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International Journal of Research in Orthopaedics
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This is an Open Access Journal

Open Access journal
ISSN (Online) 2455-4510
Published by Medip Academy

[12 journals]

Clinical outcomes of S2 Alar-Iliac screw technique in the treatment of
severe spinal sagittal imbalance: a retrospective 2-year follow-up study
- Authors: Yao Zhao, Jianchuan Shu, Longtao Qi, Chengxian Yang, Beiyu Xu, Zhengrong Yu, Chunde Li
  Pages: 415 - 421
  Abstract: Background: The treatment of adult spinal deformity (ASD) remains a significant challenge, especially in elderly patients. This study aimed to evaluate the outcomes of the S2AI screw technique in the treatment of severe spinal sagittal imbalance with a minimum 2-year follow-up.Methods: From January 2015 to December 2018, 23 patients with severe degenerative thoracolumbar kyphosis who underwent placement of S2AI screws for long segment fusion were retrospectively reviewed. Patients were divided into group A (no mechanical complications, 13 cases) and group B (with mechanical complications, 10 cases) according to the occurrence of mechanical complications at the last follow-up. Radiographic parameters were compared between groups preoperatively, 1 month postoperatively and at the last follow-up. Risk factors for mechanical complications were analyzed.Results: The incidence of mechanical complications was 43.5% and the revision rate was 17.4%. At 1 month postoperatively, sagittal correction was better in group A than in group B (p<0.05). The area under the curve for predicting mechanical complications of sacral slope (SS), lumbar lordosis (LL), PI (pelvic incidence)-LL at 1 month postoperatively were 0.762 (p=0.035), 0.896 (p=0.001) and 0.754 (p=0.041) respectively and the best cut-off values were 24.1°, 32.8°and 12.0°. The sagittal correction of both groups was partially lost at the last follow-up.Conclusions: A high incidence of mechanical complications was observed in long-segment corrective surgery with the S2AI screw technique for severe spinal sagittal imbalance. Inadequate sagittal correction is a risk factor for the development of mechanical complications.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221617
  Issue No: Vol. 8, No. 4 (2022)
Frequency of lumbar magnetic resonance imaging findings in patients with
low back pain
- Authors: Somayeh Zeynizadeh-Jeddi, Firouz Amani, Sahar Masoumi
  Pages: 422 - 425
  Abstract: Background: Back pain is one of the main causes of disability and has been the most common cause of disability in the last decade. MRI imaging is able to identify soft tissues, including the intervertebral disc, nerves, and muscles, that are potential sources of back pain; it should be noted, however, that in some cases MRI is not able to identify the source of low back pain.Methods: This cross-sectional study was done on 256 patients who referred to the imaging ward of Ardabil city hospital for lumbar MRI from September 2020 and September 2021. These patients in terms of gender, age, type of insurance, disc dehydration, disc protrusion, disc extrusion, disc sequestration, disc dehydration, spondylolisthesis, retrolysis, presence of Taylor cyst, hemangioma, vertebral fracture, spinal abnormality, spinal abnormality Bone marrow SG, spinal canal stenosis, furaminal stenosis, modic changes and the presence of scoliosis were evaluated.Results: The mean age of patients was 45.10 with a standard deviation of 14.28 years. 152 patients (59.4%) were male. 240 patients (93.7%) had health insurance.55 patients (21.5%) had normal MRI. The most common MRI findings in the present study were: extrusion (67.6%), intervertebral disc dehydration (59.4%), protrusion (40.2%), spinal canal stenosis (29.7%) furaminal stenosis (24.2%), retrolysis (19.5%), lumbar scoliosis (14.7%), modic changes in the lumbar vertebrae (14.5%), scoliosis (13.7%), hemangioma (10.5%), spondylolisthesis (9.4%), sequestration (3.1%), spinal abnormalities (2%) and bone marrow SG (1.6%).Conclusions: Based on the results, the most common abnormal findings in MRI of patients with low back pain were: extrusion, protrusion and dehydration of the intervertebral disc. Also, most of these changes were in the lower levels of the lumbar vertebrae.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221618
  Issue No: Vol. 8, No. 4 (2022)
Functional and radiological outcomes of mid-shaft clavicle fracture
managed by flexible intramedullary nailing
- Authors: Pravin Agrawal, Kaustubh Belapurkar
  Pages: 426 - 433
  Abstract: Background: Clavicle fracture is a common injury accounting for 2.6-5% of all injuries. The commonest site of fracture is the midshaft. Historically clavicle fractures were managed conservatively with figure-of-eight bandage resulting in higher non-union and symptomatic malunion rates. With the advent of operative fixation of these fractures the ideal surgical technique remains elusive. Flexible intramedullary nailing stands out as a minimally invasive and effective method with excellent outcomes for fixation of these fractures.Methods: A prospective study was carried out over 18 months. A total of 26 patients met the inclusion criteria and were operated with flexible intramedullary nailing. Regular follow up was done till 14 weeks. At each postoperative visit patients were evaluated for shoulder function using constant score and DASH score. Radiographs were taken at each visit to evaluate for fracture alignment and union.Results: In this prospective study a total of 26 patients with closed midshaft clavicle fracture were managed using flexible intramedullary nail. Average time to radiological union was 7.5 weeks. Average disabilities of arm, shoulder and hand (DASH) score at 14 weeks was 13 and average constant score was 95 suggesting excellent functional outcome.Conclusions: Flexible intramedullary nailing is a simple, minimally invasive surgical technique with excellent functional outcomes for management of midshaft clavicle fractures.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221334
  Issue No: Vol. 8, No. 4 (2022)
Impact of post-operative hip-knee-ankle angle changes on functional
outcome of total knee arthroplasty: a prospective longitudinal study
- Authors: Sukanya Palit, Tapobrata Guha Roy
  Pages: 434 - 440
  Abstract: Background: Coronal malalignment as residual varus may have deleterious effects on functional outcomes of total knee arthroplasty. This study aimed at highlighting the impact of postoperative hip-knee-ankle (HKA) angle changes on the functional outcome of total knee arthroplasty.Methods: 689 total knee arthroplasty (TKA) knees (from 386 patients) with varus postoperative HKA angle were included. HKA angle was measured on standing orthoscanograms. The knees were divided into 5 subgroups according to postoperative HKA angle as: neutral (0±3.0 degrees); mild (3.1-6.0 degrees); moderate (6.1-10.00 degrees); severe (10.1-5.0 degrees); very severe (>15.0 degrees). Functional outcome of TKA in these subgroups was observed by knee society score (KSS), knee society pain score (KSS-P), Oxford knee score (OKS), lower extremity functional scale (LEFS) at 6 months, 1 year, 2 years, 3 years. Statistical analysis was done by statistical package for social sciences (SPSS) version 16; Spearman’s correlation coefficient and Kruskall Wallis test was used to compare the functional outcome of TKA between COHORTs.Results: 69 knees were present in the mild varus cohort (mean: -1.92), 223 knees in the moderate varus COHORT (mean: -4.77), 260 knees in the moderate varus COHORT (mean: -7.86), 121 knees in the severe varus COHORT (mean: -11.60) and 16 knees in the very severe varus COHORT (mean: -16.54). Mild to moderate varus knees were maximum, but no significant difference in functional outcome between these COHORTs was found by correlation analysis and Kruskall Wallis test.Conclusions: Changes in postoperative HKA angle (coronal alignment) has no significant impact on functional outcome of TKA.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221582
  Issue No: Vol. 8, No. 4 (2022)
The joy stick technique: an easy, reliable, safe and cost effective,
technique in closed reduction and percutaneous fixation of supracondylar
fracture of the humerus in children
- Authors: Birendra Kumar, Deepak Kumar, Vishal Mishra, Abnish Nandan, Arun P. Cheriyachandu, Ashutosh Mishra, Ashish Singh
  Pages: 441 - 445
  Abstract: Background: Supra condylar fractures of humerus account for approximately 16% of all pediatric fractures. This produces an extension type fracture in 97–99%. Flexion type accounting for 1-3%. This often causes significant morbidity due to malunion (gun-stock deformity) reported in 12 to 20%, while neurovascular complications and compartment syndrome is documented in worse scenarios.Methods: A prospective study was conducted with 24 cases of supracondylar humerus fracture between June 2017 to June 2021. Both males and females aged 3 years to 12 years, within 5 days of injury, with modified Gartland’s type III and type IV, without compartment syndrome were included and followed up for 6 months to one year. The fracture was closely reduced using a 2-2.5 mm k-wire (joystick) in proximal fragment placed 5-7 cm proximal to fracture line and fixed with multiple percutaneous pinning under C-arm. All the patients were followed for rate of union and functional outcome using Flynn’s criteria.Results: All the 24 cases were managed by closed maneuver with the help of a joy stick. This reduces the surgical time and stress, preventing opening of fracture. Outcome was assessed in each follow up using Flynn’s criteria. 87.5% of patients had good to excellent outcomes.Conclusions: Our results demonstrate that good functional outcomes are expected in supracondylar fracture regardless of age at injury, sex, weight, side of extremity provided satisfactory reduction by closed technique with help of joy stick. This simple technique reduces surgical stress, duration of surgery and also minimizes the C-arm exposure.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221619
  Issue No: Vol. 8, No. 4 (2022)
Understanding the pattern and volume of various orthopaedic disorders
observed at a tertiary care hospital, before and during the COVID-19
pandemic
- Authors: Girish Rathod, Pushkar Borole, Chandan Shetty, Nitin Raut, Namrata Britto, Vijaykumar Gawali
  Pages: 446 - 450
  Abstract: Background: The COVID-19 pandemic has lead to a huge loss of life and disruption of lifestyle. The pandemic has also led to disruption in the health sector, as significant changes in the pattern of hospital admissions, medical care and variations in disorders have been observed especially in the orthopaedics department. To assess the change in pattern and volume of trauma in our region, we evaluated data from our center for the pandemic period and compared it with the previous years’ data (pre-pandemic period).Methods: Comparison of orthopaedic in-patient records was carried out of the pre-pandemic and during the COVID-19 period, to assess the effect of COVID-19 on the orthopaedic in-patient load and prevailing diseases. Medical records of the patients were analyzed and the data collected were subjected to statistical analysis using IBM SPSS software version 1.0.Results: Significant reduction in patient load was observed during the pandemic period. Cases of various types of fractures were observed to be high in number, followed by arthritis. The only disorder that was observed to be highly prevalent in both the periods is proximal femur fractures.Conclusions: A high variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. A significant decrease in overall admissions was observed, this could be related to the period of societal restrictions and nationwide lockdown.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221620
  Issue No: Vol. 8, No. 4 (2022)
Functional outcome of mild and moderate residual varus in posterior
stabilized total knee arthroplasty in primary osteoarthritis knee: a
prospective study
- Authors: Bharath M. C., T. H. Prakashappa, Madhusudan B., Nithin S. M.
  Pages: 451 - 456
  Abstract: Background: Total knee arthroplasty (TKA) is one of the most commonly done orthopaedic surgical procedures for treating severe arthritis of the knee joint caused by osteoarthritis or inflammatory arthritis. The current clinical investigation, done at the Sanjay Gandhi Institute of Trauma and Orthopaedics in Bengaluru, provided the short-term functional result of mild and moderate residual varus in posterior stabilized TKA. The aim was to evaluate the efficacy of mild and moderate residual varus in total knee replacement for primary OA knee in terms of pain relief, range of motion and stability of the joint. Methods: 30 total knee replacements were performed. All patients were examined pre- and post-operatively using the knee society clinical and functional score. The average pre-op KSS knee score was 38.7, with a functional score of 23.3. The most common reason for TKR was osteoarthritis. The follow-up time ranged from 6 to 12 months.Results: By the knee society clinical, functional score method, 96.6% of our patients received an outstanding assessment after scoring 80 points or higher. The mean post-operative KSS knee score is 86.57, and the knee society functional score is 92. 92% of patients had little/no pain after surgery, and walking ability increased and was unlimited in 80% of patients.Conclusions: After a short term follow up of 1 year in a research population of 30 with pre-operative osteo arthritis of the knee, with post-operative mild to moderate varus alignment showed better clinical results.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221621
  Issue No: Vol. 8, No. 4 (2022)
A prospective comparative study of functional outcome of distal extra
articular tibia fracture fixed with intramedullary nail versus locking
compression plate
- Authors: T. H. Prakashappa, Madhusudan B., Bharath M. C., Nagaraju H., Ashwin S.
  Pages: 457 - 462
  Abstract: Background: Distal tibia fractures are one of the most common long bone fractures and their management presents with a series of problems due to the soft tissue surroundings and even more at risk due to their proximity to ankle joint. In our paper we showed functional outcome of distal extra articular tibia fracture while comparing its management between intramedullary nailing and locking compression plate.Methods: There were 40 patients from November 2019 to November 2020 with distal extra articular tibia fracture. Patients were divided into 2 groups, first group included 20 patients managed with intramedullary nail and the second group included 20 patients managed with locking compression plate. Patients were followed preoperatively, intraoperatively and postoperatively for functional outcome and assessed clinically using AOFAS score and radiologically using X-ray.Results: Out of the 40 cases treated in this manner, all cases were available for the follow up for a period of 1 year. Overall results by 1 year follow up showed excellent in 7 cases (35%) good in 13 cases (65%) in nailing group and in plating group showed excellent in 4 cases (20%), good in 12 cases (60%), fair in 3 cases (15%) and poor in 1 case (5%).Conclusions: All fractures united well. Complications were encountered in 4 patients, 2 patients had superficial wound infections,1 patient had deep infection and another had persistent ankle pain in plating group and 2 patients had superficial wound infection in nailing group. No cases showed malunion or nonunion in both plating as well as nailing group.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221622
  Issue No: Vol. 8, No. 4 (2022)
Outcome analysis of cross-pinning versus lateral pinning and various
lateral pinning configuration in the treatment of displaced paediatric
supracondylar humerus fracture
- Authors: Deva Paramasivam, Thirunthaiyan Ramachandran, Tarun Prashanth Ravindranath, Doraikumar Raja, Aravindh Sellakrishnan
  Pages: 463 - 469
  Abstract: Background: Supracondylar humerus fracture accounts for 3% of all the paediatric fractures. Displaced fractures need usually closed but rarely open reduction and stabilization with k-wires by either cross or lateral pinning technique. Controversies prevail regarding the type of pinning which will reduce complications (such as ulnar nerve palsy and loss of reduction which will lead to cubitus varus deformity) and provides better functional and radiological outcome. The aim of study was to analyse outcomes of various pinning techniques in displaced supracondylar humerus fracture treatment.Methods: This was a prospective study done in SRIHER, Chennai (January 2019 to September 2020) included children with displaced supracondylar humerus fracture (modified Gartland type 2B,3). Preop, postop and intraop assessment were done with respect to incidence of ulnar nerve palsy, Baumann's angle, Flynn criteria till 14 weeks postop period. The results of cross pinning and lateral pinning group were statistically compared.Results: There were totally 37 (male-25, female-12) patients. Mean age was 5.6. The mean change in Baumann’s angle of cross pin and lateral pin group at 14 weeks postop period comparing immediate postop period were 4.13 and 4.15 degrees, which was statistically insignificant using Mann Whitney test (p>0.05). Flynn criteria at 14 weeks postop period between two groups were also statistically insignificant. Difference in Baumann’s angle at 14 weeks postop period between divergent (2.82) and parallel (5.53) pin group was statistically significant using Mann Whitney test (0.01). There were no cases of ulnar nerve injury in both the groups.Conclusions: Lateral pinning technique with the use of 3 divergent pins for the treatment of displaced supracondylar humerus fracture gives stability as good as cross pin configuration and also avoids the risk of ulnar nerve injury.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221623
  Issue No: Vol. 8, No. 4 (2022)
Total hip resurfacing/replacement with metal-on-metal prosthesis in young
patients: studying efficacy
- Authors: Syed M. Adil, Dilip Kumar Deepak, Anuj Singh
  Pages: 470 - 476
  Abstract: Background: This prospective case series study was carried out to review the literature and compare the efficacy of usage of metal over metal prosthesis in young patients undergoing hip replacement versus conventional metal over polyethylene prosthesis.Methods: The study was conducted at tertiary care hospital of Indian armed forces with sample size of n=25, to assess early functional outcome of total hip replacement with metal-on-metal prosthesis. Analysis was carried out in terms of improvement in functional status, pain relief, achieving greater range of motion and joint stability.Results: Mean follow up period was 26 months. The average pre-op Harris hip score was 38.96. The average post-op and last follow up Harris hip score was 84.92 and 86.1. The average pre and post op Harris hip scores of the patients with Idiopathic AVN were 39.7 and 82.5 respectively and the average pre and post op Harris hip scores of the patients with post-traumatic AVN were 37.4 and 86.2. The average pre op and post op Harris hip scores of the patients with non union fracture neck of femur were 36.5 and 86.7 respectively. None of the patient had aseptic loosening, heterotopic ossification or migration of the components, stem failure. There were no cases of dislocation of prosthesis, aseptic loosening, osteolysis, heterotrophic ossification.Conclusions: This observational study demonstrated better clinical acceptability and profile of metal on metal prosthesis in young patients, having undergone hip replacement.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221624
  Issue No: Vol. 8, No. 4 (2022)
Study of importance of medial cortex in distal femur comminuted fracture
- Authors: Mayur K. Kalariya, Ankit R. Patel, Dhruvik K. Lathiya
  Pages: 477 - 480
  Abstract: Background: Distal femur fractures require high energy trauma by means of road traffic accidents. There are various modalities of fixation, involving plating, external fixator and intramedullary nailing. cause of nonunion like smoking, osteoporosis, early weight bearing, improper construction of fixation, improper reduction.Methods: The study was conducted on 20 patients having distal femur fractures operated previously by using a different modality of implant goes in failure like bending of implant, broken of implant, peri implant fracture after second episode of trauma. Patient was preoperatively assessing for rule out occult low grade infection by blood investigation like ESR and CRP. Previous X-ray review to find cause of nonunion.Results: All patients showed a complete union at the fracture site with an average duration of 4-6 months. There was no complaint of infection, joint stiffness or difficulty in weight bearing after treatment with revision fixation and bone grafting. Patients were able to walk without affecting their daily activity of living. Conclusions: Comminuted medial cortex left unfixed or maligned will go into varus collapse and leads to failure of fixation.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221625
  Issue No: Vol. 8, No. 4 (2022)
A cross-sectional survey of Indian orthopaedicians to understand the place
in therapy for the latest soft gel formulation of etoricoxib
- Authors: Sagar Karvir, Sameer S. Jadhwar, Kapil Dev Mehta
  Pages: 481 - 484
  Abstract: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for arthritis (RA), osteoarthritis (OA), low back pain (LBP) and other musculoskeletal disorders. Novel formulations such as soft gel formulations are being introduced for NSAIDs in place of the traditional tablet formulation. The objective of this study was to quantify orthopaedicians insights for the recently available soft gel formulation of Etoricoxib.Methods: The questions for the survey instrument (Google forms) were developed by researchers upon review of scientific literature and subsequent discussions with practicing orthopaedicians. This was a cross-sectional digital survey involving 506 orthopaedicians across India via online responses collated via Google forms.Results: 81.4% doctors agreed that etoricoxib soft gel capsules are faster acting than the tablet formulation, whereas 89.6% of the doctors agree/strongly agreed that etoricoxib soft gel capsules would have better compliance because of its bitter taste masking ability. More than 96% doctors acknowledged that etoricoxib soft gel capsule’s characteristics such as higher drug dissolution and absorption would benefit their patients more than the etoricoxib tablet formulation.Conclusions: Given its advantages, the etoricoxib soft gel formulation, in the days to come, could be one of the preferred options for the management of pain and other arthritic conditions for patients in India.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221626
  Issue No: Vol. 8, No. 4 (2022)
Revisiting the epidemiology of mid shaft clavicle fracture-recent and
emerging trends
- Authors: Kaustubh Belapurkar
  Pages: 485 - 487
  Abstract: Background: Clavicle fracture is a common injury involving upper limb. It accounts for 2.6-5% of injuries. Most common mechanism causing this injury is a fall on an outstretched hand. Clavicle fractures have a bimodal distribution with 1st peak in young active adult males less than 30 years of age. Second peak in elderly females with osteoporotic bones. The annual incidence is highest in male under 20 age group, decreasing with subsequent age groups. Road traffic accidents is another mode of injury which is becoming increasingly common for mid shaft clavicle fractures.Methods: A prospective study was carried out over 12 months. A total of 126 patients met the inclusion criteria. The epidemiological data was collected at the time of presentation using standard case sheet proforma. Radiographic assessment was done for fracture classification.Results: Mid Shaft clavicle fracture was most common in middle aged males (31-40 years) with right side being most commonly affected. Road traffic accidents was the most common cause of injury (62%). AO/OTA type 15B1 is the most common fracture morphology (45%). Most of the high energy road traffic accidents are associated with 15B3 type fractures while type 15B1 is more common in low energy mechanisms like ground level fall.Conclusions: Mid shaft clavicle fracture is a common injury in young population. It is increasingly being associated with road traffic accidents. The number of comminuted fractures, which represent high energy injury mechanism has been on the rise due to increase in high velocity accidents.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221565
  Issue No: Vol. 8, No. 4 (2022)
Pure internal subtalar dislocation: review of 5 cases
- Authors: Mohamed Sidibe, Mohamed Lamine Bah, Fode Mahamoud Sylla, Minkailou Camara, Alhassane Soumah, Serge Ntungwanayo
  Pages: 488 - 491
  Abstract: Pure subtalar dislocation is a rare injury. It accounts for 1% of dislocations seen in trauma. It involves a loss of anatomical relationship between the talus, calcaneus and scaphoid, but the tibio-peroneal-astragalic congruence is maintained. The aim of this study was to find an explanation between the occurrence of subtalar dislocation in its medial variety and the Jakarta motorbike crash. Five male patients who had fallen from a Jakarta motorbike were included. Two cases of open dislocation were reported. They received wound trimming under spinal anaesthesia. We proceeded to reduce the dislocation using a boot puller maneuver and restraint with a plaster boot. The postoperative course was simple with wound healing. The casting lasted 6 weeks but was extended to 8 weeks for open dislocations. After removal of the cast, rehabilitation was prescribed for all patients. This consisted mainly of proprioception in order to restore the functions of the ankle. At a mean follow-up of 25.2 months, the patients did not complain of pain or stiffness and the X-rays taken were normal.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221627
  Issue No: Vol. 8, No. 4 (2022)
Titanium elastic nail for infected humerus fracture with wrist drop: a
rare case report
- Authors: Neetin Prahlad Mahajan, jayesh Mhatre, Pritam Talukder
  Pages: 492 - 494
  Abstract: Humerus mid-shaft fractures are typically managed with ORIF and plate fixation but a rare attempt for CRIF with titanium elastic nail (TENS) nail done even with infection in situ. A 28 year old male, a daily wage worker presented to us with mid-shaft humerus fracture with wrist drop after an incident of fall while carrying heavy load on his head. On X-ray evidence of osteolysis at the fracture site was found and following bone biopsy infected foci was discovered. Later, managed with CRIF with TENS nail and antibiotics. CRIF for infected long bone fracture is rare, but a bold attempt was made for internal fixation which yielded good results and post-operative 3 months showed great results with full active range of motion without any infective foci and with recovery of wirst range of motion.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221628
  Issue No: Vol. 8, No. 4 (2022)
Functional outcome of complex acetabular fractures by combined anterior
and posterior approach in a single sitting: a case report
- Authors: Neetin P. Mahajan, Amey Sadar, Pranay Kondewar, Syed Rahman Hifzur, Sushant Shrivastava, Ninad Kale
  Pages: 495 - 497
  Abstract: Complex acetabular fractures described by Judet and Letournel present with a formidable diagnostic and therapeutic challenge. Simultaneous anterior and posterior exposures of the acetabulum are a safe and are useful alternative to other extensile exposures and can be performed with similar morbidity. The advantages of simultaneous anterior and posterior approaches over extensile exposures include less morbidity, less hospital stay, early mobilisation and avoidance of soft tissue contracture. The combined approach is most useful in transverse, transverse posterior wall fractures with wide anterior displacement, T type fractures with significant anterior-inferior displacement, or both column fractures with posterior wall involvement. 23-year-old male came with chief complaints of pain and swelling at right hip since 3 days. He had history of fall from train and then referred to us for further management. clinical and radiological assessment was done. Approachment of the case was done with combined anterior and posterior incision in single sitting. It provided excellent clinical and radiological outcome. Complex acetabular fracture is a challenging entity. Association of these fractures with complex anatomy, delicate soft tissue handling and extensive blood loss makes it more difficult to manage. Combined anterior and posterior approaches of aceatabulum in a single sitting can be used as safe alternative to step wise extensible approaches used routinely. Outcomes associated with single sitting are good as its associated with lesser morbidity of patient, early functional mobility and less hospital stay. Though it’s not devoid of its own complications decision must be taken depending upon the condition of the patient and surgeon’s choice.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221629
  Issue No: Vol. 8, No. 4 (2022)
A rare case of periprosthetic supracondylar fracture with fracture medial
condyle of femur after total knee arthroplasty
- Authors: Sukanya Palit
  Pages: 498 - 501
  Abstract: Periprosthetic supracondylar fracture with fracture of medial condyle of femur after total knee arthroplasty (TKA), is of rare incidence. The risk factors include morbid obesity, increased varus deformity after primary TKA, osteopenia, prolonged use of corticosteroids or even trivial trauma leading to stress fractures. We reported a case of periprosthetic supracondylar fracture with fracture medial condyle of right femur after TKA in a patient of rheumatoid arthritis, with severe varus right knee and morbid obesity. X rays of knee revealed the periprosthetic supracondylar fracture with anterior femoral notching; CT scans revealed supracondylar fracture with severe comminuted fracture of right prosthetic medial condyle. Revision arthroplasty was done with augmented long-stem implant and patient was discharged on the 10th post-operative day. Knee movement at 6 months was 0-120 degrees with satisfactory outcome scores on follow-up. Periprosthetic supracondylar fracture with fracture medial condyle of the femoral implant requires immediate diagnosis and treatment; revision arthroplasty is mandatory if associated with morbid obesity, osteopenia and varus knees, after primary TKA. Obesity leads to excessive joint overloading, which together with varus malalignment and poor bone stock, may lead to component loosening, requiring revision arthroplasty. Weight reduction is necessary before primary TKA to improve the functional outcomes and reduce the incidence of revision arthroplasty.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221338
  Issue No: Vol. 8, No. 4 (2022)
Aggressive giant cell tumour of the talus: a rare case report and
challenges faced during its management
- Authors: Abhishek Singh, Shradha Bora, Giriraj J. K., Gopinath Menon
  Pages: 502 - 506
  Abstract: Giant cell tumour (GCT) of the bone is a locally aggressive benign tumour that commonly occurs in the epiphyseal ends of long bones. Its occurrence in the small bones of the foot like the talus is rare. In this case report we described a case of aggressive GCT of the talus (Campanacci grade 3) in a twenty-one years old male diagnosed by the presence of a well-defined osteolytic lesion seen involving the talar body with cortical breach and soft tissue extension confirmed to be a GCT by closed needle biopsy. The patient was managed surgically by excision of the tumour mass in-toto along with the talus followed by tibio-calcaneal fusion using free fibular strut graft and Ilizarov frame. At 3 months follow up no evidence of fusion was seen and therefore secondary augmentation with a cortico-cancellous graft from the iliac crest was done to aid fusion and Ilizarov fixator was removed 6 months after the surgery. The patient at one year follow up had shown no signs of recurrence of the tumour and has a pain free, stable fused tibiocalcaneal joint with a bipedal unassisted gait. Our case report found excision of talus combined with tibio-calcaneal fusion using free fibular strut graft along with cortico cancellous iliac bone graft to have a good outcome in terms of aiding tibio-calcaneal arthrodesis and thereby providing pain relief and providing a stable foot to the patient.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221630
  Issue No: Vol. 8, No. 4 (2022)
Distal femur arthroplasty for non-union distal femur fracture with failed
osteosynthesis in osteoporotic octogenarian: a case report with literature
review
- Authors: Lavindra Tomar, Gaurav Govil, Pawan Dhawan
  Pages: 507 - 511
  Abstract: Distal femur fractures (DFF) in the elderly have high morbidity and management challenges. The low energy trauma commonly presents significant fracture comminution, osteoporosis, pre-existing knee arthritis, co-morbid medical conditions affecting the union, weight-bearing potential and rehabilitation with profound functional disability. An octogenarian presented with a failed osteosynthesis resulting in non-union of a distal femur fracture compounded by osteoporosis and knee arthritis. He had been non-ambulatory with a painful, deformed knee. Management with a single-stage removal of the distal femur locked plate constructs and the defect reconstruction with the distal femur arthroplasty (DFA). The outcome was a pain-free weight-bearing mobilization with a functional range of knee motion. The surgical management in the elderly for the displaced intra-articular distal femur fractures is to restore the limb length and articular congruence for a functional knee. Fixation with either a distal femur locking plate or an intramedullary nail has a propensity for non-union, malunion, knee stiffness, and failed fixation. Salvage procedure gives good functional outcomes in failed osteosynthesis with DFA. The arthroplasty allows an immediate pain-less weight-bearing potential with improved ambulatory status and quality of life. The single-stage procedure in the elderly can regain a stable, functional knee joint.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221631
  Issue No: Vol. 8, No. 4 (2022)
Percutaneous screw fixation for trapezium fracture
- Authors: Vetri Nallathambi R., Raviraman V.
  Pages: 512 - 514
  Abstract: Isolated trapezial fracture is a rare diagnosis which can lead to long term symptoms if missed. We reported a case of vertical intra-articular displaced trapezial fracture treated with percutaneous cancellous screw fixation with good functional outcome.
  PubDate: 2022-06-24
  DOI: 10.18203/issn.2455-4510.IntJResOrthop20221632
  Issue No: Vol. 8, No. 4 (2022)