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International Journal of Research in Orthopaedics
Number of Followers: 0  Open Access journalISSN (Online) 2455-4510 Published by Medip Academy  [12 journals]
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- On the kinematics of the cross body abduction and hand behind the back
tests to assess osteoarthritis of the acromioclavicular joint
Authors: Bethany R. Arn, Mohamed S. Hefzy, Abdul A. Mustapha, Brian Trease
Pages: 221 - 229
Abstract: Background: Osteoarthritis of the acromioclavicular joint is one of the most common sources of shoulder pain. One of the current standard clinical physical examination tests is the cross body adduction test which has been shown to signal the presence of osteoarthritis. Another test referred to as the hand behind the back test has been described to provide a more accurate diagnosis than the CBA test for some patients. Through this work, both the CBA and the HBB tests were modeled in order to determine if there is merit for the HBB test to be used as a diagnostic tool for clinicians. Methods: Both tests were modeled using the zygote solid 3D 50th percentile male human anatomy model and MSC-ADAMS Software to compile and run the simulations. Within MSC-ADAMS the bones were outfitted with joints. During simulation, the bones were moved from the anatomical position to the final position for each test and the corresponding minimum distances between the bones at the acromioclavicular joint were then determined. Results: It was found that the distance between the acromioclavicular joint articulating surfaces decreased by 0.3 mm from the anatomical position during the CBA test and by 1.65 mm from the anatomical position during the HBB. This shows that the minimum space decreased from the anatomical position by more than 5 folds during the HBB test than during the CBA test. Conclusions: These results indicate that the HBB test may be a better diagnostic test due to the greater stress and irritation it places upon the acromioclavicular joint.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230457
Issue No: Vol. 9, No. 2 (2023)
- Impact of surgical approach and size of femoral head in risk of
dislocation post total hip arthroplasty
Authors: Rupesh Jung Belbase, Kumud Limbu, Anil Kumar Basnet, Pushpak Regmi
Pages: 230 - 237
Abstract: Background: Total hip arthroplasty (THA) is one of the orthopedic procedures that are both economical and routinely successful. THA offers dependable benefits for patients with end-stage degenerative hip osteoarthritis (OA), including pain alleviation, functional recovery, and overall better quality of life. Methods: This was a retrospective study which was conducted on patients who visited the hospital's outpatient department received THA and also received the revisions of THA, were included. The reasons for THA were analyzed and their revisions were studied. The patients were studied according to various approaches based on the hip surgery, such as, straight lateral, anterolateral, posterolateral, and anterior and also based on the sizes divided into three groups 22-28 mm, 32 mm, and 36 mm. Results: The posterolateral approach (n=40) was used for the majority of THAs, followed by the straight lateral (n=35), anterior (n=25), and anterolateral (n=20) approaches. 22.5% of THAs that were done with a posterolateral approach used a 36-mm head. Each reason for different size of heads have been statistically analyzed. During the six-year follow-up, this (unadjusted) risk was 1.15% for femoral heads measuring 22 to 28 mm. THA with 32-mm heads had a considerably decreased risk of revision for dislocation (0.75%), compared to 36-mm heads (0.55%). Conclusions: The study concluded that the patients who received THA at posterolateral approach, experienced dislocations more frequently and also it has been found that the patients using 22 to 28 mm femoral head had more dislocations.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230458
Issue No: Vol. 9, No. 2 (2023)
- A prospective study of functional evaluation of distal radius fracture by
external fixator using the principle of ligamentotaxis
Authors: Pramod Kumar Mahadevaiah, Suhas D., Venkatesh Kadiri, Mohammed Idrees Karamala
Pages: 238 - 244
Abstract: Background: Preservation of the articular congruity is the principal prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 years of documented clinical experience. The main aim of the study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation using the principle of ligamentotaxis. Methods: In a prospective controlled study, 30 cases of distal end radius fractures with intra articular extension were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis. Mean age of the patients was 40.2 years, external fixator was applied for a mean duration of 6 weeks. Results: In this study there were 8 patients with excellent results comprising 27%, 14 patients with good results comprising 47%, 7 patients with fair results comprising 23%, 1 patient with poor results comprising 3%. Conclusions: In a prospective investigation, static external fixators were applied to 30 intra-articular fractures of the distal end of the radius. Fixator was kept up for a total of six weeks. The results were 8 excellent, 14 good, 7 fair, and 1 poor. Only one complication, pin loosening (10%), occurred. This series concludes that ligamentotaxis by external fixation consistently produces a good result in the management of intra-articular distal end of radius fractures in younger age groups (50 years).
PubDate: 2023-02-01
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230285
Issue No: Vol. 9, No. 2 (2023)
- Prospective study of radiological and functional outcomes of humeral
mid-shaft fractures by anterior bridge plating technique
Authors: Joydeep Kumar Dey, Sunil H. Shetty, Shikhar Dalbir Singh, Abhilash Srivastava, Sarang Agrawal, Ravi Rajan Modi, Venkatesh Jyoti, Ojasv Gehlot
Pages: 245 - 249
Abstract: Background: The humerus can be considered the most versatile bone in the human body. Can be successfully approached by a variety of methods for fracture fixation including functional bracing, plating (posterior, lateral, and anterior), and intramedullary nailing (antegrade and retrograde). Notably, many humeral fractures can be successfully managed conservatively due to the wide range of acceptability for reduction. Anterior bridge plating (ABP) which utilizes the minimally invasive approach popularly known as the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique can be said to be the latest entrant in this list. The present study was undertaken to evaluate the efficacy of ABP. Methods: The study was carried out from July 2020 to July 2022 in DR. D. Y. Patil medical college and hospital, Nerul, Navi Mumbai, involving 32 patients who met the selection criteria and were operated at the tertiary care centre. Informed consent was obtained from all the patients for use of their clinical and imaging data. Ethical committee approval was taken. The assessment of the patients was done based on functional and radiological outcomes periodically. Results: Majority of patients belongs to age group 18-25 years (46.87%). Majority of side of injury were found right side (65.62%). In most of the cases, the extent of the displacement of fractures were 2-5 cm (71.87). Conclusions: In conclusion ABP is a very good technique in treating mid-shaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.
PubDate: 2023-01-16
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230022
Issue No: Vol. 9, No. 2 (2023)
- Reliability and assessment of partial or complete anterior cruciate
ligament injuries with diagnostic arthroscopy
Authors: Surya Sri Karun Chintapalli, Praveen Narayan, Pothuri Rishi Ram, Harshavardhan Bhaktharahalli Ramchandran
Pages: 250 - 255
Abstract: Background: Partial tears of anterior cruciate ligament (ACL) were more commonly identified in young group with knee twisting. Partial tears are characterized by tear involvement of less than 50% of the ligament is torn. The arthroscopic evaluation is considered as gold standard in diagnostic evaluation. The comparison of findings between partial and complete tears in magnetic resonance imaging (MRI) and arthroscopy helps in finding out reliability of diagnostic modalities and consider the surgeon to establish the plan of treatment. Methods: 2-year prospective study at the department of orthopedics, RRMCH, Bangalore, India. 40 consecutive patients with suspicion of cruciate injuries of knee were selected for the study from July 2018 to May 2021. The MR imaging of knee in selected cases were performed and the findings were obtained. The descriptive statistical analysis was prepared which includes spectrum of MRI findings in cruciate injuries of knee that were correlated with arthroscopy findings in determining the accuracy. Results: Total 40 patients, we obtained 100% sensitivity and 66.67% specificity, 93.75% accuracy of MRI with arthroscopy in diagnosing complete ACL tears. We obtained 90.91% sensitivity and 80% specificity, 87.50% accuracy of MRI with arthroscopy in diagnosing partial ACL tears. Conclusions: The partial tears can be missed or can be over diagnosed on MRI. These misinterpretations are more likely to happen due to intra-substance signal abnormality. Description of the status of ACL ligament in arthroscopy helped the orthopaedic surgeons in decision making as conservative approach in partial tears and reconstruction in a complete tear.
PubDate: 2023-02-18
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230351
Issue No: Vol. 9, No. 2 (2023)
- A prospective randomized control trial of topical tranexamic acid used in
elderly patients with femoral neck fractures treated with hemiarthroplasty
Authors: Pruthvi K. P., Ramesh Chandra Meena, Mallikarjun K. Rayanad
Pages: 256 - 260
Abstract: Background: Geriatric hip fracture patients frequently suffer femoral neck injuries. The advantage of using TXA topically over the IV route is that maximum concentration of the drug is attained at the wound/surgical site with minimal systemic side effects of drug and also it is easy to administer locally. Aim of current study was fragmented necks of the femur can be treated with Tranexamic acid to reduce postoperative blood loss. Methods: Over the course of 20 months from June 2020 to December 2021, the orthopaedics department at SMS Hospital, Jaipur, conducted this study. A total of 174 patients (87 in each group) of age >60 years, presenting with neck of the femur in orthopaedics wards were enrolled in this study. Results: Compared to the control group, the case group experienced 408 ml more blood loss, which was treated with tranexamic acid. In cases and controls, transfusion was necessary for 31 and 41 patients, respectively. Conclusions: One dosage of topical tranexamic acid may be given to an older patient undergoing bipolar hemiarthroplasty for a fractured femoral neck in order to minimize post-operative blood loss.
PubDate: 2023-02-01
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230286
Issue No: Vol. 9, No. 2 (2023)
- Epidemiological study of thoracolumbar spine fracture patients reported to
tertiary care center of Central India
Authors: Rajesh Kishanrao Ambulgekar, Niranjan Sunil Ghag
Pages: 261 - 266
Abstract: Background: Thoracic and lumbar spine fractures account for 90% of all spine fractures recorded. In low- and middle-income countries, spinal injuries are associated with significant disability and decreased life expectancy. Non-operatively, these injuries can be managed with a thoracolumbar orthosis or hyperextension cast. The operative management with a posterior, anterior or combined approach will offer immediate mobilization and earlier rehabilitation, providing a better environment for restoration of neurological function. Aim of the study was to find out epidemiology of patients with thoracolumbar spine fracture patients. Methods: A cross sectional observational study was conducted in department of orthopaedics at tertiary care, teaching hospital among patients with traumatic thoracolumbar spine fractures. Epidemiological data variables were collected. In statistical analysis data from 60 patient reported was recorded and analysed. Results: Fall from height is the leading mechanism of injury among middle aged people (30-60years) with male predominance, accounting for 58.33 percent of all spinal cord injury cases. The majority (45%) of fractures were of the burst kind, followed by compression (28.3%), and then translation/rotation (21.6%). And the most-rare of all was the distracted type (just 5%). An only 15% of patients had had a complete spinal injury, whereas the remaining 85% had sustained incomplete/ no spinal cord injury. Conclusions: Knowledge about the burden brought on by spinal cord injury makes it clear that preventing such injuries is the backbone of care. preventive measures for high-risk individuals and early definitive response by paramedics can help reducing the load caused by these injuries.
PubDate: 2023-02-14
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230344
Issue No: Vol. 9, No. 2 (2023)
- Middle phalanx base fractures managed with Suzuki frame: a series of 23
patients
Authors: Nawaz Ahmad Bhat, John M., Zubair Ahmad Lone, Tanveer Ahmed Bhat, Abdul Ghani, Mohammed Farooq Butt, Sanjeev Gupta
Pages: 267 - 271
Abstract: Background: Intra-articular fractures of the base of middle phalanx are difficult to manage. With many known methods of treatment available, the authors present their experience of managing these injuries by Suzuki’s pin and rubber traction method. Methods: A prospective study of five years duration which included 23 patients. All the patients were managed with Suzuki’s pin and rubber traction system. The primary outcome variable was ROM at the PIP joint. The secondary outcome variable was the complication profile. Results: The mean ROM at the PIP joint at the final follow-up was 80±12.2 (range: 50-100) degrees. The mean flexion at PIP joint at the final follow-up was 82.72±10.5 degrees and the mean extension at PIP joint was -2.7±4.5 degrees. No case of non-union was observed in the present study. Pin tract infection occurred in 17.39% of cases and was the commonest complication observed. Two patients needed realignment of K-wires for pin displacement. One patient developed osteomyelitis of middle phalanx at three weeks and needed early removal of hardware. The same patient also developed complex regional pain syndrome (CRPS) at two months. One patient developed painful arthritis of PIP joint. Conclusions: Suzuki’s pin and rubber traction method is an effective modality of treatment for intra-articular fractures of the base of proximal phalanx of fingers of hand. Although, not free of complications the final results in most patients are good. However, the authors recommend large randomized control trials to be held for these injuries to compare carious modalities of treatment.
PubDate: 2023-01-16
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230023
Issue No: Vol. 9, No. 2 (2023)
- Comparison of open reduction internal fixation by lateral extensile
approach versus conservative management in sanders type 2 and 3 calcaneum
fractures: a prospective, two-arm, parallel group study
Authors: Pankaj V. Tathe, Rohit Garg, Nilesh S. Sakharkar, Aniket Adewar, Ayush Mithal, Akshay J. Atilkar
Pages: 272 - 277
Abstract: Background: Calcaneum bone is the most common tarsal bone to get fractured. It accounts for 50-60% of all fractured tarsal bones. Calcaneum fractures are always debilitating and are challenging and cumbersome to treat. There is a paucity of Indian studies to assess the comparative treatment outcomes of calcaneal fractures treated by non-operative conservative procedure and open reduction internal fixation by lateral extensile approach. Methods: Adult patients with closed intra-articular calcaneum fractures of Sanders type 2 and 3 were enrolled. Patients managed by cast application (non-operative) or open reduction internal fixation (operative) were separated into two groups. The VAS score for pain, range of motion, radiological angles (Bohler’s and Crucial angle of Gissane) and parameters, functional scores American orthopedic foot and ankle society and Maryland foot score were evaluated sixth month and 1-year post-intervention and compared between the study groups. Descriptive statistics were used for statistical analysis. Results: 29 patients managed with open reduction internal fixation (N=15) or cast application (N=14) were enrolled. The mean age of patients was 39.54±7.81 years, 22 being males and 7 females. Mean VAS score was significantly lower in the plating group at sixth month (4.31+0.69 vs. 5.01+0.66, p<0.05) but not significant at 1 year (1.25+1.09 vs. 1.86+0.77, p<0.05). Range of movements at the ankle and subtalar joints were higher in the operative group. Mean Bohler’s angle was significantly higher and Gissane’s angle lower in the operative group (p<0.05). Significantly higher AOFAS and Maryland scores were noted in the operative group (p<0.05). Subtalar arthritis with malunion was more common in the non-operative group. Conclusions: Operative open reduction and internal fixation methods were found to be significantly better than the conservative management of calcaneus fracture based on clinical, radiological and functional outcomes. Results are most favourable if wound complications are minimized.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230459
Issue No: Vol. 9, No. 2 (2023)
- Novel triple therapy in osteoarthritis of knee joint
Authors: Kalyan K. Hukumathirao, Ashok N. Kotha, Venugopal R. Pondugula, Satya K. Koduru
Pages: 278 - 283
Abstract: Background: Regenerative medicine may be defined as the process of replacing or regenerating human tissues or cells of humans to restore or to get very near to normal function of human life. Biological tissues found in humans such as blood, fat, bone marrow are the main resources of regenerative medicine which help in natural process of healing of soft tissue. Extracorporeal shock wave therapy (ESWT) is a physical modality that helps in enhancing healing process of soft tissues. Osteoarthritis of the knee joint is a gradually progressive degenerative condition with the loss of articular cartilage. The early stages of disease are managed conservatively with the aim of retarding the rate of cartilage destruction. Methods: A total of 80 patients underwent the novel triple therapy. The objective is to find out the potential of combination therapy in early degenerative disease of knee with the aim of reduction of inflammation. A protocol was developed which involved three injections of platelet rich plasma (PRP), six sessions of combined ESWT and physiotherapy. Results: Evaluation was mainly based on WOMAC/KSS/VAS scores. Patients in stage 1 and 2 (55+15=70) had excellent results for 36 months, patients in stage 3 (10 cases) had satisfactory outcome at 24 months. Conclusions: Triple therapy is an alternative treatment or in few cases a definitive treatment in degenerative disease of knee joint where medical and surgical management has minimal or no role. Triple therapy in mild to moderate osteoarthritis of knee joint has better outcome.
PubDate: 2023-01-20
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230040
Issue No: Vol. 9, No. 2 (2023)
- A comparative analysis of pain reduction following a single
intra-articular injection of platelet-rich plasma, steroid or normal
saline in chronic external shoulder impingement syndrome
Authors: Mohit R. Shete, Sanjay V. Popere, Rushan Khan, Abhay P. Kulkarni, James John
Pages: 284 - 288
Abstract: Background: Shoulder impingement is a common diagnosis for patients with pain and dysfunction of shoulder joint. Due to its chronicity of clinical manifestation of the impingement syndrome, there is a need to find new therapies that collaborate to improve pain management. Methods: A hospital based descriptive, epidemiological study was conducted with 150 patients. The patients were divided in the following three groups of 50 patients each: Platelet-rich plasma (PRP) group: 50 patients received PRP, steroid group: 50 patients received steroid injection normal saline group: 50 patients received normal saline injection. Baseline visual analogue scale (VAS) score on overhead activities were recorded. After the 4th week, 12th week, and 24th week, patients were examined in the outpatient clinic. The main outcome measure was pain with overhead activities using a VAS. Results: The VAS score improved significantly in PRP group and Steroid group compared to normal saline group at the 4th week, 12th-week and 24th-week follow-up periods post injection, as per ANOVA test (p<0.05). Conclusions: PRP and steroids, both can be considered effective methods to treat pain in chronic shoulder impingement syndrome (SIS) and less invasive compared to surgical treatment. They improve the pain and hence shoulder function in chronic impingement syndrome.
PubDate: 2023-01-16
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230024
Issue No: Vol. 9, No. 2 (2023)
- Short and midterm functional and radiological outcomes of revision total
hip arthroplasty with uncemented extensively porous coated monoblock
cylindrical femoral stems
Authors: Kashyap L. Zala
Pages: 289 - 292
Abstract: Background: This retrospective cohort study examines clinical and radiological outcomes of revision total hip arthroplasty (THA) using uncemented extensively porous coated mono block femoral stems. Methods: Patients who were operated for revision THA at medical college Baroda, between January 2008 to December 2018, and who had at least 36 months follow up were included in the study. Details were retrieved from hospital records. Harris hip score (HHS) was used for functional outcome and Paprosky classification was used for femoral bone defects. Results: Mean age of patients was 60.1 year (range 35-86 years), mean follow up was 84 months (range 40-126 months), Paprosky type 1 defect was found in 4 hips, type 2 was found in 20 hips and type 3a defect was found in 21 hips. Mean HHS improved from pre-operative 30 to post-operative 78 (p=0.0104). Expected survival at 5 and 10 years was more than 95%. No stem was loose at the end of follow up. Thigh pain and proximal osteolysis were most common complications. Conclusions: Extensively porous coated cylindrical stems give good functional and radiological outcomes at short and midterm follow up.
PubDate: 2023-01-16
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230025
Issue No: Vol. 9, No. 2 (2023)
- Outcome of treatment of Gartland type lll supracondylar humerus fractures
in children by closed reduction and percutaneous pinning vs. open
reduction and internal fixation by K-wires
Authors: Vishal Prakash, Neelu Singh, Vinay Prabhat
Pages: 293 - 299
Abstract: Background: Extension fractures are more common than flexion fractures, and were classified into three subgroups by Gartland: type I, with no displacement; type II, with moderate displacement and intact posterior cortex and type III, with complete displacement. According to many authors, the ideal treatment for type 3 supracondylar humerus fractures is closed reduction and percutaneous pinning. Methods: This study was conducted in the department of orthopaedics, Rajendra institute of medical sciences, Ranchi during the period from December 2020 to December 2022. Both male and female patients were included in the study. Implant used are K wires of various diameter ranging from 1.5 to 2 mm. Results: The results with CRPCP are better than ORIF method as far as range of motion of elbow is concerned. Baumann angle were also comparable in both the groups. Conclusions: In our study, in the ORIF group, the ROM of the elbow treated improved with time. There was improvement in the range of motion at the 6-months follow-up as compared to the 3-months follow-up.
PubDate: 2023-02-03
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230291
Issue No: Vol. 9, No. 2 (2023)
- Functional outcome of proximal tibia intra-articular fractures after open
reduction and internal fixation
Authors: Nagesh Akhade, Ranjit Chopade, Pranav Shere, Pratik Shahare
Pages: 300 - 303
Abstract: Background: Tibial plateau fractures are common fractures which constitute approximately 1% of all fractures. These involves the particular area of tibia and difficult to manage. These fractures require absolute stable fixation to improve the function and to prevent the post traumatic arthritis. We aim assess the functional outcome of patients in proximal tibia fractures treated with ORIF. Methods: Patients assessed at OPD visits with knee injury and Osteoarthritis score (KOOS) and Westerna Ontario and Mc-master university OA index (WOMAC). With informed consent patients are assessed one year after fixation of fractures and data recorded in case record forms. Results: Out of 74 patients studied, majority belonged to age group 21 to 40 years old (44 cases, 59.45%); followed by 21 cases (36.48%) from age group 41-60 years old. 7 patients (9.45%) were found in age groups 61 to 80 years old. Mean KOOS scores shows FAIR outcome in type I, type II, type III and type IV Schatzkers. While poor outcome was found in type V and type V and type VI. High energy trauma is associated with poor functional outcome as compared to low energy trauma. Mean WOMAC scores are found good in type I, type II fractures while fair outcome found in type III and type IV, poor outcome observed in type V and type VI Schatzkers type. Conclusions: As per this study we concluded that fractures treated with ORIF showed good functional outcome. ORIF with buttress plate gives good to fair results.
PubDate: 2023-02-03
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230292
Issue No: Vol. 9, No. 2 (2023)
- Assessment of myofascial pain syndrome among married female healthcare
workers: a cross sectional comparative study in a tertiary care centre
Authors: James C. George, Subin Babu, Deny Mathew, Rejul K. Raj, Henry Z. Kurian, Koshy Abraham, Kevin Joseph, Rahul George Eapen, George Saju
Pages: 304 - 309
Abstract: Background: Myofascial pain syndrome (MPS) is common among females between ages 20-40 years. Psychosomatic and mechanical reasons are attributed as causative factors. Female health care workers (FHW) in hospitals with rapid patient turn over are vulnerable to develop MPS. Our aim was to ascertain the prevalence of MPS in married FHW working in various departments of the hospital and its association with poor sleep and work stress. Methods: We selected married FHWs in 20-50 years age group and divided them into two groups, medical and paramedical (those involved directly and indirectly with patient care respectively). MPS was diagnosed after detailed personal interview and clinical examination. Sleep duration was divided into less than 5 hours and more than 5hours. Presence of work-related stress and other medical parameters were also recorded. Results: A total of 150 medical and 150 paramedical FHWs were included in the study. Overall prevalence of MPS among FHWs was 42%, of which, medical group was 32% and paramedical was 52%. The paramedical group showed significantly higher prevalence of MPS (p: 0.02). Sleep was less than 5 hours in 29.3% of medical FHW and 13.3% of paramedical. This difference didn’t show any association to MPS (p=0.8). 38% FHW perceived excessive work stress, 40% were paramedical and 36% were medical. This didn’t correlate with prevalence of MPS (p=0.2) among them. Conclusions: Paramedical FHW experienced more MPS than medical and it was more of mechanical type and not due to work stress or sleep deprivation.
PubDate: 2023-02-07
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230318
Issue No: Vol. 9, No. 2 (2023)
- Relationship of incidence of anterior cruciate ligament injuries and
body-built Index somatotype in Indian population
Authors: Sandeep Deore, Sachin Kale, Ajit Chalak, Vanashree Nalawade, Suraj S. Doshi
Pages: 310 - 316
Abstract: Background: Incidence of ACL injuries and physical parameters like age, sex, height, weight and BMI has been studied intensely as a risk factor. Each of them poses as a different risk factor for occurrence of ACL injuries. But body-built index-somatotype considers relative proportions of fatness, muscle mass and skeletal architecture in terms of endomorphy, mesomorphy and ectomorphy in a single individual which neutralises variables like age, sex, BMI. Methods: 100 patients were included in the study, excluding those with multiligament injuries, associated fractures around knee, mucoid degeneration of ACL and road traffic accident cases. Parameters such as skin fold thickness, circumference and epicondylar, condylar width was taken into consideration. Body built index was calculated in terms of endomorphy, mesomorphy and ectomorphy using the heath-carter anthropometric somatotype manual. Results: We found that amongst all those have ACL injury, endomorphy was higher grade (5.49), followed by mesomorphy (4.75). Lesser grades of ectomorphs i.e., slender people were having ACL injuries. Though there was low margin of grading between the two, endomorphy was higher in ACL injured people followed by mesomorphy. Conclusions: Endomorphs and mesomorphs have higher tendancy of ACL injury. Ectomorphs have lesser incidence of ACL injury.
PubDate: 2023-02-09
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230329
Issue No: Vol. 9, No. 2 (2023)
- Total hip arthroplasty in ankylosing spondylitis in a tertiary care
hospital: a prospective COHORT study
Authors: Pervez Ahsan, Israt Jahan, Abul Khair
Pages: 317 - 322
Abstract: Background: Ankylosing spondylitis is a chronic inflammatory-type arthritis that forms part of the group of spondyloarthritides. It primarily affects the spine and pelvis but peripheral arthritis and enthesitis are also common features. Onset of AS often occurs at a relatively young age and that is accepted as a greater risk of hip involvement. THA in AS patients is a challenging procedure owing to multiple factors. The aim of this study was to evaluate the clinical, radiological & functional outcomes of total hip arthroplasty among patients with Ankylosing Spondylitis. Methods: This was a prospective cohort study and was conducted in the Department of Orthopaedic Surgery of Ibn Sina Medical College Hospital, Dhaka, Bangladesh during the period from June, 2021 to May, 2022. In this study we included fifty patients with ankylosing spondylitis who underwent total hip arthroplasty. Result: In our study we found the highest prevalence (36%) was present in aged between 31-40 years old. The mean±SD of age among patients was (37±12). We found the mean±SD of Harris hip score was 44.2±12.3 & 87.2±17.4 during preoperative & postoperative phase respectively. Conclusions: In our study, we found that total hip arthroplasty is a safe and effective treatment of advanced hip involvement in patients with AS. It results in significant improvements in objective outcome measures such as HHS, patient mobility & reduced the difficulty level of patients in their day-to-day activities.
PubDate: 2023-02-03
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230293
Issue No: Vol. 9, No. 2 (2023)
- A descriptive longitudinal study of functional outcome in intra-articular
distal end radius fracture with volar displacement treated by locking
compression plate
Authors: Nanasaheb D. Bhosale, Deepak Naikwade
Pages: 323 - 328
Abstract: Background: The distal radius metaphysis is composed mainly of cancellous bone. On articular surface there is a biconcave articulating surface with the proximally placed carpal row (scaphoid and lunate fossae) and also a notch for articulation with the ulna. Objective of the research was to study the functional outcome in distal end radius fracture with volar displacement treated by locking compression plate. Methods: A hospital based descriptive, longitudinal study was conducted with 114 patients aged between 20-60 years to assess functional outcome in patients of distal end radius fracture with volar displacement treated by locking compression plate. Results: According to demerit point score system of Gartland and Werley, 75 (69.4%) patients had excellent score while 24 (17.5%) and 15 (13.1%) patients had good and fair score respectively. No patient had poor score. 6 (5.3%) and 2 (1.8%) patients had superficial infection and hypertrophic scar respectively while 1 (0.9%) patient had developed malunion. Conclusions: Volar plating has excellent functional outcome with minimal complications thus proving that it is the prime modality of treatment for distal radius fractures.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230460
Issue No: Vol. 9, No. 2 (2023)
- Comparative study of vacuum-assisted closure therapy versus
vacuum-assisted closure therapy supplemented with vitamin C in compound
wound healing
Authors: Sachin Kale, Raju Patil, Joydeep Kumar Dey, Manan B. Paneliya, Suraj Doshi, Ravi Rajan Modi
Pages: 329 - 333
Abstract: Background: It is imperative for early and precise management of the compound wound for preventing further complication and delaying definitive management. As we all know superiority of vacuum assisted closure (VAC) therapy in wound management over any other method, but adding vitamin C has been shown to accelerate wound healing, reducing hospital stay, and cost of management and prevention of delaying definitive management of wound due to some conspicuous property of vitamin C that serve as superior adjuvant in wound healing. Methods: A case series of 40 patients who have been inflicted with compound wounds with most following road traffic accidents. We then categorised patients and tried to observe any difference in rate of satisfactorily healing of wound with 20 patients put on VAC therapy alone and other 20 patients put on VAC therapy supplemented with vit C. Results: Patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced the amount of vacuum dressing sittings. Conclusions: It was observed that, in general, patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced amount of vacuum dressing sittings, improved rate of granulation tissue, reduced hospital stay, early definitive fixation of associated fracture and skin grafting and showed superior outcomes in terms of better tissue recovery.
PubDate: 2023-01-07
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230004
Issue No: Vol. 9, No. 2 (2023)
- A study on greater trochanter reconstruction in unstable inter
trochanteric fracture of femur
Authors: Sudhir Sharan, Kartik P. N., Shivsagar Jadhav
Pages: 334 - 339
Abstract: Background: A study on greater trochanter reconstruction in unstable intertrochanteric femur fracture. Methods: The 2019 to 2022, Patients were randomly divided into two groups with the help of computer-generated coded envelopes; Group A (unstable intertrochanteric femur fracture patients treated by hemi-arthroplasty or PFN with greater trochanter reconstruction) and Group B (unstable intertrochanteric femur fracture Patients Treated by hemi-arthroplasty or PFN with no greater trochanter reconstruction) with 20 patients in each group Outcomes were evaluated based on Harris hip score calculated at 2 weeks 6 weeks 3 months and 6 months. Results: Most common surgery in study groups performed were PFN, on radiology as non-union and union, most common study participants show union, on follow up at 2,6 weeks,3 months and 6 months Harris hip score was calculated and it was found to be statistically significant suggestive of improved quality of life, on radiological evaluation all cases shows non-displacement of GT position but in follow-ups at 6 weeks, 3 months and 6 months one case each reported displaced implant. Conclusions: The result of our study shows that there is improved quality of life and significant improvement in Harris hip score after reconstruction of greater trochanter in unstable intertrochanteric femur fracture.
PubDate: 2023-02-18
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230352
Issue No: Vol. 9, No. 2 (2023)
- Comparative study between choices of preoperative and post operative dress
wear among orthopedics patients
Authors: Gunjan Upadhyay, Ashok Kumar, Vikas Rao, Saurav Brar
Pages: 340 - 344
Abstract: Background: Clothes are identity of an individual. A monk, a priest, a doctor, a lawyer etc. all can be identified by clothing. But can we identify preoperative and postoperative orthopedics patient simply by difference in clothing' Can we evaluate the reasons for this difference in clothing mainly due to hide surgical scar or may be due to comfort fit or may be due to compensation of gait abnormalities etc. Methods: The study was conducted at Maharaja Agrasen medical college, India with a population of 1000 OPD and indoor patient for a period of 6 months from January 2022 to June 2022, with data collection and compilation for another 3 months. Our study is an observational retrospective study which discovers where pre trauma preference is for skin tight clothing like jeans, t shirt for men and skirt for girls, post trauma post operative preference shifts to loose and formal clothes like full sleeves shirt, formal pant, pajama, lungi, dhoti for men and full length skirt for girl and saree for women. Results: Causes enlisted for such clothing was hiding surgical scar (80%), comfortable fitting (10%), to hide gait abnormalities (7%), limb length discrepancies (2%), miscellaneous (1%). Conclusions: We claim to be first in literature to have thought and research on this wonderful topic. We claim to devise new system of surgical and non-surgical wear in post operative patients with our research. We also bring out reason for such difference in clothing and work closely with our in-house patient for preference in clothing.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230461
Issue No: Vol. 9, No. 2 (2023)
- Comparative study of functional outcome of distal one-third shaft tibia
fractures treated with tip locking tibia nailing versus precontoured
anatomical locking plate
Authors: Siddharth H. Daruwala, P. N. Kulkarni, Nikhil Deokar, Vibhu Pratap Singh
Pages: 345 - 351
Abstract: Background: The distal 1/3rd shaft tibia extra-articular fractures are treated with both tip locking intra-medullary nailing (TLIMN) and precontoured anatomical locking plates (PCALP). The aim of this study was to compare the results of TLIMN and PCALP in distal tibia fractures and to determine dominant strategies. The complications and functional outcome in both groups were compared. Methods: Forty patients with distal 1/3rd shaft tibia were randomly assigned to TLIMN (group 1) and PCALP group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared. Results: The average union time was 15.05±3.33 weeks in group 1 and 13.4±2.46 weeks in group 2 (p=0.045). The mean AOFAS score at 1 year follow up was 89.8±6.13 in group 1 and 89.1±6.15 in group 2 (p=0.262). Five patients in group 1 and one in group 2 had mal-alignment. Deep infection was present in one and superficial infection was present in two cases in group 2. Four patients in group 1 developed anterior knee pain and five patients in group 2 had hardware prominence. Conclusions: We conclude that tip locking intra-medullary nail is a reliable and satisfactory method for treatment of fractures of distal 1/3rd shaft tibia AO type 42A, 42B and 42C fractures with good functional outcomes and high union rates with comparatively low complications. Prevalence of malunion was higher in TLIMN group and hardware prominence was more prevalent in PCALP group. Implant removal are more in PCALP group mostly due to implant irritation.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230462
Issue No: Vol. 9, No. 2 (2023)
- Clinical and MRI profile of patients with knee injuries and correlation of
MRI with arthroscopic findings
Authors: Janani Moorthy, Prabhu Radhan, Vasantha Kumar, Vinoth Thangam, Balasubramanyam Gadiraju
Pages: 352 - 356
Abstract: Background: MRI is radiation free modality and has ability to understand the soft tissue, anatomy and musculoskeletal system pathologies. MRI has the advantage of demonstrating the cartilages, bones, soft tissue in detail. Objectives of current study were evaluation of ligaments and meniscal injuries using magnetic resonance imaging, to study the pattern and spectrum of knee injuries in relation to mechanism of injury and to correlate MRI findings with that of arthroscopic findings. Methods: All the MRI studies were done using a 1.5T MRI scanner (Siemens Magnetom) in our department, department of radiodiagnosis, ACS medical college, Chennai. Patient taken up for arthroscopy and the arthroscopic findings were collected. The data of MRI collected was compared with arthroscopy findings. Results: On correlation of the overall findings the sensitivity of MRI versus arthroscopy was 90.62% Specificity was 84.55% positive predictive value was 92.06%, negative predictive value was 80.00% Between them with a kappa 0.059 Conclusions: MRI of knee is considered efficacious especially in the setting of indeterminate clinical finding and can stratify patients, thereby increasing the diagnostic confidence of the clinicians leading to appropriate surgical planning and management.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230463
Issue No: Vol. 9, No. 2 (2023)
- Clinical and epidemiological profile of the patients with anterior
cruciate ligament tear attending a tertiary care hospital at Srinagar
Authors: Mohamad Azhar Gilani, Naseer Ahmad Mir, Aadil Hussain Lone
Pages: 357 - 361
Abstract: Background: Anterior cruciate ligament (ACL) is the most frequently injured knee ligament especially as regards sports that include movements with sudden direction changes as knee supports body weight during them. The ACL is crucial in stabilizing the knee joint. The objective of the study was to describe the general and clinical profile of the patients having ACL tear. Methods: This was a hospital based cross-sectional observational study. It was conducted on patients with ACL tear presenting to the department of orthopaedics SKIMS medical college and hospital Bemina from-December 2019 to June 2021. Information was obtained about the general characteristics and clinical profile of the patients. Knee stability was assessed by stability tests, Lysholm knee scoring and international knee documentation committee (IKDC) scale. Results: Of the 40 patients, 50% belonged to the age-group of 31-50 years, 90% were males and 57.5% (n=23) were from rural areas. Sports injury was most common 35%. Giving way was the most common presenting symptom (100%) followed by locking (57.5%). Maximum patients 25(62.5%) had a score of 2 for manual Lachman grading, anterior drawer test 28 (70%) and Pivot shift grading 21(52.5%) whereas for Tegner activity level 23 (57.5%) had a score of 3. The mean Lysholm knee scoring was 64.65±6.82 and the mean IKDC scoring was 51.88±6.70. Conclusions: ACL injury is mostly found in young people with active lifestyle. Sports related activities and road traffic accidents are the most common cause of ACL injury. Giving way and locking of the knee are the most common symptoms.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230464
Issue No: Vol. 9, No. 2 (2023)
- Assessment patient satisfaction after total hip replacement in Indian
population
Authors: Mohan M. Desai, Ranjit Indrajeet Chopade, Pratik Shahare, Pranav Shere
Pages: 362 - 366
Abstract: Background: We aim to assess the satisfaction of patients after total hip replacement in Indian population. Nоwаdаys tоtаl hiр аrthrорlаsty is the finаl treаtment орtiоn рrоvided tо раtients with unsаlvаgeаble, severely аrthritiс, раinful аnd defоrmed hiрs. Раtient sаtisfасtiоn hаs been meаsured in multiрle оrthораediс рrосedures, inсluding tоtаl hiр аrthrорlаsty. THА is а соmmоn surgiсаl рrосedure thаt imрrоves the lives оf раtients with end-stаge аrthritis by deсreаsing раin, аnd imрrоving mоtоr function and mоbility аs measured by vаlidаted heаlth-relаted оutсоme tооls. Methods: Patients were assessed at OPD visit or with telephonic conversation scores are calculated and mentioned in excel sheet. Post-surgery satisfaction score is the score created to measure the satisfaction after total hip replacement. This score contains different questionnaires. These questions include inquiry about relieve of pain, ability to do daily routine activities, requirement of walking aids etc. Score contains total 7 questions with answers. Results: Out of 95 patients we found through this study that about 92.63% of patients are satisfied after total hip replacement. 7.37% of patients are dissatisfied. Satisfaction rate is more as compared to dissatisfaction rate. Conclusions: In present study we have tried to eliminate other factors responsible for dissatisfaction such as hospital ward cleanliness, hospital administration, patient and hospital staff communication. We recommend total hip replacement surgery for end stage arthritis and is more beneficial to the patients in terms of improvement in post-operative pain and function.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230465
Issue No: Vol. 9, No. 2 (2023)
- Correlation of magnetic resonance imaging findings and arthroscopy
findings in diagnosis of intra articular ligament injuries of knee joint
Authors: Surya Sri Karun Chintapalli, Pavith Janardhan Thekkada
Pages: 367 - 371
Abstract: Background: The knee is the largest synovial joint in body with extra and intra articular ligaments which act as supporting structures around the joint. The intra articular ligaments of knee are more commonly injured. An accurate and early diagnosis of the internal derangement of knee is necessary for planning the treatment. In this study we compare the findings of magnetic resonance imaging (MRI) with arthroscopy and evaluate the accuracy of MRI in diagnosing intra-ligament injuries of knee. Methods: It is a prospective study conducted in the department of orthopaedics, Raja Rajeswari medical college and hospital, Bangalore from July 2018 to May 2021. Selection criteria include 80 patients who presented with history of ligamentous injury to the knee. The MRI was obtained and selected cases were posted for arthroscopic surgery after obtaining the informed consent. The MRI findings and Arthroscopy findings were correlated and statistical data analysis is prepared to obtain accuracy of MRI. Results: In this study 80 patients were selected and data was prepared. ACL tear presented with 100% sensitivity and 95% accuracy, PCL injuries shows 100% sensitivity and 97% accuracy, medial meniscus tears presented with sensitivity 96.15% and accuracy 95%, lateral meniscus tears presented with sensitivity 95.83% and accuracy 97.50% of MRI. Conclusions: In our study the MRI has more capable in detecting anterior horn tears, multiple tears and underneath tears that may be overlooked in arthroscopy. However, appropriate sequences, analysed in different planes, newer techniques, powerful tomograms will improve the diagnostic accuracy and reduce errors.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230466
Issue No: Vol. 9, No. 2 (2023)
- Intraarticular use of tranexamic acid during primary total knee
arthroplasty
Authors: Prathap Urumkar Surendrakumar, Syed Abdul Hadi, Girish Marappa
Pages: 372 - 376
Abstract: Background: Tranexamic acid (TXA) is effective in reduction of blood loss after major surgical procedures. In TKA surgeries, it is commonly administered intravenously. Since there are contraindications of systemic use of TXA, local/intraarticular TXA can also be used. The efficacy of both systemic and local TXA administration is demonstrated in the literature. The aim was to assess the effect of intraarticular TXA during total knee arthroplasty in terms of total blood loss and transfusion rate. Methods: A total of 50 TKA in 34 patients were included in this prospective study. Patients received one dose of intraarticular TXA of 3 g after skin closure and before deflation of the tourniquet. Results: The mean total blood loss in intra-articular TXA was 456.9 ml. None of the patients required transfusion postoperatively including those who underwent bilateral staged TKR. Mean postoperative hemoglobin loss was 1.07. Conclusions: TXA reduced blood loss and transfusion requirement. Intra-articular administration of TXA seems to be more effective in terms of reducing total blood loss and transfusion rates. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230467
Issue No: Vol. 9, No. 2 (2023)
- Comparison of orthogonal versus parallel double plating technique in
patients type C distal humeral fractures: a randomised control trial
Authors: Rohan Sarode, Sajal R. Mitra, Saurabh Sah, Nilesh S. Sakharkar, Aniket Adewar
Pages: 377 - 383
Abstract: Background: Distal humerus fracture accounts approximately 2%-6% of all fractures and 30% of all elbow fractures, intra articular distal humerus fracture are rare accounting 0.5% of all fractures. These fractures had bimodal distribution, with respect to age and gender, with peaks of incidence in males aged 12 to 19 years and females aged 80 years and over. Methods: Patients were randomly divided into two groups, one undergoing perpendicular plating with 17 patients and the other parallel plating with 17 patients. Patients were followed up minimally for 12 months. Results: We observed that time of union for parallel plating method was 12.82 weeks and 12 weeks in orthogonal plating. In our study functional outcome based upon Mayo elbow performance score, in group 1 (Parallel plating) was excellent in 7 patients (41.17%), good in 6 patients (35.29%), fair in 4 patients (23.52%). Conclusions: In terms of arc of motion and stability a good to excellent functional outcome was achieved in >85% of the study group. In cases of osteoporotic and comminuted bones, a rigid construct must be achieved.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230468
Issue No: Vol. 9, No. 2 (2023)
- Necessity of fixation of fibula in distal tibia fractures
Authors: Aashay Sonkusale, Satyajeet Jagtap, Hanuman Khedekar, Pranav Keswani
Pages: 384 - 389
Abstract: Background: Distal tibia fractures and concomitant fibula fracture associated with soft tissue injury present as common orthopedic problems. This study evaluates the need to fix fibula fractures which are associated with closed distal third tibia fractures. Methods: An interventional observational study was undertaken to analyse the efficacy of fixation of fibula, in a Tertiary care hospital with a sample size of 78 patients which were divided into 2 groups of 39 patients each- one in which fibula was fixed (A)-with nail (A1); with plate (A2) and one in which fibula was not fixed (B). Cases were followed up for a mean period of six months post-operatively. Results: The comparison of functional outcome among both groups showed that combined group A (A1+A2) had 4 (10.25%) excellent functional outcome as compared to 1 in group B (2.56%). Group A shows better functional outcome as compared to group B with significant statistical difference. The mean duration of bone union in Group A1 was 21.26±1.43 weeks, A2 was 21.08±1.38 weeks and in group B was 23.60±2.47 weeks showing a statistically significant difference. Conclusions: Fixation of fibula proved to facilitate ease of reduction of tibia and better rotational and angular stability with a superior ankle range of motion. The method of fixation of fibula did not seem to impact the outcome as long as the alignment, length, rotation were not compromised. Wound complications are not uncommon with precarious skin around the ankle, and should be managed appropriately.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230469
Issue No: Vol. 9, No. 2 (2023)
- A prospective study of the functional outcome of 3 stitch technique in a
compound humerus shaft fracture
Authors: Sachin Kale, Raju Patil, Suraj S. Doshi, Joydeep Kumar Dey, Shashwat Anand, Ravi Rajan Modi, Sonali Das
Pages: 390 - 395
Abstract: Background: Intramedullary nailing of compound shaft humerus fractures has been an innovative and surgically friendly technique to deal with extensive soft tissue injury that impedes open reduction and internal fixation. The purpose of this article is to highlight the minimally invasive technique of intramedullary humerus nailing to prevent the perioperative and postoperative complications encountered. A 1 year follow up of all the patients have shown functionally excellent results and good surgical outcome. Methods: We have conducted this prospective study from Jan 2020 to Jan 2022 at DR. D.Y. Patil medical college and hospital. Informed consent from each patient was taken explaining the methods of study and probable complications. By this 3-stitch technique we have treated 25 adult patients sustaining post traumatic compound humerus shaft fractures by Antegrade humerus nailing. We have included compound injury upto type 3A (Gustilo-Anderson classification). Results: Out of the 25 patients, 23 patients showed functionally excellent outcomes with good compliance to rehabilitation protocol but 2 patients had delayed wound healing of which 1 patient had undergone VAC therapy, which later healed well after a period of 2-3 weeks with sequential dry dressings. None have gone into nonunion. Conclusions: Our study suggests that the 3-stitch technique is a good alternative method compared to external fixators and other various surgical techniques and yields good results with lesser complications and better cosmetic outcomes in compound injuries.
PubDate: 2023-02-03
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230290
Issue No: Vol. 9, No. 2 (2023)
- Prospective study comparing between plate osteosynthesis and antegrade
interlocking nailing its functional and radiological outcome in treating
humeral shaft fractures
Authors: Harshavardhan Bhaktharahalli Ramachandra, Praveen Narayan, Surya Sri Karun Chintapalli, Pothuri Rishi Ram
Pages: 396 - 404
Abstract: Humeral shaft fractures are common injuries making upto 1-3% of all fractures. They are widely treated by conservative methods leading to higher rates of non-union. Henceforth surgeons tend to perform operative procedures to treat them. To statistically analyse and compare the functional and radiological outcome of two treatment modalities of humeral shaft fractures, they are plate osteosyntheis and antegrade intramedullary nailing. A total of 22 patients of humeral shaft fractures were operated by either of two methods 12 in plating (P) group ,10 in nailing (N) group and their radiological outcome was assessed by rate of union, time taken for callus formation etc and their Functional outcome was analysed based on Rodriguez Merchan criteria. The commonest age group of patients operated is 21-40 years (70%) majority being males (70%) and road traffic accident being commonest mode of injury. The plate osteosynthesis group stands superior than nailing group in terms of duration of union (20 weeks), rate, percentage of union (100%), least risk of non-union (0). Statistically significant (p<0.05) improvement in shoulder joint function with minimal complications. The plate osteosynthesis method is the most promising surgical procedure for treating humeral shaft fracture due to negligible rates of non-union and early recovery of motion. Though nailing group has minimal need of soft tissue dissection, preserves fracture biology, decreased operative time and early rehabilitation period it still stands inferior when it comes to complications like rotator cuff injury, shoulder impingement pain and restriction of shoulder movements. Ultimately the post operative quality of life is equally good in both techniques.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230470
Issue No: Vol. 9, No. 2 (2023)
- Modified Weaver-Dunn procedure, a novel approach to type-3
acromioclavicular joint dislocation
Authors: Veer Abhishek Goud, Venu G., Surya Prakash P.
Pages: 405 - 411
Abstract: Even though a generally accepted opinion is present about conservative management for type 1 and type 2 acromioclavicular dislocation and surgical management for type 4 to type 6 dislocations, different opinions come under play for conservative versus surgical management in cases with acute type 3 acromioclavicular joint dislocation. We came across 20 cases of type 3 AC joint dislocation with a varied age profile (range 18 to 50 years, mean 34.4±6.5 years). Patients usually complain of pain and swelling and difficulty in moving shoulder joint. The diagnosis can be confirmed by radiographs which shows widening of AC joint >2-4 mm and coracoclavicular distance >5 mm and superior displacement of distal clavicle. In our series, we have treated them with modified Weaver Dunn technique. Immobilized arm in arm pouch for 3 weeks and follow up was done to assess functional outcome. In this study we present the outcome and related complications with modified Weaver Dunn technique for type 3 acromioclavicular joint dislocation.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230471
Issue No: Vol. 9, No. 2 (2023)
- Tibia fractures managed with minimally invasive internal fixation: a case
series of 20 cases
Authors: Narendra Babu S., Prashanth Dhanraj, Ehtesham Raza Sayeed, Syeda Sakina Amatul Ali
Pages: 412 - 417
Abstract: Distal tibia fractures are frequently associated with an extensive soft tissue injury, leading to a higher risk of complications such as skin complications, infection, non-union, and eventually poor overall outcome. This study aims to measure the outcome of open/closed distal tibia fractures treated with minimally invasive internal fixation. We aim to propose an algorithm for the management of distal tibia fractures by evaluating the treatment options, outcomes, and risk factors present. This study is a case series study of all distal tibia fractures treated surgically in Kamineni Academy of Medical Sciences, LB Nagar from 2018 to 2022. Patient records were reviewed to analyze the outcomes of surgical treatment and the risk factors associated with it.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230472
Issue No: Vol. 9, No. 2 (2023)
- A case series of Stener’s lesion of the first metacarpophalangeal
joint
Authors: Kritika, Ashish Verma, Sanjay B. Shahu, Rajaram Sharma, Yogesh Kumar Sharma
Pages: 418 - 421
Abstract: Ulnar collateral ligament (UCL) injuries have a high prevalence however; these are usually being missed in the initial clinical evaluation. Depending on the chronicity of the injury there are two acronyms for UCL tear. One is the skier's thumb and the other is the gamekeeper's thumb. If the UCL of the first metacarpophalangeal joint (MCP joint) has a complete tear with entrapment of aponeurosis of adductor pollicis muscle between the MCP joint and torn ligament, is called a Stener’s lesion. This is a rare clinical entity that requires early surgical correction because of entrapment. The mechanism of injury is the coerced abduction of the thumb from the index finger, causing ligament tears or sprain with or without ensuing avulsion fracture. The incidence of Stener’s lesions associated with UCL rupture has been reported to be up to 52% per intra-operative finding. In Stener’s lesions, the UCL tears from the base of the proximal phalanx (PP) then retracts proximally and displaces superficial to the adductor pollicis. Here we are presenting four cases of Stener’s lesions, with the usefulness of magnetic resonance imaging (MRI) in diagnosing this entity, which can prevent possible long-term complications such as chronic pain, joint degeneration, and joint instability.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230473
Issue No: Vol. 9, No. 2 (2023)
- Prospective evaluation of the role of limb reconstruction system in
fracture non-union of femur: a case series
Authors: Rajeev Biswas, Manideep Banerjee, Archak Roy
Pages: 422 - 426
Abstract: Traditionally the Ilizarov’s ring fixator was used in the management of non-union of long bones, especially in the cases with infection. But limb reconstruction system (LRS) is a viable lightweight, technically easier alternative for the same. The aim of this study was to assess the functional outcome, the radiological outcome and the complications associated with the management of fracture non-union femur treated with LRS. A prospective case series was undertaken comprising of 10 patients. Both infected and non-infected shaft of femur fractures were enrolled. Patients underwent debridement, implant removal and definitive fixation with LRS. Post-operative radiological outcome and functional outcome using the ASAMI (Association for the Study and Application of the Method of Ilizarov group) score. In 70% cases the mechanism of injury was road traffic accident. Mean period of non-union before admission was 11.9 months, mean time for union was 10.10 months, with 90.0% cases successfully uniting. 70% cases underwent lengthening following Ilizarov’s principles. ASAMI radiological outcome was excellent in 70%, good in 10%, fair in 10% and poor in 10% cases. ASAMI functional outcome was excellent in 60%, good in 10%, fair in 10% and poor in 20% cases. Pin tract infection was the most common problem at 70.0% while knee stiffness at 40% was the most common true complication. Thus by this study it can be expressed that LRS is a feasible alternative to ring fixators for the management of fracture non-union shaft of femur.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230474
Issue No: Vol. 9, No. 2 (2023)
- Rotating hinge knee as a means of limb salvage in a patient operated on
five times for periprosthetic joint infection: from despairs of darkness
to lights of joy!
Authors: Vikram Shah, Javahir Pachore, Jayesh Patil, Pranay Gujjar, Amit Kumar Sinha
Pages: 427 - 431
Abstract: The demand for revision knee arthroplasty is increasing daily with the increase in the number of patients undergoing primary knee arthroplasty. The aim of revision arthroplasty therefore should be the restoration of the mechanical alignment of the limb with the restoration of joint line and biomechanics and these goals should be accomplished with the least possible use of constrained implants which otherwise depends on the degree of bone defects and integrity of collateral ligaments. We have hereby reported a case of a 51-year-old lady operated on five times before who was financially drained, mentally and psychologically depressed with the patient and her relative’s considering amputation of the limb as a last resort!
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230475
Issue No: Vol. 9, No. 2 (2023)
- Modified dual osteotomy for Madelung’s deformity
Authors: Aditya Agarwal, Rahul Patel, Mohit Jain, Shubham Arora, Paresh Golwala, Srishty Agarwal
Pages: 432 - 434
Abstract: Madelung’s deformity is one of the rare congenital deformities of the forearm and wrist, typically seen as positive ulnar variance and increased volar tilt due to the “Vickers” ligament. Different corrective surgical methods for this have been done in the literature. In this case of a 9-year-old Madelung’s like deformity, we have performed a modified dual osteotomy with periosteal preservation allowing natural articulation and bone to be modified, especially in a younger child. This article gives the surgical option to orthopedics for the future, especially in a younger child with severe deformity. This is a level V evidence-based therapeutic study.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230476
Issue No: Vol. 9, No. 2 (2023)
- A case report on surgical excision of intracapsular osteochondroma of
femur neck using medial approach without hip dislocation in a young male
Authors: Neetin P. Mahajan, Akshay Gund, Pranay Kondewar, Kunal Chaudhari, Pramod Bagimani, Ravi Patel
Pages: 435 - 438
Abstract: Osteochondromas also called exostosis are commonest benign bone tumours. Traditionally Osteochondroma are considered as developmental malformations rather than true neoplasms and are thought to formed inside the periosteum due to separation of small epiphyseal growth plate cartilage. But recent studies suggested it’s relation with mutation in gene exotoxin 1 so now they are considered as true neoplasm. The lesions consist of a bony mass produced by progressive endochondral ossification of a growing cartilaginous cap. Most lesions are found during the period of rapid skeletal growth. Approximately 90% of patients only have a single lesion. Osteochondromas generally found on the metaphysis of a long bone near the physis like distal femur, proximal humerus, and proximal tibia. Due to risk of AVN after surgical management makes it difficult for excision. Due to close proximity to important neurovascular bundles these lesions can cause symptoms related to compression. Hip impingement is also common in these cases. Recurrence of osteochondromas are rare sometimes seen due to failure to remove the entire cartilaginous cap. A 24-year-old male presented with complaints of pain around the right hip and difficulty in walking and running since 2 year. On radiographic examination Right sided neck femur osteochondroma was diagnosed, which was located along the anteroinferior margin of the femur neck. Excision of the lesion was done in supine position using medial approach to hip without dislocation of the femur head. Femur neck osteochondroma should be removed surgically safely without dislocating hip. Osteochondroma must be removed completely with cartilagenous cap to avoid recurrence.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230477
Issue No: Vol. 9, No. 2 (2023)
- Tuberculosis of the talus in a 2-year-old: a diagnostic dilemma
Authors: Swapnil A. Keny, Rudra M. Prabhu, Shubhranshu S. Mohanty, Shubham Y. Dakhode, Abhishek K. Rai
Pages: 439 - 442
Abstract: Extra-pulmonary tuberculosis involving the ankle and foot is a rare entity with its prevalence being ever rarer in the pediatric population. Here, we report the case of a two-year-old female child who presented with a gradually progressive non-traumatic swelling involving the right foot and ankle since two months. The patient was initially managed by a local doctor with immobilization of the foot and ankle in a slab for three weeks. Blood investigations were suggestive of an inflammatory process and a lytic lesion involving the talus was seen on radiographs. The patient was managed with debridement and curettage of the lesion along with anti-tubercular chemotherapy as per pediatric dosage for one year. The patient was asymptomatic at latest follow-up of 1 year and radiographs showed that lytic lesion had resolved.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230478
Issue No: Vol. 9, No. 2 (2023)
- A solitary giant cell tumor of the tendon sheath of left third finger in a
23-year-old man: a case report
Authors: Panduranga B. V., Guruprasad S.
Pages: 443 - 445
Abstract: Giant cell tumor of the tendon sheath (GCTTS) is a common condition usually encountered in middle aged men, usually seen on the thumb, index, middle fingers. These benign tumors are known to reoccur. Re-occurrence can be attributed to poor surgical technique, excision of the tumor in toto is considered difficult given the close proximity of the digital nerves, blood vessels, tendons to the tumor. A magnifying loop is usually used in these cases to identify and resect the satellite lesions. In this case report, we are presenting a case of solitary GCTTS of the tendon sheath in a 23-year-old man with history of gradually progressive painless swelling over his left third finger. Musculo-skeletal ultrasound revealed a heterogeneously hypo-echoic well-defined lesion over the ventral aspect of the left third finger. Histopathology showed giant cell morphology. Patient underwent exploration, tumor excision in toto with primary suturing in our institute with an uneventful postoperative period. No loss of range of movements of the PIP, DIP joints was noted in the postoperative period. Good dissection with excision of the tumor in toto gives better outcomes.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230479
Issue No: Vol. 9, No. 2 (2023)
- Neglected fracture shaft femur presenting with pseudoaneurysm: a case
report
Authors: Pankaj Tathe, Saurabh Sah, Prateek Jain, Ayush Mittal, Chandan Arora
Pages: 446 - 449
Abstract: A pseudoaneurysm is a collection of blood leaking from a damaged arterial wall. Development of the false aneurysm is due to either initial injury of the vessel or is a complication of internal fixation of the femoral fracture. Femoral artery pseudoaneurysms (FAPs) may close spontaneously if the tear is small enough to allow for clotting and sealing. On the other hand, rupture of the aneurysm can trigger thrombosis, distal embolization and compression of adjacent structures. We present a case of left superficial femoral arterial pseudoaneurysm in a 36-year-old male with fracture of left femoral shaft. A 36-year-old male with history of road traffic accident presented to our institute with pain and swelling in left thigh. Patient was investigated and diagnosed with fracture left femoral shaft with a pseudoaneurysm of the left superficial femoral artery (SFA). Stenting was done for SFA followed by open reduction and internal fixation of the femoral shaft fracture. Such cases require multidisciplinary approach and a proper planning with involvement of different medical specialities to achieve optimal results and to minimise any intraoperative and post operative complications.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230480
Issue No: Vol. 9, No. 2 (2023)
- Non traumatic pathological sternoclavicular joint dislocation an
unexplored complication of clavicle osteomyelitis-a case report
Authors: Sivabalaganesh Amirthalingam, Sundar Suriyakumar, Giriraj Harshavardhan, Karthikeyan Manickam
Pages: 450 - 453
Abstract: Non-traumatic pathological sternoclavicular joint dislocation due to medial end of clavicle osteomyelitis is extremely rare. This kind of rare complication should be anticipated while encountering these kinds of cases. A sixty-three-year-old male came with pain and swelling over the left neck and was diagnosed to have left clavicle osteomyelitis. The unexplored complication of sternoclavicular joint dislocation and successful management of such complications has been discussed in this case report. To best of our knowledge this is the first case report of a non-traumatic pathological sternoclavicular joint dislocation due to clavicle osteomyelitis. This case report will supplement the inadequate literature in management of such cases.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230481
Issue No: Vol. 9, No. 2 (2023)
- Synovial lipoma of the ankle and foot: a rare case report
Authors: Aniket K. Wankhede, Rohit Rathod, Girish Mote, C. M. Badole, Mrigank Medhi
Pages: 454 - 457
Abstract: Synovial lipomatosis is an extremely rare type of disease in which there is an excess of adipose tissue involving the synovium layer of joints or synovial sheath around the tendons causing pain, paraesthesia, and weakness. The most common site being reported till now is Knee joint or parapatellar space other joints such as elbows and shoulders are being reported after the knee joint, and the ankle joint is rarely reported 2 cases have been reported in the English literature. We report a case of a 28-year-old male presenting with swelling of the right foot for 12 years and developed symptoms of pain and tingling on the toes for 2-3 weeks. Multiple bony hard lesions were palpated on the base of the foot, ultrasonography (USG) showed a subcutaneous lesion around the extensor tendons of the foot and fine needle aspiration cytology (FNAC) had a picture of the synovial cyst. Surgical excision was done and histopathology was reported to be as a fibrofatty tissue with multiple adipocytes suggesting lipoma arborescent.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230482
Issue No: Vol. 9, No. 2 (2023)
- Correction of neglected post-burn severe calcaneo-valgus deformity of foot
with Joshi’s external stabilization system: a one stage surgical
procedure
Authors: Faisal N. Mir, Anika Adfar, Naseer A. Mir
Pages: 458 - 461
Abstract: Post burn calcaneovalgus is a complex foot deformity and management becomes increasingly difficult especially if deformity is neglected in growing young child resulting in secondary bony deformity. A simple technique of single stage surgical correction with Joshi’s external stabilization system (JESS) is described using principle of distraction osteogenesis or histogenesis without need of extensive plastic surgical procedure. A functional plantigrade foot is achieved after completion of the procedure without need of any bony procedure and least chances of any neurovascular compromise. JESS is a versatile external fixation device for correction of neglected postburn complex calcaneovalgus deformity.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230483
Issue No: Vol. 9, No. 2 (2023)
- Total hip replacement in a black hip: a case report and review of
literature
Authors: Vikram Shah, Javahir Pachore, Jayesh Patil, Pranay Gujjar, Amit Kumar Sinha
Pages: 462 - 466
Abstract: Alkaptonuria is a rare metabolic disease leading to the accumulation of a blue-black pigment namely homogentisic acid in the cartilaginous tissue and body fluids giving them a black color. It is an autosomal recessive disease due to the deficiency of the hepatic enzyme oxidase which results in the accumulation of homogentisic acid in the skin, cartilage, and collagenous tissue giving them a black color. Herein we report a case of 65 years old gentleman who presented to our emergency department post domestic fall on his left hip, after which pain and swelling developed around the left hip and he was unable to bear weight with restricted mobility around the same.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230484
Issue No: Vol. 9, No. 2 (2023)
- Extensive humeral hydatid cyst with extraosseous involvement: a case
report
Authors: Rahul Patel, Rahul Parmar, Jayraj Mehta, Anshul Gupta, Srishty Agarwal, Aditya Agarwal
Pages: 467 - 470
Abstract: Hydatid cysts caused by Echinococcus species mainly involve visceral organs. Rarely skeletal involvement occurs. The spine and pelvis account for half of the cases of osseous hydatidosis, making humeral hydatid cysts one of the rarest conditions. We report a case of humeral hydatidosis in a 42-year male who presented to us with pain and swelling over the left upper arm, radiological investigations suggestive of osseous cystic lesions were inconclusive and diagnosis of hydatidosis was confirmed with a biopsy subsequently. Surgical excision and curettage of bone and surrounding soft tissue were done, and the void was filled using PMMA cement followed by antihelminthic chemotherapy. No complication or recurrence has been found postoperatively at the end of 6 months of follow-up, with preservation of limb function. To keep orthopedic surgeons aware of this morbid condition, due to its low prevalence, and advanced presentation which is likely misdiagnosed, and even after the early intervention, there is a high recurrence rate which makes this one of the rare cases of humeral hydatidosis notifiable.
PubDate: 2023-02-24
DOI: 10.18203/issn.2455-4510.IntJResOrthop20230485
Issue No: Vol. 9, No. 2 (2023)
