International Journal of Research in Orthopaedics 2023-12-29T20:17:41+0530 Editor Open Journal Systems <p>International Journal of Research in Orthopaedics is an open access, international, peer-reviewed journal that publishes original research work across all disciplines of orthopaedics and allied sciences. The journal's full text is available online at The journal allows free access to its contents. The journal aims to provide a platform for the exchange of information about all areas of orthopaedics and to promote the discipline of orthopaedics throughout the world. International Journal of Research in Orthopaedics is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new techniques. It is published every two months and available in print and online version. International Journal of Research in Orthopaedics complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></strong></p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix: 10.18203</strong></p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. 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The purpose of this study is to evaluate risk factors for conversion of hip arthroscopy to THA within 3 years after the procedure.</p> <p><strong>Methods: </strong>Hip arthroscopies for FAI performed at our institution between 2013 and 2019 were reviewed. Inclusion criteria included a minimum 3-year follow-up or a conversion to THA within 3 years. Patient characteristics and radiographic evaluation was made for each patient. This collected data were compared in the two groups Total hip arthroplasty vs non total hip arthroplasty (THA vs non-THA).</p> <p><strong>Results: </strong>A total of 136 patients met the inclusion criteria (69 men, 67 women, mean age 38,21 years). During the follow-up period, 22 underwent a THA in less than 3 years after the procedure (16.2%). A statistically significant association was found between conversion to THA and the Tönnis grade (p&lt;0.05), Kellgren-Lawrence grade (p&lt;0.05) and the joint space (p&lt;0.05). It was also found that the patient's age, body mass index (BMI), race and sex did not add independent predictive information.</p> <p><strong>Conclusions: </strong>Our analysis demonstrates a strong and significant association between the radiographic evaluation of osteoarthritis (Tönnis grade, Kellgren-Lawrence grade and joint space narrowing) and the risk of early conversion to THA. Other patient characteristics, like patient's age, BMI, race and sex, doesn´t seem to increase the risk.</p> <p><strong> </strong></p> 2023-12-12T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Comparison of the radiographic and functional outcome in pediatric orthopaedic patients with Gartland type II supracondylar fracture treated by operative versus non operative management 2023-08-23T15:12:31+0530 Wesson Pious A. Espiritu Juan Alejandro Legaspi <p><strong>Background:</strong> The non-operative method of closed reduction and application of long arm posterior splint and the operative method of closed reduction and percutaneous pinning are both putative management for Gartland II supracondylar fracture. The purpose of this study is to compare which method is superior in the management of this type of fracture thru the comparison of the radiographic as well as the functional outcome.</p> <p><strong>Methods:</strong> This study includes 51 pediatric patients undergoing supracondylar fracture treatment. The enrolled participants were randomly allocated to one of the two groups to receive either non operative or operative treatment. Radiographic and functional outcome was assessed post treatment.</p> <p><strong>Results:</strong> The operative group exhibited significant superiority versus the non operative group as reflected by the results of the post-treatment radiographs utilizing the anterior humeral line while the Baumann’s angle showed no significant difference between the two groups. Moreover, the operative group demonstrated a better Mayo elbow performance score total per follow up, only in the first 3 months but showed no significant difference thereafter.</p> <p><strong>Conclusions:</strong> We therefore conclude that non operative and operative management are both effective treatment for Gartland II supracondylar fracture. The operative group showed significant superiority with results of the anterior humeral line falling mostly at the central one-third of the capitellum. The operative group manifested a better Mayo elbow performance score total only during the first 3 months of follow up.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Suprascapular nerve block in shoulder dislocation 2023-10-23T22:58:53+0530 Sofia A. S. Madeira Marcelo P. T. Alves Catia F. C. Nunes Maria Ines S. Rocha João D. P. Cabaço <p><strong>Background:</strong> The suprascapular nerve is the main sensitive nerve of the shoulder. In 1973, the suprascapular nerve block was applied in the reduction of a series of cases of acute shoulder dislocations using mepivacaine. Barber described a method using anatomic landmarks to locate and block the suprascapular nerve.</p> <p><strong>Methods:</strong> This study was approved by our Institutional Review Board and all patients signed an informed consent. We performed a prospective longitudinal study, characterized by a consecutive series of first episode of traumatic shoulder dislocation in patients over 18 years old. From July 2020 to April 2022, 50 cases were included in our study. All patients had their pain evaluated before the blockage, during the reduction and after the reduction. We used the Barber method for the blockage and the Spaso maneuver for reduction.</p> <p><strong>Results:</strong> From the 50 cases, 29 were males (58%). The mean age was 58,7 years. 47 cases were anterior dislocations, 2 cases posterior dislocations and one case of <em>luxatio erecta</em>. The mean initial VAS was 7.5 points (minimal 4, maximum 10). The main score during the reduction maneuver was 2 points (0-5) and the main score after reduction was 0,4 (0-3). In only one case, reduction was not successful after 3 attempts, and reduction was performed under sedation.</p> <p><strong>Conclusions:</strong> The suprascapular nerve block by Barber’s method proves to be a secure, effective and simple procedure to aid the shoulder dislocation reduction in the emergency room, without the need of any imaging resources.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation 2023-12-03T11:39:28+0530 Shah Md. Faisal Eskander Proma Orchi Khaled Mahmud Nurul Mahmud Saikat M. Ashiqur Rahman <p><strong>Background:</strong> Fractures of the ischiopubic bones, S-I joint, and sacrum are among the most common bony injuries. Various procedures are available for managing this condition. Biomechanically, internal fixation of both the posterior and anterior lesions can offer complete stability to the pelvic ring. This study aimed to assess the functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation.</p> <p><strong>Methods:</strong> This descriptive observational study was conducted at the Department of Orthopedics &amp; Traumatology, Dhaka Medical College &amp; Hospital, Dhaka, Bangladesh from July 2016 to June 2018. A total of 44 patients with pelvic injuries admitted to the respective department were purposively enrolled as the study population. Data analysis was performed using the MS Office tools.</p> <p><strong>Results:</strong> Most patients (68.18%) continued their jobs with reduced performance, while 22.72% maintained both job and performance levels. Regarding functional assessment, 54.54% could sit pain-free, with only 13.63% experiencing discomfort. None reported painful sexual intercourse. Mobility-wise, no one was bedridden or could only walk a few meters, and 0% needed walking sticks. Additionally, 18.81% could walk for one hour with a stick, while 63.63% had a normal walking distance for their age. No limitations in walking time or distance were observed in 63.63% of cases.</p> <p><strong>Conclusions:</strong> This study concludes that stabilization of LC type-II pelvic ring fractures by anterior, combined, or posterior reconstruction plate provides a good result concerning daily living activities.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Comparison of American orthopedic foot and ankle society score between anterior to posterior lag screws versus posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture 2023-11-21T13:47:17+0530 Khandoker Muhammud Mazher Ali Muhammad Mozaherul Islam K. M. Badar Uddin M. Rukanuddawla Khan M. Atikur Rahman Shojib <p><strong>Background:</strong> Posterior malleolar fractures are frequent, occurring in up to 44% of all ankle fractures. Surgical management typically involves anterior to posterior (AP) lag screws or posterior buttress plates. This study aimed to compare the AOFAS (American orthopedic foot and ankle society) score between AP lag screw and posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture.</p> <p><strong>Methods: </strong>This quasi-experimental study was conducted at the department of orthopedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from November 2020 to October 2021. It involved 28 patients with ankle fractures, equally divided into two groups. Group A received AP lag screw fixation, and group B underwent posterior buttress plating. Data analysis was performed using MS office tools and SPSS version 23.0.</p> <p><strong>Results: </strong>The posterior plating group demonstrated superior postoperative AOFAS scores compared with the AP screw group with statistically significant differences (88 versus 81, p=0.008). Significant differences were noted in the AOFAS pain score (p=0.045) and function score (p=0.019) at the final follow-up between the two groups.</p> <p><strong>Conclusions:</strong> Patients with tri-malleolar ankle fractures in whom the posterior malleolus is treated with posterior buttress plating show superior postoperative AOFAS scores at follow-up compared to those treated with AP screws.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Outcomes of early active mobilization after surgical repair of injured extensor tendon of hand and forearm 2023-12-13T22:37:40+0530 Sujit Kundu Shawon Dutta Mohammed Amirul Islam Daniul Alam <p><strong>Background:</strong> Extensor tendon injuries in the hand and forearm, if left untreated, can significantly impair backhand function. Timely and effective treatment is crucial. Recent evidence suggests that early active mobilization post-surgery yields better short-term outcomes, with less disparity in long-term results.</p> <p><strong>Methods:</strong> This prospective observational study was conducted at the department of orthopedic surgery, BSMMU, Dhaka, Bangladesh, from March 2014 to August 2016, with a total of 40 patients.</p> <p><strong>Results:</strong> The study evaluated the efficacy of early active mobilization following surgical repair of extensor tendon injuries in zones V-VIII of the hand and forearm. At 12 weeks post-surgery, 75% of patients reported no pain, increasing to 90% at 6 months and stabilizing at 85% by 12 months. Furthermore, 75% of patients regained a range of motion greater than 120 degrees at 6 months, with 60% maintaining this at 12 months. Notably, 90% of the patients maintained normal grip strength at both 6 and 12 months. Final assessments using the Mayo wrist score showed satisfactory outcomes for 70% of patients at 12 weeks, 90% at 6 months, and 95% at 12 months. The Dargan criteria echoed these positive results, with satisfaction rates of 80% at 12 weeks, 90% at 6 months, and 95% at 12 months. Complications were minimal, including superficial skin infections (5%), hypertrophic scars (10%), and tendon rupture (5%).</p> <p><strong>Conclusions:</strong> The study concludes that early active mobilization, complemented by a simple static splint, facilitates faster recovery, full range of motion, improved grip strength, and earlier return to work in the early postoperative period.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Comparative study of functional and radiological outcomes of the usage of two devices, derotation type cephalomedullary nail and the helical blade type in unstable intertrochanteric fractures in the geriatric population at a tertiary-level center 2023-10-19T22:00:23+0530 Vishal Prakash Neelu Singh Govind Kumar Gupta Vinay Prabhat <p><strong>Background: </strong>Intertrochanteric fracture is a common osteoporotic fracture among elderly populations in an aging society. Early surgical fixation on these aging patients has been proposed recently for early rehabilitation and has had a positive impact on reducing comorbidities. For unstable fractures, intramedullary implants generally present biomechanical advantages over their extramedullary counterparts.</p> <p><strong>Methods: </strong>The study was a 2 years prospective comparative study from 1<sup>st</sup> December 2020 to 1st December 2022 conducted in the department of orthopaedics, Rajendra institute of medical sciences, Ranchi, Jharkhand, India. Total number of patients were 50, PFN done in 25 cases and PFN-A2 in another 25 cases.</p> <p><strong>Results: </strong>Mean age is 64.4 years in PFN group as compared to 67.3 years in PFN-A2 group. PFN-A2 was done in 84% male while PFN in only 76 % male and in both groups right side was mostly affected. Average surgery time, amount of blood loss, average number of C-arm shoot was more in PFN group.</p> <p><strong>Conclusions: </strong>In this study of 50 patients, 25 treated by PFN and 25 by PFN-A2, it was concluded that PFN-A2 was a better construct to treat patients of older age group having osteoporosis because here reaming was not done and helical blade was inserted by hammering which caused compaction of bones in head and neck region.</p> 2023-11-02T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Ultrasound guided platelet rich plasma or corticosteroid for supraspinatus tendonosis or partial tear: an observational study of clinical outcome 2023-11-10T16:52:00+0530 Tirthankar Dasgupta Mainak Das Tushar Gogia Narender Singh Aashish Tiwary Vaibhav Verma <p><strong>Background:</strong> The clinical application of platelet rich plasma (PRP) in rotator cuff tears has increased recently. Many studies have found no difference between placebo controls and PRP and corticosteroids (CS) and some have found more rapid benefits with PRP injections. The present study was undertaken with the objectives to observe and assess efficacies of the two different treatment modalities in terms of symptomatic relief and recovery of ROM and to ascertain the duration of symptom free period and functional improvement on follow up.</p> <p><strong>Methods:</strong> Observational clinical outcome study, conducted at a tertiary care hospital between September 2020 and March 2022 after institute ethical committee clearance. A total of 100 patients, with a positive clinical test for supraspinatus and magnetic resonance imaging (MRI) suggestive of supraspinatus tendinitis were divided to 2 groups and based on whether they received either intra-articular CS or PRP injection under ultrasonography (USG) guidance All patients were followed up at for assessing the outcomes at 6 weeks, 3 months and 6 months from intervention</p> <p><strong>Results:</strong> The clinical outcome of the group receiving the PRP was better than group receiving CS intervention.</p> <p><strong>Conclusions:</strong> PRP should therefore be considered as a viable option to treat supraspinatus tendinopathy/partial tear as it is cheap, readily available modality using patients own blood which is more acceptable to patient and also safe to individual where complications related to corticosteroids anticipated. Ultrasound guided procedure were found to enhance the accuracy of injection.</p> 2023-11-21T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics An observational retrospective study on safety and functional outcomes of arthroscopic anterior cruciate ligament reconstruction using Sironix suture button and interference screw 2023-12-13T18:10:55+0530 Murtuza Ahmed Mohammed Apurve Parameswaran Vinay Kishore Ponnala Krishna Kiran Eachempati Sunil Apsingi Ashok Kumar Moharana Sachin Angrish Deepak T. S. <p><strong>Background: </strong>Anterior cruciate ligament (ACL) injury is a persistent orthopaedic condition that affects a wide spectrum of people. ACL reconstruction (ACL-R) stands out as the primary treatment option. Graft fixation with suture buttons and interference screws has proven to be a highly successful and reliable method for ACL-R. In this context, our research aims to assess the safety and functional outcomes of patients who underwent arthroscopic ACL-R using the Sironix suture button and interference screw.</p> <p><strong>Methods: </strong>This was a retrospective observational study. Patients who underwent arthroscopic ACL-R using Sironix suture button and interference screw (January 2018-March 2022) were included in the study. Functional outcomes of patients were evaluated using the international knee documentation committee (IKDC) assessment, the Tegner activity scale (TAS), the Lysholm knee scoring scale, the modified knee injury and osteoarthritis outcome score (KOOS) quality of life subscale, and the single assessment numerical evaluation (SANE) score. Adverse events, if any, were recorded.</p> <p><strong>Results: </strong>All patients achieved excellent outcome measures for IKDC, Tegner, Lysholm, KOOS, and SANE scores. The mean (SD) IKDC score was 88.76 (7.16), Tegner activity score was 5.9 (1.13), while the Lysholm score was 96.9 (6.56). The overall KOOS score was 93.7 (7.52), and the overall SANE score for the affected joint was 94.5 (7.22).</p> <p><strong>Conclusions: </strong>Arthroscopic ACL-R using Sironix implants (Helysis titanium interference screw, Helysis PLDLA+β-TCP interference screw, Infiloop fixed loop UHMWPE suture titanium button, Proloop adjustable loop UHMWPE suture Titanium button, and Titanium suture disc) demonstrated safety and good functional outcomes.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics A prospective and observational study to assess the efficacy of pregabalin versus Gabapentin in relieving early post operative neuropathic pain with respect to clinical and functional outcomes in patients undergoing open lumbar discectomy surgery 2023-09-29T16:18:40+0530 Rohit N. Garg Shweta Vaje Hrishikesh Patil Sanket Bajaj <p><strong>Background: </strong>Post-operative neuropathic pain is one of the most dreadful complications following lumbar spine surgeries. Owing to the similarities in the pathophysiological and biochemical mechanisms underlying epilepsy and neuropathic pain, many anti-epileptic drugs (AEDs) like pregabalin and gabapentin are being used in the treatment of post-operative neuropathic pain.</p> <p><strong>Methods: </strong>This prospective and observational study included a total of 60 patients out of 261 patients undergoing lumbar discectomy surgery, who postoperatively had neuropathic pain as diagnosed with LANSS score; and were randomly divided into pregabalin (n=30) and gabapentin (n=30) supplementation groups, and the efficacy was compared with respect to visual analog scale (VAS) score (clinically) and Oswestry disability index (ODI) score (functionally) at pre-operative and post-operative follow-ups; and also, total analgesia consumed.</p> <p><strong>Results: </strong>No statistical differences were observed between any of the demographic variables and surgical levels operated upon between the two groups. Both the groups showed significant improvements in clinical (VAS) and functional (ODI) outcome as compared to pre-operative status. Leeds assessment of neuropathic symptoms and signs scale (LANSS) score was significantly increased in both the groups postoperatively till the 3<sup>rd</sup>monthfollow-up, after which there was a significant decrease in the score. The Pregabalin group showed significant (p&lt;0.05) improvement in VAS and ODI scores at the post operative 1<sup>st</sup>, 3<sup>rd</sup>, and 6<sup>th</sup> month, as compared to the gabapentin group; however, at other follow-ups the difference was insignificant. Total analgesia consumed was significantly higher in the gabapentin group.</p> <p><strong>Conclusions: </strong>Our study concluded that both pregabalin and gabapentin are highly effective in the treatment of early post-operative neuropathic pain; showing encouraging clinical and functional improvements. Pregabalin had significantly better outcomes on short-term follow-ups; however, on longer follow-ups, both had similar beneficial outcomes. Pregabalin supplementation showed a significant analgesia-sparing effect as compared to gabapentin.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization 2023-05-12T11:59:11+0530 Chitturi Yashwanth Madhav Khadilkar Denish Aghara <p><strong>Background:</strong> Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture.</p> <p><strong>Methods:</strong> Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction.</p> <p><strong>Results:</strong> In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%).</p> <p><strong>Conclusions:</strong> There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Prospective study of surgical management of femoral shaft fractures in children using tens nail 2023-06-13T06:09:44+0530 Mohammed Ismail Hathiwale Vishwas M. Mundewadi Mohammed Nadeem Ahmed <p><strong>Background:</strong> Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.</p> <p><strong>Methods:</strong> This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria.</p> <p><strong>Results:</strong> Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion.</p> <p><strong>Conclusions:</strong> TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Open sequential, open staged, and laparoscopic-assisted approaches 2023-08-27T15:38:20+0530 Subbiah Shanmugam Radha Siva Bharath <p><strong>Background:</strong> This retrospective study evaluates sacrectomy techniques and associated outcomes in 32 patients at our department. Sacrectomy, challenging due to complex anatomy and vascularization, has evolved from open single-stage abdomino-sacral to a staged approach and laparoscopic-assisted methods.</p> <p><strong>Methods:</strong> We examined total, subtotal, and partial sacrectomies, transitioning from a single-stage to a staged procedure (with a 1-2 day gap) and finally to laparoscopic-assisted sacrectomy. We focused on postoperative morbidity.</p> <p><strong>Results: </strong>Results show 14 partial, 8 subtotal, 8 total, and 2 laparoscopic-assisted partial sacrectomies. Giant cell tumors and chordomas were common. The staged approach was used in 16 patients, the sequential in 12, and laparoscopic in 2. The latter, despite longer surgery times, resulted in less blood loss, shorter hospital stays, less pain, and faster recovery. Wound dehiscence was the main complication, typically managed conservatively or with skin grafts. One case required a gluteal flap. Bowel and bladder dysfunctions, mostly following total and subtotal sacrectomies, improved with conservative management. The staged approach showed reduced morbidity compared to the sequential.</p> <p><strong>Conclusions: </strong>In conclusion, sacrectomy has become less morbid due to improved anatomical understanding, surgical advancements, and rehabilitation. Staged sacrectomy reduces peri-operative morbidity versus the sequential method. Laparoscopic-assisted sacrectomy, promising reduced blood loss, pain, and hospitalization, requires careful patient selection.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics The study outcome of bouquet technique for the management of displaced boxer's fracture 2023-10-01T11:15:28+0530 Ranjith Kumar Narender Saini Meena D. S. Sukhandeep Singh Bains Ajith Kumar <p><strong>Background:</strong> Fifth metacarpal neck fracture is also called Boxer's fracture. Most commonly occurs due to aggression behaviour that result in punch on a wall with a clenched first. If there is a displacement of boxer’s fracture more than 50<sup>0</sup> then it has to be managed operatively. We here present the outcome of bouquet technique that we used to operate the 80 cases of 5th metacarpal neck fracture.</p> <p><strong>Methods:</strong> We studied and did follow up of the 80, 5th metacarpal neck fracture that managed by bouquet technique. Clinical and radiological assessment was done at 4weeks and 6 weeks and 12 weeks. Total active motion, radiography and complication were noted.</p> <p><strong>Results:</strong> Out of 80 patients that were studied 72 got excellent results and 8 got fair results. Whereas one patient got infection and 2 got adventitious bursitis at the entry site which requires k wire removal.</p> <p><strong>Conclusions:</strong> The technique of antegrade intramedullary 3 kirschners wire in management of 5th metacarpal neck fracture is safe, simple, soft tissue sparing, minimally invasive technique with excellent functional and cosmetic outcome with minimal complications.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Management of adhesive capsulitis of shoulder joint with arthroscopic release vs. manipulation under anaesthesia: a comparative study 2023-10-26T12:54:39+0530 P. Sai Vikranth G. Shravani Surendranath Reddy J. Deepak N. Vamshi Varenya <p><strong>Background:</strong> Shoulder stiffness is a manifestation of various pathologies or clinical scenarios variously described as scapula humeral periarthritis, frozen shoulder and adhesive capsulitis. Frozen shoulder is characterized by significant restriction of active and passive motion of the shoulder that occurs due to unknown factors. Adhesive capsulitis causes contracted, thickened joint capsule that seemed to be drawn tightly around the humeral head with a relative absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule. In this study we did a comparison of 30 patients treated with arthroscopic release and manipulation under anesthesia.</p> <p><strong>Methods:</strong> There were 30 patients in this study with 15 patients in each group of different age groups. All the patients were studied for a period of one year between July 2021 to July 2022. The functional outcomes were assessed using dash scoring system.</p> <p><strong>Results:</strong> in this study of 30 patients with different age groups followed for 12 months and assessed by DASH scoring system. We had excellent results in arthroscopic group with postop dash score standard deviation is 5.87.</p> <p><strong>Conclusions:</strong> The arthroscopic capsular release of shoulder joint in adhesive capsulitis was found to have a better functional outcome as compared to the manipulation of shoulder joint under anaesthesia. Currently no treatment protocols are universally effective which needs more and more research and developments for proper treatment strategies. Morbidity with this condition has caused significant loss both economically and psychologically.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Functional outcome of arthroscopic labral repair in adults for traumatic shoulder instability: a prospective study 2023-10-28T21:05:07+0530 Vijay Chaudhary Tirthraj Dave Swapnil Nalge Hari Menon Kalgi Shah Ishan Shah Kishor Chaudhary Aakash Parmar Dixit Patel <p><strong>Background: </strong>Anterior shoulder instability is often treated either by open procedure or arthroscopic method. present study to assess the functional outcome of the patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization to evaluate shoulder function with labral tear and after repair of labral tear, to study epidemiology of labral tear and to study epidemiology of associated lesions.</p> <p><strong>Methods: </strong>Prospective study in the 25 consented patients admitted in the orthopaedics department in new civil hospital Surat with different shoulder injury after IEC approval. Statistical analyses done in MS excel.</p> <p><strong>Results: </strong>Mean age at time of first dislocation was 30 year and most (50%) were of 20-30 years. Most patients were males (92%). 84% of the cases, the dominant side is involved, right shoulder. Number of episodes of recurrent dislocation prior to surgery averaged 5 times. most common mechanism was Accidental fall (48%) followed by sports (32%), RTA (20%). Association of Hill-Sachs lesions was 80% with labral-tear secured with extra suture anchor. Preoperative parameters; number of dislocations, chronicity, reduction method do not have any significance on outcome. Rowe-score improved from 40.2% Preoperatively to 89.8% postoperatively at 12 weeks. 80% of patients is having excellent outcome.</p> <p><strong>Conclusions: </strong>Arthroscopic Bankart’s repair is gold standard for labral tear due to recurrent shoulder dislocation which led to short surgery time, less intraoperative and postoperative complications, increased shoulder function among patients. Associated Hill Sach’s lesion should be repaired for better functional outcome.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics A prospective and comparative study to evaluate the efficacy of oral pregabalin vs gabapentin combined with IV paracetamol as preemptive analgesic for post-operative pain in patients undergoing single level open lumbar spine decompression surgery in a tertiary health care center 2023-10-20T18:07:32+0530 Rohit N. Garg Shweta Sonu Vaje Hrishikesh Patil Sanket Bajaj <p><strong>Background:</strong> Post-operative pain in spine surgery, whether neuropathic or nociceptive, presents a significant challenge for both surgeons and patients. Previous research has demonstrated the effectiveness of pre-operative oral gabapentinoids in reducing postoperative pain, extending the time to first rescue analgesia, and diminishing overall analgesic requirements.</p> <p><strong>Methods:</strong> This study involved 120 patients undergoing lumbar discectomy for disc herniation. They were randomly assigned to receive pre-operative oral pregabalin, gabapentin, or a placebo, along with IV paracetamol as preemptive analgesia. The study assessed their efficacy through post-operative pain scores (VAS), and sedation scores (Ramsay sedation score) at various intervals, time to first rescue analgesia, and total analgesia consumption.</p> <p><strong>Results:</strong> No significant differences were found in demographic variables, surgical levels, or duration among the groups. The placebo group had the shortest time to first rescue analgesia, while the pregabalin group showed the longest, with a notable difference. Across most time frames, the pregabalin group reported the lowest mean postoperative VAS scores, whereas the placebo group had the highest. Initial variations in sedation scores converged in later time frames, with the placebo group consistently recording the lowest scores. Total rescue analgesia (tramadol) in the initial 24 hours was highest in the placebo group, followed by the gabapentin group, and lowest in the pregabalin group, with no significant variance.</p> <p><strong>Conclusions:</strong> This study affirms the superiority of pre-operative oral pregabalin with IV paracetamol. It effectively prolongs the time to first rescue analgesia and reduces overall analgesic consumption post-lumbar spine surgery, compared to pre-operative oral gabapentin with IV paracetamol.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Evaluation of the role of computed tomography guided biopsy in effective diagnosis and management of patients with Koch’s spine in India 2023-10-31T13:21:41+0530 Subith S. Kumar R. Dussa Sagar Kokate Shubham Tungenwar Shubham Dakhode <p><strong>Background:</strong> In the Indian population, tuberculosis and malignancy are the most common spinal pathologies. Radiological findings are often non-specific, thus non-diagnostic and fail to provide a prognostic perspective if the disease is established. Therefore, bacterial and/or histological evidence must be obtained to distinguish one infection from another or neoplasm. In this study, we evaluated the role of Computed Tomography-guided biopsy in Koch's spine by assessing diagnostic yield, the incidence of patients with drug-resistant tuberculosis, and drug sensitivity.</p> <p><strong>Methods</strong>: Patients with suspected Koch's spine attending outpatient department of tertiary health care centre in India were selected for the study. Data were collected using proforma containing demographic, clinical, radiological and other laboratory variables. In addition, biopsy samples were sent for microbiological and histopathological analysis. Patients were followed up at an interval of 3 months to one year.</p> <p><strong>Results</strong>: Most patients had Lumbar vertebra involvement followed by dorsal and least with cervical spine.41.25% of cases were drug resistant. In resistant cases, Isoniazid resistance is more seen, followed by Rifampicin. The clinical assessment revealed a significant difference in fever, back pain, Weight WBC count, Erythrocyte Sedimentation Rate and C Reactive Protein post-biopsy and treatment.</p> <p><strong>Conclusions: </strong>Patients with Koch's spine should have tissue sampling for diagnosis and drug sensitivity; otherwise, they will not receive adequate treatment, leading to delayed recovery, disease worsening and resistance. Computed tomography guided biopsy thus helps early diagnosis and guides to proper anti-tuberculous treatment. In addition, it helps to decrease the burden of morbidity associated with Koch's spine.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Functional evaluation of various modalities of management in floating knee injuries at a tertiary care centre in central India 2023-10-31T15:32:45+0530 D. K. Sharma Laxman Banodha Pranav Mahajan Anshul Meena Roshan Goyal <p><strong>Background:</strong> The injuries involving femur and tibia fractures due to high velocity are known as floating knee injuries. These fractures may involve the shaft, metaphysis or the articular surface. There are many complications associated with these injuries. This study evaluates the functional, clinical and radiological outcomes of floating knee injuries.</p> <p><strong>Methods</strong><strong>:</strong> A Prospective and interventional study was performed at MGMMC and MYH Hospital, Indore. We included 30 patients in our study. Femur fractures are managed by intramedullary nailing or distal femur plating. Tibia fractures are managed by Intramedullary nailing or tibia plating. Patient were called for regular follow up for a minimum of 6 months. Functional and clinical evaluation done by Karlstorm and olerud scoring system and radiological outcome by union on x rays were done.</p> <p><strong>Results: </strong>Out of 30 patients 28 (93.33%) male and 2 (6.66%) female. According to Fraser classification, 17 (56.66%) type 1, 4 (13.33%) type 2A, 4 (13.33%) type2B, 5 (16.66%) type 2C injuries. A majority of the injuries occurred due to road traffic accidents involving right limb 21 (70%) more then left 9 (30%). Knee stiffness occurred in 8, infection in femur 3, infection in tibia 2, malunion of femur 2, limb length discrepancy in 2 patients. Outcome was excellent in 5 (16.66%), Good in 10 (33.33%), Acceptable in 9 (30%) and poor in 6 (20%).</p> <p><strong>Conclusions:</strong> Fraser type 1 fracture has excellent results and Fraser type 2C has poor results. Closed fracture has better outcome compared to compound Fractures. A better functional outcome can be determined on the basis of implant choice based on Fraser Classification, level of injury, open or closed injury, simple or compound type of fracture.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Teriparatide therapy in joint replacement surgery: mitigating complications and improving patient outcomes in osteoarthritis 2023-11-01T15:13:57+0530 Yogesh Chaudhari <p><strong>Background:</strong> Teriparatide, a synthetic form of parathyroid hormone, has gained significant recognition as an effective treatment for osteoporosis. Its ability to stimulate bone formation and improve bone mineral density has made it a valuable therapeutic option in managing this prevalent skeletal disorder. However, its safety and potential benefits in preventing bone mineral density (BMD) loss after joint replacement surgery and post-surgical complications have yet to be extensively investigated.</p> <p><strong>Methods:</strong> This retrospective study included 32 patients who received teriparatide following joint replacement surgery for osteoarthritis. The analysis focused on assessing teriparatide’s effectiveness in any reductions in post-surgical complications and adverse events, if any.</p> <p><strong>Results:</strong> No teriparatide-related adverse events and post-surgical complications were reported during the follow-ups and the entire study duration.</p> <p><strong>Conclusions:</strong> Teriparatide demonstrated effectiveness in joint replacement patients. Further research is needed to explore long-term benefits and effects on implant longevity.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Femoropatellar alterations in knees with chronic anterior cruciate ligament injuries: a radiographic analysis 2023-11-01T22:52:21+0530 Ekjot S. Arora B. P. Sharma Narottam Das Mukul Mohindra Sandeep Shaina <p><strong>Background:</strong> The objective of this study was to correlate the occurrence of patellofemoral malalignment in a chronic anterior cruciate ligament (ACL) deficient knee using common radiological parameters.</p> <p><strong>Methods:</strong> A case-control study was conducted on 35 adult patients with previously diagnosed unilateral chronic ACL injury. The injured knee was considered as the case, while the contralateral normal knee served as the control. Radiological parameters including the Caton-Deschamps patellar height index, Merchant patellar congruence angle, and Laurin lateral patellar tilt angle were measured on X-rays obtained from both normal and ACL injured knees. A comparative analysis was performed between the two groups.</p> <p><strong>Results:</strong> The Caton-Deschamps patellar height index had a mean value of 0.95±0.05 in the ACL-deficient knee. The Merchant patellar congruence angle showed mean values of 12.66±0.84 degrees in the ACL injured knee, while the Laurin lateral patellar tilt angle was 8.06±1.41 degrees in knees with ACL failure. These results indicate lower patellar height, greater lateral displacement of the patella, and increased lateral patellar tilt in knees with chronic ACL tears, thereby affecting the patellofemoral joint.</p> <p><strong>Conclusions:</strong> Chronic ACL tears are associated with patellofemoral malalignment, characterized by decreased patellar height, increased lateral displacement of the patella, and greater lateral patellar tilt, thus impacting the patellofemoral joint.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics A short term analysis of external rotation deficit following a combined arthroscopic bankart with remplissage and rotator interval closure for anteroinferior instability with subcritical bone loss 2023-11-08T13:28:42+0530 Ayyappan V. Nair Sreejith Thampy J. Maythilisharan Rambhojun Sruthi Baburaj Prince S. Khan <p><strong>Background:</strong> Our study aims at assessing the clinical outcomes of our patients who have undergone arthroscopic bankart and remplissage along with rotator interval closure in the treatment of anteroinferior instability with subcritical bone loss, with focus on external rotation deficit.</p> <p><strong>Methods:</strong> This is a single-center retrospective study including 48 consecutive patients who underwent surgery Arthroscopic Bankarts with remplissage procedure for anterior shoulder instability with Hill-Sachs lesion. In our study, the minimum follow-up was 6 months and the average follow-up of was 21months. At the last follow-up, active range of motion, western ontario shoulder instability index (WOSI) and University of California at Los Angeles (UCLA) scores were assessed.</p> <p><strong>Results:</strong> 48 patients who underwent surgery in the time period of 2019-2023 who completed minimum 6months follow up were included in the study. The average age of the patients was 31.7 years (range, 16-52 years), with 93.8% male patients and 6.2% female patients. The range of motion at follow-up was comparable with the normal side, with loss of terminal external rotation in 2 patients (4%). Average University of California at Los Angeles score was 30.7 and Western Ontario shoulder instability index was 3.8%. One patient had only one episode of subluxation and there was one case of infection.</p> <p><strong>Conclusions:</strong> The results of our study validate the combination of Remplissage and rotator interval closure with Bankart repair in the treatment of anterior instability with glenoid bone loss &lt;15% irrespective of tracking of Hill Sachs lesion for excellent functional outcomes, least rate of recurrence and without significant loss of external rotation.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Impact of COVID-19 related delays on outcome of intertrochanteric neck femur fractures 2023-11-10T00:20:30+0530 Ganesh R. Yeotiwad Harshad G. Argekar Mohit R. Upadhyaya Lakshya L. Bhardwaj Amit S. Yadav <p><strong>Background: </strong>We are aware of no other study that has examined how the epidemic has affected an emergency service. Hence, the present study aims to determine the functional outcomes of delayed fixation to understand the impact of COVID-19 related hindrance to emergency service.</p> <p><strong>Methods: </strong>During the 1st wave of COVID-19, prevailing staff shortages and need for COVID tests resulted in minimum delay of 10 days between admission and surgeries as compared to the recommended urgent fixation standard. Harris Hip Score was calculated at 1 year follow up for these patients.</p> <p><strong>Results: </strong>The results showed that the mean age of the patients was 68.65±8.03 years. Out of all the patients, 50.9% were males and 49.1% were females. The mean Harris Hip score at 1 year follow-up was 78.76±11.65. Out of all, 3.63% were lost to follow up, and 20% were expired.</p> <p><strong>Conclusions: </strong>Early surgery seems to improve survival and decline in pressure sores. Conservative management should be well planned and used on patients who actually have a good risk to benefit ratio to it as the patients can develop increased risk of pulmonary, skin, and urinary infections. Efforts should be made to operate patients on within one to two days. Despite the fact that the overall number of trauma cases declined in this unprecedented COVID-19 scenario.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Evaluation of the clinical, functional and radiological outcomes in patients with distal tibia fractures with simple intra-articular extension treated with intramedullary multidirectional locking nail: a prospective study 2023-11-19T21:40:26+0530 Sanket Bajaj Raunak Dhawale Rohit N. Garg <p><strong>Background: </strong>Distal tibia fractures with extension into the ankle joint (AO/OTA type 43C) poses challenge for an orthopedic surgeon, due to its subcutaneous nature and precarious blood supply. Literature has described various treatment modalities; most commonly used being locking compression pates, external fixators and intramedullary multidirectional locking nails.</p> <p><strong>Methods: </strong>This prospective study included 60 patients with distal tibia fracture AO type 43C1 and 43C2, managed with intramedullary multidirectional locking nails in a close manner, with intra-articular fragment fixation preceding the nail insertion. The aim of this study was to evaluate the clinical, functional and radiological outcomes as well as the complications in these patients.</p> <p><strong>Results: </strong>Patients’ mean age was 48.7±16.6 years; most had type 43C1 fractures (51 patients). The mean surgery time was 88.4±17.5 minutes, performed within 5.6±2.01 days post-injury. The 30 patients had fibula fracture with syndesmotic injury which was fixed with TENS nail. The functional assessment with Johner and Wruh’s criteria; 45 patients (75%) had excellent, 12 patients (20%) had good and 3 patients (5%) had fair outcomes. The fracture union averaged 16.7±1.63 weeks (14-20 weeks). 6 patients had superficial wound complication, while 3 patients had valgus malalignment; all managed without further surgery.</p> <p><strong>Conclusions: </strong>Intramedullary nailing following specific surgical technique, and potential percutaneous screws; is a safe, effective and successful treatment option for AO/OTA types 43C1 and 43C2 fractures with high fracture union rates, high functional results, and low complication rates.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Day case orthopaedic trauma surgery effectiveness: a systematic review 2023-09-12T09:10:44+0530 Donald Buchanan Islam Sarhan Jamie Hind Gur Sidhu Andrew Dekker Neil Ashwood <p>Day case surgery facilitates effective orthopaedic care for ambulatory trauma cases and can act as an effective pathway in times of reduced resource availability within acute hospitals. A systematic review of the available literature was performed using a narrative synthesis to look for themes underpinning day case trauma practice. A 25 papers were selected from a total of 9956 papers screened to identify those papers that considered day case trauma surgery and its impact on clinical outcome, patient satisfaction and feasibility of delivery within the UK. 9014 patients had day case trauma operations within the 25 papers identified, 86% had general anaesthesia and 14% either regional or local anaesthesia. The mean reported age was 37.5 years with a wide age range (2-83) years treating roughly similar proportions of men and women with a high satisfaction rate when recorded. All areas of the upper limb were operated on apart from the scapula the commonest being the wrist. In the lower limb surgery was undertaken in the knee, ankle or foot with removal of foreign body or ankle fixation being the commonest procedures undertaken. Prevalence of complications at 0.0156% of cases undergoing day case surgery was seen to be lower than in a similar group of inpatient cases. resources are stretched. Day case surgery for trauma procedures within orthopaedics is safe, cost effective and well tolerated by patients. It frees up resources to facilitate treatment and should be utilised within each hospital to enable timely care.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Para-tricipital approach for extra articular fractures of the distal humerus: a case series 2023-09-20T17:17:44+0530 Rasiq Rashid Imtiyaz Ahmad Beigh Shahid Shabir Khan Reyaz Ahmad Dar Saheel Maajid <p>Extra-articular fractures of the distal humerus are frequently managed surgically as these fractures are often unstable and have associated radial nerve injury. Different surgical approaches can be used to fix this fracture. We operated on a series of 9 patients with extra-articular fractures of the distal humerus utilizing the para-tricipital approach. Clinical outcomes were assessed by Mayo elbow performance score and visual analog scores. Radiological outcomes were assessed by plain radiographs. Time to union was an average of 4.2 months. Mean range of motion achieved at final follow-up was 122.5<sup>0</sup>. Mean Mayo elbow performance score was 92.4. Excellent clinical results can be achieved by utilizing para-tricipital approach in extra-articular fractures of the distal humerus. Besides providing adequate exposure for rigid fracture fixation, this approach prevents the morbidity associated with triceps injury.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Ewing sarcoma: a tumor with an uncanny predilection for uncommon sites 2023-10-16T00:24:08+0530 S. Subbiah Sandhya P. A. <p>Ewing sarcoma is one of the most common bone tumors diagnosed in pediatric age group second only to osteosarcoma. The tumor is known to involve most commonly pelvic bones and long bones while extra-skeletal Ewing sarcoma accounts for 15%. Ewing sarcoma of other sites like scapula, clavicle, hands, and feet are quite rare, accounting for only 3-5%. To determine the epidemiological profile of Ewing sarcoma of unusual sites treated in our department including age at diagnosis, site of origin and mode of management along with survival data. Details of Ewing sarcoma patients reported our department in last 9 years were collected and data was analysed. We report a total of 20 cases of Ewing sarcoma in last 9 years with 4 (20%) extra skeletal Ewing sarcoma arising from soft tissues of extremities and 30% from rare sites (3 scapula, 1 clavicle, 1 phalanx, 1 calcaneum). All patients were operated after 4-7 cycles of chemotherapy with 66% limb salvage rate. With an average necrosis of 40%, with a median follow up of 36 months, the overall survival of the group was found to be 77.7%. Ewing sarcoma is one of the rare tumors of bone and soft tissue with the predilection for unusual sites, with reasonable survival outcomes in localized disease. Though scapula, clavicle, hands and feet are rare sites for Ewing sarcoma, they accounted for 30% in our department, possibly because of the referral patterns.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Step-cut, biplanar, elongation and angulation ulnar osteotomy with annular ligament reconstruction in neglected Monteggia fracture dislocation in children: a retrospective study 2023-10-20T18:14:07+0530 Rohit Nirbhay Garg Dinesh Gupta Soutrik Kundu Shweta Sonu Vaje <p>Monteggia fracture dislocation is an infrequent injury in children, with around 20-50% cases being missed on initial consultation; leading to their chronic and neglected forms leading to number of complications; thus justifying their operative management. Various treatment modalities have been suggested in the literature for these neglected injuries. A retrospective study of 7 patients (5 males and 2 females), with mean age of 9.58 years (7-14 years); with neglected Monteggia fracture dislocation undergoing corrective reconstructive surgery in the form of elongation and angulation proximal ulnar osteotomy with radial head reduction combined with annular ligament reconstruction was conducted and was then evaluated clinically and functionally using Mayo Elbow Performance Index (MEPI) score; and radiographicaly were graded as good, moderate or poor. The mean interval from time of injury to the time to corrective surgery was 10.58 weeks (range 6-16 weeks). The mean improvement in the post operative MEPI score was 23.57. The mean improvement in the post operative flexion-extension arc was 28.57˚, while that in the supination-pronation arc was 20.72˚. We concluded that Step-cut, biplanar, elongation and angulation proximal ulnar osteotomy with additional reinforcement in the form of annular ligament reconstruction is an effective technique to treat neglected Monteggia fracture dislocations in children; having excellent clinical, functional and radiological outcomes.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics A case of a rare hibernoma tumour and a brief literature review 2023-09-26T12:37:22+0530 Kristen Gauci Fabian Debono Fiona Gauci Francesca Panzavecchia <p>Hibernomas refer to benign tumours of immature adipose tissue known a brown fat. They are most commonly found in areas where brown adipose tissue is still present in adulthood such as the shoulder, back, neck, best, arm and abdomen. This case study describes a 60 year old male who presented with a growing 15 mm lump in the right forearm. On examination, tenderness in the area surrounding the mass was elicited. A magnetic resonance image of the right forearm was performed which reported a large intramuscular lipomatous tumour within the brachioradialis muscle, in close relation to the neuromuscular bundle. Surgical excision was performed successfully. Histology was consistent with a diagnosis of a hibernoma tumour. The patient healed well with no evidence of infection or recurrence on follow up.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Dislocation of the metacarpophalangeal joint: a narrative review treatment and examination 2023-10-27T11:16:37+0530 Saran Malisorn <p>The dislocation of the metacarpophalangeal (MCP) joint is complex, often occurs due to complications from excessive stretching or overextension that cannot be reduced. The volar plate moves to back of the head metacarpal bone and the base of the proximal phalanx that is near the proximal phalanx, acting as an obstruction to the contraction. Although it is true that pathophysiology is relatively complex, the resulting damage is not normal, and the reduction of such damage often depends on experience. Present a case of a complex fracture of the MCP joint, along with a review of the literature on the anatomical relationship and therapeutic armamentarium.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Neck fluid extravasation in shoulder arthroscopic surgery-a life-threatening complication: a report of two cases 2023-11-15T17:51:00+0530 Diogo A. Sousa João Reis André Guimarães António L. Lopes <p>Fluid extravasation in shoulder arthroscopy may lead to life-threatening consequences, such as airway compromise. These cases are rare and few were reported in the literature. Clinical cases of 2 female patients submitted to shoulder arthroscopy for a rotator cuff tear repair, complicated with fluid extravasation that led to trachea compression and need for intensive care unit (ICU) admission with postponed extubation. Neither patients showed any sequelae in the follow-up period. Report of these rare complications, with detailed and reproducible information, is vital for their comprehension and future elaboration of surveillance and treatment guidelines.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Gradual distraction on hinged-based Ilizarov ring fixator to correct fixed flexion deformity of knee: description of the surgical technique 2023-10-19T13:00:50+0530 Anil Regmi Bishwa B. Niraula Shivam Bansal Rohan Gowda Saptarshi Barman Mohit Dhingra <p>Knee deformity in flexion is the most disabling deformity. Surgical correction can be attempted with soft tissue release, osteotomy, or both. However, acute correction can cause serious complications. Ilizarov technique has become an appealing alternative to open surgery, where skeletal traction is used to distract the joint gradually and steadily in order to reduce the risk of skin problems or neurovascular injuries. Two patients and three limbs, male aged 28-42 (mean=35 years) with severe fixed flexion deformity were corrected by a hinged-based Ilizarov ring fixator. Mean flexion of the knee was pre-operatively 86.66 degrees (80-90 degrees). The mean extension angle at the last follow-up was 168.3 degrees (165-170). The mean knee society score (KSS) was 44.3 (35-50), mean KSS functional score was 43.3 (0-65). One patient had satisfactory outcomes and could stand without walking aids and walks on extended knee with walking aids. Arthrodesis of knee or creating a stiff knee in the most extended position may be most effective for severe, fixed contractures.With the gradual, calculated distraction, the Ilizarov apparatus is an effective tool for treating severe cases of knee contracture.</p> 2023-11-06T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics A rare location of the rare tumour-chondromyxoid fibroma of calcaneum 2023-02-22T12:54:19+0530 Narendrasinh Rajpurohit Fardeen Shariff <p>Chondromyxoid fibroma (CMF) primary location is the long tubular bones of the lower extremity followed by foot and knee. This benign cartilaginous tumor of bone is the rarest reported neoplasm of cartilaginous origin. This mass can mimic other benign and malignant bone tumors owing to its variable histologic features. We report a case of CMF of the calcaneum with varying presentations. Pathologic examination is difficult but can be used to differentiate this lesion from more serious conditions. A quick and accurate diagnosis of CMF can prevent unnecessary treatment that could be harmful to the patient.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Arthroscopic decompression and debridement for the treatment of anterior cruciate ligament ganglion cyst in a 45-year-old female 2023-10-19T09:42:08+0530 Rahul Krishnan Sandeep Mohan <p>Anterior cruciate ligament (ACL) cysts are infrequently encountered in clinical practice, with limited reported cases. These cysts usually present with chronic knee pain and clinical examination is usually unremarkable except for knee tenderness. Due to the lack of characteristic symptoms and deficiency of precise clinical techniques to diagnose the condition, timely diagnosis requires a high index of suspicion, supported by magnetic resonance imaging (MRI). Hence management of ACL ganglion cysts poses unique challenges for healthcare providers. We present a case study of a 45-year-old female with an ACL ganglion cyst successfully treated with arthroscopic decompression and debridement. This article outlines the clinical presentation, diagnostic workup, surgical intervention, and post-operative outcomes of this case, providing insights into the effective management of this uncommon condition. Furthermore, we provide a comprehensive review of the existing literature on ACL ganglion cyst, emphasizing findings and treatment outcomes reported in previous studies. This case underscores the importance of considering ACL cysts in the differential diagnosis of knee pain and discomfort. Early identification and appropriate management, such as arthroscopic cyst excision, can lead to favorable outcomes and complete recovery.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Iatrogenic femoral nerve palsy after a routine knee ligament surgery 2023-10-19T09:44:40+0530 Prunav Adhav Prithvi Raj Madan Mohan Anoop Pilar Harish Kodi Rajkumar S. Amaravathi <p>Peripheral nerve injuries following surgery can have a significant impact on the rehabilitation process. We report a case of a 25-year-old male who was unable to actively raise his leg and extend his knee following knee surgery (Arthroscopic Posterior cruciate ligament reconstruction and Posterolateral corner reconstruction). Following the surgery, it was noticed that the patient's knee range of movements and power was 0/5 as per the Medical Research Council (MRC) scale. On subsequent evaluation, it was found to be due to femoral nerve axonal neuropathy. We report such a case of femoral nerve axonal neuropathy following arthroscopic posterior cruciate ligament (PCL) reconstruction and posterolateral corner (PLC) reconstruction.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Malunited supracondylar femur fracture in haemophilia A: a case report on evaluation and management 2023-10-28T20:01:33+0530 Swati Sharma Amit Kumar Sanjay Sharma <p>Haemophilia is a rare inherited X-linked bleeding disorder associated with various levels of coagulation factor VIII (type A) or IX (type B) deficit. Hemophilic patients can be affected by trauma and fractures just like the general population. But due to their bleeding disorder, such patients need specific multidisciplinary management, from the emergency room to the operating theatre, in order to limit severe complications. The goal of modern fracture treatment is to obtain an optimal outcome, with the patient's return to full activity as soon as possible. If a fracture is correctly treated in a haemophilic patient, it will progress to consolidation in a similar time-frame to fractures occurring in the general population. Worldwide, there are only a few specialized orthopaedic centres dedicated to the management of hemophilia. Management of supracondylar femur fracture in patients with haemophilia is no different from general population if an adequate haemostasis is achieved. The purpose of this paper is to report our experience on the supracondylar fracture of the femur in hemophilia by a multidisciplinary team at a single institution.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics How to manage blocked intramedullary canal while reaming during hip arthroplasty 2023-10-31T00:35:50+0530 Harish Bansal Laxmi Narayan Jajoriya Aditya Verma <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><span style="font-size: 10.0pt; color: #212121; background: white;">Blockage of femoral canal while doing hemiarthroplasty is rare finding. Before inserting the femoral stem trial we should manage this blockage adequately to prevent iatrogenic fracture. Herein, we present a case of fracture neck of femur right in a 79-year-old male who presented with history of right hip pain and later was diagnosed with neck of femur fracture subcapital type that was treated with cementless hemiarthroplasty. In conclusion, if the canal is blocked, start with small diameter (K-wire), then insert guide wire and then reaming over it to open the blocked canal, do not hammer directly to prevent iatrogenic fracture. Go sequentially to open the blockage. First open the marrow then insert trial stem.</span></p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Recurrent myxoid liposarcoma of thigh 2023-11-04T14:40:09+0530 Vismaya K.B. Rihan Rashid <p>We are presenting the case of a 78 year old man who presented to our out-patient clinic with a history of a recurrent mass over the anteromedial aspect of the left thigh. The aim of this case report is to study the clinical, radiological findings, diagnosis and surgical management of a well differentiated liposarcoma.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Nocardiosis ‘great imitator’: unusual disease with usual presentations at unusual site 2023-11-06T12:53:37+0530 Akram Jawed Ankit Singh Vikas Gupta <p>Nocardia, an aerobic actinomycete, typically affects immunosuppressed individuals, commonly manifesting in the lungs. Cutaneous infections, particularly by <em>N. pseudobrasiliensis</em>, can occur, presenting as lympho-cutaneous, superficial, or mycetoma subtypes. <em>Nocardia farcinica</em>, resistant to third-generation cephalosporins, is particularly virulent. A 50-year-old female with type 2 diabetes presented with painful nodules, bullae, and recurrent discharge over the left wrist, mimicking cellulitis. Culture-sensitivity revealed <em>Nocardia farcinica</em>. Treatment involved debridement, De quervain release and prolonged Linezolid therapy for a complete cure. Cutaneous Nocardiosis can mimic cellulitis, posing diagnostic challenges due to slow growth and microbiological detection. <em>N. farcinica</em> demonstrated resistance to conventional antibiotics. This case emphasizes the importance of considering Nocardia infections in diverse clinical presentations, highlighting the need for a comprehensive diagnostic approach, especially in immunocompromised individuals.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation 2023-11-11T11:16:06+0530 G. Lakshman Prasath <p>Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Non-ossifying fibroma of distal tibia: case report 2023-11-21T00:29:52+0530 Girish H. R. Prabhat Mittal Aravind M. <p>Non-ossifying fibroma is a benign fibrohistiocytic lesion most commonly seen in the metaphyseal region in children. It usually doesn’t present with any symptoms. As the bone grows and undergoes remodeling, the lesion tends to vanish and get substituted with healthy bone. Nonetheless, the lesion can debilitate the affected bone, leading to a potential fracture. Here, we report a case of non-ossifying fibroma in the metaphyseal region of the tibia in a 13-year female. The patient presented with complaints of pain in the left leg for 5 months and underwent radiological investigation showing a well-defined, multi-loculated, expansile, radiolucent, lytic lesion with a thin sclerotic margin in the meta-diaphyseal region of the distal tibia, for which extended bone curettage with bone grafting was performed. The sample was sent for histopathological examination, which showed bony trabeculae with bits of tumor composed of spindle cells with elongated nuclei and scant cytoplasm, arranged in a storiform pattern along with many scattered multinucleate giant cells and foamy histiocytes suggestive of non-ossifying fibroma. Post operatively, non-weight bearing mobilization was advised for 4 weeks. Most non-ossifying fibromas were diagnosed in childhood to late adolescence, found incidentally, and clinically asymptomatic. Most distal tibial non-ossifying fibromas (NOFs) tend to transpire at a specific anatomical site located at the far end of the interosseous membrane. The prognosis for NOFs is typically excellent with a low risk of recurrence.</p> 2023-12-29T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics Role of 3D printed customized implants in periarticular fractures: a narrative review 2023-11-18T00:22:37+0530 Rohan Gowda Shivam Bansal Tushar Gupta Anil Regmi Bishwa B. Niraula Saptarshi Barman Pradeep K. Meena <p>“3D printing” is a common term used for a number of technologies which operate on the principle of converting a computer-generated 3D image into a physical model. Advantage of 3D printed parts is that they can assume complex shape, with solid and porous components that can be combined to provide the best combination of strength and performances and can help visualize the complex fractures which are difficult to apprehend with conventional imaging. Presently, the primary applications for 3D printing are the production of anatomical models for planning and surgery simulation, patient-specific instruments and custom-made prosthesis which have transformed how orthopedic problems are addressed now. This review aims to describe the utility and future directives into the application of this technology in orthopedics.</p> 2023-11-30T00:00:00+0530 Copyright (c) 2023 International Journal of Research in Orthopaedics