International Journal of Research in Orthopaedics

Beneath the white coat: decoding stress among Indian medical postgraduates

Arjun Ganesh — 2024-08-28

Stress among medical postgraduates in India has reached alarming levels, with significant implications for individual well-being and the healthcare system. This review aims to explore the multifaceted nature of stress among Indian medical postgraduates, encompassing factors such as increasing suicide rates among doctors, senior toxicity, loss of quality doctors, and its role in doctor migration. Through an analysis of recent articles from reputable journals, this review examines the prevalence, causes, manifestations, and consequences of stress in this population, alongside strategies for mitigation and intervention.

Long term outcomes of neonate septic arthritis of the shoulder

Bárbara Choupina — 2024-08-28

Upper limb palsy in the newborn may be caused by a large number of pathologies, such as fracture, brachial plexus palsy or infection. The diagnosis of neonatal osteoarticular infection is extremely challenging, especially in the shoulder joint. The lack of obvious clinical signs can frequently result in a delay in the diagnosis, which can lead to important sequelae. A retrospective study of nine patients with a history of neonatal septic arthritis of the shoulder was performed. All patients were treated at the same institution.

Diagnosis and treatment of subchondral bone insufficiency fracture of the knee joint: case series

Koshman Gennadiy — 2024-08-28

Subchondral insufficiency fracture of the knee (SIFK) is a stress fracture that happens under the cartilage usually due to repetitive stress to the bone which is already weakened by non-cancerous diseases which impacts the bone strength and fragility. SIFK is a new nosologic entity that has replaced the diagnosis of spontaneous osteonecrosis of the knee. Primary avascular necrosis of the femoral condyles is a differential diagnosis of subchondral fracture of bone insufficiency of the knee joint, which requires a different approach to treatment. The aim of our study was to evaluate the effectiveness of conservative treatment of subchondral bone insufficiency fracture of the knee joint (SIFK).

Total knee arthroplasty stabilized with autologous bone graft for tibial bone defect correction

Halley P. Junior — 2024-08-28

Evaluate the functional results obtained with total knee arthroplasty stabilized with autologous bone graft to correct axis deviation with tibial bone failure. A retrospective study with a convenience sample, consisting of fifteen patients operated between February 2015 and June 2019. Data were obtained through analysis of medical records: age, biological gender, affected side, pre- and postoperative radiographs, description of the surgical technique and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire results preoperatively and 6 months after surgery. The average age of the patients was 67 years, majority male (53.3%) and varus deformity (80%). The mean time to release the load was 31 days and all patients were discharged two days after surgery, with no complaints of complications. In the preoperative period, pain and physical function had the highest scores in WOMAC questionnaire. After total knee arthroplasty, there was a significant improvement in the three dimensions of WOMAC, with a reduction of 78.6% in the total score. Total knee arthroplasty stabilized with autologous bone graft to correct axis deviation with tibial bone failure resulted in improvement of symptoms and physical function in most patients evaluated, reducing pain and functional disability due to gonarthrosis.

Outcome of dome osteotomy for correction of angular deformity around knee: a case series

Maruti B. Lingayat — 2024-08-28

Angular deformities around the knee, such as genu valgum, genu varum, and recurvatum, can lead to significant functional impairments and pain. Dome osteotomy is a surgical procedure designed to correct these deformities by providing high adjustability, stability, and avoiding limb length discrepancies. This retrospective cohort study involved 20 patients, aged 16 to 23 years, who underwent dome osteotomy for knee deformities between January 1, 2023, and December 31, 2023. The study was conducted at a government tertiary care center and medical college. Preoperative assessments included detailed medical history, physical examination, and radiographic evaluations. The surgical technique involved a cylindrical bone cut centered at the CORA, with postoperative management including immobilization and gradual weight-bearing.The mean preoperative intermalleolar distance (IMD) was 14.52 cm, which improved to 6.85 cm postoperatively (p<0.0001). The clinical tibiofemoral angle improved significantly in both bilateral (from 20.35 degrees to 12.92 degrees, p<0.0001) and unilateral cases (from 18.67 degrees to 8.67 degrees, p<0.004). Patients reported significant pain relief, improved stability, and enhanced mobility during follow-ups. Dome osteotomy is an effective and reliable surgical technique for correcting angular knee deformities. Its high adjustability, stability, and avoidance of limb length discrepancies contribute to significant improvements in clinical and radiological outcomes, enhancing patient quality of life and preventing long-term complications.

Direct lateral approach for hemiarthroplasty: a case series

Ashoke K. Chanda — 2024-08-28

Worldwide, hip fractures are a public health concern. The primary course of treatment for displaced femoral neck fractures is still surgery. Even now, hemiarthroplasty remains a highly preferred surgical procedure. The most popular methods for gaining access to the hip joint are the direct lateral and posterior approaches. Aim of this series is to research the short-term functional results, risks, and disadvantages of the direct lateral approach to the hip. Patients with traumatic neck of femur fracture coming to the Department of Orthopaedics, Calcutta National Medical College and Hospital and was elected for bipolar hemiarthroplasty as treatment option. Among the 12 cases 9 were males and 3 were females. The value of z is 2.4495. The value of p is 0.01428. The result is significant at p<0.05. Garden’s classification - there were 2 cases of type 3 garden and 10 cases of type 4 garden fractures. The value of z is 3.266. The value of p is 0.00108. The result is significant at p<0.05. Though there is a chance of iatrogenic gluteal nerve and vascular injury -which we did not encounter in our case - the direct lateral approach exposes the hip joint to a sufficient but limited degree. However, the risk of post-operative hip dislocation is minimal because the rotator cuff of the hip joint is preserved; none of the 12 cases that were chosen had this condition.

Surgical and functional outcomes of vancouver type B2 postoperative periprosthetic femoral fracture treated with revision arthroplasty and coxa femoral bypass

Shivaraj Amruthrao Chatrashali — 2024-08-28

As the number of total hip arthroplasties have steadily increased, one would expect a concomitant increase in catastrophic postoperative events such as periprosthetic fractures. This study evaluates the surgical and functional outcome, along with the associated complication rates in patients undergoing revision arthroplasty following Vancouver type B2 post-operative periprosthetic femoral fracture. We studied 14 Clinically and radiologically diagnosed patients with Vancouver type B2 Post-operative Periprosthetic femoral fracture. The post-operative VAS score has decreased to 2.23±0.92 from a pre-operative score of 8.30±0.9, p<0.001. The average Harris Hip Score has improved from 44.05±7.71 pre-operatively to 83.63±7.75 post-operatively at 6 months, p<0.001. At 6-month follow-up, we had 57% excellent results, 29% good results, 7% fair results, and 7% poor results based on Harris Hip Score. The revision arthroplasty of Vancouver type B2 post-operative periprosthetic femoral fracture with revision arthroplasty and coxa femoral bypass has excellent-good surgical as well as functional outcomes in terms of regaining abductor function by an increase in range of motion at the affected hip joint, significant pain relief leading to improved quality of life after surgery at short term follow up period.

Functional outcome of Latarjet procedure in anterior recurrent shoulder instability

Maruti Lingayat — 2024-08-28

The Latarjet procedure is a surgical technique which was described by Michel Latarjet in France in 1954. He described it as an open stabilization technique of the glenohumeral joint in patients with recurrent anterior glenohumeral instability. It is a procedure of combination of coracoid process bone graft and a form of stability provided by the conjoined and subscapularis tendons. The benefits of the procedure are provision of stability, restoration of range of shoulder motion, preservation of shoulder muscle strength and return to premorbid activities of daily living. Patients with recurrent anterior shoulder dislocation with bone loss the bone blocking technique of Laterjet is the technique of choice. This technique has been effective in 98% of patients in avoiding recurrence without losing external rotation. Hence, present study was aimed to determine the functional outcome of open Laterjet procedure for recurrent shoulder dislocation. Case series was conducted based on post-operative Laterjet cases in a government tertiary care centre and medical college, involving 20 patients who underwent Latarjet’s procedure, with duration 1st January 2023 to 31st December 2023 patients of either gender or age more than 18 years with recurrent anterior shoulder dislocation. Ethical clearance was obtained from the institutional ethics committee. The indication for the Laterjet procedure was defined with preoperative clinical findings proving recurrence of anterior shoulder instability and confirming the cause of dislocations with radiographs and MRI scans. In the included subject’s complete history, physical examination and relevant investigations were done. The incidence of poor, fair, good, and very good outcomes was found to be 1 (5%), 2 (10%), 14 (70%), and 3 (15%) respectively. There was significant improvement in shoulder motion and reduction in pain after 6th month's follow-up. We reported re-dislocation in 1 patient. Mean VAS (Visual analogue scale) for pain among the patients in the study also reduced from pre-operative value of 7.2 to 6.5, 4.5 and 1.5 at 6 week, 3 months and 6 months postop respectively and this reduction in pain was found to be highly significant. Recurrent anterior shoulder dislocation can be effectively treated by open Latarjet technique being a safe and reliable treatment alternative with good functional outcomes. Surgeons should be aware that these procedures are technically demanding.

A study of outcome of diaphyseal fractures of radius and ulna in paediatric age group treated with titanium elastic nailing system

Vijayanand Bedge — 2024-08-28

A study of outcome of diaphyseal fractures of radius and ulna in paediatric age group treated with titanium elastic nailing system. The current study is an attempt to find out the functional outcome, radiological union, and complications of paediatric diaphyseal radius and ulna fracture treated with titanium elastic nail. This is a prospective study of twenty-five patients of age group 6 years to 16 years diagnosed with a diaphyseal fracture of radius and ulna treated with percutaneous nailing with titanium elastic nails in Department of Orthopaedics, S Nijalingappa Medical College and HSK Hospital, Bagalkot between November 2019 to April 2022. Clinical, functional and radiological outcomes were assessed with Anderson et al criteria for 6 months. In terms of union and range of motion using Anderson et al criteria 20 patients had excellent results, 2 patients had satisfactory results and one patient had an unsatisfactory result. There were no cases of poor results. Five cases had complications like Nail prominence, elbow stiffness, olecranon bursitis and super skin infection. The radiological union was achieved in a mean time of 8.24±2.62 weeks. Complications resolved after implant removal. Titanium elastic nail system showed excellent results in terms of bony union, functional outcome with minimal complications which resolve after nail exit. Therefore, titanium elastic nail system should be considered as an effective alternative of conservative management for forearm fractures in pediatric age group.

Tibial pilon fractures: management and evaluation of the outcome in mean and long term about 51 cases

Abdoulaye Camara — 2024-08-28

Background: the management of tibial pilon fractures is a real challenge in our regions.

Methods: This was a mixed study: dynamic from January 1 to December 31, 2013 involving 19 patients; retrospective from January 1, 2014 to December 31, 2018, covering 32 patients, received, treated and followed up for tibial pilon fracture in the Orthopedics-Traumatology department of the Donka university hospital center, Conakry Republic of Guinea. The clinical diagnosis was guided by the pain, functional impotence, a context of high trauma energy and confirmed by the X-ray of the ankle in antero-posterior and lateral views. The AO (association for Osteosynthesis) classification was used in our department.

Results: The average age was 36.21 years old with male predominance, the sex ratio was 5.4. The road accidents were the mostly found (86.27%). The motorbicycles were the mostly involved; the osseous lesions the mostly found were the type C according to AO classification (56.86%), followed by type B (33.33%). The orthopaedical treatment (27.45%), and surgical (72.55%). The ankle arthrosis was the most complication found (27.45%).

Conclusions: Tibial pilon fractures are rare but serious however the treatment depends on the anatomopathological type. The prognosis of these lesions remains always reverved in our context of lack of equipment in our hospitals.

Osteosynthesis, arthroplasty or resection of the radial head-which guarantees the best results in Mason III radial head fractures?

Joao Pires — 2024-08-28

Background: Fractures of the radial head are common, accounting for approximately one third of elbow fractures and 4% of all fractures. The most accepted classification is modified Mason, with type III being comminuted fractures, normally requiring surgery. There is currently no consensus on the most effective treatment method.

Methods: This study aims to compare the radiological and functional results of Mason III fractures, treated at our hospital between 2017 and 2022. During this period, 23 patients were surgically treated with osteosynthesis, arthroplasty or resection of the radial head. Inclusion criteria (isolated fractures of the radial head with follow-up of more than 6 months) and exclusion criteria (neurovascular, ligament injuries/ other associated fractures) were considered. Functional assessment was based on Broberg-Morrey elbow score; Mayo elbow performance score (MEPS) and QuickDASH.

Results: The differences in functional results between the various treatments were not statistically significant (p>0.05), despite the best results being seen in the arthroplasty group.

Conclusions: In our series there was a 47.82% complication rate. Five patients developed heterotopic ossification. Which was significantly higher than expected in the arthroplasty treatment group, with a statistically significant difference; but there was no translation in functional terms, since this group achieved the best functional scores. The group of patients who underwent osteosynthesis were those with the worst functional scores and the most complications (3 cases of post-traumatic arthrosis, 3 nonunions and 1 aseptic necrosis). Our series is small, but the results are similar to previous studies.

Evaluation and compare the outcomes of patients undergoing either a unipolar or bipolar hemiarthroplasty for fractures of the femoral neck in aged patients

A. F. M. Julfikar — 2024-08-28

Background: Treatment of displaced intra-capsular femoral neck fractures in older patients remains controversial. Factors such as age, fracture type, bone quality, and socio-economic status influence treatment decisions. Surgical options like hemiarthroplasty and internal fixation are considered, each with distinct outcomes and considerations. The study aimed to compare radiological and clinical outcomes, as well as functional results, between elderly patients undergoing unipolar and bipolar hemiarthroplasty for femoral neck fractures.

Methods: The prospective interventional study conducted over a period of 30 months, from July 2021 to December 2023. A total of 72 patients were included in this prospective interventional study, which was conducted at the 250-bed general hospital Gopalganj and the Sheikh Sayera Khatun Medical College Hospital. Of them, 36 underwent treatment with a unipolar prosthesis and another 36 underwent treatment with a fenestrated bipolar prosthesis via a lateral approach. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 24.

Results When the unipolar and bipolar groups were compared, comparable demographic distributions and mean ages (71.12 years) were found. Statistically significant differences were observed in hip scores (p value=0.019), activity on stairs (p value=0.043), and wearing shoes (p value=0.023), with the bipolar group demonstrating better outcomes in these aspects. Satisfactory outcomes were achieved by 80.55% of the unipolar group and 72.22% of the bipolar group, with 19.45% and 27.78% experiencing unsatisfactory outcomes, respectively.

Conclusions: Bipolar hemiarthroplasty with a fenestrated stem may offer older patients with displaced intracapsular femoral neck fractures better functional outcomes and fewer complications compared to Austin-Moore unipolar prostheses.

War-related orthopedic injuries: a comprehensive analysis from Benghazi medical center 2013-2016

Ayman Alhoiti — 2024-08-28

Background: The majority of war-related injuries involve the extremities and typically necessitate surgical intervention. These injuries are notably severe due to the impact of high-velocity rockets, including gunshot wounds and blast injuries. However, epidemiology of the war-related injuries of the last decade Libyan conflict remains under investigated. The study aimed to illustrate the characteristics of the cases volume, mechanism of injury, and the emergency department management protocol.

Methods: A retrospective observational study included all patients admitted to the orthopedic department with war-related injuries between December 2013 and December 2016. Relevant data collected included patient demographics, injury patterns, and treatment modalities. The data was organized and analyzed using SPSS statistical software.

Results: The 563 patients with war-related orthopedic injuries were treated during the study period. The highest percentage of patients were seen in 2015 (45%) and 2014 (44.2%), with a peak in July/summer months. Most patients were male (86.3%) with a mean age of 30.5 years. The most common causes of injury were gunshot wounds (36.1%) and explosions (28.2%), primarily affecting the upper (35%) and lower (29.3%) extremities. The 75.7% of injuries resulted in fractures, with 16.2% having associated injuries like bowel, nerve, and amputation. The most common emergency interventions were damage control surgery, debridement, and fixation.

Conclusions: This data provides valuable insights into the complex nature of war-related orthopedic injuries and the challenges healthcare teams face in conflict-affected regions. The findings underscore the critical need to strengthen the resilience and capacity of medical systems to effectively address the specific needs of war trauma.

Results of surgical management of unstable proximal humeral fractures by proximal humeral locking plate

Pankoj Kanti Mondol — 2024-08-28

Background: Unstable fractures of the proximal humerus present a significant surgical challenge despite the variety of treatment options available. One effective surgical method for managing these fractures is the use of a proximal humerus locking plate. This approach provides stability and support to the fracture site, facilitating proper healing and potentially improving patient outcomes. The aim of this study was to evaluate the outcome of treatment of unstable proximal humeral fractures with proximal humeral locking plate.

Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 100 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study.

Results: The mean age of patients with unstable proximal humerus fractures was 41.53 years, ranging from 23 to 78 years. Most patients were male and primarily in business occupations. Fracture types included three-part fractures (53%), four-part fractures (7%), and fracture dislocations (40%). The mean time to plate fixation was 18 days, with a range of 2 to 78 days. High-velocity accidents caused 93% of injuries. Complications included avascular necrosis (7%), screw loosening (7%), and subacromial impingement (13%), with no reoperations needed.

Conclusions: The result of the study demonstrates that the proximal humeral locking plate provides sufficient fracture stabilization in the treatment of unstable proximal humeral fractures.

Patterns of traumatic long-bone fractures in North-Eastern Nigeria: a prospective multicenter study in 5 tertiary hospitals in Nigeria

Shaphat Shuaibu Ibrahim — 2024-08-28

Background: Traumatic musculoskeletal injuries have formed a significant burden on healthcare delivery worldwide. Long bone fractures are the most common musculoskeletal injuries encountered in this category and with the advent of insurgency in the northeastern part of Nigeria, there has been a rising incidence of assaults, gunshots, and other traumatic causes of long bone fractures.

Methods: A prospective cross-sectional study of patients with traumatic long-bone fractures in north-east Nigeria presenting in the tertiary hospitals involved in the study during the 6months study period (September, 2023 to February 2024). information of all patients presenting with traumatic long bone fractures were collected; biodata, presenting complains and findings on examination including the Glasgow coma scores were collected and documented. Radiological findings and intervention given. All information were collected and documented using a structured questionnaire. Data collected were analyzed using SPSS version 29.

Results: 227 patients were seen from the five major tertiary centers in north-eastern Nigeria that participated in the study. The 123 patients (54.2%) from Abubakar Tafawa Balewa university teaching hospital (ATBUTH)-Bauchi, 43 patients (18.9%) from Modibo university teaching hospital (MAUTH)-Yola, 32 patients (14.1%) were seen in Federal medical center (FMC)-Jalingo, 18 patients (7.9%) from federal teaching hospital (FTH)-Gombe and 11 patients (4.8%) from Maiduguri teaching hospital Maiduguri (UMTH)-Maiduguri. The 178 (79.1%) were males and 47(20.9%) females, making a male to female ratio of 4:1.

Conclusions: Long bone fracture causes a significant health care burden in north-East Nigeria with a high incidence of road traffic accidents, assaults and gunshots likely from the increasing effects of insurgency and kidnappings activities in this region.

Evaluation of the results of cubitus varus deformity by stepcut osteotomy

Ratan K. Paul — 2024-08-28

Background: A gunstock deformity or varus elbow is the commonest late deformity in supracondylar fractures of the humerus. The elbow is bowed outward making a bow elbow or cubitus varus deformity. The aim of this study was to evaluate the effectiveness of the step cut osteotomy technique for correcting cubitus varus deformity following supracondylar fractures of the humerus

Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka and 250 beded General Hospital, Kushtia, Bangladesh from July 2010 to June 2018.

Results: The majority 36 patients (75% of total) were aged between 11 to 20 years, 8 patients (16.67% of total) were aged 10 years or younger and 4 patients (8.33% of total) were aged between 21 to 30 years respectively with female male ration 1:5. Majority 44 patients (91.67% of total) were students and 4 patients (8.33% of total) were workers respectively. Left side involvement was in 32 (66.67%) and right side in 16 (33.33%) cases. In our study 20 (42%) cases result was excellent, good in 16 (33%) cases and poor in 12 (25%) cases respectively.

Conclusions: This study demonstrates that the corrective osteotomy of cubitus varus deformity using the stepcut technique is a satisfactory method of treatment.

Functional outcomes of displaced metastatic fractures of proximal femur: comparison between prosthetic replacement and intramedullary nailing

Noppadol Wangjiraphan — 2024-08-28

Background: Surgical treatments for proximal femur metastasis include prosthetic replacement (PR) and intramedullary nailing (IMN). Controversy persists regarding the most appropriate surgical option, and previous studies have mixed outcomes of patients with both displaced and impending fractures. This study aimed to assess the early functional outcomes in patients undergoing PR or IMN specifically for displaced metastatic fractures.

Methods: A retrospective cohort study was conducted on patients with displaced metastatic proximal femur fractures treated surgically between January 2013 and March 2023. Patients with metastases confined to the femoral head or neck without trochanteric extension, which is not an indication for IMN, were excluded. Patients were divided into PR and IMN groups. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score at three months postoperatively.

Results: Seventeen patients (10 females, 7 males; mean age 63.1±10.7 years) were treated with PR, and 31 patients (18 females, 13 males, mean age 61.4±11.3 years) were treated with IMN. Preoperative MSTS scores were similar between PR and IMN groups (3.8±2.6 vs. 2.9±1.6, p=0.179). Postoperatively, PR group had significantly higher MSTS scores (16.6±7.0 vs. 12.8±5.1, p=0.045), with better scores in function (p=0.028), supports (p=0.005), and walking (p=0.032). PR group had longer operative time (142 vs. 90 min) and greater blood loss (650 vs. 200 ml) compared to IMN group.

Conclusions: Patients with displaced proximal femur fractures from metastatic lesions had significantly higher MSTS scores with PR than with IMN at three months postoperatively.

Thin lateral wall cortex intertrochanteric proximal femur fractures: a comparative study between past and present

Mohammad Ahmad Abushahot — 2024-08-28

Background: There has been a growing recognition of the significance of preserving the integrity of the lateral wall of the proximal femur, in addition to the previously emphasized importance of the posteromedial portion in predicting fracture stability. Consequently, this study aimed to compare the outcomes of various fixation methods employed in treating intertrochanteric proximal femur fractures with a thin lateral wall.

Methods: This retrospective study assessed 225 cases of treated intertrochanteric fractures with a thin lateral cortex, examining radiological outcomes at different follow-up intervals to evaluate the efficacy of different treatments. The study compared Dynamic Hip Screw (DHS), Dynamic Condylar Screw (DCS), and Proximal Femoral Nail (PFN) in terms of healing, mortality, and complications.

Results: The average age of patients was 79.75 years, with 61.3% having comorbidities. The three treatment modalities showed similar healing times, revision rates, and mortality rates. The one-year mortality rate stood at 26%. PFN consistently maintained a favorable position during follow-up assessments. While DHS initially exhibited excellent reduction on postoperative X-rays, less than half of the fractures maintained acceptable reduction during the first follow-up due to shaft medialization (32%) and varus collapse (24%). DHS treatment was also frequently associated with nonunion, with intraoperative lateral wall fractures occurring in 15.4% of cases. DCS was found to be the least effective treatment, being commonly associated with varus collapse.

Conclusions: In treating intertrochanteric fractures with a thin lateral wall component, PFN demonstrated superior outcomes in terms of reduction and lower complication rates compared to other fixation methods. Therefore, PFN should be the preferred choice, while DHS and DCS should be avoided for this fracture pattern.

Comparison of the effectiveness between external fixations and conservative treatment for distal radial comminuted fracture

Shamol Chandra Barman — 2024-08-28

Background: Comminuted distal radial fracture is a potentially unstable fracture. It can be managed by external fixation and closed reduction with immobilization by plaster casting. But external fixation has better outcome than plaster casting. This study aimed to compare the effectiveness between external fixations and conservative treatment for distal radial comminuted fracture.

Methods: This prospective interventional study was carried out in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University from March, 2013 to September, 2015. 30 patients of distal radial comminuted fracture were selected. Total patients were divided into two groups. In Group A patients were treated by external fixation and in group B patients were treated by plaster cast.

Results: In this study, out of 30 patients, majority were male (60%). Mean age was 38.93(±10.45) years in group A and 40.66(±11.04) years in group B. Left side involvement was more 17 (56.7%) than right side 13 (43.3%). After 12 weeks, final follow up in group A 08 (53.3%) patients were recovered with excellent outcome. In group B 06 (40%) patients were recovered with excellent outcome. In group A, 14 (93.3%) patients were satisfactory outcome and in group B, 13 (86.7%) patients were satisfactory outcome.

Conclusions: External fixator decreases the complications of re-displacement and shortening for the treatment of comminuted distal radial fracture. It gives more satisfactory radiological, functional and clinical outcome as compared to cast immobilization.

Evaluation of primary high-grade osteosarcoma by surgical resection in PT Birta city hospital

Rupesh Jung Belbase — 2024-08-28

Background: Classic OS had a 20% five-year survival rate during most of the 20^th century. Adjuvant chemotherapy was first used to treat OS in the 1970s, raising survival rates to 50%. The standard course of treatment for OS includes surgery, neoadjuvant chemotherapy, and adjuvant chemotherapy. When treating a patient with soft tissue and bone sarcomas, the extent of surgical procedures is frequently described using surgical oncologic classifications. Radical resection refers to the removal of the whole bone or compartment harboring the tumor, whereas wide resection refers to the removal of the affected area of the bones with a cuff of healthy tissue.

Methods: The study conducted a retrospective analysis of 120 patients who visited to orthopedic outpatient department of PT Birta city hospital and research center, Nepal from October 2019 to November 2022. Radical resection was defined as the removal of the entire affected bone, while wide resection was described as partial bone excision. The baseline characteristics of the patients were analyzed and the data regarding radical and wide resection in osteosarcoma (OS) was evaluated.

Results: The analyzed report shows that 65/120 (54.1%) radical resections and 55/120 (45.8%) wide excisions were the extent of the resection. On the other hand, a central review of the extent of resection data revealed 100/120 (83.3%) wide excisions and 20/120 (16.6%) radical resections.

Conclusions: OS is currently treated with extensive resection, neoadjuvant chemotherapy, and adjuvant chemotherapy, with a strict emphasis on the overall intensity of treatment and prompt restart of post-resection chemotherapy.

Evaluation of the results of sub axial cervical spine injury with incomplete neurology treated by posterior lateral mass fixation with screws and rod and fusion by bone graft

M. Zia-Ur-Rahman — 2024-08-28

Background: The cervical spine is a highly mobile segment of the spinal column, liable to a variety of diseases and susceptible to trauma. Lateral mass screw fixation has become the method of choice in stabilizing subaxial cervical spine among other posterior cervical fixation techniques. This study aimed to assess the radiological efficacy of the cervical lateral mass screw insertion and rod fixation by Yoon's method.

Methods: This was a prospective observational study conducted in the Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, over a period of two years from July 2014 to June 2016. We included 100 patients who will be admitted with a diagnosis of unstable cervical spine injury during period of study.

Results: The mean age of the patients was (36.87±7.45) years. Majority of the patients were male (80%). Bearing load on the head was the most common (40%) cause. Most commonly involved level of injury was C5/C6 (30%) and type of injury was Fracture Subluxation (35%). Hemorrhage (15%) was the most common per operative complication followed by neck pain (12%), superficial infection (10%), screw pull out (10%), and post-operative khyphotic deformity (10%). Evaluation of final outcome revealed 67% and 33% patients had satisfactory & unsatisfactory results respectively.

Conclusions: The lateral mass screw insertion and rod fixation is a safe and reliable technique with low rate of complication related to instruments. This method enhances neurological recovery, reduce pain and improve working status with early rehabilitation.

Timing of surgical interventions for open lower limb long bone fractures as a determinant of the length of hospital stay in a tertiary hospital in Nigeria

Miriam U. Eroh — 2024-08-28

Background: Open fractures are major orthopaedic emergencies with known complications such as infections, amputations and death. Fractures involving the long bones of the lower limb are usually more common. Surgical interventions range from basic debridement to major surgery and vascular repairs. The timing of these interventions is debatable, with medical bodies developing differing standards to improve overall patient outcome. The aim was to determine the effect of the timing of surgical interventions on the length of hospital stay in patients with open lower limb long bone fractures.

Methods: This was a retrospective cross-sectional study of 45 patients who presented in a tertiary facility over a 5-year period with open fractures involving the long bones of the lower limb. Patients’ time to presentation/initial debridement, time to surgery, and length of stay post-surgery were evaluated. The obtained data were analysed using the IBM statistical package for social sciences (SPSS) Statistics version 26 for Windows (SPSS Inc., Chicago, IL, USA).

Results: This study revealed that all our patients fell between Gustilo-Anderson I and IIIA. Sixty-nine percent underwent initial debridement within 6 hours of injury. Forty-two percent had surgery within 1–3 days postinjury. Majority (62%) left the hospital within 1 week of surgery. Multivariate analysis revealed no significant correlation between the time of injury to surgical intervention and length of hospital stay (ρ=-0.087; p=0.590).

Conclusions: This study concluded that while the timing of surgical interventions may be important, it did not significantly affect the length of hospital stay.

Functional outcome of femoral shaft fracture in pediatric patients treated by titanium elastic nailing system

A. H. M. Abdul Wahid — 2024-08-28

Background: Pediatric femoral shaft fractures are common, typically occurring in early childhood due to low-energy incidents and during adolescence due to high-energy trauma. These fractures represent around 2.2% of all bone injuries in children, with an incidence of 20-25 per 100,000 children per year, and are more prevalent in boys.

This prospective study aims to assess the outcomes of treating pediatric femoral shaft fractures with TENs.

Methods: This prospective study at North Bengal Medical College and Hospital included Twenty-three patients, aged 4 to 12 years, with diaphyseal femur fractures treated using TENS (Titanium Elastic Nailing System) for one year, from January 2023 to December 2023.

Results: Most patients (52.17%) were 9-12, with a higher prevalence of males (73.91%). The most common fracture type was transverse (69.57%), predominantly on the right side (69.57%). Union rates were 21.74% at 8 weeks, 56.52% at 10, and 21.74% at 12 weeks. Complications included limb lengthening (21.74%) and malalignment (13.04%). Functional outcomes at 12 weeks post-operation were mostly excellent (60.87%) or satisfactory (30.43%), with one poor result (8.70%).

Conclusions: Titanium elastic nailing system (TENS) is effective for pediatric femoral shaft fractures, achieving high bone union rates and minimal complications. Most fractures healed within 10 weeks, and patients had excellent or satisfactory functional outcomes, supporting TENS as a beneficial treatment for children aged 4 to 14.

A comparative study of clinical and radiological outcomes of open tibia fractures, managed with uncoated versus antibiotic coated intramedullary interlocking nail

Bhagvan P. Meena — 2024-08-12

Background: Open tibia fractures are a significant clinical challenge, especially in densely populated regions like Jaipur, Rajasthan, where elevated trauma incidence and diverse healthcare access issues compound treatment intricacies. This study compares the clinical and radiological outcomes of open tibia fractures managed with conventional uncoated intramedullary nails versus antibiotic-coated intramedullary interlocking nails. The introduction of antibiotic-coated nails aims to reduce the incidence of infection, a major concern in open fractures due to the direct exposure of the fracture site to the external environment.

Methods: A prospective, observational study was conducted at the department of orthopedics, SMS Hospital, Jaipur, focusing on a cohort of 100 patients with open tibia fractures treated from January 2016 to December 2018. Patients were included based on specific criteria, including the type of fracture and the treatment received, either with uncoated or antibiotic-coated intramedullary nails. Data were collected retrospectively from hospital and operation charts, with radiographs and clinical information reviewed independently by two authors.

Results: The comparison revealed a lower infection rate and a higher rate of bone union at 12 months in the group treated with antibiotic-coated nails versus the uncoated group. Specifically, the antibiotic-coated group showed a 10% lower infection rate and a 10% higher bone union rate.

Conclusions: The use of antibiotic-coated intramedullary nails for the treatment of open tibia fractures demonstrates a promising reduction in infection rates and improved bone healing, offering a significant advantage over traditional uncoated nails in managing these complex injuries.

Evaluating the efficacy of rehabilitation outcomes of the femoral neck system in treating femoral neck fractures: a two-year prospective study

Sachin Kale — 2024-07-06

Background: Femoral neck fractures are prevalent among the elderly, and the femoral neck system (FNS), introduced in 2017, provides a minimally invasive treatment option with a dynamic bolt feature that enhances stability and facilitates early mobilization.

Methods: This study involved 30 patients with femoral neck fractures treated with FNS at Dr. D. Y. Patil Medical College and Hospital from January 2021 to February 2023. The patients, aged 45-85 years, adhered to a structured rehabilitation protocol. Clinical outcomes were assessed using the Harris hip score (HHS) over 2-year follow-up period.

Results: The cohort consisted of 30 patients (mean age: 65±10 years; 70% male). Fractures were classified as Pauwels I (30%), Pauwels II (40%), and Pauwels III (30%). At the final follow-up, 27 patients (90%) achieved union. The HHS improved significantly from a mean of 35±10 preoperatively to 85±15 postoperatively. Complications included one implant failure, one instance of limb shortening, and one case of avascular necrosis.

Conclusions: The FNS is a safe and effective treatment for femoral neck fractures, promoting early weight-bearing and joint mobilization, leading to improved functional outcomes and reduced complications.

Evaluation of efficacy and safety of Collashot C2 plus capsule in osteoarthritis patients

Bijoy Deb — 2024-07-12

Background: Osteoarthritis (OA), the most prevalent joint disease, is marked by chronic joint pain and debilitating symptoms. Many drugs are available in the market for treating osteo arthritis symptoms but there is still need for drugs with least adverse effects. So, in this study, an attempt has been done with Collashot C2 plus capsule, a nutraceutical for treating OA symptoms.

Methods: This is an outcome, quasi-experimental study where patients with OA were included. Patients were given capsule Collashot C2 plus daily for 3 months. A total of 30 male and female patients were included in the study. Changes from baseline to 12 weeks in knee pain intensity measured by pain visual analogue scale (VAS) and in Western Ontario and McMaster universities OA index (WOMAC) pain subscale, laboratory parameters, participant's global assessment of improvement of OA were assessed. Adverse drug reactions were also observed during the study period.

Results: There was a statistically significant improvement in the VAS pain scale, WOMAC pain score and in participant's global assessment of improvement of OA at week 4, week 8, and week 12 compared to baseline (p<0.001) was observed.

Conclusions: Collashot C2 plus capsule has proved to be very safe and effective in the management of OA Participants by reducing inflammation, providing adequate pain relief without causing any major side effects.

Functional outcome of autologus platelet rich plasma injection as treatment for patients with plantar fascitis

Sandesh F. Akki — 2024-08-28

Background: Plantar fasciitis (PF) is the most common cause of pain that occurs in the heel, and approximately 11% to 15% of adults having foot symptoms require an expert care. Heel pain and tenderness are some of the common symptoms. Many conservatives methods are available, Platelet rich plasma is one of the safe and effective therapy in relieving symptoms. To describe the functional outcome of autologus platelet rich plasma as treatment for patients with plantar fasciitis. To describe any complications associated with the procedure.

Methods: It is a prospective observational study 45 patients with chronic Plantar fasciitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at regular intervals post treatment. The PRP was prepared from venous whole blood.

Results: Pain score was assessed at the time of injection. The mean pain score of all the patients was 8.614. Percentage pain relief showed 48% had 100% pain relief, 33% had more than 50% pain relief and 6% had less than 50% pain relief from the study.

Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of Plantar fasciitis. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months.

Comparative study of compound both bone leg fractures managed with versatile antibiotic intramedullary inter locking nailing with external fixator

Sachin Nargund — 2024-08-28

Background: Background Compound fractures of the tibia are more likely to result in non-union and the development of infection because of inadequate blood supply and the absence of soft tissues in the antero-medial side of the tibia. Whether to undertake a primary fixation or a staged fixation is still a difficult decision to make in situations like these. Hence, we performed this study to compare the clinical, functional and radiological outcome of compound both bone leg fractures managed with Versatile Antibiotic Intramedullary Interlocking Nailing system and external fixator.

Methods: This is a Prospective comparative study performed on all patients admitted with compound fractures (Grade 1,2,3A,3B) of both bone leg fractures in the Department of Orthopaedics at a tertiary care center. Thorough wound debridement was done layer by layer after adequate extension of the wound. Fracture ends were debrided, thorough wound wash given with Reamer Irrigation Aspiration system (RIA).

Results: In our study, there is a significant association between the time delay of surgery and post operative infection (p value 0.008). In our study, average time from admission to surgery was 20.9 hours in group A vs group B (21.81 hours).

Conclusions: The final outcome in our study mainly depended on wound debridement and thorough pulsatile lavage and early intervention (VAIL Nailing), earlier the surgery better the outcome.

Clinico-radiological outcomes of proximal humerus fractures using locking compression plates among adults in a tertiary care hospital: an observational study

Kumar V. S. V. — 2024-08-28

Background: Proximal humerus fractures represent 45% of humerus fractures and are the third most common fracture in the elderly due to trivial falls and weakened cancellous bone, and in the young population due to high-energy trauma. These fractures can be disabling and require surgical expertise for a good functional outcome. This study analyzes the clinico-radiological and functional outcomes of adult patients with proximal humerus fractures treated with locking compression plates.

Methods: A prospective observational study was conducted on patients with proximal humerus fractures treated with locking compression plates from June 2022 to June 2023 at SIMS Hospital, Chennai. Functional outcomes were measured using the SPADI score and radiological union of fractures at follow-ups of 2, 6, 12, and 24 weeks.

Results: In this study, 34 patients underwent ORIF with locking compression plates. All fractures healed completely without secondary procedures, nonunion, malunion, or implant failure. No postoperative complications were observed. The average time for radiological union was 14.5±2.4 weeks. The SPADI scores at 2, 6, 12, and 24 weeks were 82, 63.26, 22.26, and 4.06, respectively, showing statistically significant improvement (p < 0.05).

Conclusions: ORIF with locking compression plates, combined with proper anatomical reduction and suture augmentation of the rotator cuff, yields early ROM return and good functional outcomes. This method achieves earlier radiological union compared to other methods, making it the preferred choice for proximal humerus fractures across all age groups.

Study of operative outcomes of proximal tibia fractures treated with locking plates

Parth Mcwan — 2024-08-28

Background: In this study we have studied the functional outcome of proximal tibial fractures treated by open reduction and internal fixation treated with locking compression plates after a minimum follow up period of 6 months.

Methods: We conducted the study of 50 patients that aimed at assessing the functional outcomes of radiologically confirmed proximal tibia fracture (both intra articular and extra articular) treated using locking compression plates, between July 2020 to May 2022 at Department of Orthopaedics in our Institute. The Schatzker classification was used for classifying the fractures and planning the treatment strategy using plain radiographs and CT scan films. The treatment modality was decided after classifying the type of fracture, the displacement, and the amount of depression of the tibial plateau, in our study, we included only those patients who were undergone ORIF or MIPPO for definitive treatment.

Results: Maximum number of patients (total 12) were in age group of 41-50 years (24%). Out of total 51 proximal tibia fractures, 4 (7.8%) were of type 1 variety, 12 (23.52%) were of type 2 variety, 2 (5.8%) were of type 3 variety, 4 (7.8%) were of type 4 variety, 6 (11.76%) were of type 5 variety and 9 (17.64%) were of type 6 variety according to Schatzker classification. out of 50 patients treated with locking compression plates, 26 patients (52%) showed excellent outcome with score between 28-30; 17 patients (34%) showed good outcome with score between 24-27; 7 patients (14%) showed fair results with score between 20-23, according to Modified Rasmussen’s scoring system.

Conclusions: Locking compression plates (LCP) for the treatment of the proximal tibia fractures including difficult fracture situations seem to be good implant of choice for better post operative outcomes.

Functional and radiological outcome of intramedullary nailing in proximal tibial fractures through supra patellar approach

Brijesh Sharma — 2024-08-28

Background: Proximal third tibial fractures pose complex challenges in orthopaedic trauma care. The choice of surgical approach plays a pivotal role in achieving successful outcomes. This study was conducted to address the significant gap in research regarding the functional and radiological outcomes of the supra patellar approach in intramedullary nailing for proximal tibial fractures.

Methods: This prospective cohort study was conducted on a total of 100 patients presenting with proximal tibial fractures. All patients underwent intramedullary nailing using the supra patellar approach. Functional Outcome was assessed using the lower extremity functional scale (LEFS) at 3 weeks, 3 months, and 6 months and 1-year post-surgery. Union status, alignment, and hardware-related complications were assessed through X-rays at each follow-up point to study the radiological outcome.

Results: At the end of 1-year follow-up, 88% of patients had an excellent LEFS score,10% had a good LEFS score, and 2% had a fair LEFS score. All patients had a radiological union at 1 year follow up with an average radiological union time being 5.6 (±1.8) months.

Conclusions: We advocate for the utilization of suprapatellar nailing as the preferred approach for managing proximal third tibial fractures. This method consistently yields excellent clinical and radiological outcomes while maintaining a minimal complication rate in comparison to other management modalities.

Effect of platelet rich plasma versus triamcinolone versus placebo-normal saline in chronic plantar fasciitis: regenerative medicine in orthopaedics

Darshan Gaddenahalli Thimmegowda — 2024-08-28

Background: Heel pain is a common presenting condition in orthopaedic outpatient units. There are many causes of this condition, but one of the most common is plantar fasciitis. This study was conducted to find out the efficacy of a single injection of platelet-rich plasma versus steroids versus normal saline as a placebo in treating patients suffering from plantar fasciitis.

Methods: Randomized single-blinded placebo-controlled trial with 3 months and 6 months follow-up using visual analogue scale and FAOS (Foot and Ankle Outcome Score) was carried out at a tertiary care hospital for a total of 120 patients (40 patients in each group). First group injected with platelet rich plasma, second group with triamcinolone and third group with normal saline.

Results: Pain relief achieved in the platelet-rich plasma group and triamcinolone group was found to be statistically significant as compared to normal saline at both 3 months and 6 months follow-up. Steroid injection was associated with complications like depigmentation at the injection site and sub dermal atrophy. No complications were found with PRP or normal saline.

Conclusions: This study concludes that the efficacy of a single injection of platelet-rich plasma to relieve the pain of Plantar fasciitis is better than triamcinolone or placebo over a short-term follow-up period. However, more studies are required to evaluate the efficacy of PRP over the long term with multicentric study and comparison with the currently available treatment options.

Functional outcome of intertan nailing in intertrochanteric fractures: a retrospective study utilizing Oxford hip score

Varun Roheet S. S. — 2024-08-28

Background: This study evaluates the functional outcome of intertan nailing in intertrochanteric fractures in terms of the Oxford Hip Score (OHS).

Methods: Twenty-eight patients (10 males, 18 females, mean age: 75.2 years, range: 60-94 years) were analyzed. Mean follow-up period was 6 months (3–8 months) and 5 patients were lost to follow-up.

Results: The overall average OHS was 37.2, with scores varying from 22 to 47. Nine patients had OHS scores above 40, indicating satisfactory function, while 10 patients scored between 30-39, denoting mild loss of function. Four patients had OHS scores of 20–29, indicating a moderate to severe loss of function.

Conclusions: These findings indicate the varied functional outcomes of intertan nailing in intertrochanteric fractures and highlight the importance of individualized treatment strategies.

Association of calcaneal spur in patients with plantar faciitis

Aakash Mishra — 2024-08-28

Background: A benign and self-limiting condition, degeneration at the root of the plantar fascia at the medial calcaneal tuberosity of the heel is the etiology of plantar fasciitis. Calcaneal spurs are tiny, fibro-cartilaginous triangular projections. These are found in the calcaneum and can be of varied sizes. However, the degree of coexistence of the two conditions has not been established and the evidence is quite low. Knowing these associations would provide valuable insights and aid in better management protocols.

Methods: The study included 131 patients who were diagnosed with plantar fasciitis and a control group of 131 cases (who underwent heel X-ray and assessments for some other reason). The history and physical examination were the main factors used to diagnose plantar fasciitis. To check for the existence of calcaneal spurs and other heel pathologies in both groups, X-rays were taken.

Results: All patients suffered from heel tenderness and stretch pain in the plantar fasciitis group. The 84 cases (64.12%) in the plantar fasciitis group and 25 cases (19.08%) in the control group were noted to have calcaneal spurs. The difference in the incidence of calcaneal spur was found to be statistically significant (p<0.05). The mean age was noted to be significantly higher in the subgroup of calcaneal spur cases, in the plantar fasciitis group (p<0.05).

Conclusions: The incidence of calcaneal spur was noted to be significantly higher with plantar fasciitis versus control group, indicating an association between the two conditions.

Efficacy and safety of tablet Ligashot in patients with ligament injury of knee and shoulder

Bijoy Deb — 2024-08-09

Background: Ligament injuries of knee and shoulder disrupts joint homeostasis and leads to an imbalance between joint mobility and stability. Many drugs are available in the market for treating ligament injury grade 1 and 2 along with standard of care but there is still need for drugs with least adverse effects. So, in this study, an attempt has been done with tablet Ligashot, a nutraceutical for treating grade 1 and 2 ligament injury of knee and shoulder.

Methods: This is an outcome, quasi-experimental study where patients with ligament injury of knee and shoulder were given tablet Ligashot daily for 3 months. A total of 30 male and female patients were included in the study. Changes from baseline to 12 weeks in pain intensity measured by pain visual analogue scale (VAS) and inflammatory markers (ESR, Hs CRP), MRI changes, time to return to pre-injury level of activity, patient reported physical function and quality of life (QoL) were assessed.

Results: There was a statistically significant improvement after 12 weeks of treatment compared to baseline in VAS pain scale, time to return to pre-injury level of activity, patient reported physical function and in QoL questionnaire. There was also a statistically significant reduction in inflammatory markers-ESR and Hs-CRP (p<0.001).

Conclusions: Ligashot tablet has proved to be safe and effective in the management of ligament injury of knee, shoulder joint by reducing inflammation, pain. It also improves visco-elasticity and participant's functional capacity without causing any major side effects.

Comparative study of fully threaded and partially threaded cancellous cannulated screws versus partially threaded cancellous cannulated screws in femoral neck fractures in adults

Rajeev Kelkar — 2024-08-28

Background: Femoral neck fractures constitute a significant portion of orthopaedic trauma, with intra-capsular fractures representing 50% of all hip fractures, their incidence is projected to rise dramatically due to the aging population. These fractures, particularly in the elderly, lead to high morbidity and mortality. Optimal surgical treatment for femoral neck fractures remains debated, especially in younger adults.

Methods: This hospital-based prospective comparative study was conducted over one year. Patients aged 18-60 years with femoral neck fractures were randomized into two groups: Group A were operated using combination of fully threaded and partially threaded cancellous cannulated screws and group B using partially threaded cancellous cannulated screws. Functional outcomes were assessed using the Harris hip score (HHS) and visual analog scale (VAS) for pain, and radiological union times were recorded. Complications such as non-union, screw back-out, and infection were also evaluated.

Results: The study included 30 patients, with 15 in each group. Group A showed significantly better HHS at 6 months (88.53±7.46) compared to group B (77.69±13.35) (p<0.05). VAS scores were lower in group A, indicating less pain, though the difference was not statistically significant. Radiological union time was shorter in group A (12.55±2.39 weeks) compared to group B (13.89±5.29 weeks) (p<0.05). Group A had fewer complications, with no cases of screw back-out compared to four in group B.

Conclusions: The combination of fully threaded and partially threaded cancellous cannulated screws when used appropriately offers better functional outcomes, faster radiological union, and fewer complications compared to partially threaded screws alone in femoral neck fractures in young adults.

Mechanisms of action of native collagen type II and Aflapin® on the pathophysiology of osteoarthritis and their evidences

Rakesh Verma — 2024-07-06

Osteoarthritis (OA) is a degenerative and chronic inflammatory disease that affects the entire joint tissue such as articular cartilage, synovial membrane, subchondral bone, and ligaments. Imbalance between anabolism and catabolism lead to degradation of articular cartilage which may further initiate inflammatory cascades. There is an interplay of mechanical and immune-mediated injuries that lead to cartilage destruction and inflammation in OA. The mainstay of OA treatment involves drugs like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) which provide symptomatic relief in many cases; but are unable to inhibit disease progression. Also, long-term use of these drugs, is associated with major safety concerns. Native collagen type II (NC-II) and Aflapin, especially when used in combination, can slow down the disease progression in OA and serve as a safer and effective treatment option for OA. NC-II is non-hydrolyzed collagen having intact triple helix structure with active epitopes and antigenicity. Aflapin is a novel synergistic composition of Boswellia serrata gum resin having higher composition of 3-O-acetyl-11-keto-betaboswellic acid (AKBA). Various experimental studies have demonstrated the mechanisms by which both these agents exert their benefit in OA. Further, multiple clinical studies have demonstrated the efficacy and safety of NC-II and Aflapin, when used individually or as a combination. This is a narrative review of the pathophysiology of OA, current treatment modalities, and non-clinical and clinical evidence of the beneficial effects of NC-II and Aflapin in the management of OA.

Comparative analysis of the outcome between aperture and suspensory graft fixation methods in anterior cruciate ligament reconstruction surgeries: a systematic review

Priyank R. Bhatt — 2024-08-28

Human knee joint is a complex hinge joint which is relatively unstable compared to other joints of the body. The ligaments of the knee stabilize the joint during the different range of motion and are under continuous tension. This results in anterior cruciate ligament (ACL) being injured during unnatural movement of the joint particularly in sports. With the advent of arthroscopy and better understating of ligament injuries with the use of MRI, the ligament reconstruction procedures have increased. The Reconstructive procedures for the ACL impart use of an Autograft which is secured in the bony tunnels of femur and tibia using various methods. As with any fixation these materials are subjected to various biological and mechanical forces. Suspensory or aperture graft fixation are the two most commonly employed methods in recent times. Both these methods have different tensile strengths and failure rates. Various studies have been conducted to assess the outcomes of these methods to evolve the most suitable and fail-safe method of securing the ACL allograft in the bony tunnels.

Bilateral symptomatic ring-shaped meniscus: a case report

Rita Alçada — 2024-08-28

Discoid meniscus is the most common meniscal anatomical variant, affecting almost exclusively the lateral meniscus. Ring-shaped meniscus is an extremely rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns, forming a complete ring. Ring-shaped meniscus is generally asymptomatic and found incidentally. We present the case of a 16-year-old male who presented with bilateral mechanic knee pain associated with positive meniscal tests. Arthroscopic surgery was performed and ring-shaped lateral meniscus with complex tears were identified in both knees. Partial lateral meniscectomies were performed on both knees and hay-bale mattress sutures were used to preserve the remnant lateral meniscus of the left knee. After surgery, the patient obtained good outcomes with regards to pain and mechanical symptom relief. To our knowledge this is the first reported case of bilateral symptomatic ring-shaped meniscus. The reported case demonstrates that complex ring-shaped lateral meniscus tears can be successfully addressed with arthroscopic surgery.

Osteomyelitis or myositis ossificans: a diagnosis in disguise in a case of hereditary sensory and autonomic neuropathy type 4

Abdulaziz Matar — 2024-08-28

Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN-IV), also known as Congenital Insensitivity to Pain with Anhidrosis (CIPA), is an extremely rare condition with loss of peripheral unmyelinated and small myelinated nerve fibres, leading to the absence of pain sensation and inability to sweat. Affected patients require careful care in order to prevent debilitating consequences and potential morbidity as a result of recurrent trauma and self-mutilating behaviour. We report a case of 4 years and 10 months old boy who has been diagnosed with HSAN-IV at 6 months of age, which was confirmed by genetic testing. This study was conducted in the largest tertiary medical complex in the Kingdom of Bahrain. He had multiple hospital presentations with various upper and lower extremity injuries requiring a multidisciplinary approach for different management strategies. The diagnosis can be extremely challenging due to an exhausting list of differential diagnosis and limited number of cases provided in the literature.

A rare case of giant cell tumor in navicular bone: a case report

Abhishek K. Taraviya — 2024-07-18

Giant cell tumor (GCT) is a benign but locally aggressive lesion of the bone. They are common in skeletally mature individuals with a slight female preponderance. Rare unusual presentations can occur. This case report describes a rare case of GCT of bone in the right navicular bone in a 25-year-old male patient who presented with complaints of pain and swelling in right foot and difficulty in walking. The diagnosis was made with radiological investigations and was then confirmed with histopathological evaluation. The lesion was managed with extensive curettage and bone grafting. Patient had complete resolution of symptoms post-surgery with no signs of local recurrence at 18-months follow-up.

A rare case of proximal arm neurofibroma causing ulnar nerve compression: successful surgical intervention and recovery

Najeeb Mohammed K. — 2024-08-28

Compressive neuropathy of the ulnar nerve due to a neurofibroma above the elbow is extremely rare, with few cases reported worldwide. A young male presented with a progressively enlarging swelling and increasing pain in the right upper arm. Over time, the patient developed symptoms indicative of ulnar nerve compression, including numbness, tingling, and weakness in the hand and forearm. Physical examination and diagnostic imaging revealed the presence of a neurofibroma compressing the ulnar nerve above the elbow. The patient also exhibited generalized features consistent with neurofibromatosis, such as multiple café-au-lait spots and cutaneous neurofibromas. Given the severity of the symptoms and the confirmed diagnosis, the patient underwent surgical excision of the neurofibroma along with neurolysis to decompress the ulnar nerve. The surgical intervention aimed to relieve pain and improve sensory and motor function. The surgical procedure was successful, resulting in significant pain relief and marked improvement in sensory and motor functions. Postoperatively, the patient reported substantial symptomatic relief and regained functional use of the affected limb. This case underscores the importance of considering rare causes of ulnar nerve compression, such as neurofibromas, particularly in patients with underlying neurofibromatosis. It also highlights the effectiveness of surgical removal and nerve decompression in resolving symptoms and restoring function in such complex cases.

A case report of a rare incidence adnexal nodular hidradenoma mimicking as simple ganglion cyst in hand

Harshil R. Merja — 2024-08-28

Soft tissue swelling of hand is a common condition presenting in orthopedic outpatient department (OPD). Simple ganglion cyst is the most prevalent presenting disorder among the various differential diagnoses for this ailment, which include ganglion cyst, inclusion cyst, giant cell tumor of tendon sheath, enchondroma, carpal bossing, leiomyoma, and adnexal tumors. A 75-year-old male patient presented with soft tissue swelling over dorsum of his left hand, which was insidious in onset and painless in nature at initial stages, but over the past 6 months it grew over to become of approximately 7×3 cm in size, and now causing slight pain and discomfort to patient. Primary investigation like X-ray, ultrasonography and magnetic resonance imaging (MRI) was done. Clinical and radiological investigation was suggestive of simple ganglion cyst. So patient was operated for it as surgical excision and tissue biopsy was sent for histological examination to arrive at definitive diagnosis of the condition and further line of management. Histological finding of tissue biopsy was suggestive of adnexal nodular hidradenoma with nodular and cystic areas of differentiation. Thus, before drawing a final diagnosis, a rare tumor like adnexal hidradenoma should also be taken into account as a differential diagnosis. This aids in the planning of the patient's future course of treatment. This instance emphasizes the significance of tracing reports prior to repeat surgery and submitting biopsies of all hand lesions for histological testing.

The untold story of a coughed-out screw: a case report

Sushant Srivastava — 2024-08-28

A 70 years old male, case of Cervical Spondylotic Myelopathy (C3-C4, C4-C5) with complaints of difficulty in walking and weakness of upper and lower limbs for 6 months presented to the outdoor department. Patient had restricted and painful movements of cervical spine. Patient was evaluated and then operated for anterior cervical discectomy and fusion with bone grafting at C3-C4, C4-C5. After first surgery the, Pre-op VAS Score improved from 8 to 2 and the Nurick Score improved from grade 4 pre op to grade 2 postop. Once the union of graft appeared adequate, we tried to convince the patient for early removal of prominent and prouting implant as the proximal screws were backing out but patient refused surgery. He finally presented with a coughed-out screw in his mouth in emergency. After removal of implant the surgical wound healed well and he did not complaint of any difficulty in deglutition. Loosening of implants after anterior cervical spine fusion surgeries adds to the morbidity to the procedure. Proper sized low-profile implants with good locking mechanism can reduce the complication rates. Adequate pre-operative planning is a must for successful outcome of cervical spine surgeries.

Subungual osteochondroma of great toe: a unique presentation

Reddy L. Sai — 2024-08-28

Osteochondroma is routinely encountered in daily practice. It is often considered as developmental aberration rather than a true neoplasm. It arises due to enchondral growth from cortex adjacent to metaphysis. Osteochondroma is usually encountered in femur, fibula and humerus in more than fifty percent of cases. It is rarely encountered in phalanges of toes and fingers. In very few cases this tumor affects small bones, localizing to the distal phalanx and producing deformity of the overlying nail. These cases are termed subungual osteochondromas and are altogether with subungual exostosis the most common bony lesions affecting the nail unit. Osteochondromas of the nail unit are often asymptomatic and present as firm nodules, nail deformity, tender on palpation. Many of these cases are associated with history of trauma. A 11-year-old male presented to us with an abnormal outgrowth of right great toe. The out growth was preceded by a history of trauma 10 days before the presentation. The swelling surface consisted of granulation tissue and bleeding spots were found on the surface. The swelling is fixed to the underlying bone and seems to have caused the destruction of nail plate. Biopsy revealed osteochondroma of the great toe with no malignant transformation and atypical cells.

Arthroscopic excision of giant cell tumour at femoral attachment of anterior cruciate ligament and simultaneous anterior cruciate ligament reconstruction: a case report

Shreekanth K. S. — 2024-08-28

Giant cell tumors (GCT) are typically noncancerous bone tissue growths that have a slow growth rate, occurring more frequently in the age group of 15-40 years. They are mainly found in the distal femur, proximal tibia, and tendons of hand. Magnetic resonance imaging (MRI) is gold standard for diagnosis. The preferred method of treatment is surgical excision performed under direct visualization. Here we present a rare case involving a GCT located in the distal femur at the attachment of anterior cruciate ligament (ACL) concomitant with a tear in the ACL. The patient presented with pain and instability of left knee while walking following trauma. MRI revealed a chronic partial tear of ACL and altered signal area in lateral condyle of femur at the attachment of ACL. CT guided biopsy showed osteoclastoma over postero-medial aspect of lateral condyle of left femur. Diagnostic arthroscopy showed lax and torn ACL. Soft mass with reddish pink appearance was noted. Arthroscopic excision was done under direct vision and ACL was reconstructed with Semi-tendinosis graft. A simultaneous minimally invasive approach to treating a GCT and ACL tear can offer significant benefits in terms of reduced recovery time, improved functional outcomes, and potentially lower recurrence rates.

Widespread skeletal brown tumor with rare elbow involvement and associated hydronephrosis in a case of primary hyperparathyroidism

Syed Ali Raza Abidi — 2024-08-28

We report a rare case of primary hyperparathyroidism in a 32-year-old female caused by a parathyroid adenoma. The patient initially complained of left elbow pain. Imaging revealed multiple skeletal brown tumors affecting unusual sites such as the elbow, as well as multifocal involvement of the vertebrae, sternum, radius, ulna, humerus, femurs, pelvic girdle, and scapulae. An abdominal ultrasound further revealed hydronephrosis and renal calculi in the right kidney. This case highlights the uncommon widespread skeletal distribution and involvement of atypical sites by brown tumors, along with the rare complication of hydronephrosis.