropriate technique of screw insertion. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222709
      Issue No: Vol. 8, No. 6 (2022)
       
  • Functional outcome analysis of fixation of distal radius fractures using
           five pin technique

    • Authors: Nilesh S. Sakharkar, Pankaj V. Tathe, Rohit K. Bhurre, Chandan Arora
      Pages: 701 - 705
      Abstract: Background: One of the most frequent injuries seen in orthopaedic practise is a distal radius fracture. They account for 8-15% of all adult bone injuries. Younger and older age groups are both affected by distal radius fractures, which are bimodal in distribution and correspond to high and low energy trauma, respectively.Methods: 25 patients with distal radius fractures who were hospitalised and subsequently underwent five pin fixations as well as those who came to the outpatient department for postoperative follow-up.Results: We evaluated at 25 patients who had distal radius fractures prospectively. The patients' ages ranged from 22 years to 68 years old, with a mean age of 42.8 years among them at the time the fracture was first noticed. Among the patients, there were 18 men (72%) and 7 women (28%).Conclusions: The five-pin technique treats displaced intra and extra articular fractures without significant articular and metaphyseal comminution and is minimally invasive.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222710
      Issue No: Vol. 8, No. 6 (2022)
       
  • Multiple stab incision technique to prevent postoperative acute
           compartment syndrome of leg in proximal and segmental fracture tibia and
           fibula: a prospective study

    • Authors: K. Parthasarathi Naik, Shankarlinga S., Basavaraj S. Kyavater, Prashanthkumar M.
      Pages: 706 - 710
      Abstract: The objective is to study the effectiveness of Multiple stab incision technique in preventing acute compartment syndrome (ACS) in proximal and segmental fractures of both bones (Tibia and fibula) in leg. This study is prospective done at K. S. Hospital Koppal, Karnataka spanning for a period of one year (April 2020 to April 2021). A total of 20 patients of both genders aged 20-60 years were included in the study. Multiple stab incision technique was performed in patients after fixation of Tibia by either closed nailing or MIPPO plating. This procedure was done under spinal anesthesia. Multiple stab incision technique significantly decreased the chances of post-op ACS in proximal and segmental fractures of both bones (tibia and fibula) in leg. Multiple stab incision technique is help full in preventing developing compartment syndrome.  
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222613
      Issue No: Vol. 8, No. 6 (2022)
       
  • The management of complex periprosthetic femoral fractures: a case series
           of plating with wire augmentation, and a review of the literature

    • Authors: Neetin P. Mahajan, Kunal Chaudhari, Ravi Patel, Pramod Bagimani, Akshay Gund
      Pages: 711 - 715
      Abstract: Periprosthetic fractures continue to increase in frequency. This is due, in part, to the increasing number of primary and revision arthroplasties performed annually and to the increasing age and fragility of patients with such implants. All types of periprosthetic fractures can present unique and substantial treatment challenges. Here we present a case series of 3 elderly patients who came to us with periprosthetic hip fractures in previously operated case of hip hemiarthroplasty/total hip replacement done. The injuries were managed with splintage and operative procedures. Postoperatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Periprosthetic fractures are becoming quite common in elderly and difficult to treat as the number of hip joint arthroplasty operative has increased in developing countries. the correct procedure is very challenging as every case needs to be treated very individualistically. A good plan always results in much reduction in the operating time and better patient post operative outcome. Postoperatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. So that early appropriate treatment and mobilization can be done with good functional outcome.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222711
      Issue No: Vol. 8, No. 6 (2022)
       
  • Repair of avulsion flap injury of heel by multiple point anchorage using
           Kirschner wires-a case series

    • Authors: Prateek Jain, Pankaj Tathe, Chandan Arora, Nilesh Sakharkar, Aniket Adewar, Rohan Sarode
      Pages: 716 - 721
      Abstract: The heel pad is a dense band of fibrous tissue with complex anatomy. Injuries to heel pad are uncommon but very challenging due to its precarious blood supply. In this study we tried fixing acute heel pad avulsion injuries using multiple Kirschner wires and results were evaluated according to the American orthopedic foot and ankle society hind foot score. Results were excellent for 3 -out of 9 patients and good for 6 patients according to the AOFAHS scoring system. Anchorage of acute heel pad avulsion injuries using multiple Kirschner wires is an effective and reliable treatment modality.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222712
      Issue No: Vol. 8, No. 6 (2022)
       
  • Vascular injuries associated with total knee arthroplasty

    • Authors: Narayan Hulse, Prashanth Naik, Naveen Dilip, Nagabhushan K. N., Adarsh Krishna K. Bhat
      Pages: 722 - 727
      Abstract: Iatrogenic vascular injuries are rare but potentially devastating complications of total knee arthroplasty (TKA). This retrospective study analyzes vascular injuries associated with total knee arthroplasties in an urban, tertiary level referral hospital between 01 April 2010 to 31 March 2020 consisting of 6548 TKAs. Six patients sustained vascular injuries which included five primary, and one revision TKAs. Three patients were bilateral, and two were unilateral primary TKAs. The mean age-adjusted Charlson’s comorbidity index was two (range 1-3). Only two injuries were recognized intraoperatively. They underwent successful vascular repair. The third patient was diagnosed and underwent a vascular repair on the first postoperative day but experienced a permanent foot drop. Two other patients underwent thrombectomy on the fifth postoperative day; one required above-knee amputation, and the other continued to suffer from vascular claudication and paraesthesia. Another patient developed a pseudoaneurysm, which was identified and repaired five months after the primary TKA. The site of vascular injury was popliteal artery in five and superficial femoral artery in one patient. The mechanism of injury was a direct laceration in three, posterior Hohman's retractor in one, the effect of tourniquet on calcified vessels in one, and unknown in one patient. Early recognition was the only factor that significantly altered the functional outcome and limb salvage. Bilateral simultaneous total knee arthroplasties had no higher risks. A mandatory institutional protocol to recognize the early signs of vascular injuries is necessary for successful vascular repair.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222713
      Issue No: Vol. 8, No. 6 (2022)
       
  • Exploration of radial nerve in patients with humerus shaft fracture with
           radial nerve palsy, is it necessary'

    • Authors: Marouf Aslam, Asif Sultan
      Pages: 728 - 730
      Abstract: Fractures in the distal third of the humerus shaft usually are associated with complete or incomplete radial nerve lesions which may be caused due to traction, entrapment or compression between bony fragments. We managed these patients by bridge plating using minimally invasive percutaneous plate osteosynthesis. A total of 5 patients were operated on and all showed full functional recovery of radial nerve. Fracture united in all cases and no patient developed any complication.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222714
      Issue No: Vol. 8, No. 6 (2022)
       
  • Prospective study of outcome of trimalleolar ankle fractures

    • Authors: Shreekantha K. S., Ankit A. Nyamagond
      Pages: 731 - 735
      Abstract: Trimalleolar fracture are complex and challenging to treat. We conducted a study on 15 patients with trimalleolar fracture. Fractures were classified based on Lauge Hansen classification. They were treated with open reduction and internal fixation (ORIF) with plate and screws for posterior malleolus and lateral malleolus, tension band wire (TBW)/cannulated cancellous (CC) screw for medial malleolus functional and radiological outcomes were assessed by Olerud and Molender score and Kristenson’s criteria respectively. Functional outcome was satisfactory in 93% of cases and radiological outcome in 86%. Early treatment without delay, anatomical reduction of fracture with stable fixation of every fracture component, stringent post operative mobilization should help to improve outcome in operated trimalleolar fracture patients.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222715
      Issue No: Vol. 8, No. 6 (2022)
       
  • Case report of step cut osteotomy for cubitus varus: a superior surgical
           technique

    • Authors: Jeeno Jayan, Hany Hameed, Momin Bin Latheef
      Pages: 736 - 739
      Abstract: Lateral closing wedge osteotomy is a commonly described procedure for correcting cosmetically unacceptable post-traumatic cubitus varus deformity in children. We report a case of 12-year-old boy who underwent step cut osteotomy for cubitus varus deformity. Preoperative measurements of varus deformity followed by planning of osteotomy using a template was done. Intraoperatively the preplanned cuts were made using a posterior approach and then fixation was done using k wire. Patient recovered completely with correction of deformity. Step cut osteotomy has key advantages over traditional closing wedge osteotomy and hence can be used as an alternative surgical technique. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222627
      Issue No: Vol. 8, No. 6 (2022)
       
  • Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited
           radial neck and deformed radial head with insidious onset extension block:
           a case report and results after excision

    • Authors: Chandan Arora, Satyajeet Jagtap, Prateek Jain, Nilesh Sakharkar
      Pages: 740 - 743
      Abstract: Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head.  The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222716
      Issue No: Vol. 8, No. 6 (2022)
       
  • Synovial chondromatosis of knee joint: a case report

    • Authors: Paparao Bezawada, Saipramod Yadlapalli, Hari Chandana Katta
      Pages: 744 - 746
      Abstract: Synovial chondromatosis is a benign condition encountered infrequently within joints which is also known as synovial osteochondromatosis. They present as multiple nodules in the synovium which are either fibrin type or cartilaginous type. The fibrin type usually results from bleeding within the joint, rheumatoid arthritis and tuberculosis. The cartilaginous type is usually due to trauma or osteoarthritis. This typically involves large joints, knee being the most common, rarely small joints also may be involved. Here we report a case of 30-year-old female who presented to us with symptoms of swelling, restriction of movement and pain in the right knee. After clinical and radiological assessment, arthroscopic exploration with loose body removal and synovectomy done, following which patient achieved painless complete range of movements. Histopathological examination confirmed the diagnosis as synovial chondromatosis.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222717
      Issue No: Vol. 8, No. 6 (2022)
       
  • Primary tendon repair in a case of acute traumatic tibialis anterior with
           extensor hallucis longus tendon rupture in a young male-a case report

    • Authors: Ravi Patel, Neetin P. Mahajan, Kunal Chaudhari, Pramod Bagimani, Akshay Gund
      Pages: 747 - 750
      Abstract: Tibialis anterior tendon rupture is a rare entity which can be either traumatic and non-traumatic. It often presents late due to mild clinical symptoms and signs. Acute ruptures are traumatic occurring in young individuals while chronic ruptures are due to degenerative processes occurring in elderly individuals, commonly after 45 years of age. Tibia anterior along with extensor hallucis tendon is an even rarer entity, operative management of which becomes mandatory, more so in a young active individual for better outcome. We have a 31-year-old male patient, who presented to us with an acute post traumatic tibialis anterior tendon rupture of 3 days duration which was diagnosed following an initial clinical examination, an unremarkable X-ray picture, and Ultrasonography confirming the diagnosis. The patient was managed with primary repair of the tibialis anterior tendon along with Extensor hallucis tendon (which was found intra-operatively) with 2-0 ethibond sutures using a cross-linked Bunnell technique. The patient regained full ankle range of motion at 8 weeks post operative period with ankle dorsiflexion and great toe extension back to pre-injury state.As we have seen with this case, early primary repair in a case of acute rupture at tibialis anterior and extensor hallucis longus rupture with non-absorbable suture has significant improved post operative outcome in terms of return of the affected range of motion and can be practice safely in new hands with limited resources as material of suture and technique has not significant effect in post operative outcome. Acute tibialis anterior and extensor hallucis tendon rupture, non absorbable suture, ethibond, cross linked Bunnell technique. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222718
      Issue No: Vol. 8, No. 6 (2022)
       
  • Successful single stage management of trifocal femoral fracture associated
           with distal medial condyle and Hoffa’s component by a novel technique

    • Authors: Kumardev Arvind Rajamanya, Girish Marappa
      Pages: 751 - 756
      Abstract: Isolated fractures of the shaft of the femur are relatively common injuries. Ipsilateral multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures and additional distal femoral fracture occurring in 3-4%. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. These fracture patterns are seen in the young adult population following high velocity trauma such as fall from height and road traffic accidents. The sequence of fracture type to be fixed first and the type of implant to be used are questions yet to be answered as one implant used for fixation of one fracture may not be amenable for fixation of the other fracture. These fractures are associated with significant complications and delayed rehabilitation. We describe a novel method in one such trifocal fracture pattern where the distal femoral intra-articular medial condyle with a hoffas element was stabilised by open reduction with a 4.5 proximal tibial ipsi-lateral anterolateral LCP and 2 inter-fragmentary compression screws which has not been reported in literature before. The advantages of such an implant is easy contour ability to the medial femoral condyle and adequate strength and achieving satisfactory absolute stability with options of using uni-cortical locking screws, all of which facilitates early knee ROM and rehabilitation. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222719
      Issue No: Vol. 8, No. 6 (2022)
       
  • Non-pigmented villonodular synovitis of knee joint in a 11-year-old boy on
           long term steroids: a case report

    • Authors: Shreekantha K. S. Rao, K. Nikil Gowda
      Pages: 757 - 760
      Abstract: Pigmented villonodular synovitis (PVNS) is a rare condition, commonly affecting the knee joint and hip joint. It is seldomly seen in pediatric age group. Aetiology is unknown. Magnetic resonance imaging (MRI) is the imaging modality of choice. Managed by surgical resection of the synovium performed with an open, arthroscopic or combined approach. Post-operative adjuvant external beam radiotherapy have reduced recurrence rate. In this case report we are going to present a rare case of eleven-year-old boy on long term steroid intake, who presented with a history of pain and swelling of right knee joint with restriction of range of movements. MRI suggested extensive villonodular synovitis of knee joint. Diagnostic arthroscopy showed extensive villonodular synovitis of suprapatellar pouch, medial gutter, lateral gutter, intercruciate space, posterior-medial and posterior-lateral compartments and villi had atypical yellow fatty appearance. Extensive arthroscopic synovectomy was done and histopathology showed chronic synovitis. Post-operatively pain and swelling reduced and range of movements improved. Arthroscopic synovectomy is the most effective line of management for villonodular synovitis.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222720
      Issue No: Vol. 8, No. 6 (2022)
       
  • Tension band wiring in a rare case of isolated acromion fracture: a case
           report

    • Authors: Prateek Jain, Vikas Atram, Ayush Mittal, Chandan Arora
      Pages: 761 - 764
      Abstract: Fracture of the acromion process is an uncommon injury. The most common mechanism of injury is direct trauma to the acromion. Isolated acromion fractures are rare as usually they are associated with concomitant skeletal and soft tissue injuries of the shoulder. We present a case of a 45-year-old male with a type 3 fracture of acromion process with reduction of subacromial space. Patient was managed surgically and fracture was fixed using tension band wiring. Patient was followed up using UCLA, DASH and VAS scores and showed good radiological and functional outcomes. Minimally displaced fractures should be regularly followed up for displacement and sub-acromial space compromise. Although acromion fractures are usually treated conservatively, albeit a higher non-union rate, they should be treated surgically in the event of displacement or sub-acromial space reduction, in order to achieve good functional recovery. 
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222721
      Issue No: Vol. 8, No. 6 (2022)
       
  • Osteoarthritis: insights into pathogenesis and futuristic treatment
           strategies

    • Authors: Ajay Singh, Vikramaditya Rai, Sushmita Pandey, Manisha Chavan, Deepthi Ketha
      Pages: 765 - 774
      Abstract: Osteoarthritis is the most common musculoskeletal condition world over that causes significant health, economic, and societal burdens. Till date, no therapeutic approaches have been able to stop or delay the progression of osteoarthritis satisfactorily. Structural and clinical features of the disease are characterized by a high inter-patient variability. This heterogeneity is believed to be a major factor associated with the complexity of osteoarthritis and the on-going difficulty to identify a single therapy for all sub-groups. The objective of this review is to highlight recent advances in the understanding of the pathophysiology of osteoarthritis and latest biological treatments available, their limitations and to bring to notice the latest state-of-the-art on-going research on novel therapies. For this study we searched different online databases such as PubMed and Cochrane Library from inception to January 2022. We identified eligible studies on the pathophysiologic findings, prevalence, or incidence of knee osteoarthritis, available treatments, and current research for future therapies. Besides the availability of vast literature on cartilage extracellular matrix and its changes in osteoarthritis, the complicated mechanism of the disease still has missing links in the chain. Presently, biological treatments such as platelet rich plasma, bone marrow mesenchymal stem cells and autologous fragmented adipose tissue containing structural vascular fraction are commonly used. In future, gene therapy could become a potential option for treating the disease. More extensive insights into the pathophysiology of osteoarthritis will be helpful in designing therapies that can curb structural progression and promote cartilage regeneration thus providing more potent relief from painful and disabling condition associated with osteoarthritis.
      PubDate: 2022-10-27
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20222722
      Issue No: Vol. 8, No. 6 (2022)
       
 
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