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International Journal of Research in Orthopaedics
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ISSN (Online) 2455-4510
Published by Medip Academy Homepage  [12 journals]
  • Disability prevention with early screening and intervention among children
           with congenital clubfoot in India

    • Authors: Alisha Aggarwal, Anisha Aggarwal
      Pages: 873 - 877
      Abstract: Background: Congenital clubfoot has an incidence of 1-9/1000 live births. Untreated clubfoot leads to physical, social, psychological, and financial burden on the family and society. Early intervention can prevent disability in the future. The aim of this study is to assess the effectiveness of an early intervention and conservative management to treat congenital clubfoot and prevent disability.Methods: We conducted a retrospective analysis at an urban multispecialty hospital in North India among children with a diagnosis of congenital clubfoot managed with Ponseti technique (manipulation, casting, tenotomy and bracing). Descriptive statistics and chi-square test were used to measure association between variables.Results: We had a total of 125 feet (41 bilateral, 43 unilateral). 78.5% (n=66) children were below 12 months of age with a mean age at diagnosis of 7.8 months. 70.2% (n=59) children were corrected with less than 5 casts to achieve complete correction. Tenotomy was required in 69% of children (n=58) and was statistically significant. A 100% success rate was achieved in our study.Conclusions: Early intervention is essential to correct idiopathic/ congenital clubfoot, prevent disability and improve quality life in adulthood. National programs with a focus on prevention, surveillance, advocacy, and research are vital for universal health coverage.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203708
      Issue No: Vol. 6, No. 5 (2020)
       
  • Radiological and functional outcome of displaced mid-shaft clavicular
           fracture managed with open reduction and internal fixation with
           precountered anatomical clavicular locking plate: a prospective study

    • Authors: Sagar Panthi, Rishiswor Shrestha, Rajan Shakya
      Pages: 878 - 883
      Abstract: Background: Displaced mid-shaft clavicular fractures are treated by conservative methods which shows higher rate of malunion and non-union with suboptimal outcomes. Fracture fixation by pre-countered anatomical clavicular locking plate avoids these complications. This study aims to assess the radiological and functional outcome after open reduction and internal fixation by pre-countered anatomical clavicular locking plate.Methods: Fifty patients of mid-shaft clavicular fractures with age group of 18 to 60 years were treated with open reduction and internal fixation with precountered anatomical clavicular locking plate from, in the span of November 2018 to May 2020. All the patients were followed up for six months for the study. Final functional outcome was assessed in six months.Results: All the fractures united at the average time of 16.32±2.37 weeks. Mean Constant and Murley score was 96.0±5.20. The outcome was graded as excellent in 45 (90%), good in 4 (8%) and fair in 1 (2%) patients.Conclusions: Hence displaced mid-shaft clavicular fractures can be treated with by precountered anatomical clavicular locking plate.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203709
      Issue No: Vol. 6, No. 5 (2020)
       
  • Impact of age, gender and body mass index on the efficacy of tranexamic
           acid in total knee arthroplasty

    • Authors: Rui Viegas, Abhishek Kumar, Maria M. Carvalho, João Vide, Ana P. Fontes, João P. Sousa
      Pages: 884 - 887
      Abstract: Background: Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.Methods: We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.Results: Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).Conclusions: TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203710
      Issue No: Vol. 6, No. 5 (2020)
       
  • Comparative study of anterior cervical discectomy and fusion by anterior
           cervical plate and stand-alone cervical cage

    • Authors: Ansari Muqtadeer Abdul Aziz, Venktesh Dattatray Sonkawade, Ansari Ishtyaque Abdul Aziz, Nair Pradeepkumar Sasidharan
      Pages: 888 - 895
      Abstract: Background: Anterior cervical discectomy (ACD) was used for management of degenerative cervical disc disorders (DCDD) in previous days. Further research and developments in management of DCDD led to evolution of standard and widely used operative technique as anterior cervical discectomy and fusion (ACDF) by either anterior cervical plate (ACDF-ACP) with bone grafting or stand-alone cage (ACDF-SAC). There is less data available in literature regarding when and where to use ACDF-ACP and ACDF-SAC.Methods: The study was conducted on 20 patients operated in Government Medical College and Hospital and Pacific Hospital and Research Centre, Aurangabad from June 2018 to March 2020. These patients divided into group A - 10 patients, operated by ACDF-SAC which are further divided as group Aa - 6 patients - operated for single level ACDF-SAC and group Ab - 4 patients - operated for two level ACDF-SAC, group B - 10 patients, operated by ACDF-ACP which are further divided as group Ba - 5 patients - operated for single level ACDF-ACP and group Bb - 5 patients - operated for two level ACDF-ACP. Patients evaluated preoperatively and postoperatively using X-ray cervical spine anteroposterior (AP) and lateral views, MRI cervical spine, visual analogue scale (VAS) for pain, Robinson’s criteria and Cobb’s angle.Results: In our study we found, ACDF-SAC has small incision size, less intraoperative time, easy to carry out for surgeons, less intraoperative complications and better clinical outcome as compared to ACDF-ACP. Whereas only radiological results were better in ACDF-ACP than ACDF-SAC.Conclusions: ACDF-SAC is superior to ACDF-ACP for appropriately selected patients and in well experienced hands.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203540
      Issue No: Vol. 6, No. 5 (2020)
       
  • A study on outcome of various K-wire fixations in paediatric supracondylar
           humerus fractures

    • Authors: Shalin Bharat Shah, Kushal Nikhil Parikh, Pradipkumar Ishvarbhai Paraliya
      Pages: 896 - 901
      Abstract: Background: The ideal pin geometry for treatment of paediatric supracondylar humerus fracture is still debated. Various studies have been carried out comparing medial-lateral pinning (MLP) and lateral only pinning (LOP), but none have compared all three individually i.e. MLP, lateral divergent pinning and Lateral Trans olecranon fossa four cortex purchase pinning (TOF-FCP). This study aims to compare the cosmetic and functional outcome of these three pinning methods.Methods: 54 children with supracondylar humerus (Gartland type 2 or 3) meeting inclusion criteria were treated operatively and followed up till 6 months postoperatively. At 6 months the cosmetic and functional outcomes were assessed using the modified Flynn criteria.Results: All fractures united within 3 to 6 weeks duration. The mean duration of fracture union was 4.05 weeks. Functional outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent pinning. cosmetic outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent.Conclusions: Functional and cosmetic outcome of all three pinning geometries after operative intervention of paediatric supracondylar humerus fracture is similar in expert hands. The incidence of complications with TOF-FCP construct is less amongst the lateral only pinning.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203525
      Issue No: Vol. 6, No. 5 (2020)
       
  • A study of periprosthetic fractures following hemi-arthroplasty of hip in
           elderly population: diagnosis and management

    • Authors: Gagandeep Mahi, Milind Atmaram Lokhande, Lokesh Kumar Yogi, Ankit Gawri
      Pages: 902 - 906
      Abstract: Background: Hemi-arthroplasty of hip for intracapsular fractures of femoral neck is one of the most commonly done surgical procedures in the low mobility older Indian population. Although there are numerous complications associated with the procedure, we want to study the types and management of peri-prosthetic fractures in patients treated with hip hemi-arthroplasty.Methods: A total of 26 patients were included in the study. A retrospective analysis of the radiological cum clinical diagnosis and management of peri-prosthetic fractures was performed. All patients were followed up till 1.5 years post-operatively.Results: According to Vancouver classification of peri-prosthetic fractures, 10 fractures were classified as type A, 7 as type B1, 3 as type B2, 4 as type B3 and 2 as type C. Fractures were managed either by Open Reduction with Internal Fixation (ORIF) or Revision hemi-arthroplasty. Fractures type AG, B1 and C were managed with ORIF and type B2 and B3 fractures were managed with revision hemi-arthroplasty using longer stem.Conclusions: As evident in our study, majority of fractures occurred intra-operatively, a thorough evaluation of pre-operative x-rays of both hips should be done along with special focus on anatomical variations. Correct diagnosis based on radiological and intraoperative findings followed by appropriate treatment are of paramount importance in the management of peri-prosthetic fractures.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203483
      Issue No: Vol. 6, No. 5 (2020)
       
  • In vitro biomechanical comparison of various implants in Pauwels type 3
           fracture neck femur

    • Authors: Birju Manjhi, S. C. Goel, Abhijeet Kunwar, Vakil Singh
      Pages: 907 - 913
      Abstract: Background: The objective of this study was to find out the correlation among type of implant, type of fracture and quality of bone in a cadaveric model of unstable fracture neck of femur (Pauwels type 3) fixed with either; proximal femoral nail (PFN), dynamic hip screw (DHS), dynamic hip screw with an anti-rotation screw (DHS and ARS) or cannulated cancellous screws (CCS).Methods: This study was conducted on 24 cadaveric bones (6 in each group) in which unstable fracture neck of femur (Pauwels type 3) were created and fractures in each group were fixed with different implants after creating a comparable group using DEXA scan. These were tested on a cyclic physiological loading machine at 2 cycles per second with a load of 200kg. The test was observed for 10,000 loading cycles or till failure whichever occurred earlier. Subsidence was measured and analyzed.Results: Five specimens in the PFN group, 3 specimens in the DHS and ARS and DHS group completed 10,000 cycles while all the specimens in CCS group failed before 10000 cycles. Mean subsidence of the PFN group was significantly lower than the other groups.Conclusions: PFN constructs were stronger than the other constructs. However, these data must be interpreted as strictly biomechanical, representing only part of the scenario at work in vivo. Nonetheless, the significant findings of increased strength of fixation over the DHS, DHS with ARS and CCS certainly appear to support the use of PFN clinically. 
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203062
      Issue No: Vol. 6, No. 5 (2020)
       
  • Micro-core decompression combined with intralesional zoledronic acid as a
           treatment of osteonecrosis of femoral head: a novel technique

    • Authors: Muhammed Ashraf, Jyothis George, Ibad Sha I.
      Pages: 914 - 919
      Abstract: Background: Avascular necrosis (AVN)/osteonecrosis of the femoral head is a debilitating condition affecting the hip joint and is one of the most common causes of total hip replacement. The available treatments include pharmacological and surgical options with total hip arthroplasty (THA) being the mainstay of treatment. This present study is a novel technique of combining micro core decompression with intra-lesional bisphosphonate as a treatment for osteonecrosis of the hip.Methods: A prospective study of 19 hips was done. There were 11 males and 4 females ranging 42-63 years. Four hips were stage I, ten hips were stage IIA, three hips were stage IIb and two hips were stage III.  16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The minimum period of follow up was 24 months. All patients were assessed according to the Harris hip score. The operative procedure includes decompressing the avascular area with drilling then injecting the zoledronic acid locally.Results: The mean preoperative modified Harris hip score in stage I (n=4), stage IIa (n=10), stage IIb (n=3) and stage III (n=2) were 81.9, 72.7, 68.8 and 59.2 respectively. The mean postoperative modified Harris hip score at two years in stage I, stage IIa, stage IIb and stage III were 97.3, 91.1, 88.4 and 82.5 respectively.Conclusions: We found that the use of micro core-decompression with intra-lesional bisphosphonate will provide higher chances towards hip preservation especially in late cases or cases with larger lesions where core decompression may not be successful. 
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203060
      Issue No: Vol. 6, No. 5 (2020)
       
  • Functional and radiological outcome of valgus osteotomy (abduction
           osteotomy of Pauwel) and fixation with dynamic hip screw in neglected
           fracture neck of femur

    • Authors: Venugopal S. M., Naveen Babu, Naresh Odnala, Gudaru Jagadesh
      Pages: 920 - 925
      Abstract: Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203504
      Issue No: Vol. 6, No. 5 (2020)
       
  • A prospective comparative study between interlocking nail and locking
           compression plate for management of diaphyseal fractures of the humerus

    • Authors: Mallesh Rathod, Sandeep Kumar Kanugula, Pannuri Raja
      Pages: 926 - 932
      Abstract: Background: The aim of this study was to compare the outcomes between open reduction and internal fixation by locking compression plate (LCP) and closed reduction and internal fixation with anterograde interlocking nail (ILN) for the treatment of diaphyseal fractures of the humerus.Methods: This is a prospective comparative study, with diaphyseal fractures of the humerus treated by LCP in 30 patients and with ILN in 30 patients. Patients were followed up to 18 months. The clinical and radiographic outcomes were assessed in terms of union, complications, reoperation rate and functional outcome using the American shoulder and elbow surgeons’ score (ASES) and Stewart and Hundley’s criteria.Results: Union was achieved in 93.3% of patients in LCP group and 90% in ILN group. The mean blood loss in LCP group was 280±22.10 ml (160-400 ml) and in ILN group was 110±17.62 ml (70-150 ml) (p=0.001). The ASES score was 42.47±5.532 in LCP group and 40.93±6.330 in nailing group (p=0.320; p>0.05). Stewart Hundley criteria showed excellent and good results in 26/30 and 17/30 patients in LCP group and ILN group respectively (p=0.070; p>0.05). Complications and re-operation rate were higher in ILN group.Conclusions: Our study concludes that LCP can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it had lower incidence of complications, less re-operation rate and better union rate. However, there is no difference between the two groups in terms of union time and functional outcome.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203055
      Issue No: Vol. 6, No. 5 (2020)
       
  • A study of surgical management of idiopathic congenital talipes
           equinovarus by posteromedial soft tissue release

    • Authors: T. Parameshwari, Ketavath Thulasiram, D. Narender, N. Kalyani, Anjaneyulu K
      Pages: 933 - 938
      Abstract: Background: Idiopathic congenital talipes equinovarus is a complex deformity that is difficult to correct. The treatment of club foot is controversial and continues to be one of the biggest challenges in paediatric orthopaedics. Most orthopaedicians agree that the initial treatment should be non-surgical but if it fails, advise surgical treatment in the form soft tissue release for better results. The study was done with the aim to study a short term follow up of 14 patients treated to assess the efficacy of the treatment modality.Methods: 14 patients underwent the posteromedial soft tissue release (PMSTR) at Department of Orthopaedics, S. V. S. Medical College during the period from October 2013 to September 2015. Patients were followed up regularly up to one and half year. Severity of foot deformities were graded according to Denis-Brown classification.Results: Out of 14 cases there were 10 males (71.4%) and 4 females (28.6%) for the sex ratio of 2.5:1 male to female. The youngest child was 6 months old and oldest child was 3 years old. In bilateral cases both feet were operated at an interval of 7 to 10 days. Good results were seen in 15 feet (71%), fair: in 04 feet (19%) and poor: in 02 feet (10%).Conclusions: The PMSTR method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics after surgery and surgery at late age are causes for failure of technique.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203048
      Issue No: Vol. 6, No. 5 (2020)
       
  • Outcome analysis of surgical management of type 2, 3a and 3b open
           fractures of distal 2/3rd tibial diaphysis using external fixators

    • Authors: Dibin K. Thomas, Nishara M. S.
      Pages: 939 - 944
      Abstract: Background: There is confusion regarding ideal fixation method for intermediate grades of open fractures of tibia. In distal 2/3rd of tibia the blood supply is precarious and so it further increases the confusion. Purpose of this study is to evaluate effectiveness of external fixator as definitive treatment in these fractures.Methods: 55 patients with type2, 3A or 3B open fractures of distal 2/3rd tibia were studied. External fixator applied at the time of debridement is removed and cast applied once wound is healed. Follow up at 1, 3, 6 and 9 months recorded. Union assessed using rust scoring system. Functional outcome assessed using Modified Functional Evaluation System by Karlstrom- Olerud after patients are mobilized.Results: Union rate was 74.5%.Functional outcome was satisfactory in 34%, moderate function in 32% and good function in 24.4%. In 7.3% the function was poor. Only one case gave excellent function.Among diabetic patients 71.4% developed wound infection and all developed pin tract infection showing strong association between diabetes and infection.Conclusion: Though external fixation followed by serial casting technique gave fare outcomes, there is scope for better results and so the option of other methods of treatment should not be excluded. There is a significant association between diabetes and infection and so special care and covigilance is advised in diabetic patients.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203711
      Issue No: Vol. 6, No. 5 (2020)
       
  • All polyethylene tibia - results of functional and radiological outcome at
           5 years follow-up

    • Authors: Digen Patel, Kunal Ajitkumar Shah, Mohan Madhav Desai, Swapneel S. Shah
      Pages: 945 - 950
      Abstract: Background: Earlier, all-polyethylene tibial (APT) components were the only option available for TKA. APT components improved over years and have shown results similar or superior to MBT components with respect to survivorship and rate of complications. This study aimed to assess the functional and radiological outcome of TKA with APT components with 5 years follow-up.Methods: This longitudinal study was conducted in a tertiary care center in Mumbai in year 2018. All patients who underwent TKA with APT components during the year 2012 were included in the study. Total of 147 knees were operated in 120 patients. Ninty patients (111 knees) followed up at 5 years. Preoperative and postoperative assessment of patients was done for function, pain and radiological outcome. Functional scores used were Knee society score, WOMAC osteoarthritis index, Bristol score and Oxford knee score. Visual analogue scale (VAS) score was used for pain assessment. Pre and postoperative X-rays were done and component alignment angles (α, β, γ and δ) were calculated.Results: Statistically significant difference was found in pre and postoperative values of VAS score, knee society score, WOMAC osteoarthritis index, Bristol score and Oxford knee score (p value <0.001). Component alignment angles were found to be same pre and postoperatively. None of the patients had radiologic evidence of loosening of implants.Conclusions: APT components have good to excellent functional outcome and good radiological outcome at 5 years. They are safe in view of radiologic component migration at 5-year follow-up.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203712
      Issue No: Vol. 6, No. 5 (2020)
       
  • A prospective study of distal 1/3rd tibia fracture treated using locking
           compression plate by minimally invasive percutaneous plate osteosynthesis
           technique

    • Authors: P. S. Vikranth, N. Vamshi Varenya
      Pages: 951 - 955
      Abstract: Background: Distal tibia fractures are common and represent 6-8% of all lower limb fractures treated by an orthopaedic surgeon. Anatomical reduction with good fracture stability and minimal soft tissue dissection give good functional results. Locking compression plate combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique has yielded good results. In this prospective study, authors studied 30 patients treated with LCP using MIPPO technique to know the functional outcome.Methods: A total 30 patients were studied in this technique, which include both male and females of different age groups treated with LCP using MIPPO technique. All the patients were followed up for 12 months between March 2018 to March 2019 in orthopaedic department. The functional and radiological outcomes were assessed.Results: A total 30 patients both male and females were studied with age groups between 18 to 65 years. Average follow-up was 12 months using Olerud and Molander scoring system authors had excellent results in 16 patients (54%), good in 9 patients (30%), fair in 4 patients (12%) and poor outcome in 1 patient (4%).Conclusions: Surgery with locking compression plate along active physiotherapy proved to be better for distal tibia fractures.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203713
      Issue No: Vol. 6, No. 5 (2020)
       
  • Rising incidence of hip fractures in Sindhudurg west coast of Maharashtra,
           South India (2000 to 2011)

    • Authors: Raghavendra S. Kulkarni, Aditya P. Kulkarni, Rachana A. Kulkarni, Ranjani R. Kulkarni, R. S. Deshpande, Sriram R. Kulkarni
      Pages: 956 - 962
      Abstract: Background: The incidence of hip fractures in Sindhudurg, west coast of Maharashtra has been reported in relation to age and gender.Methods: Using the medical records and X-ray registers from May 2000 to October 2011, all patients of proximal femoral fractures were recorded and included in this study. The data was cross checked doubly with details of indoor case papers against ward admission and operation theatre registers, were found to be congruent after verifying the names of patients.Results: The total male incidence was bimodal with moderate peaks at 31 to 50 years and very high at 51 to 70 years. The female incidence with peaks at 41 to 60 years with regular steady increase up to 80 years. Males of 31 to 70 years 2.5 times more likely to sustain a fracture (95% CI 2.3 to 2.8) than females. Females between 40 to 60 years 2.8 times more likely to sustain fracture than males (95% CI 2.5 to 3.0). The trend was stable from year to year. This high increase in hip fractures in men of 51 to 70 years incidence documented osteoporotic fractures in contrast with too much emphasis on the importance of menopause in hip fractures.Conclusions: Despite wide variations in age specific hip fracture rates over a decade, reasons for differences are not clear. From 2000 to 2011, the hip fractures in district hospital increased by a factor of 6.6%, 14.34% in both the genders above the age of 41 years in parallel with hospital admissions. 
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203714
      Issue No: Vol. 6, No. 5 (2020)
       
  • Management of lateral epicondylitis (tennis elbow) by local infiltration
           of platelet rich plasma an outcome study

    • Authors: Pradeep Kumar Kumawat, Rajesh Goel, Urmila Kumhar, Rahul Parmar, Rajesh Sharma, Bharat Sharma
      Pages: 963 - 967
      Abstract: Background: Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.Methods: A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2nd week, 4th week, 3rd month and 6th month.Results: At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value <0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.Conclusions: An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203715
      Issue No: Vol. 6, No. 5 (2020)
       
  • Role of bone marrow infiltration in management of delayed union of long
           bones fracture

    • Authors: Sanjay Kumar Meena, Naveen Goyal, Devendra Tetarwal, Bharat Sharma
      Pages: 968 - 974
      Abstract: Background: Usually delayed union of fracture long bones are managed by putting a bone graft at fracture site , but bone grafting have donor site complication like scar, infection ,hernia ,gait disturbance , cosmetic problem, as well as recipient site complication like soft tissue trauma , de-vascularisation of fracture fragment. Bone marrow infiltration is a minimally invasive method done percutaneously. It is easy, safe procedure with no associated complications that may occur in bone grafting.Methods: This prospective study was conducted in the Department of orthopedics, Government Medical College, Kota from June 2011 to November 2013 to evaluate the efficacy of percutaneous bone marrow infiltration in cases of delayed union of long bones. 27 patients included in study with 28 bones, as one patient has given bone marrow injection in two bones (tibia & femur), so the cases included in study counted as 28 cases. The mean age of this study was 38.28 years, ranging from 18 years to 75 years.  All cases were follow up after 4 to 6 weeks and thereafter one month interval. Final follow up was taken when fracture site shows clinical and radiological sign of union.Results: Out of 23 united cases 19 had excellent results and 04 cases had good results. The five cases which fail to unite were taken as poor results.Conclusions: Bone marrow infiltration is a minimally invasive, safe bone graft substitute for delayed union of long bones and have less complications.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203716
      Issue No: Vol. 6, No. 5 (2020)
       
  • SPARSH: a camp based approach for orthopaedic disabilities and its success
           in central India

    • Authors: Prakhar Singhal, Santosh Kumar Mishra, Jiten Shukla, Rahul Verma, Ashish Gohiya
      Pages: 975 - 980
      Abstract: Background: Around 15% of population in the world is living with disability. The present study was carried out during the special project for assistance, rehabilitation and strengthening of handicapped (SPARSH) camp to know the current pattern of locomotor disability and to observe the outcome of the camp surgeries for the correction of deformity.Methods: This prospective observational cross-sectional study was conducted at the department of orthopaedics and traumatology Gandhi Medical College at SPARSH camp organised by the Government of M. P. at J. K. hospital Bhopal. All the patients with locomotor disability attending the SPARSH camp irrespective of age, sex and cause, were included in the studyResults: In total 287 patients attended the camp in which majority of the patients were suffering from cerebral palsy. 107 patients were selected for operative intervention in which tendo-achilles lengthening was performed most commonly.Conclusions: The corrective surgical camp provides an avenue of healthcare opportunity for the underprivileged sector of society. A camp based approach helps in identification, gradation & rehabilitation of orthopaedic deformities.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203717
      Issue No: Vol. 6, No. 5 (2020)
       
  • Functional outcome of instrumented and non-instrumented fusion in lumbar
           canal stenosis

    • Authors: Ansari Muqtadeer Abdul Aziz, Nair Pradeepkumar Sasidharan, Ansari Ishtyaque Abdul Aziz, Venktesh Dattatray Sonkawade
      Pages: 981 - 986
      Abstract: Background: Lumbar canal stenosis (LSS) is a source of significant morbidity and economic burden in the Indian population. Spinal canal compression is the sine qua non of lumbar canal stenosis but whether instrumentation should be done or not is the major dilemma. In this study, we aim to compare the functional outcome of instrumented versus non-instrumented fusions for the treatment of lumbar stenosis along with the post-operative complications and cost-effectiveness of both procedures.Methods: This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between May 2016 and May 2018 were included. Patients were assessed using the modified Oswestry disability index (MODI) and visual analogue scale (VAS). These evaluations were done at 3, 6, 12 and 24 months.Results: We found similar pain relief and stabilization in both the groups in the initial post-operative period, but after 2 years, there was a significant difference (p=0.0001) between the two groups in terms of VAS (back) and MODI score. Complication rate was higher in instrumented patients. Conclusions: Patient selection is the most important thing in the management of lumbar canal stenosis. We believe that, with the flowchart on the management of lumbar canal stenosis, it would help choosing patients better as to who would require instrumented fusion. Non-instrumented fusions might cost less and have fewer complications, but the overall outcome of the patient in the future should be kept in mind.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203518
      Issue No: Vol. 6, No. 5 (2020)
       
  • Assessing the prevalence of various modes of injury and type of malleolar
           fractures based on Lauge-Hansen classification presenting at a tertiary
           care center

    • Authors: Jairam D Jagiasi, Mohit R. Upadhyaya, Pranjal Rai
      Pages: 987 - 991
      Abstract: Background: Ankle fractures represent approximately 9% of all fractures and are a common occurrence with an incidence of 138-169 per 100,000 per year. The mechanism of injury differs in terms of mode of injury in various age groups. The Lague-Hansen classification is a pathologic-anatomic classification and emphasizes different stages of ligamentous injury, in addition to the fracture pattern, and provides options for fracture treatment.Methods: A retrospective observational study, where the prevalence of various types of ankle fractures were classified according to the Lauge-Hansen Classification, in the period of 2018 onwards till date. The mode of injury and age group of the patient was also noted.Results: A total of 84 patients were analyzed, supination-external rotation (48.7%) were the most frequently observed fractures in our study population, with no significant correlation between mode of injury and fracture pattern noted. There was a statistically significant association (p<0.05) between the velocity of injury and the age groups suffering ankle trauma.Conclusion: The Lauge-Hansen Classification continues to be an important tool in assessing the biomechanics of ankle fractures and the management options available, especially in a country like India where more expensive imaging modalities may not be available or affordable at times. Our study also highlights that high velocity fractures continue to be a major cause of morbidity in the younger age group, especially in developing countries such as India. Stringent traffic rules and public awareness need to be put into practice to reduce the toll of this problem.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203718
      Issue No: Vol. 6, No. 5 (2020)
       
  • Efficacy of local anaesthetic cocktail infiltration in a total knee
           replacement: a prospective, randomized study

    • Authors: Ameya U. Kulkarni, Umesh M. Kulkarni
      Pages: 992 - 995
      Abstract: Background: The aim of this study is to assess the efficacy of local anaesthetic cocktail infiltration in pain management during a total knee arthroplasty.Methods: In this study we had 25 patients each in study and control group. The study group was infiltrated with the local anesthetic cocktail just before final implantation. Pain was documented by a visual analogue scale in a double blinded manner. Statistical significance was calculated using an unpaired “t” test.Results: In study group, pain levels were significantly lower as compared to control group for the first 48 hours after surgery with a ‘p’ value of 0.0224 (<0.05). The need of intravenous tramadol for breakthrough pain on the second day was significantly lower in study group as compared to control group with a ‘p’ value of 0.033(<0.05).Conclusions: This study shows that the local high volume anaesthetic infiltration is effective in reducing immediate postoperative pain and the need of IV opioids for the first 48 hours after surgery.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203719
      Issue No: Vol. 6, No. 5 (2020)
       
  • Treatment of supra condylar fractures of humerus in children, a SKIMS
           medical college study

    • Authors: Jawed Ahmed Bhat, Arshad H. Wani, Abid Din, Reyaz Dar, Naseer Ah Mir
      Pages: 996 - 1000
      Abstract: Background: Supracondylar fractures of the humerus account for sixty percent of all fractures around the elbow in children. Delayed presentation of these fractures is very common even in developed countries. The aim of the present study was to evaluate the clinical, radiological and functional results following closed reduction (C/R) and percutaneous pinning of widely displaced supracondylar fractures of humerus. An objective of this study was to study supracondylar fractures of humerus in children in Skims medical College.Methods: A total 86 patients with displaced extension type supracondylar fractures (gartland type III) of humerus were managed by closed reduction and percutaneous fixation at Skims medical college after achieving optimal and satisfactory reduction. There were 52 boys and 28 girls. Average age was 6.69 years (range 2-12).Results: A total 86 patients were successfully treated with C/R and cross pinning. 6 patients were lost to follow-up. 80 patients with a minimum follow-up period of 12 months formed the basis of this study.Conclusions: C/R and pinning is effective method despite delayed presentation. Strict anatomical reduction and stable fixation minimises the risk of developing cubitus varus deformity.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203720
      Issue No: Vol. 6, No. 5 (2020)
       
  • Functional and radiological outcomes of intertrochanteric fractures
           treated with proximal femoral nail

    • Authors: Mayur Chopra, Sanjay Kumar Srivastava, Sumit Kumar, Deepak Kumar Mishra
      Pages: 1001 - 1007
      Abstract: Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203721
      Issue No: Vol. 6, No. 5 (2020)
       
  • Post-operative complications of displaced unstable distal end radius
           fracture treated by volar plating

    • Authors: Rajesh K. Ambulgekar, Vishal Gurnani
      Pages: 1008 - 1011
      Abstract: Background: Fracture of the distal radius (DRF) is one of the most common fractures present in emergency. The most common operative treatments of these fractures are open reduction and internal fixation with volar locking plates. The incidents and types of complications associated with the use of these operations is an ongoing process till date. The objective of the study was to find demographic profile of patients of displaced unstable distal end radius fracture, and to study the post-operative complications among above patients treated by volar plating.Methods: We performed a prospective study documenting types of complications and their occurrence in a group of patients who received open reduction and internal fixation. Our definition of a complication was a case in which the patient had one or more complications which required an intervention medical or surgical.Results: A total of 33 patients were included, most of the cases, (63.63%) were from the age group 21-40 years. We had 4 cases (12. 12%) females, and 29 cases (87.88%) males. Post-operative complications were noted in 7 individuals 22.2 % and no complications noted in 26 cases (78.8%). In 30 cases there was no any deformity found in postoperative one year follow up, 2 patients develop prominent ulnar styloid found in follow up of one year ,and 1 residual dorsal tilt found after one year.Conclusions: Our finding that 22.2% suffer from complication when treated using a volar locking plate must be taken into consideration when surgeons choose between conservative or operative treatment for DRF treatment. A few other studies have looked at the incidents of complications and have reported similar results.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203722
      Issue No: Vol. 6, No. 5 (2020)
       
  • Best technique for fixation of displaced transverse olecranon fractures:
           tension band wiring or plate fixation'

    • Authors: Lokesh Kumar Yogi, Gagandeep Mahi, C. R. Thorat, Moti Janardhan Naik
      Pages: 1012 - 1015
      Abstract: Background: Fractures of olecranon are common fractures in upper limb. Tension band wiring (TBW) and plate fixation (PF) are mostly used techniques but choice is based on type of fracture and surgeon’s preference.Methods:  A study assessed functional results in 28 patients that were enrolled after the clinical event of trauma has occurred. Patients were divided into two groups- Group (A) for TBW and Group (B) for PF; here gender, age and side of fracture were ignored. Post-operative functional outcome were evaluated by using the Mayo Elbow Performance (MEP) and the Disabilities of the Arm, Shoulder and Hand (DASH) score parameters.Results: Mean (SD) union time as determined by postoperative radiographs was 8.5 (1.48) weeks for group (A) and 9 (2.08) weeks for group (B). Mean (SD) MEP score at 9 months in group (A) 84.28 (7.28) and 80.71 (10.92) in group (B). Mean (SD) DASH at 9 months in group (A) 12.2 (8.8) and 11.7 (10.4) in group (B). Complications were reported in group (A) 6 patient (42.85%) out of 14 patients and in group (B) 1 patient (7.14%) out of 14 patients.Conclusions: The current study shows that there are no significant differences in functional outcome between both the study groups. Due to lesser complications, we recommend the plate fixation approach as the better choice for transverse displaced olecranon fractures. More large scale studies are required to further confirm our results.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203723
      Issue No: Vol. 6, No. 5 (2020)
       
  • Importance of calculating various casting indices in predicting
           radiological outcomes of paediatric forearm fractures

    • Authors: Pyntngen Kharbamon, Binoti A. Sheth, Pankaj Pawar, Siddhart Parekh, Rishabh Jaiswal, Umesh Kanade
      Pages: 1016 - 1021
      Abstract: Background: The present study is aimed at determining the importance of various casting indices in predicting the outcome of paediatric forearm fractures treated with closed reduction and plaster application in our department.Methods: Thirty children, aged 5 to 15 years, with closed forearm fractures not requiring surgical fixation were included to assess their casting indices and radiological outcomes using X-rays. After satisfactory casting, patients were followed up weekly till 6 weeks with anteroposterior (AP) and lateral X-ray.Results: Acceptable reduction was achieved in 26 cases, while re-manipulation was done in 4 cases. Cast Index ranged from 0.80±0.09 at first week to 0.78±0.09 at 6 weeks, Padding Index was 0.30±0.04 at first week and increased to 0.31±0.03 at 6 weeks, Canterbury Index was 1.07±0.24 at first week and 1.07±0.78 at 6 weeks, Gap Index 0.15±0.02 remained the same throughout, and Three Point Index changed from 0.81±0.08 at first week to 0.77±0.18 six weeks. Radial bow of children showed no significant change at various time points of assessment. Rotational mal-alignment was observed in 5 patients, one had a 0.5 cm radial overlap, while none had an ulnar overlap. Radial angulation was observed in five and six children on AP and lateral X-ray respectively. Ulnar angulation was seen in two and one child on AP and lateral X-ray respectively.Conclusions: Continued use of these casting indices to assess paediatric forearm cast adequacy is supported by this study.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203724
      Issue No: Vol. 6, No. 5 (2020)
       
  • Management of intercondylar femur fracture with distal femur locking
           compression plate: outcome analysis of 72 cases

    • Authors: Nadeem Ashraf Khan, A. M. Atif, Abhinandan Chatterjee
      Pages: 1022 - 1026
      Abstract: Background: Supra-condylar and inter-condylar fractures of the distal femur account for 7% of all femoral fractures and have always been difficult to treat and regaining full knee function is often difficult. The purpose of this study is to evaluate the functional outcome, fracture healing, complications of distal femoral intercondylar fractures managed by locking compression plate.Methods: Total 72 patients of intercondylar femur fracture were operated by ORIF with distal femur-locking compression plate via the standard swashbuckler approach. The functional outcomes were analyzed using modified hospital for special surgery scoring system.Results: Muller type C2 fracture was the most common fracture type with 50 out of 72 patients. The average range of motion achieved was about 99.03°±24.73° (Closed fractures =105.83°±19.41°and open fractures = 89.50°±28.36°). There was also a significant difference in the duration of operative time, 84.28±18.32 minutes for closed fractures and 98.46±22.47 minutes for open fractures. The average duration for radiological union was 14.52±2.21 weeks for closed and 17.20±2.44 weeks for open fractures. The average knee score was 80.13±13.38 using modified Hospital for Special Surgery score.Conclusions: Closed fractures have a higher range of motion and a better knee score compared to open fractures, supporting the fact that soft tissue compromise also affects range of motion and post-op rehabilitation of the limb. The outcome seems to correlate with the nature of injury i.e. high vs low velocity, type of fracture, anatomic reduction, associated injuries, time elapsed since injury to fixation and the stability of fixation.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203725
      Issue No: Vol. 6, No. 5 (2020)
       
  • Functional outcome following conservative management of acetabular
           fractures

    • Authors: Rajagopal H. P., Madan Mohan M., Binu T. Kurian, Ramesh L. J., Anoop Pilar, Keith Behram Tamboowalla
      Pages: 1027 - 1031
      Abstract: Background: Acetabular fractures are complex injuries caused due to high velocity injury and constitutes about 18 % of Pelvic fractures. To obtain articular congruency and anatomical reduction is the gold standard in treating these fractures. In this study we have studied about the functional outcome in acetabular fractures managed conservatively with the long-term follow.Methods: A retrospective study with prospective analysis done between 2011-2020 involved 39 patients with acetabular fractures who were treated conservatively at St John’s Medical college Hospital. Patients were followed up at 6 months, 1 year, 2 years and at the end of 5 years for functional evaluation and assessment with the clinical outcome scores with Merle d’Aubigne and Postel score & Harris Hip Score.Results: Study included 39 patients with the average age of 41.3 years with 31 male and 8 female patients. Functional outcome score showed good to excellent results in 80%, fair to satisfactory results in 18%, 0.5 to 2% had poor result in the patient analyzed with both Merle d’Aubigne and Postel score and Harris Hip Score. 80 % of the patients were able to sit cross legged, 90% had returned to regular work and 10% of the patients changed their occupation to desk jobs.Conclusions: Conservative management of acetabular fractures gives a good long-term result following congruent reduction of the fracture, good early rehabilitation and gradual weight bearing. Return to activity of daily living was good even in congruently reduced acetabular dome fractures with good to excellent functional outcome scores.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203726
      Issue No: Vol. 6, No. 5 (2020)
       
  • Injection of platelet rich plasma for low backpain caused by lumbar disc
           degeneration: a prospective study

    • Authors: M. Shanmugam, Shivakumar .
      Pages: 1032 - 1036
      Abstract: Background: Though the etiologies of chronic low back pain can be diverse, lumbar disc degeneration is one of the important causes of low backpain. In intractable cases of low back pain surgical interventions may be warranted. Intradiscal injection of platelet rich plasma is emerging as a novel treatment modality for chronic backpain and has been reported to have good results in terms of reduction of pain and improvement in functional abilities.Methods: This was a prospective study in which 30 patients with chronic low back pain were included. Platelet rich plasma was injected in nucleus pulposus of the affected part of lumbar spine under fluoroscopic control. Patients were followed up for 3 months. Reduction in severity of pain and functional improvement was assessed by Visual Analogue Scores (VAS) and Roland-Morris Low Back Pain and Disability Questionnaire (RDQ) scores.Results: The Mean age of the male patients was found to be 50.05±9.04 while the mean age of females was found to be 48.50±10.19. 18 (60%) patients were either overweight or obese. Remaining 12 (40%) patients had a normal BMI. The difference between mean VAS scores and RDQ scores at presentation and 3 months after PRP injection was found to be statistically highly significant (p<0.0001).Conclusions: The intradiscal injection of platelet rich plasma in patients with low back pain secondary to lumbar disc degeneration is effective in reducing back pain and causing significant functional improvement.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203727
      Issue No: Vol. 6, No. 5 (2020)
       
  • Clinical and functional outcome of elastic stable intramedullary nailing
           in pediatric femoral fractures in the age group of 5-16 years

    • Authors: Ajin Edwin, Ibad Sha I., Roshna S. R., Namitha Shah
      Pages: 1037 - 1042
      Abstract: Background: Fractures of the femur are the most incapacitating fractures. The best treatment for children between five to sixteen years of age is still debated. The ESIN has the benefits of early immediate stability to the involved bone segment, permitting early mobilization and return to the normal activities of the patients, respect for the physes, minimal scarring with lower complications. The purpose of this study was to present this study results following fixation of femoral shaft fractures with titanium elastic nails between the age 5-16 years of age.Methods: A total 52 patients in the age group of 5-16 years with femoral shaft fractures were stabilized using flexible nailing. Clinical and radiological follow-up was for a minimum period of 24 months. The final results were analysed using Flynn’s criteria.Results: Mean age at surgery was 7.4 years (range 5.6-14.3 years). The average duration of surgery was 65.3 (45-95) minutes and the mean duration of hospital stay was 8 (5-14) days. Skin irritation due to nail ends was the most common complication followed by significant lengthening (n=6), infection (n=2), significant shortening (n=2), varus angulation (n=2) and delayed union (n=2). The final outcome was excellent in 65.4% cases, satisfactory in 30.8% cases and three patients had poor outcomes as per Flynn's scoring criteria.Conclusions: In this study, ESIN showed good clinical and radiographic results in the age group 5 to 16 years, with minimal complications and high parent satisfaction consistent with previous studies but lesser number of mid adolescent age groups in the present study is a limitation.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203728
      Issue No: Vol. 6, No. 5 (2020)
       
  • Efficacy of proximal femoral nail augmentation in unstable
           intertrochanteric fracture

    • Authors: Purushotham V. J., M. Ayyub Khan, Navneeth Kumar
      Pages: 1043 - 1049
      Abstract: Background: To assess the short term functional and radiological outcome of unstable intertrochanteric fracture fixation using proximal femoral nail with augmentation using Cannulated Cancellous (CC) screw or Stainless Steel (SS) wiring.Methods: A prospective study was conducted with 20 cases of unstable intertrochanteric femoral fractures from May 2017 to March 2019. Six females and fourteen male patients in the age group between 40 and 80 years were included in this study. There were 8 cases of AO31A2 and 12 cases of AO31 A3. Fracture were fixed by proximal femoral nail with augmentation by an additional CC screw or encirclage with SS wires to strengthen the lateral trochanteric wall.Results: Fracture union was achieved in all cases with a mean period of 15.4 weeks. Patients were followed up for a period of 6 months. At the end of follow up the Modified Harris Hip Score was found to be more than 90 % in 16 cases.Conclusion: Augmentation of proximal femoral nail in unstable intertrochanteric fracture with additional screw or cerclage wire increases the efficacy and stability of construct, aiding union and expedition of time to union.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203729
      Issue No: Vol. 6, No. 5 (2020)
       
  • Comparative evaluation of management of intertrochanteric fracture femur
           with proximal femoral nailing versus dynamic hip screw

    • Authors: Navneet Adhikari, Chandra Shekhar, Ganesh Singh, Hardev Singh
      Pages: 1050 - 1056
      Abstract: Background: Fractures involving trochanteric region of femur are one of the common fractures affecting elderly population. Presently surgical treatment is the treatment of choice with early mobilisation as primary goal. The two most common implants that are used are Dynamic hip screw (DHS) and Proximal femoral nail (PFN).Methods: This was a prospective study with 50 patients divided randomly into two groups of 25 each. One group operated by PFN and other with DHS. Patients were evaluated periodically and final comparison between two group was done at six months for analysing results on the basis of Harris hip score.Results: At final follow up in patients in PFN group 9 (36%), 7 (28%), 5 (20%), 4 (16%) patients had functional grade in excellent, good, fair and poor category respectively. In DHS group patients, 7 (28%), 10 (40%), 6 (24%), 2 (8%) patients had functional grade in excellent, good, fair and poor functional grade. Harris hip score was insignificantly (p>0.05) lower in patients of PFN (82.68±12.28) than DHS (84.60±10.39).Conclusion: At final follow up we found that pain, limp, use of support while walking and hospital stay was less in PFN group. However, range of motion and hip functions were better in patients treated with DHS. Complications like Varus malunion and infection were common in DHS group while hip joint stiffness was seen more commonly in PFN group. So, both PFN and DHS in are comparable in respect to most of functional criteria for treatment of intertrochanteric fracture femur.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203730
      Issue No: Vol. 6, No. 5 (2020)
       
  • A prospective study on surgical fixation of complex supracondylar femur
           fracture with distal femoral locking compression plate: our experiences at
           a tertiary care centre

    • Authors: Rajesh Kumar Sharma, Anuradha Upadhyay, Rahul Parmar
      Pages: 1057 - 1062
      Abstract: Background: The optimal treatment of complex supracondylar femur fractures remains always challenging and controversial. the purpose of this prospective study was to evaluate the efficacy of distal femoral locking compression plate (DF-LCP) in terms of functional outcome and union rate for highly unstable complex supracondylar femur fractures and to determine the influencing factors of an unfavourable outcome.Methods: After obtaining approval from institutional ethics committee, 45 patients with complex supracondylar femur fractures were managed by open reduction and internal fixation with DF-LCP through lateral approach and as per standard protocol. The follow-up results were analysed clinically and radiologically, using the “Schatzker and Lambert criteria” at once in a month for first three months, once in three months up to one year and once in six months thereafter up to 2 years post-operatively.Results: In the present study, average duration of radiological union was 16 (range 12-22) weeks. The average range of motion of knee joint was 105 degrees. Out of 45 patients, clinical results were excellent in 48.9%, good in 17.8%, fair in 22.2% and poor in 11.1% patients according to Schatzker and Lambert criteria. Knee stiffness (7 cases), secondary arthritis (5 cases), and non-union (4 cases) were the main complications observed in this study, which were treated accordingly.Conclusions: DF-LCP holds the metaphyseal bone strongly and prevents metaphyseal collapse and mal-rotation in complex or highly unstable supracondylar femur fractures and simultaneously, it provides stable fixation to promote fracture union and allows early rehabilitation with acceptable complications.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203731
      Issue No: Vol. 6, No. 5 (2020)
       
  • A study on epidemiology of foot injuries in South Indian population at a
           tertiary care centre

    • Authors: Gopisankar Balaji, Sandeep Nema, Anand Kumar
      Pages: 1063 - 1069
      Abstract: Background: Knowledge of the epidemiology of foot injuries might be useful for implementing injury prevention programmes and for academic research purpose.Methods: This retrospective descriptive study was conducted on patients presenting with foot injuries to our emergency medical service department from May 2018 to April 2019.Results: Total 604 foot injuries were available for final evaluation. There were 461 male and 131 female patients. The mean age was 32.09 years.  The commonest mode of injury was road traffic accident. Total 192 feet had only soft tissue injuries while 412 had bony injuries. Total 140 of 323 cases of forefoot injuries were due to metatarsal fractures followed by 63 cases of proximal phalanx fractures. Among the midfoot injuries, Lisfranc fracture dislocation was more common accounting for 12 out of 38 cases. Calcaneal fractures were more common among hindfoot injuries accounting for 27 out of 45 cases.Conclusions: To conclude, foot injuries account for 13.4% of all musculoskeletal injuries. 68.2% accounts for bony injuries. Among foot bony injuries, forefoot injuries (78.4%) are more common.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203732
      Issue No: Vol. 6, No. 5 (2020)
       
  • Comparative study of modified Stoppa approach and ilioinguinal approach
           for pelviacetabular fractures

    • Authors: Ansari Muqtadeer Abdul Aziz, Venktesh D. Sonkawade, Shivkumar Santpure
      Pages: 1070 - 1076
      Abstract: Background: The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.Methods: Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.Results: Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.Conclusions: MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome. 
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203037
      Issue No: Vol. 6, No. 5 (2020)
       
  • Epidemiology and pattern of paediatric trauma in one of the biggest trauma
           centres of India

    • Authors: Abhijeet Kunwar, Birju Manjhi, Anand Saurabh, Shubhanshu Shekhar
      Pages: 1077 - 1081
      Abstract: Background: The objective of the study was to assess the epidemiology and pattern of trauma in paediatric patients coming to a tertiary care trauma centre in Purvanchal region of country.Methods: Study was conducted at Trauma Centre, Institute of Medical Sciences, BHU. A retrospective data was collected from the emergency entry record book for the paediatric patients coming to emergency with trauma from January to December 2018. A total of 328 patients were included in study. Patient with accidental hanging and those of sexual assault and drowning were not taken in study.Results: Patients in the age group of above 6 years were most numerous 61%. Boys were more commonly injured then girls of same age group with M: F being 1.4:1.  Fall was the most common mode of injury overall 45.12% and for the children below 6 years of age 63%. However, RTA was the most common cause in children of above 6 years age group 40.5%, closely followed by fall. Home was found to be the most common location of injury. Females outnumbered males in case of assault injury (7 of 12). Musculoskeletal injury was most common 42%, head injury 27%, polytrauma 12%, while superficial injuries in form of abrasion, contusion etc were 19%. Of all 42% were taken inpatient, 50% discharged on OPD basis and 8% went LAMA.   Conclusions: Most of the times the paediatric traumas occur in foreseeable circumstances, most of them occurring at home or around it suggesting the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. Planning of strategies should be according to the epidemiological trends.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203061
      Issue No: Vol. 6, No. 5 (2020)
       
  • Functional outcome of patients undergoing open rotator cuff repair

    • Authors: Albin Savio, Nishara M. S.
      Pages: 1082 - 1086
      Abstract: Background: Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon rather than injury from sports or trauma. Rotator cuff tear can be treated arthroscopically, arthroscopically assisted (mini-open) or by an open procedure. Because of the technical demands of arthroscopic repair many surgeons consider open repair for the treatment of rotator cuff tears. This study was done to evaluate the functional outcome of shoulder after open rotator cuff repair.Methods: 26 patients with partial and complete rotator cuff tears underwent open rotator cuff repair and acromioplasty. Cases were followed up at 3 months and 6 months intervals and shoulder function was assessed using Constant-Murley scoring system and compared with the preoperative scores and analyzed using SPSS software.Results: Mean preoperative constant score was 33.95±7.545 while the mean constant score at 6 months post-surgery was 79.83±8.51 which was highly significant according to paired t test. The difference between preoperative, 3 months and 6 months constant scores of complete and partial tear patients was found to be statistically significant.Conclusions: There was highly significant increase in Constant-Murley score after 6 months in patients treated by open rotator cuff repair. Open repair still stands as an effective treatment for rotator cuff tears and doing acromioplasty during the procedure adds to better outcome after surgery.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203733
      Issue No: Vol. 6, No. 5 (2020)
       
  • Difficult diagnosis of a neurogenic thoracic outlet syndrome and review of
           the current literature

    • Authors: Joao Maia Rosa, Arnaldo Sousa, Helder Fonte, Eva Pereira, Rita Sapage, Miguel Trigueiros
      Pages: 1087 - 1089
      Abstract: Thoracic outlet syndrome (TOS) is an uncommon disorder, without a clear clinical presentation or a fully accepted definition. The patients usually present a set of symptoms arising from compression of the brachial plexus or subclavian vessels during their passage through the thorax, between the base of the cervical region and the axilla. The authors present a case of a 20 years old woman with sporadic paresthesia in the territory of C7-T1 nerve root. At the physical examination she had a positive Wright's test. The imaging studies revealed the presence of a right cervical rib. A partial rib resection was performed with exploration of the braquial plexus and at the current follow up; 24 months after the surgery, the patient is asymptomatic. Our objective is to present a case of TOS and to highlight the clinical-management and treatment challenges of this pathology.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203734
      Issue No: Vol. 6, No. 5 (2020)
       
  • Total elbow arthroplasty for end-stage rheumatoid elbow arthritis with
           major instability: a case report

    • Authors: Diogo A. Sousa, Rita Sapage, Carlos Branco, Rita Sousa, Joao Reis, Antonio L. Lopes, Antonio G. Cruz
      Pages: 1090 - 1092
      Abstract: A 73 years old female diagnosed with rheumatoid arthritis for over 30 years with an end-stage right elbow arthritis (stage V of Larsen’s classification) with a major instability. The patient presented gross deformity and severe pain with critical limitation of limb function. The patient was treated with a total elbow arthroplasty with an intraoperative olecranon fracture. At six months follow up, the patient presents with an excellent active range of motion and painless joint, without daily activities limitation.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203735
      Issue No: Vol. 6, No. 5 (2020)
       
  • Intrapelvic migration of the hip screw of a proximal femoral nail: report
           of two cases and review of the literature

    • Authors: Mazen A. Abdalla, Leon T. Oikonomou, Konstantinos A. Giannikas
      Pages: 1093 - 1099
      Abstract: Two cases of medial migration of the hip screw in cases of cephalon-medullary nailing for the treatment of extra-articular proximal femoral fractures are reported. The first case was revised to hemiarthroplasty, that was subsequently complicated with infection and death of the patient, while the second was revised to a similar devise with favorable outcome. A review of the literature is performed in order to identify the contributing factors that result in the medial migration of the hip screw. Emphasis is given in further reporting of similar cases in order to abolish this potentially lethal complication.   
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203736
      Issue No: Vol. 6, No. 5 (2020)
       
  • Necrotizing fasciitis caused by Pseudomonas aeruginosa: a rare case report
           and recent concepts in diagnosis and management

    • Authors: Naresh Kumar, Akshay Lamba, Jyotirmay Das, Avik K. Neogi, Kunal Arora, Surinder Jaiswal, Mayank Jain, Sargam Chhabra, Urvashi Sharma, Navdeep Malik
      Pages: 1100 - 1103
      Abstract: Necrotizing fasciitis caused by Pseudomonas aeruginosa is an extremely rare and life threatening bacterial soft tissue infection. Here we report a case study of fully established necrotizing fasciitis associated with monomicrobial pseudomonas infection in a 34 years old male. The patient presented with painful, necrosed areas of skin and soft tissue over right gluteal region which rapidly progressed to right upper back. Aggressive supportive measures and early debridement lead to a full recovery with no functional deficits.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203484
      Issue No: Vol. 6, No. 5 (2020)
       
  • Tumour induced osteomalacia: a diagnostic challenge and its implications
           in orthopaedic surgery

    • Authors: Shivkumar Santpure, Ansari Muqtadeer Abdul Aziz, Gagandeep Mahi, Lokesh Kumar Yogi
      Pages: 1104 - 1108
      Abstract: Tumor-induced osteomalacia (TIO) is a paraneoplastic phenomenon which encompasses a wide array of clinical features ranging from musculoskeletal pain to pathological fractures. An excess of fibroblast growth factor 23 (FGF23) is produced which is a parahormone with its target receptors in proximal convoluted tubules of glomeruli. This results in decreased blood phosphate levels and decreased hydroxylation of 25-OH vitamin-D, ultimately leading to osteomalacia. Compliance with medical treatment is unsatisfactory and tedious owing to repeated dosing schedules and overwhelming side effects. Surgical excision of the lesion is the only suitable treatment.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203036
      Issue No: Vol. 6, No. 5 (2020)
       
  • Juxta articular osteoid osteoma of the calcaneum: a rare case report

    • Authors: Gunjan Upadhyay
      Pages: 1109 - 1111
      Abstract: Osteoid osteoma of calcaneum in a juxta-articular position is a rare finding, it is most often misdiagnosed. It mimics as arthritis. Osteoid osteoma is benign bone neoplasia mostly in male in 2nd - 3rd decade of life. It has typical features of night pain relieved with salicylates. 35 years old female present with right heel pain. Mother has positive history of rheumatoid arthritis. X-ray and computer tomography were done for diagnosis. Diagnosis was made of juxta –articular position of osteoid psteoma in the calcaneum. Lesion was excised after pre-anesthesia checkup and sent for histopathology. Once investigation was done diagnosis was made as an osteoid osteoma in juxta articular position of calcaneum. Treated by excision of the lesion surgically and specimen sent for biopsy which confirm osteoid osteoma.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203737
      Issue No: Vol. 6, No. 5 (2020)
       
  • Surgical excision of a solitary osteochondroma arising from the lesser
           trochanter in an adult: a case report

    • Authors: Swapnil Keny, Aditya Dahapute, Swapneel Shah, Nandan Marathe
      Pages: 1112 - 1116
      Abstract: The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203738
      Issue No: Vol. 6, No. 5 (2020)
       
  • Tuberculosis of sternoclavicular joint: a rare case report

    • Authors: Atil Kumar Lal, Sudhir Shyam Kushwaha, Ajay Bharti, Mahima Pandey
      Pages: 1117 - 1119
      Abstract: Osteoarticular tuberculosis comprises 10-15% of the all cases of extrapulmonary tuberculosis. Tubercular involvement of the sternoclavicular joint is very rare. We hereby present a rare case report of the 38 year old female with sternoclavicular joint tuberculosis with cold abscess. The diagnosis was confirmed by FNAC and on ZN staining AFB was isolated. Patient was managed successfully by the anti-tubercular therapy at the end of the treatment. So, a degree of suspicion of the tuberculosis at these rare sites along with investigation followed by anti-tubercular therapy leads to successful treatment of the disease.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203739
      Issue No: Vol. 6, No. 5 (2020)
       
  • Tardy posterior interosseous nerve palsy associated with operated proximal
           shaft of radius fracture: a rare case report

    • Authors: Amit Bansal
      Pages: 1120 - 1122
      Abstract: Tardy Posterior interosseous nerve palsy (PIN) is rare diagnosis. It is a mostly motor nerve. It is prone to injury around radio-humeral joint due to its proximity to joint and neck of radius. Early diagnosis is must to improve recovery. In our case, 39-year-old male presented with tardy PIN palsy secondary to united proximal shaft radius fracture with implant in situ. Electrodiagnostic studies revealed motor radial neuropathy left upper limb. Magnetic resonance imaging (MRI) brachial plexus and screening of cervical spine was normal. After preoperative investigation, patient underwent PIN neurolysis with plate removal. Postoperatively patient started showing improvement after 2 months. Patient recovered to achieve good grip at end of 8 months. Early diagnosis followed by nerve exploration is necessary for good recovery and improvement.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203740
      Issue No: Vol. 6, No. 5 (2020)
       
  • A controlled diaphyseal expansion osteotomy for the implantation of a
           wagner cone prosthesis in a stenotic femoral canal encountered in a polio
           limb: a case report of the technique

    • Authors: Tushar S. Kadam, Mohan M. Desai
      Pages: 1123 - 1129
      Abstract: Dysplastic hips pose a significant technical challenge to arthroplasty surgeons. Such deformed hips might be encountered either in congenital and developmental conditions or as sequel of neuromuscular disorders (like poliomyelitis), following infections, or after childhood surgical procedures of the hip. The scientific literature, focussing on total hip arthroplasty (THA), for coxarthrosis in patients with residual poliomyelitis, is relatively rare. Several anatomical distortions seen in dysplastic femurs are described, one of which includes an undersized diaphysis with a stenotic medullary canal. We present a case of a 28 years old male with residual poliomyelitis who underwent a cementless THA for a non united transcervical neck of femur fracture. The patient had an extremely narrow medullary canal which posed a formidable difficulty in the procedure. This was overcome by a novel diaphyseal expansion osteotomy, which enabled the implantation of Wagner Cone prosthesis. This technique, which has hitherto not been described in the literature, can significantly facilitate the implantation of an appropriately sized stem in an undersized femur while at the same time ensuring a good long-term result.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203741
      Issue No: Vol. 6, No. 5 (2020)
       
  • Salter-Harris type II fracture of the middle phalanx with concomitant
           central slip injury in an 11 year old: a case report

    • Authors: Devan O. Higginbotham, Andrew G. Tsai
      Pages: 1130 - 1134
      Abstract: An 11-year-old male sustained an irreducible, completely displaced epiphyseal fracture of the proximal interphalangeal joint (PIPJ) of the middle finger with an associated central slip injury. Central slip injuries occurring in conjunction with Salter-Harris type II middle phalanx fracture are rare entities, with no previously documented case. Our patient underwent open reduction, internal fixation through crossed-pins to achieve reduction and fixation. He was then splinted in extension for six weeks to allow healing of the central slip injury. At 1-year follow-up, the patient had full range-of-motion with no clinical indication of physeal disruption or growth arrest of the repaired digit. We demonstrate a case in which ephiphyseal fractures of the proximal interphalangeal joint with a concomitant central slip injury can safely be treated with open reduction internal fixation combined with a period of immobilization. We characterize a surgical method of reduction and fixation with splinted immobilization and describe lessons learned from this previously unreported case.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203742
      Issue No: Vol. 6, No. 5 (2020)
       
  • Plexiform or multinodular schwannoma of posterior tibial nerve: case
           report with review of literature

    • Authors: Prahalad Kumar Singhi, Sivakumar Raju, Somashekar V., Bharat Kumar, Anil Kumar
      Pages: 1135 - 1138
      Abstract: A schwannoma is a benign tumor that develops from the Schwann cells, which assists conduction of nerve impulses and located in the nerve sheath of peripheral or cranial nerves. Plexiform or multinodular Schwannoma of posterior tibial nerve is a rare presentation, can cause diagnostic dilemma with Lumbosacral radiculopathy, Tarsal tunnel syndrome, Entrapment neuropathy or Chronic regional pain syndrome. Unexplained leg pain, a positive Tinel's sign with or without a palpable swelling and Magnetic Resonance Imaging will clinch the diagnosis after excluding other causes. In symptomatic cases with long standing complaints, surgical resection yields satisfactory outcome. We present an interesting case of plexiform schawannoma along posterior tibial nerve with review of literature.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203743
      Issue No: Vol. 6, No. 5 (2020)
       
  • Long term outcome of ipsilateral dislocation of open displaced elbow with
           close shoulder dislocation: a case report

    • Authors: Vitthal Bhardwaj, Kuldeep Nahar
      Pages: 1139 - 1141
      Abstract: 52 years old man presented with open dislocation of elbow due to road traffic accident was not complaining of another joint injury or pain was radiographed as per protocol of including the adjacent shoulder joint and incidentally discovered with anterior dislocation of shoulder was treated with close reduction of shoulder dislocation and debridement  as well as reduction and trans fixation of ulno-humeral joint with k-wires. Skin coverage later was done. Patient recovery was excellent in terms of motion at both joints. The purpose of reporting of this case is to convey a message that ipsilateral dislocation of shoulder and elbow is a very rare occurrence but do occur and a high degree of suspicion and imaging protocol can save from missing this event.
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203744
      Issue No: Vol. 6, No. 5 (2020)
       
  • Fracture of neck of femur with fracture of posterior column of acetabulum:
           a rare case of floating hip

    • Authors: Avik K. Neogi, Naresh Kumar, Jyotirmay Das, Akshay Lamba, Abhishek Garg, Ankush Kundu, Pritam Yadav, Sachin Sachdeva, Ipanshu Malik, Neeraj Khare
      Pages: 1142 - 1144
      Abstract: Injuries around the hip joint are one of the most common orthopedic injuries and these types of injuries are grossly debilitating until treated properly. Simultaneous occurrence of fracture of proximal femur with fracture of ipsilateral acetabulum or pelvis is termed as floating hip injury. These injuries are very rare, only to be found 1 in 10,000 as well as there is lack of literature support regarding proper treatment protocol. Here we are going to present a case of fracture of neck of left femur along with fracture of left acetabulum in a 45 years old male undergone road traffic accident. 
      PubDate: 2020-08-26
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20203485
      Issue No: Vol. 6, No. 5 (2020)
       
 
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