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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]
  • The influence of retropatellar fat preservation on the positioning of the
           tibial component of total knee arthroplasty

    • Authors: Rodrigo B. Vieira, Mateus R. Muniz, Filipe S. Santos
      Pages: 855 - 862
      Abstract: Background: The good clinical-functional outcomes of total knee arthroplasty (TKA) depend on several factors, such as the surgical time and the adequate positioning of the prosthesis components. The present study aims to evaluate whether the preservation of retropatellar fat pad during the surgical act influences the rotational alignment of the tibial component and the surgical time of the procedure. Methods: The study was carried out with 50 patients operated on by the main author, who were randomly divided into two groups, experimental and control. For the evaluation of the positioning of the tibial component, the patients underwent computed tomography (CT) four weeks after the surgery, on average. Casuistry was determined by pilot study with the first five patients of each group. For the sample calculation, the t-student test was used for two independent samples. Results: All patients presented internal rotation of the tibial component, with no statistical difference in mean rotation between the experimental and control groups. When there was complete detachment of the fat in the experimental group, the tibial component showed greater external rotation, with a statistical difference. Surgical time was shorter in the experimental group, varying in this group according to the degree of osteoarthrosis. Conclusions: Maintenance of retropatellar fat pad did not influence the rotational alignment of the tibial component; however, in patients with advanced osteoarthrosis, such maintenance increases the surgical time.
      PubDate: 2023-07-18
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232179
      Issue No: Vol. 9, No. 5 (2023)
  • Comparison of calcareous replacement hemiarthroplasty and proximal femoral
           nail in elderly ıntertrochanteric femur fractures

    • Authors: Deniz Erkmen, Ozdamar F. Oken, Yunus Demirtaş
      Pages: 863 - 869
      Abstract: Background: In this study, a retrospective evaluation was made of patients aged 70 years and over who were applied with proximal-femoral nail (PFN) or calcareous replacement cemented hemiarthroplasty in respect of early and late-stage morbidity and mortality and functional personal independence. Methods: The study included a total of 77 patients aged over 70 years with an AO type 31-A1 or 31-A2 fracture. The patients were separated into two groups as those applied with proximal femoral nailing and those applied with calcar replacement hemiarthroplasty. Statistical comparison was made of the groups in respect of preoperative age, comorbidities, type of anaesthesia, ASA score, and fracture type, and postoperative amount of blood loss, albumin decrease, wound complications, other complications, Harris hip functional scores, Barthel daily living activity index, mortality rates. Results: The two groups were found to be similar in respect of age, gender, comorbidities, AO fracture type and type of anaesthesia. The operating time was shorter in the proximal femoral nailing group. The Harris hip scores and the Barthel daily living activity ındex values were similar in both groups. Rates of wound infection were higher in the hemiarthroplasty group. Mortality rates at one month, six months and one year were similar in both groups. Conclusions: Proximal femoral nailing can be one of the primary treatment options for intertrochanteric hip fractures in the elderly. Furthermore, although functional results and mortality rates are similar, as cemented calcar replacement hemiarthroplasty has serious life-threatening complications, it should not be the first choice of treatment method.
      PubDate: 2023-08-03
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232462
      Issue No: Vol. 9, No. 5 (2023)
  • Efficacy of postural awareness by booklet on back pain among the sweet

    • Authors: Anawarul Q. Nazim, S. M. Mustofa Kamal, Kutub Uddin, Joy K. Sheel, Pangkaz K. Dash, M. Majidur Rahman, Sabrina Z. Shova
      Pages: 870 - 875
      Abstract: Background: The purpose of the study was to identify the efficacy of postural awareness by a booklet on back pain among sweet makers. Objective was to explore socio-demographic (age, gender, educational status, occupation) characteristics of sweet-makers with back pain. To compare the rating of pain intensity before and after postural awareness by a booklet with the back pain of sweet-makers. Methods: This study was conducted by pre-test post-test experimental study in which a total of 25 sweet-makers were selected with back pain from January 2021 to December 2022. Data were collected by using the functional rating index questionnaire to evaluate the activity of daily living and pain measured by the visual analogue scale questionnaire. Statistical package for the social sciences (SPSS) was used for data analysis. Results: In this study, the results showed significant improvement in the reduction of back pain and increase functional activities of daily living by postural awareness with an educational booklet among sweet-makers. The NPRS score in pair sample t-test before and after 15 days of postural awareness by booklet was the level of significant 0.000123, the mean of 0.640±0.700. The pattern of pain before and after 15 days of postural awareness by booklet was the level significant 0.042896 when the mean difference was -0.160±0.374. The referred pain before and after 15 days of postural awareness by booklet was 0.000032 level significant where the mean difference was -0.520±0.510. Conclusions: The result of this study suggests that postural awareness through a booklet on back pain was effective and it also improves activities of daily living among sweet-makers.
      PubDate: 2023-07-18
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232180
      Issue No: Vol. 9, No. 5 (2023)
  • The role of concomitant vitamin D3 and K2 treatment after laminectomy in
           spinal stenosis surgery of patients with osteoporosis

    • Authors: Abdulsamet Emet, Yunus Demirtas
      Pages: 876 - 880
      Abstract: Background: Readmission because of ongoing pain and complaints who undergone spinal surgery with osteoporosis is increasing. This study investigated the efficacy of concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis. The aim of the study was to treatment strategy is to reduce the patient’s low back pain and decrease readmission rates due to ongoing pain. Methods: A total of 22 patients with osteoporosis included in the study who had lumbar decompression via laminectomy surgery with posterior instrumentation for spinal stenosis. Patients were divided into groups according to use additional supplement of vitamin D3+K2. Group 1 was control group who received only vitamin D3 and group 2 was patients who received vitamin D3+K2 treatment. Patients were called to their sixth month check-up and their pre-and post-treatment VAS scores and Roland-Morris scores were filled in and readmission rates due to ongoing pain were compared. Results: 9 male and 13 female participants with a mean age of 64.4 were in the study. The mean T-score in bone mineral density (BMD) was -2.7 in group 1 and -2.6 in group 2. A significant difference was found when the pre-operative and post-operative VAS and RM scores of all patients were compared (p<0.05). The mean readmission rates due to ongoing pain is 4 in group 1 and 7 in group 2. A significant difference was found when readmission rates due to ongoing pain were compared (p<0.05). Conclusions: Concomitant vitamin D3 and K2 usage in the surgical treatment of patients with lumbar spinal stenosis who have osteoporosis is a valuable treatment option to reduce the rate of admission to the hospital because of ongoing pain.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232603
      Issue No: Vol. 9, No. 5 (2023)
  • Comparison of Lapidus procedure fixation methods for hallux valgus: a
           10-year retrospective analysis

    • Authors: Akshatha Daniel, James Peaty
      Pages: 881 - 887
      Abstract: Background: The purpose of this study was to identify the type of Lapidus fixation method used in Leeds Teaching Trust Hospital that produces the best post-operative radiographical measurements. Methods: Thirty-five patients who underwent the Lapidus procedure were reviewed. Pre-operative and post-operative X-rays were measured to obtain angles; hallux valgus angle (HVA), first intermetatarsal angle (IMA), distal metatarsal articulate angle (DMA), meary angle (MA), and metatarsal declination angle (MDA). The fixation groups compared were dorso-medial plate vs dorsal plate vs medial plate and plate-single screw versus plate-crossed screw. The change in angle (Δ-angles) between pre-operative and post-operative were measured and the groups were compared. The fixation method that resulted in the largest Δ-angles and is statistically significant will be regarded as a superior fixation type within that group. Results: Groups with plate-single screw fixation showed a statistically significant (p<0.05) larger change in distal metatarsal articulate angle compared to plate-crossed screw fixation. Dorso-medial plate showed largest Δ-angles in the plate group although none were statistically significant. Conclusions: Fixation systems with single-screw result in better radiographical measurements compared to crossed-screws, significantly with the distal metatarsal articular angle. Dorso-medial plates result in better radiographical measurements followed by dorsal plate and then medial plate. However, these findings need validation with a randomized controlled trial before being generalized.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232604
      Issue No: Vol. 9, No. 5 (2023)
  • Employing machine learning to predict adverse acute post-surgical outcomes
           following elective ulnar collateral ligament reconstruction

    • Authors: Trevor R. Case, Richard C. Rice, Andrew J. Cabrera, Mikayla Kricfalusi, Prathyusha Dasari, Jose Jesurajan, David E. Ruckle, Adam LaFleur, Christopher M. Jobe, Hasan M. Syed
      Pages: 888 - 895
      Abstract: Background: Ulnar collateral ligament reconstruction ameliorates valgus elbow instability in various patient populations, including overhead athletes, patients with acute UCL rupture following high energy trauma, and those with chronic, subclinical elbow laxity. This study aims to explore machine learning algorithms to identify risk factors in patients undergoing elective UCL reconstruction in the ambulatory setting to predict postoperative outcomes. Methods: RStudio was used to create a filtering code to identify adult patients who underwent elective UCL reconstruction from 2008 to 2018 in the American college of surgeons national surgical quality improvement program database. Patients were analyzed using six ML algorithms, which were trained to predict outcomes such as extended length of stay, non-home discharge, and adverse events based on various patient characteristics and surgical variables. Algorithmic performance was then assessed and top performing algorithms underwent further analysis to determine relative feature importance using a permutation feature importance method. Results: ML exhibited excellent performance in predicting LOS, with an average AUC of 0.953, similar to that of logistic regression. Regarding NHD, ML demonstrated a 60.8% increase in AUC compared to LR. In predicting AAE, ML achieved an average AUC that was 12.7% higher than LR. Conclusions: The highly predictive capability of ML indicates the possibility to represent a procedure-specific complementary tool for the preoperative risk stratification process. This study provides a comprehensive analysis of UCL reconstruction in the management and outcomes of any patient, regardless of age or activity level.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232605
      Issue No: Vol. 9, No. 5 (2023)
  • Traumatological emergencies: epidemiological and problematic aspects of
           care in the orthopedics traumatology department of the CHU Ignace Deen in

    • Authors: Tafsir Camara, Mohamed Lamine Bah, Mohamed Sidibe, Fode Mahamoud Sylla, Hippolyte Nassaaradenger Madjirabe, Mamadou Alpha Bah, Mohamed Youla, Karinka Keita, Mamadou Moustapha Diallo, Leopold Lamah
      Pages: 896 - 899
      Abstract: Background: A trauma emergency is any aggression (direct or indirect) external to the body for which no therapeutic delay is allowed at the risk of endangering the patient's life or the functional prognosis of his limbs. The objective of this study was to report the results of the management of traumatological emergencies. Methods: This was a descriptive cross-sectional study from 11 January 2021, to 11 July 2021. It focused on patients seen for traumatological emergencies in the CHU Ignace Deen Orthopaedics-Traumatology department. Results: Trauma emergencies constitute 75.2% of admissions to the emergency department. The average age of the patients was 32.2 years, with extremes of 1 and 91 years. There was a predominance of 76.3% males with a ratio (M/F) of 3.2. Road traffic accidents were the most found aetiology in 82.9%, and motorcycles were involved in 68.7%. Limb fractures were found in 34.7%. The treatment time was ≤6 hours in 67.5%, and 203 patients received drug treatment, i.e., 49.7%. Conclusions: Trauma emergencies constitute, by their frequency and seriousness, a real public health problem in Africa in general and in Guinea in particular.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232606
      Issue No: Vol. 9, No. 5 (2023)
  • Pain reduction and tolerance of type II undenatured collagen in patients
           with knee osteoarthritis

    • Authors: Tomás F. Fernández-Jaén, Carlos González de Vega, Paula Saiz, Per Björk, Elena Rodríguez-Iñigo, Juan Manuel Lopez-Alcorocho, Franchek Drobnic, Pedro Guillén-García
      Pages: 900 - 907
      Abstract: Background: Osteoarthritis (OA) is the most common cause of pain and disability in adults. Dietary supplements such as undenatured type II collagen (UC-II) have shown to have some benefits in OA treatment. This study aimed to assess changes in pain levels among knee OA patients treated with UC-II for 6 months. Methods: Patients with knee OA of any grade were given a daily 40 mg dose of UC-II (CondroArtil®) as a dietary supplement for 6 months. Pain levels were measured using the visual analog scale (VAS) before starting UC-II 6 months thereafter. A total of 100 patients (62/38: male/female) with a mean age of 46.3±13.8 years participated in the study. Most patients (60%) had mild to moderate OA (grade I or II). Results: The UC-II supplementation was shown to significantly reduce pain levels (p<0.001) with a negative correlation between pain reduction and age (p=0.006) and BMI (p=0.049). The OA severity also affected pain reduction (p=0.011), with grade II OA experiencing higher pain levels. Previous physical therapy and food supplements had a significant impact on pain reduction (p=0.017 and p=0.012, respectively). Conclusions: The study suggests that UC-II is an effective treatment for reducing pain in patients with knee OA.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232607
      Issue No: Vol. 9, No. 5 (2023)
  • Functional outcome after total hip replacement surgery

    • Authors: Syed Israr Kamal, Lutfar Rahman Chowdhury
      Pages: 908 - 912
      Abstract: Background: Total hip replacement (THR) surgery is a common and effective procedure to alleviate pain and improve function in patients with hip joint disorders, such as osteoarthritis. The aim of this study was to assess the functional outcome after THR surgery. Methods: This cross-sectional study was conducted in department of orthopedics, medical college for women and hospital and other hospitals in Dhaka, Bangladesh, during the period from March 2017 to March 2022. The sample size was 120. Results: In this study, mean age was 65.3 (SD±9.8) years and majority (52.5%) were male. At the 12-month follow-up, PCS scores improved, while MCS scores slightly decreased. Physical function, mental health, and PROM scores of Harris hip score (HHS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), and EQ-VAS showed significant improvements. Gait speed exhibited a minor decrease. The complications observed included superficial infection in 6 patients (5.0%), femoral nerve palsy in 9 patients (7.5%), hip dislocation in 7 patients (5.8%) and etc. Overall, 81.67% had an excellent functional outcome, 11.67% had a good outcome, and 6.67% had a fair outcome after surgery. Conclusions: The findings of our study demonstrate significant improvements in functional outcomes and PROMs following THR surgery.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232608
      Issue No: Vol. 9, No. 5 (2023)
  • Knee stiffness post anterior cruciate ligament reconstruction- factors to
           worry about

    • Authors: Al-Muthana M. A. Yamani, Naser F. Shari, Mohammad A. Abushahot, Ashraf F. Omor, Nizar A. A. Alannaz
      Pages: 913 - 917
      Abstract: Background: Knee stability is affected by integrity of anterior cruciate ligament (ACL). Knee stiffness is a worrying postoperative complication, preventing patients from returning back to pre-injury sport level. In this study, we analyzed incidence of knee stiffness post ACL reconstruction and possible associated risk factors. Methods: This is retrospective study, was held in Royal Medical Services/Jordan–Queen Alia Military hospital/Arthroscopic and Sport injuries division. We analyzed 250 patients’ data using computerized patients record system (CPRS) called Hakeem complaining of knee stiffness post ACL reconstruction between July 2022 and July 2023, whom ACL reconstructive surgeries were performed between March and September 2022. Results: Incidence of knee stiffness post ACL reconstruction is about 1.5% (4 out of 250). All of those 4 patients were males,3 of them had limited flexion (75%), while 1 of them had limited extension (25%). All of the 3 patients having extension contracture had an associated medial meniscus tear, repaired at time of ACL reconstruction, while flexion contracture patient had an isolated ACL tear. Conclusions: Incidence of knee stiffness post ACL reconstruction is about 1.5%. 75% of patients were associated with medial meniscus tear, who underwent meniscus repair and hinged knee brace was applied. We conclude that ACL patients having an associated meniscus tear managed by meniscus repair and hinge knee brace are at higher risk to develop knee stiffness. Therefore, we recommend limiting the usage of knee brace for ACL reconstruction with meniscus repair only.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232609
      Issue No: Vol. 9, No. 5 (2023)
  • Comparative analysis of the clinical, functional and radiological outcomes
           of proximal femoral nail alone verses proximal femoral nail along with
           lateral wall plating in management of unstable intertrochanteric femur
           fracture, AO/OTA, type 31A2 fractures with deficient lateral wall

    • Authors: M. B. Lingayat, Yogendra Agiwal, Visakh V.
      Pages: 918 - 927
      Abstract: Background: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating. Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared. Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B. Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better.
      PubDate: 2023-08-10
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232485
      Issue No: Vol. 9, No. 5 (2023)
  • Ultrasonographic evaluation of anatomical variations, of the first dorsal
           compartment of wrist, and its correlation with de Quervain’s disease
           recurrence in Indian population: a hospital based longitudinal study

    • Authors: Soutrik Mukherjee, Amlan J. Roy, Prasun Mandal
      Pages: 928 - 933
      Abstract: Background: de Quervain’s disease is a commonly encountered debilitating condition mostly treated conservatively. Cadaveric studies have revealed anatomical variations in the first dorsal compartment of the wrist; however, a causal association between the variants and recurrence of the disease has not been established. An ultrasonographic assessment of the first dorsal compartment of the wrist was done, to correlate the response to treatment, of the different anatomical variants. Methods: 106 wrists were included in the study after clinically confirming de Quervain’s disease. All were injected with 20mg of methylprednisolone acetate in the first dorsal compartment of the wrist and were followed up. Patients who were pain free for at least six months, as well as patients who did not respond or had a recurrence of disease within eight to twelve weeks, were all assessed with ultrasound. Results: 57.54% of the wrists were cured with one injection most of which revealed a tendon arrangement of one abductor pollicis longus (APL) and one extensor pollicis brevis (EPB) and two APL and one EPB without any septation. 32.07% of the wrists did not respond to this treatment and most of them comprised of septations and aberrant compartments with presence of supernumerary tendons. Conclusions: Ultrasonographic assessment of the first dorsal compartment of wrist, of all patients suffering from de Quervain’s tenosynovitis must be done to predict the outcome of conservative therapy and customize an optimal treatment modality for the individual anatomical variant.
      PubDate: 2023-07-11
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232155
      Issue No: Vol. 9, No. 5 (2023)
  • An open-label, multicenter, randomized, parallel, single-dose, comparative
           bioavailability study of two triamcinolone hexacetonide injectable
           suspensions in patients with knee osteoarthritis

    • Authors: Kaushal Anand, Praganesh Kumar, Sameer Haveri, Shivani Acharya, Anadya P. Tripathi, Milind Bhole, Deeksha Malhotra
      Pages: 934 - 941
      Abstract: Background: Triamcinolone hexacetonide (THA), a synthetic glucocorticoid with low solubility, can provide sustained pain relief and less systemic side effects in patients with knee osteoarthritis. This study aimed to characterize pharmacokinetic profile of THA-test product containing 20 mg/ml injectable suspension and compare its bioavailability with the standard reference in Indian patients with knee osteoarthritis. Methods: In this open-label, randomized, multicenter study, 44 adult patients were randomized (1:1; test n=23, reference n=21) to receive a single dose of test or reference products. The primary objective was to characterize the pharmacokinetic profile and compare bioavailability of both products via serum triamcinolone acetonide (TCA) concentration. Secondary objectives included safety and tolerability evaluation, impact on hypothalamic-pituitary-adrenal axis, and efficacy of test and reference products in reducing index knee pain. Results: Both products were absorbed with a median Tmax of 23.9 hours. Comparative bioavailability analysis demonstrated no statistically significant formulation effect for ln-transformed Cmax (1098.052 pg/ml for test, 1333.850 pg/ml for reference) and AUC0-t (159112.561 pg×h/ml for test, 211531.035 pg×h/ml for reference) for TCA. T/R ratio for Cmax was 82.3% and T/R ratio for AUC0-t was 75.2%, with >100% inter-subject variability for both Cmax and AUC0-t. Additionally, recovery time of cortisol levels of test and reference arms was 96 hours and 456 hours, respectively. Both products significantly reduced knee pain (p<0.0001). Conclusions: The test product provided lower systemic exposure and faster recovery of serum cortisol levels than the reference, while still providing similar beneficial effect in sustained index knee pain reduction.
      PubDate: 2023-07-17
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232171
      Issue No: Vol. 9, No. 5 (2023)
  • Ossification of yellow ligament-lesser known common cause of thoracic
           myelopathy in Indian subcontinent treated surgically

    • Authors: Vishnu Nair, Abhijith Shetty, Vishal Kundnani, Mukul Jain, Sunil Chodavadiya
      Pages: 942 - 951
      Abstract: Background: To undertake a study which outlines the clinical and radiological features of ossification of yellow ligament (OYL) causing thoracic myelopathy (TM) in Indian subcontinent, to assess the outcomes of surgical resection of yellow ligament and compare different preoperative factors that contribute to be a risk factor in the overall post-surgical recovery rates (RR). Methods: A retrospective analysis of prospectively collected data from a cohort of 45 patients who visited our spine OPD from January 2012 to December 2019 who underwent surgical decompression for TM due to OYL was studied. The surgical outcomes and RR were calculated, compared and pre operative risk factors which could possibly be involved in giving poorer RR were analysed. Results: Our study included 45 patients who underwent surgical resection of OYL for TM. On comparison of post operative improvement in myelopathic symptoms, pre-operative mJOA score of 4.56 had increased significantly to 7.83 at 2 years follow up. While the majority (80%) of patients had an excellent and good recovery rate while 16% of patients had a fair recovery rate and 4% had no change at all in comparison to pre-operative mJOA scores. Preoperative risk factors for poor outcomes were also analysed. Conclusions: Early and timely before the onset or progression of any neurologic involvement. The pre operative risk factors which could give guarded prognosis and lower RR are, the presence of intramedullary signal changes (myelomalacia), >6-10 months of progressive pre operative symptoms and an mJOA<5.
      PubDate: 2023-07-11
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232156
      Issue No: Vol. 9, No. 5 (2023)
  • Outcome of ganglion impar block in chronic coccydynia

    • Authors: Muhammad Farooq Butt, Tanveer Ahmed Bhat, Zubair Ahmad Lone, Sanjeev Gupta, Abdul Ghani
      Pages: 952 - 955
      Abstract: Background: Chronic coccydynia is an annoying condition and is characterized by pain in the tail bone. Most cases are treated conservatively initially but failed conservative management calls for interventions of various type. One of the interventions in the armamentarium of the orthopaedic surgeon is a ganglion impar block. The present study aimed at assessing the outcome of ganglion impar block in chronic coccydynia. Methods: This prospective study of five years duration included 27 patients with chronic coccydynia with failed conservative treatment. Visual analogue score (VAS) and Oswestry disability index (ODI) were used to quantify pain and the improvement in symptoms. Minimum final follow-up was two years. Results: The mean VAS and ODI scores pre-injection were 5.98±1.86 and 52.13±2.13, respectively. The mean VAS and ODI scores at final follow-up were 2.47±1.65 and 23.59±2.34, respectively. The improvement in the above objective scores was found to be statistically significant with a p=0.00257 for VAS score and 0.00425 for ODI score. One patient developed syncope post-injection and one patient complained of superficial injection site pain which persisted for three weeks. No significant or major complication was encountered. Conclusions: Ganglion impar block appears to be a very impressive modality of treatment for chronic coccydynia in view of the simplicity, ease and reproducibility of the technique along with minimal complication rates. However, randomized control trials with large sample size are recommended.
      PubDate: 2023-08-03
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232463
      Issue No: Vol. 9, No. 5 (2023)
  • Comparative outcome assessment of total hip arthroplasty versus bipolar
           hemiarthroplasty in intracapsular neck of femur fracture in old age

    • Authors: Sufyan M. Muslim, M. B. Lingayat, Prashant Bansode, Arpit Kesharwani
      Pages: 956 - 961
      Abstract: Background: This prospective study aimed to compare the outcomes of total hip replacement (THR) and bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: A total of 30 patients aged over 60 years with femoral neck fractures were included in the study, with 15 patients receiving a bipolar prosthesis and patients receiving THR between June 2021 and January 2023. The patients were followed up for 6 months postoperatively, with functional analysis conducted using the modified Harris hip score. Results: The results showed that the modified Harris hip score was significantly higher in the THR group compared to the bipolar prosthesis group at day 1, 3, 6 and 12 months postoperatively. Pain levels were similar between the two groups at all follow-up intervals. Gait and range of motion were significantly higher in the THR group compared to the bipolar prosthesis group at all-time points. Conclusions: Based on the short-term functional outcomes of this study, THR appears to be a preferable option over bipolar prosthesis for managing femoral neck fractures in elderly.
      PubDate: 2023-08-10
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232484
      Issue No: Vol. 9, No. 5 (2023)
  • Assessment of the effect of low-cost negative pressure dressing on wound

    • Authors: Maruti B. Lingayat, Abhay M. Kawedia, Hitarth J. Gathani, Karan Baria, Swapnilkumar Patil
      Pages: 962 - 969
      Abstract: Background: Wound care is a priority element in the management of grade 3 compound fractures and has traditionally relied on the use of dressing products (gauze, foam dressings, alginates, and hydrocolloids) and manual debridement. Paving the way to the future, there are now several alternative therapies, of which negative pressure wound therapy (NPWT) is an emerging treatment. Negative suction dressing has been proven to be superior in wound healing and is faster compared with regular dressing using gauze, hydrocolloids, and local debridement. It leads to faster rates of skin cover spontaneously or with surgical procedures like skin graft and flaps, eventually resulting in early internal fixation of fractured bones, if any. The present study was designed to assess the effect of the negative pressure dressing technique on wound healing and to compare its effect with that of the conventional dressing technique. Methods: The study was a double-blind randomized control trial conducted after ethics approval. A case record form was used for data collection after obtaining the participants’ informed consent, and a total of 120 patients participated in the study. Results: Low-cost negative pressure dressing has an effect on general conditions, fever, hyperemia, and irregular margins. It was observed to increase granulation tissue formation and decrease pus/serous discharge and was associated with a decreased number of hospital visits due to early healing compared with normal dressing. Conclusions: The low-cost negative dressing technique was effective in healing wounds in type III open fractures and was associated with early recovery compared with the normal dressing technique.
      PubDate: 2023-08-17
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232503
      Issue No: Vol. 9, No. 5 (2023)
  • Functional outcomes of early versus delayed fixation of closed ankle
           fractures assessed by objective and subjective criteria using the
           Olerud-Molander ankle score

    • Authors: Omeshwar Singh, Jawahar Mehmood Khan, Sandeep Verma
      Pages: 970 - 974
      Abstract: Background: The incidence of ankle fractures is approximately 0.01% per year. Indications for surgical fixation include severe displacement and unstable fracture pattern. Ankle fracture is one of the most common injuries treated by an orthopaedic surgeon. Ankle injuries are usually caused by simple twisting injury to high energy injuries. Methods: This study included patients attending the OPD, emergency of Orthopaedics Department, Govt. Medical College Jammu from October 2014 to October 2016 diagnosed with closed ankle fractures. Both male and female patients between the age group of 18-60 years were treated by open reduction and internal fixation. 50 patients were divided into two equal groups (25 each) as per the timing of surgery. Group 1-cases of early internal fixation within 5 days Group 2-cases of delayed internal fixation after 5 days. Results: In subjective results, in Group I 92% of the patients had good subjective results and 8% had fair results whereas in Group II 84% had good and 16% had fair subjective result. In objective results, in group I 96% patients’ good results were obtained and 4 % patients had fair results whereas in group II 88% patients had good results and 12% patients had fair results. Conclusions: In this study the overall functional outcome was good in both the groups. Thus, we felt when immediate fixation is not possible, delayed fixation of displaced ankle fracture is a reasonable option.
      PubDate: 2023-08-17
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232504
      Issue No: Vol. 9, No. 5 (2023)
  • Radiographic and functional outcome of operated closed intra-articular
           fractures of calcaneum: a retrospective analysis

    • Authors: Abhay H. Kerketta, Shivanshu Mittal, Kumar Rahul, Jayanta Kumar Laik
      Pages: 975 - 981
      Abstract: Background: The present study aims to analyse the results of surgical outcome of the operated calcaneal fractures using either plates or cannulated cancellous screws. Recently there has been considerable shift of treatment of calcaneal fractures from conservative to operative owing to better understanding of fracture pattern. However, reduction of long-term functional outcome of such patients is always questionable and remains unanswered. Methods: A 25 fractures were operated with locking plates or cannulated screws after proper assessment. Functional assessment was done using AOFAS scoring system. Radiological outcome was assessed using restoration of Bohler and Gissane angle. Results: The results were extrapolated as excellent in 20 patients, good in 3 patient's and poor result in 2 patients. Statistical analysis revealed better outcomes in percutaneous cannulated screw fixation as compared to open plate fixation. 6 patients had to undergo implant exit of which 5 were cannulated screw backout, prominence irritating the soft tissue and 1 plate removal had to be done because of infection. None of the patients had subtalar arthritis, heel pad problems, peroneal tendinitis or implant failure. Conclusions: Surgical management in the treatment of choice for intra articular calcaneal fractures after thorough evaluation. The choice of implant depends upon the communition of fracture, soft tissue compromise, joint surface incongruity and surgical expertise. Radiological maintenance of Bohler and Gissane angle intraoperatively and at follow up is a good indicator for predicting functional outcomes score.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232610
      Issue No: Vol. 9, No. 5 (2023)
  • Study of functional outcome of muller type C distal femur fracture treated
           with locking compression plate

    • Authors: Mohammed Ismail Hathiwale, Prakash A. Sasnur, Sharath Gowda Thimmarayappa
      Pages: 982 - 987
      Abstract: Background: To evaluate the functional outcome of Muller type C distal femur fracture treated with locking compression plate (LCP). Methods: This prospective study was carried out at Al-Ameen medical college and hospital, Vijayapura. Forty patients (24 males and 16 females) with Muller type C distal femur fractures were enrolled in our study. Patients were treated with open reduction and internal fixation with LCP. They were followed up for 9 months with clinical examination and serial x-rays. The functional outcome was evaluated using Neer’s scoring system. Results: Forty patients who completed follow up of 9 months were included. There were 18 muller type C1, 14 muller type C2 and 8 Muller type C3 fractures. The functional evaluation with Neer’s scoring system was excellent in 8 patients, good in 20 patients, fair in 8 patients and poor in 4 patients. Complications observed were difficulty in reduction, superficial infections, knee stiffness and limb length discrepancy. Conclusions: The LCP is a safe and effective tool to manage these difficult fractures as we had no incidence of implant failure, delayed union, non-union and revision surgery except that we had knee stiffness as commonest complication which can be tackled by early surgery, surgical expertise, meticulous soft tissue handling and vigorous early knee mobilisation.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232611
      Issue No: Vol. 9, No. 5 (2023)
  • Comparative study between deltoid split approach versus delto pectoral
           approach for proximal humerus fracture fixation

    • Authors: Prabhu Basavanagowda, Prerak Jain, Jayanth Bisaleri, Bhupender Jakhar
      Pages: 988 - 993
      Abstract: Background: Proximal humeral fracture is defined as fractures occurring at or proximal to the surgical neck of the humerus. It affects 2.4% of women over the age of 75 years. It is the commonest fracture affecting the shoulder girdle in adults and its incidence is rising. For displaced fractures that meet surgical indications, deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. Deltoid splitting approach offers advantages of better exposure and implant placement for fixation of the fracture and early mobilization of the shoulder joint. Methods: This is a comparative study of 30 cases of proximal humerus fractures treated by surgical fixation through deltoid splitting approach and 30 cases treated by delto pectoral approach. Patient of both sexes belonging to adult age group in general population presenting with proximal humerus fracture to the orthopaedic department of Bapuji Hospital and Chigateri General hospital attached to J.J.M. Medical College, Davangere. The period of survey extends from December 2020 to December 2022. The final results were evaluated using constant Murley score periodically. This constant Murley score ranges from 0 to 100 points representing worst and shoulder function respectively. Results: No statistically significant difference was observed in outcome with regard to mechanism of injury, side of fracture and type of fracture with both deltoid splitting approach and delto pectoral approach. Conclusions: The treatment of proximal humeral fractures with a proximal locking plate is reliable using both approaches. No significant difference found in functional outcome of proximal humerus fracture following deltoid split and deltopectoral approach on serial follow up.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232612
      Issue No: Vol. 9, No. 5 (2023)
  • Determination of various etiological factors for diagnosis of non
           traumatic scapulo costal syndrome

    • Authors: Kundan Kushwah, Pranav Mahajan, Vikalp Rajoria
      Pages: 994 - 999
      Abstract: Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232613
      Issue No: Vol. 9, No. 5 (2023)
  • Radiological and functional outcomes of anterior bridge plating with
           minimally invasive plate osteosynthesis technique for humerus diaphyseal
           fractures in adults

    • Authors: Harshit Dave, Nihar Modi, Eknath Pawar, Sandeep Gavhale, Rohit Topno, Vipul Shet
      Pages: 1000 - 1008
      Abstract: Background: We conducted a study to evaluate radiological, functional outcomes and complications of internal fixation of humerus diaphyseal fractures by anterior bridge plating (ABP) with minimally invasive plate osteosynthesis technique. Methods: 40 patients with humerus diaphyseal fractures operated by ABP with MIPO between August 2017 and January 2020 were included in the study. All patients were evaluated verbally, clinically, and radiologically for a minimum of 1 year. Results: Mean time to radiological union was 13.75 weeks. Disabilities of the arm, shoulder and hand score improved from a mean of 23.45 to a mean of 5.04 at 6 months. All patients except one had an excellent Mayo Elbow Performance Score score at 6 months. The variation of mean shoulder range of motion between normal and operated side was within 5 degrees at 6 months. Visual Analogue Scale score improved from a preoperative mean of 8 to a postoperative mean of 0.5 at 6 months. Mean intraoperative blood loss was 147 ml. Two patients had a superficial wound infection, one patient had a postoperative radial nerve palsy, and one patient had a delayed union, all of which recovered without any surgical intervention. Conclusions: ABP with MIPO technique for humerus diaphyseal fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction. Therefore, we recommend that ABP with MIPO should be considered as an alternative treatment option in patients with humerus diaphyseal fractures.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232614
      Issue No: Vol. 9, No. 5 (2023)
  • Fibroset™ and neuromuscular pain: a multicentric, real world,
           observational, post-marketing surveillance study in Indian patients
           suffering from neuromuscular pain

    • Authors: Kalpen Desai, Mohit Madan, Zubair Sorathia, Madu Sridhar, B. A. Gopalkrishna, Kailash Nath Jain, Anand Halyal, Manoj Kumar Gudluru, Vikrant Vijay, Rakesh Sapra, Nirmalya Deb, Tanoy Bose
      Pages: 1009 - 1015
      Abstract: Background: Neuromuscular disease (NMD) is a condition due to abnormality or damage to muscles and nerves causing painful symptoms. Symptomatic management involves use of conventional painkillers, but desirable relief is not achieved due to multimodal pathophysiology of disease. This study evaluated the efficacy and safety of Fibroset™ tablets in subjects with neuromuscular pain. Methods: Subjects with neuromuscular pain, previously unsatisfied with standard therapies, were enrolled. Subjects were advised to take Fibroset™ one tablet BID for 2 weeks with their standard therapy. Efficacy was evaluated on pain, stiffness, swelling, weakness, tenderness, and difficulty in activity of daily living (ADL) as per the visit schedule. Tolerability of therapy was also evaluated. Results: 59 patients were enrolled in study and 46 patients were included in the final analysis. Fibroset™ supplementation significantly reduced all evaluated parameters (p<0.05 vs baseline). The mean pain score from 2.50 to 0.89, while mean stiffness score was reduced to 0.55 from 1.87 at end of study. The mean swelling score was reduced to 0.81 from 2.04, while the mean weakness score was reduced to 0.64 from baseline score of 1.79. The mean tenderness score was reduced from baseline score of 1.90 to 0.65 and the mean ADL score was reduced to 0.63 from baseline score of 2.00. No treatment related side effects were observed. Conclusions: Fibroset™ is a potentially effective and safe therapy for subjects with neuromuscular pain. It can be used to reduce symptoms in patients with unsatisfactory results with conventionally standard care therapy.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232615
      Issue No: Vol. 9, No. 5 (2023)
  • Analysis of results of huge segmental bone loss of tibia treated with
           Ilizarov external fixator: our experience in Indian population

    • Authors: Vishal Patil, Sandeep Reddy, Sujith Patil B., Sahana Patil, Karthik Kolli, Prajwal K., Ronak N. Kotian
      Pages: 1016 - 1022
      Abstract: Background: Orthopaedic surgeons face challenges in treating complex tibial fractures with bone loss due to complications like infection, repeat surgeries, and patient psychological burden. The Ilizarov external fixator approach offers better clinical and radiological results, addressing these issues. The purpose of this study was to examine the outcome of tibial segmental loss treated with the Iliazrov external fixator. Methods: The study was done between January 2015 to December 2021. It’s a prospective as well as retro-prospective study. The age group of 18-65 years was considered. Patients were monitored monthly, up to nine months post-surgery, or until bone union. Functional and bone outcomes of the patients were evaluated using ASAMI criteria, knee society score, and St. Pierre ankle scoring system. Results: The study included 20 patients, all of them were male and had a mean age of 34.1±10.1. Bone union was achieved in all cases. After ilizarov application, the average bone defect was 82.6±42.9 mm. The final regeneration attained was 75.1±47.5 mm. The average limb length difference was 20.41±6.55 mm after achieving union. Out of 20 patients, 13 and 4 had good and fair ASAMI score, 1, 4, and 13 had fair, good, and excellent knee society score, and17 had fair St. Pierre score and 3 patients were lost to follow-up. Conclusions: Ilizarov technique is an excellent way for treating complicated tibial fractures. The difficulties, challenges, and complications associated with Ilizarov external fixation are negligible compared to the significant difficulties associated with open techniques.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232616
      Issue No: Vol. 9, No. 5 (2023)
  • Comparison between standard and dual mobility implants in total hip
           arthroplasty for femoral neck fractures in elderly

    • Authors: Deepak S. , Abishek B. S., Hemant .
      Pages: 1023 - 1028
      Abstract: Background: Dislocation is a major concern after total hip replacement (THR) in displaced fracture neck of femur. Recent studies have shown reduced dislocation rates with dual mobility THR (DMTHR) for femur neck fractures; however, there is a lack of comparative research to show its superiority over conventional THR. Further, its role in the Asian subcontinent, where the patient requires sitting cross-legged or squatting, has not been studied. Methods: A prospective cohort study of 30 elderly patients with displaced NOF with a minimum follow-up of 2-year. Sixteen patients were operated on with DMTHR and fourteen patients with conventional THR. Both the groups were matched; radiological and functional outcomes in terms of Harris hip score (HHS), visual analog scale (VAS), range of motion, and dislocation rate were compared between the two groups. Results: Mean HHS of the DMTHR group was 79.99 at three months and 92.73 at the end of the 2 year postoperatively, which was significantly better than the conventional THR group 59.5 at three months and 88.14 at 2-year. The range of motion was significantly better in the DMTHR group than the conventional THR group. There was no significant difference in radiological outcomes and postoperative dislocation rate between the two groups. Conclusions: Dual mobility implants give better results than conventional implants for primary THA in elderly patients of displaced FNOF regarding better function and greater range of motion. More long-term multicentric studies are still needed.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232617
      Issue No: Vol. 9, No. 5 (2023)
  • Outcome of preventive interventions on the prevalence of constipation in
           hip fracture patients admitted in orthopaedic ward of a tertiary care
           hospital in eastern India

    • Authors: Jayant Kumar, Vijay Kumar, Kumar Rahul, Kanishk Shankar, Manoj Kumar Rajak
      Pages: 1029 - 1032
      Abstract: Background: Orthopedic patients admitted with hip fractures are prone to developing constipation due to pain and immobility in bed. The reported incidence for constipation in orthopaedic patients varies from 44 % after thoracolumbar fusion surgery to 18-72% after hip replacement surgery to 39-43%. Methods: This study was conducted for the admitted patients with hip fracture in orthopaedic ward of a tertiary care hospital. The study period was divided into first 3 months where prevalence was measured while administering the present standard nursing care, without any active preventive interventions and next 3 months where the prevalence was measured after adding implementation of active preventive interventions. Results: The study had 78 % incidence of constipation in the former group compared to 26 % in intervention group. This was found to be significant statistically. Conclusions: It was safely concluded that implementation of our preventive intervention protocol in all our admitted patients with hip fractures the prevalence of constipation could be significantly reduced.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232618
      Issue No: Vol. 9, No. 5 (2023)
  • Management of patella fracture with percutaneous wiring

    • Authors: M. B. Lingayat, Nilesh I. Kachnerkar, Prashant R. Bansode, Sufyan M. Muslim, Omkar Rashinkar
      Pages: 1033 - 1036
      Abstract: Patella fractures are fixed traditionally in orthopaedics by open reduction and internal fixation as it is an intra-articular fracture. Open operative techniques are associated with high incidence of infections, cosmetic problems, and delayed rehabilitation. Percutaneous, arthroscopic techniques have fewer complications but these are technically demanding procedures to master. Percutaneous wiring of patella being a newer technique, in our study of 25 patients we evaluated its results over other conventional methods of treatment of patella fracture. The patients were followed up for 30 months and its results were studied.
      PubDate: 2023-08-21
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232506
      Issue No: Vol. 9, No. 5 (2023)
  • Figure of eight suturing technique with fiber wire for patella fracture: a
           novel approach

    • Authors: Malay P. Gandhi, Shubham S. Kapadiya, Gaurav M. Vadodaria, Aditya K. Agrawal
      Pages: 1037 - 1041
      Abstract: Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. Tension band wiring, inter-fragmentary screw fixation, and the combination of cerclage wiring and screw fixation are used for internal fixation of these fractures. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement. In this series, we present ten cases managed with open reduction and internal fixation with figure of eight suturing technique using fiber wire. This series included ten patients with fractured patella and managed with open reduction and internal fixation with Tension band wiring with fiber wire. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months. All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lysholm score and Bostman score were 85 and 27 respectively. Nine patients had excellent to good outcomes. One patient had poor outcome because of knee stiffness. Open reduction and internal fixation with figure of eight suturing technique using fiber wire are an efficient method for the management of severely comminuted and multi-fragmentary patella fractures with minimum complications.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232619
      Issue No: Vol. 9, No. 5 (2023)
  • Short term results of endoscopic discectomy in lumbar spine

    • Authors: Atit Tiwari, Sandeep V. Sonone, Nishant P. Jaiswal
      Pages: 1042 - 1049
      Abstract: A recent modification to lumbar discectomy involves the use of a micro-endoscope instead of an operating microscope for visualization. Percutaneous endoscopic lumbar discectomy (PELD) uses a rigid operating spinal endoscope that allows direct visualization and excision of contained and non-contained herniated disc fragments. The advantages of Endoscopic lumbar discectomy are remarkable due to minimal bone resection, no damage to paravertebral muscles, rapid recovery, minimally procedure related morbidity, cost-effectiveness and high patient satisfaction rate. Aims and objectives is to study and evaluate clinical and radiological outcomes of endoscopic lumbar discectomy over a period of 6 months.24 patients underwent endoscopic lumbar discectomy proven with MRI in a span of 3 years from 2018 to 2021. Every patient was followed up for 6 months in an observational, retrospective and prospective type of study and assessed on the basis of MacNab criteria, VAS pain score, Oswestry low back pain questionnaire. Mean preoperative Oswestry disability score (ODS) was 74.38 while mean postoperative ODS was found to be 29.25. Preoperative, while analyzing through Macnab criteria, poor results were seen in 95.83% of patients while fair results were seen in 4.17% of patients. Postoperatively excellent results were seen in 16.67% of patients while good results were seen in 83.34% of patients. Mean preoperative VAS was 7.33 while mean postoperative VAS was found to be 2.91. Endoscopic discectomy is a safe and effective procedure where patient satisfaction and pain relief are not compromised. It may be an effective and alternative treatment option for the upward migration of disc herniation in the upper lumbar area and offers additional advantage for early mobilization and faster improvement.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232620
      Issue No: Vol. 9, No. 5 (2023)
  • Isolated traumatic dislocation of the cuboid

    • Authors: Marcelo de P. T. Alves, Catia F. C. Nunes, Gonçalo M. X. Modesto, Sofia A. S. Madeira
      Pages: 1050 - 1052
      Abstract: The cuboid bone stabilizes the lateral column of the foot. It articulates with the midtarsal and tarsometatarsal joints and this anatomically proportionates marked stability to the cuboid. Isolated dislocations of the cuboid a rare ocurrence. The authors present a rare case of an isolated traumatic dislocation of the cuboid bone without fracture and present a short review of the pertinent literature.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232621
      Issue No: Vol. 9, No. 5 (2023)
  • Total hip replacement in a patient with contralateral hemipelvectomy: a
           case report

    • Authors: Pablo Andrés Caicedo Mazabel , Hernando Gaitán-Lee, Felipe Guzmán Nalus, Leon Alberto Sardi Barona
      Pages: 1053 - 1058
      Abstract: Total hip arthroplasty is one of the most frequently performed surgeries today with excellent clinical and functional results for patients with advanced stages of hip osteoarthritis. Performing this surgical procedure in patients with a history of lower limb amputation is rare, so some important considerations must be taken for surgical planning, positioning on the operating table, and rehabilitation. There are very few case reports described in the literature. We present the case of a patient with symptomatic stage III Tonnis hip osteoarthritis and a history of contralateral external hemipelvectomy, who underwent total hip replacement. Preoperative planning, surgical technique, and 6-year follow-up are described.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232622
      Issue No: Vol. 9, No. 5 (2023)
  • Osteochondral femoral anterior cruciate ligament avulsion in a 13 years
           old patient: a case report

    • Authors: Al-Muthana M. A. Yamanih, Mumen M. Alshaweesh, Naser F. Shari, Nizar A. A. Alannaz, Mohannad A. Odat
      Pages: 1059 - 1062
      Abstract: Anterior cruciate ligament (ACL) injury, is one of the most common injuries occurring in young active patients. Regarding pediatric group, ACL avulsion is the most common form of injury in contrast to adults, whose injury pattern is described as mid-substance injury. Tibial avulsion of ACL is the most common form of avulsion in pediatrics, while osteochondral femoral avulsion is considered rare entity. Our case report is about a 13-year-old pediatric male patient, sustained injury over his right knee during soccer game in March 2023. Immediately after injury, patient described having giving way, associated with severe pain. 2 days after initial injury, patient and his family noticed that his giving way continued to occur. Upon presentation to clinic, physical examination raised suspicion to have ACL injury, magnetic resonance imaging (MRI) and computed tomography (CT) confirmed osteochondral femoral origin avulsion of ACL. After reviewing literature, decision was to go for ACL repair through femoral origin avulsion fracture fixation using suture pullout technique secured with two anchors fixed through lateral femoral cortex to avoid physis injury while reaming femoral and tibial tunnels used for graft reconstruction. On follow up, excellent functional outcome regarding knee stability and range of motion. We conclude that although femoral-sided repair using suture pullout technique carried higher risk of failure than ACL reconstruction, this method shows excellent functional outcome, and can be used in cases of osteochondral femoral avulsion in pediatric group to avoid risk of physis injury in such age group.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232623
      Issue No: Vol. 9, No. 5 (2023)
  • When prosthetic joint infection may lead to premalignant colorectal lesion

    • Authors: Julie R. Posse, Thayná D. A. B. Werly, Fabio Souza, Naasson T. Cavanellas, Juliana A. Matos, Kelly B. G. Barbato
      Pages: 1063 - 1067
      Abstract: Osteoarthritis (OA) is a common musculoskeletal disorder that affects millions of people worldwide, and total knee arthroplasty (TKA) is a common treatment for advanced OA. However, joint replacement surgeries may lead to complications such as deep vein thrombosis (DVT), surgical site infection, and prosthetic joint infection (PJI). Our objective is to discuss a Streptococcus bovis group (SBG) PJI case after TKA and its possible consequences in clinical practice. We describe a 67-year-old female who underwent TKA and developed initial complications including wound hematoma, symptomatic anemia, and acute DVT. Further investigations because of knee pain persistence and inflammatory signs post TKA revealed the presence of Staphylococcus aureus in the synovial and scar tissues from the knee and SBG in the periprosthetic membrane from the revision surgery, as well as mitral infective endocarditis and a large stenosing villous polypoid lesion in the ascending colon. SBG osteoarticular infection post TKA is a rare condition, but it may be associated with severe diseases. This article highlights the link between SBG and colorectal cancer (CRC) and emphasizes the importance of an echocardiogram and a colonoscopy for early detection and prompt treatment of infective endocarditis and CRC. This diagnostic workup should be performed even in the absence of symptoms, for early diagnosis and increased chance of cure. A multidisciplinary approach, involving orthopedists, infectious disease specialists, cardiologists, and gastroenterologists, among others, is advised to effectively manage SBG infections and improve patient outcomes.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232624
      Issue No: Vol. 9, No. 5 (2023)
  • Proximal humeral interlocking system plate for pediatric subtrochanteric
           femur fracture: a case report

    • Authors: Pratik Mankar, Gopal Pundkare
      Pages: 1068 - 1070
      Abstract: Hip fractures are rare in the pediatric age group and they contribute about 1% of all fractures in children. Subtrochanteric femur fractures are the rarest form of hip fractures in children. The treatment for children between the ages 6-12 years is controversial. The treatment options for pediatric subtrochanteric femur fracture include traction followed by hip spica cast, immediate spica casting, cast bracing, internal fixation and external fixation. We report a case of a subtrochanteric femur fracture in a 7-year-old girl following a fall of heavy object over her leg. The fracture was fixed with an adult 3.5 mm proximal humeral interlocking system (PHILOS) plate. The purpose of this report is to provide an alternative mode of management for paediatric subtrochanteric femur fracture.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232625
      Issue No: Vol. 9, No. 5 (2023)
  • Disseminated tuberculosis in elderly-latent activation mimics metastasis:
           a case study

    • Authors: Sitsabesan Chokkalingam, Gopinath Menon, Pradeep Kumar, Harish Arvind Venkatesan
      Pages: 1071 - 1072
      Abstract: Tuberculosis (TB) is an infectious disease caused by mycobacterium species, that affects the lungs and involvement of the musculoskeletal system is not uncommon. Two or more systemic non-contiguous spread is termed as disseminated TB, and its additional involvement of lungs constitute the diagnosis of miliary TB (MTB). Immuno-suppressive conditions including malnutrition and immune-senescence in elderly can predispose to reactivation of latent TB and wide spread dissemination of the bacilli. Screening for dormant TB infection remains an impractical task and its diagnostic confirmation remains a challenge. With raising elderly population, there is a need for a high index of suspicion in the diagnosis of disseminated TB and its management, as delayed approach has increased mortality. Atypical presentation of disseminated TB with concomitant vertebral collapse and extensive lymphadenopathy needs exclusion of metastatic disease although the old nemesis of TB remains a differential diagnosis. We present one such case in a 71 years old lady to highlight the atypical presentation of disseminated TB. The disease presentation had spino-dermal pattern with lympho-reticular involvement including asymptomatic lesions bilaterally in the adrenal glands lesions.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232626
      Issue No: Vol. 9, No. 5 (2023)
  • A rare case of acute osteomyelitis in a 13-year-old with physeal

    • Authors: Jayant Kumar, Ravi Kaushal, Shekhar Chandra Sahoo, Manoj K. Rajak, Jayanta Kumar Laik
      Pages: 1073 - 1076
      Abstract: Osteomyelitis of epiphyses in adolescents is a rare finding. We evaluate one such case in which high degree of clinical suspicion and prompt surgical intervention yielded good functional results. This is a case report of 13-year-old girl diagnosed with osteomyelitis of right knee. MRI is suggestive of physeal involvement. Physeal involvement makes the management very challenging. Surgical intervention was planned to reduce bacterial load and minimize possibility of damage to knee joint (articular cartilage and joint capsule). Lateral and posterior compartment of leg was decompressed, fibular osteotomy done, drilling in tibial epiphyseal and metaphyseal region of tibia done avoiding any injury to growth plate. Pus for culture and sensitivity and specific antibiotics started with monitoring of blood parameters for infection like ESR, CRP, TLC. Patient taken up for second debridement after one week of index surgery. After 6 weeks of intravenous antibiotic patient discharged in afebrile state with reduced values of blood parameters and acceptable range of knee movement. Lower extremity functional scoring (LEFS) of 45/80 i. e., 56.83 % at the end of 4 months. Good functional outcome at the end of 1 year. Early clinical suspicion with prompt investigation, surgical and medical management gives promising result.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232627
      Issue No: Vol. 9, No. 5 (2023)
  • Unforeseen consequence: heterotopic ossification following traumatic brain
           injury and acetabulum fracture-a case report

    • Authors: Kartik Samria, Krati Bhardwaj, Dheeraj D. Shekar, Ravindra K. Lamoria
      Pages: 1077 - 1081
      Abstract: Heterotopic ossification (HO) is a rare pathological condition characterized by the formation of bone in soft tissues outside the normal skeletal system. HO can result in restricted joint mobility, nerve compression, and pain. We present a case report of a 34-year-old male who developed HO. There is a history of neurological injury and fracture acetabulum (left). Imaging studies revealed extensive HO with complete bony bridging of the hip joint, leading to severe functional impairment and chronic pain. The patient had previously undergone multiple medical treatments with non-steroidal anti-inflammatory drugs, and physiotherapy with limited success. Ultimately, he underwent a complex surgical intervention involving resection of HO, release of joint contractures, resulting in significant improvement in joint mobility and pain control. Here we discuss a rare and debilitating presentation of HO and the treatment options available for such patients. Clinicians should be aware of this challenging condition and manage patients through a multidisciplinary approach.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232628
      Issue No: Vol. 9, No. 5 (2023)
  • A rare case of extra-synovial and intracapsular ganglion cyst of the knee

    • Authors: Aditya D. Narawad, Aniket K. Wankhede, Gaurav Patel, Harold D'Souza, Deepesh Daulatani
      Pages: 1082 - 1085
      Abstract: A 23 year old female presented with knee swelling which was found to be ganglion cyst of the knee with extra synovial and intracapsular origin form the lateral meniscus which was causing pain in extreme extension. The cyst was excised and confirmation was done on histopathology. Ganglion cysts may have following differential diagnoses of ganglion cysts may include synovial chondromatosis, pigmented villonodular synovitis, meniscal or parameniscal cysts, and synovial hemangioma. Which needs good histopathological and radiological correlation. Most common sites of Intra-articular ganglion cysts are in the dorsal wrist, palm, and shoulder but rarely found in the knee joint.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232629
      Issue No: Vol. 9, No. 5 (2023)
  • Orif of lateral Hoffa's fracture with irreducible patella dislocation and
           incarcerated patella in lateral Hoffa's fragment: rare injury presentation

    • Authors: M. B. Lingayat, Prashant Rajkumar Bansode, Aditya Vijaykumar Jadhav
      Pages: 1086 - 1088
      Abstract: Majority of lateral Hoffa fracture are associated with knee injury. Presenting a case of 30-years-old gentleman who presented with pain, swelling, deformity in knee of right side after road traffic accident. On local examination there was marked swelling with inability to palpate patella, inability to flex knee. On clinical examination, there was patella dislocation as it was not in place and unable to reduce. Radiological investigation showed a lateral Hoffa's fracture with dislocation of patella and patella being incarcerated in Hoffa fragment. Operative and follow up: Patient was operated by open reduction of patella dislocation and CC screw fixation for lateral Hoffa fracture. On six weeks follow up normal ROM achieved. Patient was surgically treated to relocate locked patella fragment in Hoffa's fragment and fix Hoffa's fragment and achieved good range of motion.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232630
      Issue No: Vol. 9, No. 5 (2023)
  • Diversity in orthopaedic surgery for pacific islanders: the battle

    • Authors: Tiffany Ruan
      Pages: 1089 - 1093
      Abstract: It’s no secret that orthopaedic surgery is the specialty with the least diversity when it comes to race and gender. More than likely, patients from different ethnic backgrounds desire to be treated by physicians ethnic backgrounds desire to be treated by physicians who look like them but due to the lack of diversity in the field of orthopaedic surgery, it makes it difficult to find physicians who fully understand the cultural barriers to medicine. A systemic review was completed by reviewing research from The American Journal of Surgery, the Journal of the AAOS, and The Journal of Bone and Joint Surgery, among others. Since the rapid immigration into the United States in the early 2000s, Pacific Islanders have begun to make up an increasing portion of the US population, yet a significant increase in the representation of Pacific Islanders in orthopaedic surgery has not reflected this. This acute problem can cause long-term negative effects on the community of Pacific islanders as they continue to be treated by physicians who do not look like them and who do not completely understand the cultural barriers faced by their communities.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232631
      Issue No: Vol. 9, No. 5 (2023)
  • Enhanced recovery protocols in total hip and knee arthroplasty: what are
           the recent trends

    • Authors: Aniket A. Wagh, Vikram Lalaram, Jignesh Y. Tandel
      Pages: 1094 - 1099
      Abstract: Perioperative management of hip and knee arthroplasty patients has evolved significantly over the past few years, almost hand in hand with the advancement of the surgical technique itself. The notion of enhanced recovery protocol is rapidly being accepted by various establishments to reduce the hospital stay and perioperative morbidity. It consists of application of aggressive perioperative interventions aiming for a speedy recovery with least complications, while maintaining good patient care. We reviewed various published articles to understand the importance of each of these interventions. Components that showed improvement in the outcomes were patient education and counselling, pre-operative supplementation to improve wound healing and reduce length of hospital stay. Intra-operative use tranexamic acid and avoidance of drains reduce operative blood loss and subsequent transfusion. Multimodal analgesia, early mobilization with pharmacological and mechanical prophylaxis to reduce venous thromboembolism showed a positive correlation with rapid recovery.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232632
      Issue No: Vol. 9, No. 5 (2023)
  • New developments in combating infection from biofilm forming bacteria of
           orthopedic implants

    • Authors: Pulkit Sharma, Saqib Ayaz, Sanjeev Gupta, Rahul Singh
      Pages: 1100 - 1104
      Abstract: Orthopedic device related infections (ODRI’s) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The definitive treatment to eradicate the infections once a biofilm has established is surgical excision of the implant and thorough local debridement, but this carries a significant socioeconomic cost, the outcomes for the patient are often poor, and there is a significant risk of recurrence. The aim of the study was to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232633
      Issue No: Vol. 9, No. 5 (2023)
  • Unveiling the silent nemesis: periprosthetic joint infection-the burden
           and road to recovery

    • Authors: Arjun Ganesh, M. Mohan Kumar
      Pages: 1105 - 1107
      Abstract: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery that poses significant challenges for patients and healthcare systems. It is associated with increased morbidity, financial burdens, and emotional distress for patients. Understanding the risk factors for PJI and implementing preventive strategies are crucial to reducing its incidence and mitigating its impact on both individuals and healthcare institutions.
      PubDate: 2023-08-28
      DOI: 10.18203/issn.2455-4510.IntJResOrthop20232634
      Issue No: Vol. 9, No. 5 (2023)
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