International Journal of Research in Orthopaedics

Musculoskeletal simulation for patient transfer using hand load measurement device

Ryo Uchimura, Ryohei Fushitani, Kodai Kitagawa, Chikamune Wada — Thu, 12 Dec 2024 00:00:00 +0530

Background: Unsuitable posture in patient transfer motion causes lower back pain (LBP) among caregivers. The suitable postures to reducing lumbar loads during patient transfer are investigated by musculoskeletal simulation. However, existing musculoskeletal simulation cannot accurately predict lumbar loads because the existing musculoskeletal models are generated by only motion data. Thus, this study aimed to propose and evaluate an accurate musculoskeletal model using hand load data obtained from a hand load measurement device.

Methods: Motion and hand load data for the musculoskeletal model were measured during patient transfer by an inertial measurement unit (IMU)-based motion capture system and hand load measurement device. The existing model without using hand load data and the proposed model using hand load data predicted the activity of the erector spinae muscles and the compressive force of L4-L5. The correlation of erector spinae muscle activity was compared between the predicted and ground truth (surface electromyography) values. Furthermore, predicted compressive forces of L4-L5 were compared with reference value reported by previous study related to in vivo intradiscal pressures measurement.

Results: The proposed model could predict erector spinae muscle activity with a correlation that was significantly greater than that of the existing model (p<0.05). Furthermore, the proposed model could predict compressive forces of L4-L5 with approximate values close to in vivo intradiscal pressures measurement.

Conclusions: Proposed musculoskeletal model may more accurately predict lumbar loads during patient transfer than the existing model. Proposed musculoskeletal model will be applied to explore suitable postures for preventing LBP.

Evaluation for results of the treatment with diversities of modality in comminuted sub trochanteric fracture of femur in children

M. Gulam Mustofa, Avishek Bhadra, Sushmoy Saha, Sabbir Ahmed — Thu, 26 Dec 2024 00:00:00 +0530

Background: The diaphyseal femoral fractures account for around 2% of all pediatric fractures. Treatment includes conservative or surgical methods, but the choice of treatment differs depending on the child's age, fracture pattern, other concomitant fractures and the socioeconomic situation of the family. The study aimed to assess the result of the treatment with a diversity of modality in comminuted sub trochanteric fracture of the femur in paediatric patients.

Methods: This was a prospective randomized comparative study with a prospective follow-up that took place at the department of orthopedics at President Abdul Hamid medical college and hospital, Kishoreganj, Bangladesh from May 2022 to May 2024. The 110 patients with diaphyseal femur fracture and were 0-18 years old were included in the study and 48 participated in the outcome follow-up.

Results: Out of 110 patients 55 were males and 55 females. Conservative treatment was the most common treatment. The mean age of incurring this type of fracture was 7.45 years. Mainly, injury among all kids who fall from above standing level. The majority of the younger children received conservative treatment.

Conclusions: The treatment chosen and the outcomes after a fracture seem to be satisfactory. It is important for future studies to include a large number of patients and to examine not only the clinical outcomes, but also the social and economic aspects.

Evaluation of functional outcome of cemented bipolar prosthesis in femoral neck fracture in old age patients

Thu, 26 Dec 2024 00:00:00 +0530

Background: Older adults are at a higher risk of proximal femur fractures, particularly femoral neck and intertrochanteric fractures, often due to falls, trauma, or osteoporosis. Managing these fractures in osteoporotic bones is challenging, as they are associated with complications such as pressure sores, deep vein thrombosis, and hypostatic pneumonia. This study aimed to evaluate the outcomes of treating femoral neck fractures in elderly patients using cemented bipolar prosthesis.

Methods: A quasi-experimental study was conducted on 40 patients aged 60 to 84 years who underwent cemented bipolar hemiarthroplasty within 21 days of fracture from January 2019 to December 2019. Post-operative functional outcomes were assessed using the Harris hip score (HHS) at 3, 12, and 24 weeks, both clinically and radiologically.

Results: Of the 40 patients, 65% were female, and 52.5% had left-sided fractures. The majority (55%) experienced trivial falls. The HHS improved significantly from a mean of 43.73±6.78 at 3 weeks to 82.56±9.13 at 6 months. Garden type 3 fractures were the most common (70%). Functional outcomes were graded as good in 72.5% of patients, excellent in 17.5%, and fair in 5%, while 2.5% had a poor outcome. One patient (2.5%) died due to pulmonary embolism.

Conclusions: Cemented bipolar hemiarthroplasty in elderly patients with femoral neck fractures is a safe and effective treatment, promoting early mobilization and reducing the risk of complications such as bed sores, deep vein thrombosis, and hypostatic pneumonia.

Functional outcome of Schatzker type V and VI tibial plateau fractures managed by open reduction and internal fixation using dual plates

Thu, 26 Dec 2024 00:00:00 +0530

Background: High-energy bicondylar tibial plateau fractures (Schatzker type V and VI) occur as a result of road traffic accidents, falls from height, and sports injuries, and mostly affect the younger age group in productive life years. This study aimed to evaluate the functional outcome of high-energy tibial plateau fractures (Schatzker type V and VI) treated by dual plating through anterolateral and posteromedial incisions.

Methods: This was a hospital-based clinical trial study conducted in the department of orthopaedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from January 2018 to December 2019. Our study included 50 adult patients of both genders with high-energy tibial plateau fractures through a consecutive sampling technique. The knee function of the patients was evaluated according to the Oxford knee scoring system.

Results: Out of 50 cases, 38 cases (76%) were male and 12 cases (24%) were female with a mean±SD age was 43.95±10.89 years. All the cases (100%) were due to RTA, 70% had Schatzker type VI and 30% had type V injury. Mean±SD time interval from injury to fixation was 11.05±3.20. The average duration of operation in minutes was 107.0 (±12.07). At the final follow-up, 41 (82%) and 05 (10%) patients had excellent and good outcomes respectively.

Conclusions: Open reduction and internal fixation in high-energy tibial plateau fractures using dual plates through two incisions can provide excellent to good functional results and minimal soft tissue complications in appropriately selected cases.

Short-term clinical outcomes on a new dual-taper wedge femoral stem in total hip replacement

Thu, 26 Dec 2024 00:00:00 +0530

Background: Short femoral stems have become increasingly popular in total hip arthroplasty (THA), offering potential advantages such as bone preservation and improved load transfer. The Everglade stem (Signature orthopedics Australia), a novel dual-tapered design, aims to enhance initial stability while minimizing complications such as subsidence and fracture. This study evaluates the short-term clinical and radiological outcomes of the Everglade stem.

Methods: We conducted a retrospective review of 100 consecutive patients (41 men, 59 women; mean age 68 years) who underwent THA using the Everglade stem at the Delray beach surgical center, a physician-owned ambulatory surgical center (ASC), between December 2022 and January 2023. Pre-operative and post-operative hip disability and osteoarthritis outcome score (HOOS-Jr) data were collected. Radiological outcomes, including stem subsidence, periprosthetic fracture, and osteolysis, were assessed at the 6-week and 6-month follow-ups.

Results: The median follow-up was 161.5 days (IQR 43-187). The mean HOOS-Jr score improved from 57.07 pre-operatively to 86.03 at 6 weeks and 92.7 at the latest follow-up. No cases of stem subsidence, periprosthetic fracture, or osteolysis were observed at any follow-up. There were no stem revisions or postoperative infections.

Conclusions: The Everglade stem demonstrated promising short-term outcomes, with significant improvements in patient-reported functional scores and no radiological complications. Longer-term studies are needed to evaluate the stem’s durability and long-term performance.

Anterior cruciate ligament reconstruction using peroneus longus tendon auto-graft: functional results

Thu, 26 Dec 2024 00:00:00 +0530

Background: The peroneus longus tendon is a promising autograft alternative to the others tendons in ACL reconstruction. It offers the advantages of being expendable, having adequate length and strength, sparing morbidity from other donor sites, and allows early rehabilitation.

Methods: The study was on 30 patients with isolated ACL complete tear treated by arthroscopic reconstruction using the PL tendon in Benha university hospital in the period from July 2022 till June 2023. The patients were assessed pre-operatively and post-operatively with the IKDC score and clinical tests of instability. The ankle was also assessed pre-operatively and post-operatively though AOFAS and clinical tests of instability. Patients were followed up for 12 months.

Results: The age of patients was 18-45 years. The preoperative IKDC score ranged 49-72 with a mean SD of±14.02. The post-operative IKDC score ranged 89-100 with a mean SD of±3.5 showing marked improvement of knee function with 93.3% of patients regained normal knee function. The pre-operative AOFAS score ranged 99-100 with a mean SD of±0.16 and the post-operative score ranged 89-100 with a mean SD of±3.5 denoting minimal affection of ankle functions.

Conclusions: The peroneus longus serves as a suitable autograft for ACL reconstruction as an alternative to the others tendons based on its ability to restore knee function and the minimal morbidity at the donor site.

Trends in incidence and complications of ankle arthrodesis and total ankle arthroplasty

Paul J. Pottanat, Zachary Burnett, Pramod Kamalapathy, Joseph Park, Brian Werner — Thu, 26 Dec 2024 00:00:00 +0530

Background: Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are surgical treatment options for end-stage ankle arthritis. Providers should have a current understanding of the overall trends of these procedures as both are frequently used. Thus, the objective of the current study is to assess the trends in utilization, patient characteristics and outcomes after TAA and AA.

Methods: The PearlDiver Mariner database was used to capture patient characteristics and outcomes related to 2,494 patients who underwent TAA and 5,901 patients who underwent AA between 2010 and 2018.

Results: The incidence of TAA increased over the course of the study period (p<0.001) while the incidence of AA decreased (p=0.045). Length of stay (LOS) following AA significantly increased (3.02 vs 4.50, p<0.001) while LOS following TAA significantly decreased (2.78 vs 1.65, p=0.004). Furthermore, incidence of infections significantly increased following both procedures (AA 1.7% vs 6.6%, p=0.004; TAA 0.8% vs 2.7%, p=0.008). In 2018, patients who underwent TAA had a significantly decreased LOS (1.65 vs 4.50, p<0.001), risk of major complications (1.5% vs 3.9%, p=0.042), risk of any medical complication (7.1% vs 14.9%, p=0.004), and risk of infection (2.7% vs 6.6%, p=0.011) compared to those who underwent AA.

Conclusions: The present study demonstrates increased utilization of TAA for treatment of end-stage ankle arthritis compared to AA in recent years. Over the time period of this study, infection rates have increased and LOS has decreased for TAA while both infection rate and LOS have increased for AA.

Evaluation of functional outcome of arthroscopic isolated anterior cruciate ligament reconstruction with quadriceps tendon

Thu, 26 Dec 2024 00:00:00 +0530

Background: The anterior cruciate ligament (ACL) is one of the most important intra-articular ligaments in the knee joint. It is regarded as the main barrier preventing the tibia from anteriorly translating onto the femur. The greatest incidence occurs in 15 to 25-year-old participants of work and pivoting sports. This study aimed to assess the functional outcome of arthroscopic isolated ACL reconstruction with quadriceps tendon.

Methods: This was a prospective interventional study conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period from March 2020 to August 2022. In our study, we included 30 patients with anterior cruciate ligament injuries who attended the orthopaedic department within the study period.

Results: The preoperative Lysholm score was found to be poor in all cases. Nine months after arthroscopic isolated ACL reconstruction with quadriceps tendon Lysholm score was found as excellent in 18 (60%) cases, good in 8 (26.7%), and fair in 4 (13.3%) cases. During the last follow-up of 9 months after arthroscopic isolated ACL reconstruction with quadriceps tendon, 26 (86.7%) patients were found as satisfactory results, and only 4 (13.3%) patients were found as unsatisfactory. A significant difference was observed between preoperative and postoperative functional outcomes.

Conclusions: In our study, we found that arthroscopic isolated ACL reconstruction with quadriceps tendon showed satisfactory functional outcomes for the treatment of ACL injury, and all the functions of the knee were improved in compared with their pre-operative status.

Blount’s disease treatment outcome with Taylor spartial frame in low resource settings

Thu, 26 Dec 2024 00:00:00 +0530

Background: Blount's disease is a developmental condition defined by abnormal growth of the proximal posteromedial tibial physis, which causes progressive lower limb deformity. The deformity is primarily characterized by tibia vara, procurvatum, internal tibial torsion and limb shortening. To evaluate the outcome of treatment of Blount’s disease using circular external fixation Taylor spartial frame (TSF).

Methods: The limb deformity correction unit of the Orthopaedics and Trauma Department of University College Hospital, Ibadan conducted a 5-year retrospective assessment of patients who had Blount's disease correction using the TSF device between January 2019 and July 2023. The data was analyzed using the Social Sciences Statistical Package, Version 19.

Results: 42 patients were recruited with 68 limbs. 26 patients (62%) had both right and left lower limb deformities. The majority were young adolescent in the age group of 11–15 years. And a male-to-female ratio of 1:2.81. They all had TSF frame application, fibulotomy and metaphyseal (proximal tibia) corticotomy and subsequently had graduated adjustment of the frame until correction is achieved, following the prescription generated from the TSF software. The highest complication observed was pin site infection in 10 patients (23.8%).

Conclusions: The TSF device is considered one of the most reliable methods of achieving safe and accurate correction of the multi-planar deformities associated with severe and recurrent Blount’s disease.

Fixing of intertrochanteric fractures with proximal femoral nail antirotation 2 by a double incision technique: a retrospective analysis

Rajendraprasad R. Butala, Nrupam Mehta, Rishab Singh, Varmit Shah, Atul Yadav — Fri, 08 Nov 2024 00:00:00 +0530

Background: The incidence of hip fractures is projected to rise from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most prevalent surgical intervention for intertrochanteric fractures. Hip fractures represent a significant healthcare issue amongst the elderly. The aim of this study is to evaluate a double incision technique in comparison to the conventional incision for fixing intertrochanteric fractures using the standard proximal femoral nail antirotation (PFNA2).

Methods: This study took place at Dr. D. Y. Patil hospital in Navi Mumbai, India, from May 2023 to May 2024 employing an open-label, retrospective, randomized, and comparative methodology. A total of 100 patients with proven radiographic intertrochanteric fracture having undergone fixation with PFNA2 were analysed, with 50 undergoing the double incision and 50 serving as the stand control group.

Results: The minimally invasive technique with a modified incision using the standard proximal femoral nail A2 can reduce bleeding, enhance precision for the entry point of the guidewire, shorten the time required for the entry, decrease soft tissue injuries, and provide better aesthetic outcomes.

Conclusions: The current study delineates a minimally invasive surgical technique employing a double incision for the fixation of intertrochanteric fractures using the proximal femoral nail A2, underscoring its benefits.

A comprehensive study of fingertip injuries at a tertiary care centre- fingertip injury outcome score subset pilot

Soujanya M., Darshansingh Rajput — Thu, 21 Nov 2024 00:00:00 +0530

Background: Fingertip injury outcome score (FIOS) is a specialized tool designed to assess functional and aesthetic outcomes after treatment of fingertip injuries. It helps both clinicians and researchers evaluate the effectiveness of treatment strategies and monitor patient recovery. This pilot study aims to evaluate the feasibility and effectiveness of a customized FIOS tool using retrospective fingertip injuries data from the hospital, before broader implementation

Methods: A retrospective analysis of 58 hand injury patient’s data admitted in hospital with fingertip injuries having tissue loss, between January 2023 and February 2024. A customized FIOS tool, focusing on specific aspects such as complications, aesthetic outcome, patient satisfaction, ability to perform daily tasks and pain, was applied to the collected data. Data analyzed to evaluate how well the FIOS outcome score reflected patient outcomes and clinical findings.

Results: The customized FIOS effectively captured key aspects of fingertip injury outcomes, including pain levels, functional recovery. 7% had poor outcome score and 80% of those with poor outcomes suffered injuries from the heavy instruments with complications like revision surgery. 22% of the patients had excellent outcome scores, 53.4% had good aesthetic outcome score.

Conclusion: This pilot study demonstrates that using a customized FIOS tool with retrospective data is a viable approach for evaluating fingertip injury outcomes. The findings suggest that the FIOS subset can provide valuable insights into functional and aesthetic recovery. This approach facilitates seamless data capture, minimize duplicated efforts, and reduce errors and discrepancies.

Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy

N. Shreyas, Sanath Kumar Shetty, Mahalingam, Vinay V. Sherlekar — Mon, 11 Nov 2024 00:00:00 +0530

Background: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy.

Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test.

Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p<0.0005).

Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes.

Comparative study of crossed pinning v/s lateral pinning in paediatric supracondylar humerus fractures

Dev Krishan Sharma, Mahendra Solanki, Sunita Solanki, Akshaj E. P. — Thu, 26 Dec 2024 00:00:00 +0530

Background: Closed reduction and percutaneous pinning are the preferred management of supracondylar humerus fractures in children, but the preference of pinning pattern needs more research. A prospective comparative interventional study was undertaken to compare the stability of fixation, functional outcome and neurovascular complications between crossed pinning and lateral pinning in Gartland type 2 and type 3 fractures.

Methods: 60 patients of age group 2 to 12 years with Gartland’s type 2 and 3 fracture were randomized into 2 groups- lateral pinning (n=30) and crossed pin fixation (n=30). Intraoperative parameters were compared, post operative ulnar nerve palsy and serial range of motion were assessed. At 3 month follow up, outcome was assessed using Flynn criteria. The results were compared and analysed.

Results: There were 2 cases (3.3%) of iatrogenic ulnar nerve injury in crossed pinning group and none in lateral pinning group. Lateral group had more cases with excellent Flynn rating. The mean loss of range of motion and the mean loss of carrying angle was significantly lower for lateral method.

Conclusions: Lateral pinning provides, better functional outcome along with comparable stability without the risk of iatrogenic ulnar nerve injury.

Study on the efficiency of locking plate surgery with that of inter locking nail treatment in management of proximal humerus fracture in P. T. Birta City Hospital and Research Center

Thu, 26 Dec 2024 00:00:00 +0530

Background: Proximal humeral fractures (PHFs) commonly exhibit a bimodal distribution based on trauma energy levels, affecting mainly those over 65 through low-energy falls, often indicating osteoporosis. Treatment approaches for displaced PHFs vary, with locking plates offering high stability but posing risks to blood supply and nerves. The efficacy of surgical versus conservative treatments remains debated, especially for complex fractures, with studies linking surgical options like intramedullary nailing and locking plates to mixed outcomes, including possible shoulder limitations. Aims and objectives were to evaluate the efficiency of locking plate surgery with that of interlocking nail in treatment in management of PHF.

Methods: A prospective investigation was carried out on patients who visited our hospital's outpatient department. A general anaesthetic and brachial plexus block were delivered throughout the patients' procedures. Each operation was performed by the same team, which was proficient in both approaches. The study conducted t-test and Chi-square to analyze the data.

Results: The analysis found no significant demographic differences between the two groups (p>0.05). The non-operative group had significantly lower blood loss (71.8±10.5 ml) than the locking plate group (134.2±16.9 ml, p=0.000). Visual analog score (VAS) and Constant-Murley scores indicated greater shoulder function improvements for the locking plate group at three months (p<0.001), although no significant differences were observed at the final follow-up (p>0.05). Postoperative complications did not significantly differ between groups (p=0.337).

Conclusions: Locking plates reduce fractures faster than interlocking intramedullary nails. Both internal fixation techniques for proximal humerus fracture had similar pain and shoulder function scores.

A prospective study on the use of percutaneous titanium elastic nails for paediatric femoral shaft fractures

Thu, 26 Dec 2024 00:00:00 +0530

Background: This study aimed to assess the efficacy and safety of using percutaneous titanium elastic nail (TEN) fixation in pediatric patients with femoral shaft fractures.

Methods: A prospective study was conducted on pediatric patients presenting with femoral shaft fractures between the ages of 6 to 14 years. Patients were treated with percutaneous titanium elastic nails and followed up for a minimum of 12 months. The primary outcomes assessed included fracture union time, functional outcome, and complications related to the procedure.

Results: A total of 28 pediatric patients with femoral shaft fractures were enrolled in the study. The patients had a mean age of 10.3 years, and the average time for fracture union was 10.5 weeks. Functional outcomes assessed using Flynn’s criteria scoring systems demonstrated excellent results in 67.8% of patients. Complications such as shortening (1 patient), superficial infection (1 patient), and skin irritation at entry site (2 patients) were observed. However, these complications were managed successfully with appropriate interventions.

Conclusions: Percutaneous titanium elastic nail fixation is an effective and safe treatment option for pediatric femoral shaft fractures, offering early mobilization, minimal soft tissue disruption, and favorable functional outcomes. Despite some complications, the overall success rate of the procedure underscores its suitability for managing femoral shaft fractures in pediatric patients. Further studies involving larger sample sizes and follow-up periods is necessary to confirm these findings and refine treatment protocols.

Management of congenital talipes equinovarus by Ponseti technique and percutaneous needle tenotomy

Mohammed Mukkaram, Daniya Awais, Ali Razvi — Thu, 26 Dec 2024 00:00:00 +0530

Background: This study evaluates the Ponseti technique combined with percutaneous needle tenotomy for treating congenital talipes equinovarus (CTEV), or clubfoot, assessing efficacy, complications, and outcomes. Conducted at a tertiary medical center in Hyderabad from 2021 to 2024, it included patients of all ages presenting with CTEV.

Methods: This is a prospective and retrospective study. The Ponseti method, a conservative approach involving serial casting and gentle foot manipulation, was applied, with percutaneous needle tenotomy used for achilles tendon lengthening when necessary. Compared to traditional surgical methods, this minimally invasive approach is associated with fewer complications and improved correction rates. Patients were assessed using Pirani scores, with data on cast numbers, tenotomy needs, and relapses.

Results: The study demonstrated significant efficacy, particularly when treatment began early, reducing the number of casts required. Needle tenotomy, preferable over blade tenotomy, was particularly effective in India and among patients from lower socioeconomic backgrounds, proved more effective than blade tenotomy. The approach was associated with fewer complications and better correction rates.

Conclusions: The Ponseti technique is an effective, accessible, and economical option with minimal complications. Early diagnosis and intervention were found essential for optimal outcomes. Further research is suggested to refine treatment protocols for older children and severe deformities.

Knee injury and osteoarthritis outcome score comparing functional outcome in 30 anterior cruciate ligament reconstruction patients with quadriceps, hamstrings and peroneus longus grafts

Sunil Handralmath, Akshay Dudhanale, Ravikumar Dadhaniya, Manish Wasekar — Thu, 26 Dec 2024 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) tears are prevalent, affecting 30–78 per 100,000 individuals annually. Graft options include hamstring tendon, bone-patellar-tendon-bone, and quadriceps tendon. Hamstring tendon grafts offer advantages, including less patellofemoral crepitation, anterior knee pain, extension loss, reduced donor site morbidity, and smaller incisions. The peroneus longus tendon graft has gained favor due to fewer knee joint complications. Research shows studies comparing hamstring tendon (HT) and peroneus longus tendon (PLT) grafts revealed no significant differences in pre- and 1-year post-surgery outcomes. Recent randomized controlled trials (RCTs) comparing quadriceps tendon (QT) and HT clinical outcomes found no significant differences in functional outcomes, PROs, laxity testing, or revision rates, although two studies reported higher knee flexor strength in the QT group and greater knee extensor strength in the HT group.

Methods: Authors planned for prospective study in tertiary care government hospital, Solapur from 1 July 2023 to 1 July 2024 with Inclusion criteria of 20-50 years, Intact collateral ligaments, Intact Posterior cruciate ligaments, Playing sports as recreational activity.

Results: 30 cases operated for ACL reconstruction at our institute with three graft choices namely QT, HT, PL and knee osteoarthritis outcome score given at 3 months, 6 months, and 1 year with KOOS/symptoms, pain, daily living, sports, quality of life all noted separately and compared within the groups and outside the groups.

Conclusion: To compare functional scores in post operative ACL reconstruction with QT, HT, PL larger volume of sample, longer follow up and more detailed arthroscopy specific scoring system is required.

A comparative study of anatomical plate fixation versus intramedullary nailing of middle-third clavicle fractures in Al-ameen medical college hospital

Syed Hasan Zahid, Preetish Endigeri, Rahil T. Pasha, Riyaz Bagawan — Thu, 26 Dec 2024 00:00:00 +0530

Background: Clavicle fractures constitute 5% of adult fractures. About 80% involve the midshaft, with more than 70% displaced. Many plate and intramedullary fixation systems have been used. However, the best fixation method is still debated. Surgery includes ORIF with Anatomical Plate and CRIF with TENS. Each technique has its own advantages and disadvantages.

Methods: 40 patients with displaced middle-third clavicle fractures were prospectively randomly assigned to two groups, Group-A (plating group) and Group-B (nailing group), with an equal number of 20 patients in each. The outcomes were evaluated based on Union-time, Complications, Visual-Analog-Scale for pain. The assessment of shoulder function was conducted using the DASH score.

Results: 9 (45%) of Group A patients achieved union in 6-7 months and 11 (55%) in 8 months, mean union time being 7.5 months. 4 (20%) had implant prominence, 3 (15%) had hypertrophic scar, 1 (5%) had plate-end protrusion post-union, and 2 (10%) had surgical site infection managed by intravenous antibiotics. In group B, 16 (80%) patients achieved union by 6-7 months and 4 (20%) by 8 months, mean union-time being 7.1 months. 3 (15%) patients had nail-end prominence, 3 (15%) had nail-end irritation by 4 months, one (5%) had nail-end protrusion by 6 months, and one (5%) had medial migration by 8 months. No surgical site infection occurred.

Conclusion: Plating provides firm fixation, greater rotational stability for displaced middle-third clavicular fractures. Complications with plating like scarring, implant prominence, irritation are significantly lesser in nailing. Both fixations provide good functional outcome.

A prospective cohort study investigating functional recovery in patients with avascular necrosis hip following total hip arthroplasty using a direct anterior versus direct posterior surgical approach in Indian population

Anand Kumar, K. G. Nama, R. P. Meena, Sanjay Singh Rawat — Thu, 26 Dec 2024 00:00:00 +0530

Background: This study examines the comparative outcomes of the Direct Anterior Approach (DAA) and Direct Posterior Approach (DPP) in patients undergoing Total Hip Arthroplasty (THA) for Avascular Necrosis of the hip.

Methods: A total of thirty patients were divided equally between the two surgical methods, with half number of patients undergoing DAA and half undergoing DPP. Key performance metrics, including Modified Harris Hip Score (MHHS), blood loss, operative time and length of hospital stay, were analysed to determine which approach offered superior postoperative recovery and patient satisfaction. A convenient sampling technique was used in our study. Epi Info 2023 software was used for statistical analysis of data. The study was conducted in Government medical college and associated group of hospitals. The study was conducted from 01/06/2022 to 30/06/2023.

Results: It shows that both approaches led to significant improvements in Modified Harris Hip Score (MHHS) postoperatively, with no statistically significant difference in the final hip function at various follow-up intervals. However, DAA required a smaller incision, making it cosmetically favourable but resulted in greater blood loss and longer operative time due to its technical complexity. DPP, on the other hand, was associated with faster operative time and slightly lower blood loss but had a higher risk of postoperative dislocation. Despite these differences, there was no significant difference in hospital stay duration or overall complication rates between the two groups.

Conclusions: While both DAA and DPP are effective for THA, the choice of approach may depend on surgeon expertise and patient-specific factors, with DAA offering better cosmetic outcomes and DPP offering a technically easier procedure with fewer blood loss complications. Further long-term studies are suggested to analyse any potential differences in complication rates beyond the early postoperative period.

Expert perspectives on polmacoxib monotherapy in the management of osteoarthritis in Indian settings

Manjula S., Krishna Kumar M. — Thu, 26 Dec 2024 00:00:00 +0530

Background: Although there were several clinical studies available, there was a dearth of studies among clinicians in actual practice. So, the present survey-based study aimed to gather expert perspectives on the clinical use of polmacoxib monotherapy for the management of osteoarthritis (OA) in routine Indian settings.

Methods: This cross-sectional study employed a 19-item questionnaire to gather expert opinions on managing OA and covered topics such as prescription practices, clinical observations, preferences and experiences with polmacoxib for routine OA management. Descriptive statistics were used to analyze the gathered data.

Results: The study involved 239 participants, with 45% of respondents noting that 31-40% of OA patients are women. According to 65% of the participants, etoricoxib emerged as the most preferred nonsteroidal anti-inflammatory drug (NSAID) in clinical practice. Moreover, 87% of experts recognized the dual cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA) binding properties of polmacoxib as potentially offering superior safety profiles in cardiovascular (CV), renal aspects and Gastrointestinal (GI) tolerability. Around 35% of respondents observed improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain reduction, stiffness alleviation and enhanced physical function with polmacoxib.

Conclusions: The study highlighted a significant preference among Indian clinicians for polmacoxib in managing OA, primarily due to its dual COX-2 and CA binding properties that potentially offer better safety profiles in terms of cardiovascular, renal and GI tolerability. Additionally, the observed improvements in pain, stiffness and physical function with polmacoxib underscore its effectiveness as a monotherapy in routine OA management.

Effectiveness of teriparatide in enhancing bone formation and reducing aseptic loosening risks post-hip arthroplasty in patients with avascular necrosis

Ashish Arbat, Kandarp Thakkar — Thu, 26 Dec 2024 00:00:00 +0530

Background: The hip joint's critical role in weight-bearing and mobility is often compromised by avascular necrosis (AVN), leading to osteoarthritis (OA). This study evaluates the impact of teriparatide, a synthetic parathyroid hormone analog, on bone formation and the risk of aseptic loosening in post-hip arthroplasty patients affected by AVN.

Methods: In this retrospective, single-centre study, 26 patients who underwent hip replacement surgery due to AVN between November 2021 and November 2023 were included. Participants were selected based on specific inclusion and exclusion criteria and received daily subcutaneous injections of teriparatide (20 μg) for six months. The study focused on assessing the efficacy of Teriparatide in mitigating prosthetic loosening and enhancing bone formation post-hip arthroplasty, alongside monitoring for adverse events.

Results: The cohort had a mean age of 37.63 years, predominantly male (77%). The median time for post-surgical pain onset was 31 days. After 3 months of teriparatide therapy, all patients showed a significant reduction in joint pain and swelling, with improved mobility. Radiographic evaluations demonstrated a decrease in previously observed radiolucent lines, indicating successful prosthesis integration. At the 6-month mark, tomosynthesis revealed no space between either the femoral head or hip components and the osteotomy load surfaces. No adverse events were reported during the therapy period.

Conclusions: Teriparatide-is a promising therapeutic agent for enhancing surgical outcomes in post-hip arthroplasty in patients with AVN. Its role in promoting bone formation and reducing aseptic loosening risks is significant, suggesting its potential in improving patient recovery and pre-empting postoperative complications.

Evaluation of functional and radiological outcome of core decompression with autologous corticocancellous bone grafting and intralesional zolendronic acid in early stages of avascular necrosis of femoral head

Varun Devdass, Deepak Kumar, Karan Shetty — Thu, 26 Dec 2024 00:00:00 +0530

Background: Avascular necrosis (AVN) of the femoral head is a progressive condition leading to bone necrosis, collapse, and joint dysfunction. Core decompression with autologous corticocancellous bone grafting is a common treatment option for early-stage AVN. This study aimed to compare the functional and radiological outcomes of core decompression with autologous corticocancellous bone grafting alone versus the same procedure with the addition of intralesional zolendronic acid in patients with early-stage AVN.

Methods: A randomized controlled trial was conducted with 20 patients (26 hips) diagnosed with early-stage AVN (Ficat stages I and II). Patients were randomly allocated into two groups. Group A underwent core decompression with bone grafting, while group B received the same procedure with the addition of zolendronic acid. Functional outcomes were assessed using the Harris hip score (HHS), pain relief was measured using the visual analog scale (VAS), and radiological progression was evaluated using MRI scans at 3, 6, and 12 months postoperatively. SPSS version 23 was used for data analysis.

Results: Group B demonstrated significantly greater improvements in pain relief and functional outcomes at all follow-up intervals (p<0.05). The mean HHS in group B improved from 50.5±8.0 preoperatively to 88.0±5.5 at 12 months, while group A showed an improvement from 49.0±7.7 to 79.2±6.6.

Conclusions: The addition of Zolendronic acid to core decompression and autologous corticocancellous bone grafting significantly enhances both functional and radiological outcomes in patients with early-stage AVN.

Functional outcomes of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur

Rajesh K. Sharma, Anuradha Upadhyay — Thu, 26 Dec 2024 00:00:00 +0530

Background: Early diagnosis and management of avascular necrosis (AVN) is of paramount importance in order to preserve the femoral head. Early intervention, if implemented at the pre-collapse stage, has favourable impact on the prognosis of disease. This study was conducted to compare the functional outcome of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur and to evaluate the complications associated with the procedure.

Methods: It was a comparative, and prospective study. After obtaining ethics committee approval, total 30 hips (19 patients) divided randomly into two groups for treatment, as per inclusion and exclusion criteria. Group A (core decompression with autologous cancellous bone grafting with PRP), and group B (core decompression with autologous cancellous bone grafting without PRP). Assessment of the results, was based on the Harris hip score (HHS) and visual analogue scale (VAS) at preoperative, 2 weeks, 4 weeks, 6 weeks and 3, 6, and 9 months post-operatively.

Results: There was no statistical difference seen between two groups in terms of distribution of cases based on age, gender, side, duration of symptoms, etiology, Ficat-Arlet grade, and surgical time. Mean HHS and mean VAS was found to be comparable in two groups postoperatively at all follow ups. Excellent to good results were obtained on functional assessment by HHS grading at final follow up of 9 months in patient treated under group A while patients treated under group B showed good to fair results. Both groups showed statistically significant improvement in HHS grade at 9 months as compared to preoperative HHS. In both groups, there was a statistically significant improvement in mean VAS at 9 months as compared to preoperative VAS.

Conclusions: When combined with core decompression and bone grafting, PRP produces better HHS/functional outcomes as compared to core decompression and bone grafting alone for the treatment of early avascular necrosis of head of femur.

A comparative prospective study of retrograde nailing versus locked compression plating in distal third femur fractures

Sabavath Deepthi, Mise Priyanka, Fatima Heba Habeeb, Bharath Kumar S. — Thu, 26 Dec 2024 00:00:00 +0530

Background: Treatment of distal femur fractures is complicated by the fact that the majority of these fractures occur near to transverse neurovascular structures. Present study aimed to assess the outcome in patients undergoing retrograde nailing vs locked compression plating in distal third femur fractures.

Methods: The present prospective study was conducted among all the patients visiting Mamata general hospital Khammam with distal third femur fractures between age 18-80 years during the period of October 2020- September 2022. The patients were treated with retrograde nailing in group and locked compression plating in another group of patients with distal third femur fracture.

Results: On assessment of the clinical outcome during the follow-up period, there is significantly lower clinical outcome score among the patients in the nailing group compared to the plate. Similarly, the radiological scores between the groups, there is significantly higher mean score among the patients in the nail group compared to the plate group.

Conclusions: The present study showed a significant clinical outcome and radiological score among the patients treated with retrograde nailing compared to the patients treated with locking compression plating technique for distal third fracture of femur.

Staged tricortical bone graft with internal fixation in complex distal humerus fracture: a prospective study

Prince Maheshwari, Pushprajan, Ankur Ojha, Ajit Singh, Satyam Kumar — Thu, 26 Dec 2024 00:00:00 +0530

Background: Complex distal humerus fractures present a significant challenge in orthopaedic surgery. This study evaluates the efficacy of staged tricortical bone graft combined with internal fixation in these fractures.

Methods: A prospective study involving 50 patients with complex distal humerus fractures treated with staged tricortical bone graft and internal fixation was conducted. The primary outcomes measured were radiographic union and functional recovery using DASH and MEPS scores over a 12-month period.

Results: Radiographic union was achieved in 100% of patients at 12 months. Significant improvements in functional outcomes were noted, with DASH and MEPS scores improving from 75.3 and 55.4 at baseline to 20.1 and 95.0, respectively, at 12 months (p<0.001). The complication rate included an 8% incidence of postoperative infection and a 6% rate of non-union. Subgroup analysis indicated slightly better outcomes in patients under 50 years.

Conclusion: Staged tricortical bone graft combined with internal fixation demonstrates high efficacy in treating complex distal humerus fractures, offering high union rates and significant functional improvements. While the results are promising, further research is needed for broader validation.

A comparative study of intramedullary nailing versus minimally invasive percutaneous plate osteosynthesis for extra articular distal tibia fracture

Rahil T. Pasha, Prakash A. Sasnur, Moinuddin Basha K., Syed Hasan Zahid — Thu, 26 Dec 2024 00:00:00 +0530

Background: Distal tibia fractures are among the most challenging orthopaedic injuries due to their subcutaneous location, limited blood supply and proximity to the ankle joint. These fractures often result in complications such as delayed-union, non-union, wound infection and malalignment. This study aims to compare the effectiveness of two minimally invasive surgical methods: Intramedullary Nailing (IMN) and Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) in treating extra- articular distal tibia fractures.

Methods: A prospective study was conducted on 30 patients with extra-articular distal tibia fractures. The participants were divided into two groups, 15 patients receiving IMN and 15 patients MIPPO. Clinical assessments were carried out to evaluate functional outcomes, union time and complications. Radiological evaluations were used to monitor the progress of fracture healing.

Results: Both IMN and MIPPO were effective in treating distal tibia fractures, with each technique having its advantages and drawbacks. IMN showed a shorter union time and fewer wound complications compared to MIPPO, which demonstrated better alignment and fewer malunions. However, IMN was associated with a higher incidence of anterior knee pain, whereas MIPPO had more cases of implant irritation leading to reoperation.

Conclusions: Both IMN and MIPPO offer viable treatment options for extra-articular distal tibia fractures. IMN is preferred in cases where early weight-bearing and faster union are critical, particularly in patients with soft tissue concerns. Conversely, MIPPO is advantageous in achieving better alignment and should be considered when soft tissue conditions allow. We conclude by Intramedullary Nailing as better treatment modality for distal tibia extra articular fractures.

Comparative study of functional outcome and complication in low profile recon plates vs anatomical anteromedial distal tibial plate in extra articular distal 4th tibia fibula fracture

Kundan Kushwah, Deepak Singh Rajput, Prabhat Ghormare — Thu, 26 Dec 2024 00:00:00 +0530

Background: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as intramedullary nailing, open reduction and internal fixation (ORIF) with conventional plate osteosynthesis and external fixation have reported good functional outcomes but had a high complication rate. We decided to review the results of treatment of extra articular distal 4th tibia fracture using low profile plates.

Methods: The 30 patients with distal 1/4rd tibia extra-articular fractures with or without associated fibula fractures were treated with anatomical anteromedial distal tibia plate vs low profile recon plate. The present prospective study was conducted in department of orthopaedics, MGMMC and M. Y. hospital, Indore between January 2023- May 2024.

Results: All fractures had excellent clinical and functional outcome, with an average operative time of 49 minutes. The age of the patients ranged from 18 to 60 years (mean 42.7 years). Assessment on basis of Karstorm and Oleruad score at 6-month post treatment showed that majority of patients had excellent score (56.7%). Poor outcome was reported in only 3.3% patient. Most common complication was ankle stiffness in both type of plating groups followed by deep infection.

Conclusions: Both types plate showed similar functional outcome. However, low profile recon plate had lesser complications as compared to anatomical plates i.e., hardware like sensation, wound dehiscence ankle stiffness, deep infection and screw breakage.

Clinico-radiological assessment of vascularized muscle pedicle bone graft in scaphoid non-union

Rachit Bhatnagar, Tushar Chaurasia, Aseem P. Singh — Thu, 26 Dec 2024 00:00:00 +0530

Background: The aim of this study was to assess the clinico-radiological outcome of vascularised muscle pedicle bone graft in scaphoid non-union.

Methods: 16 men and 8 women with non-union of the scaphoid involving the proximal pole (n=6), waist (n=14), and distal pole (n=4) were randomly assigned to receive a vascularized muscle pedicle bone transplant with Herbert screw fixation. Their ages ranged from 18 to 45 (mean 32). Eight months was the average non-union period (range: 4–12 months).

Results: The mean follow-up duration was 18 months. 20 out of 24 were united. In 16 out of 24 cases, the scapholunate and radiolunate angles were corrected. 4 of 24 did not achieve union, and 3 of those were associated with proximal pole absorption. During pedicle dissection, there was no iatrogenic fracture or hardware malfunction.

Conclusions: Scaphoid non-union has been successfully treated with vascularized bone grafts, particularly in cases where the non-union has an avascular proximal pole or has not healed following prior surgery.

Evaluation of safety and functional outcomes after rotator cuff repair using Sironix suture anchor

Thu, 26 Dec 2024 00:00:00 +0530

Background: Arthroscopic rotator cuff repair procedures are performed to maximize clinical and functional outcomes. The surgical sector is experiencing a surge in repair surgeries involving arthroscopic repair of torn tendons using surgical implants. The study aimed to evaluate the safety and functional outcomes of rotator cuff tear repair using Sironix suture anchors.

Methods: Patients with a mean age of 53.8 years who underwent arthroscopic rotator cuff repair using a Sironix suture anchor between January 2019 and June 2022 were included in this retrospective observational study. Postoperatively, patients were assessed using the American shoulder and elbow surgeons score (ASES), level of activity using the simple shoulder test questionnaire (SST), quality of life using the shoulder pain and disability index scale (SPADI), the single assessment numerical evaluation score (SANE), and adverse events associated with study devices.

Results: Significant and clinically relevant ASES, SST, SPADI, and SANE scores were observed in all patients. The mean (SD) values of total ASES, SST, and SPADI scores were 91.6 (6.21), 94.1 (10.74), and 1.3 (2.48), respectively. The mean (SD) value of total SANE score in the affected joint was 95.8 (7.70), and the opposite side was 99.0 (3.04). No serious adverse events were reported.

Conclusions: Sironix suture anchors (CEPTRE^® knotted UHMWPE suture PEEK anchor, CEPTRE^® knotted UHMWPE suture PLDLA-βTCP anchor, VIPLOK^® knotless PEEK anchor with titanium tip and VIPLOK^® knotless PLDLA-βTCP anchor with titanium tip) have proven to be both safe and effective in repairing rotator cuff tears, enhancing shoulder function without any serious adverse effects.

Use of palmaris longus graft in chronic distal radio-ulnar joint instability in complex tear of triangular fibro-cartilage complex

Thu, 26 Dec 2024 00:00:00 +0530

Chronic distal radio-ulnar instability often results from complex tear of triangular fibro-cartilage complex (TFCC), which serve as a critical stabilizer for wrist. This injury frequently arises due to repetitive trauma or acute injury, leading to significant pain, functional impairment, and diereses grip strength. Chronic dislocation of the distal radio ulnar joint has traditionally been managed through intricate osteotomies and reconstructive procedures, often resulting in stubborn stiffness and diminished functionality. It is advantageous to employ a fixation method that not only restores wrist biomechanics but is also aesthetically pleasing for the affected individual. Here, we introduce a new technique for use of palmaris longus graft with fixation button stabilizing chronic distal radio-ulnar joint instability. The advantage of this surgery is decries the duration of the surgery, and start early range of movements of wrist with significant improvement in pain using the vas score. None of the patients had complications. The use of palmaris longus graft is believed to an innovative, safe, reliable and efficient method for of distal radio-ulnar joint (DRUJ) instability.

Utility of distal palmar flap in the reconstruction of distal thumb injury

D. U. Rajput, Varsha Kalyanpur — Thu, 26 Dec 2024 00:00:00 +0530

Selecting the most appropriate technique for thumb reconstruction depends on multiple factors, including level of injury, status of the remaining hand, age, occupation, overall health, and functional demands of the patient. In this study we used distal palmar flap for reconstructing distal tissue loss of thumb in patients. It was noted that such defects could be treated effectively with regional flap i.e. distal palmar flap, which gives good aesthetic outcome and patient satisfaction, Patient satisfaction was found to be better with palmar crease flap for smaller defects than larger defects, however all of the patients graded satisfaction as good (80%) and very good (20%). Distal palmar flap is a good reconstructive method for thumb reconstruction, as it an easier and non-microvascular technique which retains the thumb length, colour, vascularity and appearance of thumb. Thus, can be safely advocated for use as it has no significant complications associated with the technique.

Comparative study of lateral entry versus crossed entry pinning for paediatric supracondylar humerus fractures: a case series

Vijayakumar S. Kulambi, Mahammad A. M. Mulla, Praful R. Gombi — Thu, 26 Dec 2024 00:00:00 +0530

Closed reduction and percutaneous pin fixation techniques have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. Commonly lateral pinning and cross pinning techniques are utilised for fixation. However, controversy exists regarding the selection of the appropriate procedure. A prospective study with 24 cases of displaced fracture supracondylar humerus, treated by lateral pinning and cross pinning, was conducted between August 2022 and May 2024 at Department of Orthopaedics at J.J.M. Medical College, Davangere. Patients were treated with either the lateral entry pin alone or the cross pinning with a combination of lateral entry pin and medial entry pin. Age, gender, fractured side, duration of surgery, postoperative complications, surgical approach, direction of pin application (lateral or cross), and Modified Flynn grading system grade was noted for study outcome. No difference was found between lateral pinning and crossed pinning groups in terms of the grade of the modified Flynn grading system and complications like iatrogenic ulnar nerve damage, loss of reduction. Pin tract infection was seen in one patient.

Outcomes of proximal fibular osteotomy in osteoarthritis knee

Mihir A. Tejura, Darshankumar N. Sonawane — Thu, 26 Dec 2024 00:00:00 +0530

The need for management of mild to moderate osteoarthritis (OA) knee surgically with a new method that is relatively simple, less invasive, less expensive and suitable for Indian setting postulated to offer short to medium term relief and defers the need for a major surgery like total knee replacement was served by a novel surgical technique of proximal fibular osteotomy (PFO). The aim of this study is to evaluate the efficacy, functional outcomes and complications of PFO in OA of knee joint. Total 20 patients (33 knees) with OA knee operated by PFO were included in the study and were followed up at 1 month, 3 months and 6 months postoperatively. The outcomes of PFO were evaluated using VAS score, functional american knee society score and Kellgren Lawrence (KL) scale and the patients were evaluated post-operatively for development of any complication and it’s improvement at each follow up. The results showed significant improvement in efficacy and functional outcomes with respect to VAS score and functional American knee society score however there was no significant change in KL scale grading postoperative. Few patients developed EHL weakness and hypoaesthesia post-operatively which gradually improved at further follow ups. This study concludes that PFO is a safe and efficacious method of management of OA knee showing significant pain relief and improving functional outcomes of patient significantly.

Modified thread technique, 2 threads 7 days in cases of wrist ganglions: a case series

Ravikumar R. Dadhaniya, Santosh Ghoti, Akshay Dudhanale, Amrendra Singh — Thu, 26 Dec 2024 00:00:00 +0530

Ganglion cysts are soft tissue swellings occurring most commonly in the hand or wrist, they are usually asymptomatic. The 70% cases of ganglion are observed on the dorsal side of wrist. Ganglion cysts arise from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury. Ganglion cysts have a recurrence rate of approximately 15% to 20%. Gang et al introduced the technique of treating ganglion by passing a silk thread to induce chronic inflammation leading to obliteration of the cyst. Three cases with wrist swelling without tenderness. On examination swelling is firm consistency, slightly mobile, not adherent to underlying or overlying structures, without local rise of temperature. Ultrasonography has confirmed the diagnosis of ganglion cyst. Modified thread technique has been planned. Patient has been followed on day 3, 5, 21, 90^th day. Patient has no suture site complications, with no recurrence on 3 month follow up. The cyst was stabilised and a sterile silk/linen thread on a cutting needle was passed through the cyst and taken out from the opposite side from 3 O’clock to 9 O’clock position. Second thread was passed perpendicular to first one from 12 O’clock to 6 O’clock position. The contents of ganglion were expressed out by firm pressure. Thread was removed on the seventh day irrespective of presence or absence of yellowish discharge. Patients were followed up on the fifth day after thread removal. Patients were then followed at monthly intervals for first three months. Non-surgical techniques used are aspiration, sclerotherapy, steroid injection, hyaluronidase injection, immobilization and thread technique. These have high recurrence rates. Surgical excision has lower recurrence rates, but they have a high complication rate. The thread technique is being considered as a newer option since it has recurrence rates comparable to surgical excision and complication rates comparable to nonsurgical techniques.

3D imaging techniques for the diagnosis and surgical planning of complex limb fractures: a systematic review

Fri, 08 Nov 2024 00:00:00 +0530

This systematic study will investigate how 3D imaging techniques have improved diagnosis and planning of surgeries for complex limb fractures. These fractures are caused of high-energy trauma which presents unique challenges, so advanced imaging technologies can help to mitigate them. We strictly adhere PRISMA guidelines to ensure thorough analysis and inclusion of relevant literature. The search was conducted on Web of Science and PubMed were all thoroughly searched between 2010 and 2023. Keyword combinations such as "3D imaging," "complex limb fractures," and "surgical planning" were employed using Boolean operators and as a result, 26 studies were included following screening based on strict inclusion criteria. 56% of studies used CT scans, demonstrating a 32% increase in diagnosis accuracy over 2D techniques for complicated fractures. In 28% of cases MRI improved soft tissue evaluation. 3D printing was utilized in 16% of investigations and it improved postoperative alignment in 94% of cases and shortened operating times by 18%. We can conclude that 3D imaging greatly enhances surgical planning, patient outcomes, and diagnostic precision in complex limb fractures and it provides useful resources for surgeons and patients by improving fracture visualization, reducing operating time, and promoting quicker recovery.

Masquelet technique for infected femur bone defect in low resource setting: a case report

Mario D. Simatupang, Stevanus I. Ario — Thu, 26 Dec 2024 00:00:00 +0530

Our hospital is located on the east edge of Indonesia, in the rural city of Merauke, South Papua. In this setting, procedures to bridge large bone defects are limited. The Masquelet technique is a two-stage orthopaedic procedure to treat large bone defects. This technique has a promising future for treating large bone defects, especially in low-resource settings. A 27 years old male experienced a traffic accident. The patient went unconscious and was brought to a nearby hospital where he underwent open reduction and internal fixation of his right femur open fracture. In the 4^th week after the trauma, he was diagnosed with osteomyelitis. After multiple procedures in other hospitals, in the 74^th week, he arrived at our hospital in Merauke, South Papua. We used Masquelet technique to bridge the bone gap and treat the osteomyelitis. In the first stage, we did debridement and sequesterectomy, then filled the bone defect with antibiotic impregnated PMMA spacer. After 5 weeks, the infection had subsided and the second stage of Masquelet technique was done. We removed the spacer while preserving the membrane and filled the gap with iliac bone autograft and allograft mixture. Union was attained 56 weeks after stage 2. The patient and family are satisfied with the outcome. Masquelet technique is a promising technique with a good success rate for large bone defects, especially in infected bone cases. No need for microvascular and other specialized tools made Masquelet technique can be done in a low-resource setting.

Anatomical retinaculum repair and pseudo-pouch closure: surgical technique for management of posterior tibial tendon dislocations

Emanuel Cortesão Seiça, João Gamelas, Joana Canhoto, João Vide, Afonso Cardoso — Thu, 26 Dec 2024 00:00:00 +0530

This study aims to present a surgical technique for managing Type-II posterior tibial tendon (PTT) dislocations, characterized by a detachment of both the flexor retinaculum and periosteum from the tibia, and to review existing literature on treatment approaches for this rare condition. We describe a surgical procedure that involves an approach to the PTT, assessment, and potential deepening of the retro malleolar groove, and repair of the detached flexor retinaculum using a double suture technique. The technique addresses the challenges posed by the pseudo pouch formed due to the detachment and aims to stabilize the PTT within the groove. The surgical outcomes of two cases involving young, active patients are discussed, including pre- and post-operative assessments. In case 1, a 19-year-old male athlete demonstrated improvement in pain and function, with no recurrence of dislocation at six months follow-up. Case 2, a 40-year-old male athlete, experienced slight discomfort but returned to practice with improved strength and function. Both cases showed effective tendon stabilization within the retro malleolar groove and favorable outcomes without significant complications. The described surgical technique for Type-II PTT dislocations, involving reattachment and repair of the retinaculum, successfully addresses the challenges of the pseudo pouch and provides effective stabilization of the tendon. This approach results in satisfactory clinical and radiological outcomes, with most patients achieving a return to pre-injury function. The study highlights the need for further research to compare biomechanical effectiveness and long-term tissue healing outcomes of this technique.

Bilateral neck of femur stress fracture secondary to osteopetrosis treated with dynamic hip screw

Vinay V. Sherlekar, Ajay M. B., Mahalingam, N. Shreyas — Wed, 13 Nov 2024 00:00:00 +0530

Osteopetrosis, a rare hereditary bone disorder, is characterized by increased bone density due to defective osteoclast-mediated bone resorption. This condition often leads to skeletal fragility, resulting in recurrent fractures despite increased bone mass. Among these, stress fractures of the femoral neck pose a unique challenge where conventional management may not be optimal. Valgus osteotomy offers a viable surgical intervention to realign the mechanical axis, thereby reducing stress on the femoral neck and facilitating healing. This paper reviews the pathophysiology of osteopetrosis, its impact on fracture healing, and the role of valgus osteotomy in managing femoral neck stress fractures in osteopetrotic patients.

Sequential manual manipulation technique of closed reduction to retrieve a bent femoral intramedullary nail: a case report

Thu, 26 Dec 2024 00:00:00 +0530

A bent intramedullary nail in femur can be extremely difficult to extract when a patient presents after a secondary episode of trauma following the original episode for which nailing was done. These bent nails require utmost precision while extracting them, to prevent injury to the surrounding soft tissues and neurovascular bundle of the limb. We encountered a particularly rare case of a bent Kuntscher nail who presented to us nearly 20 years (post his primary surgery in 2001) after sustaining a secondary trauma. There was a 29-degree bend in the antero-posterior view and a 106-degree procurvatum bend in the k nail on the lateral view. We followed a technique of sequential manual manipulation under radiographic guidance to correct the acute bend of the nail, taking care not to create any additional fractures. Following nail extraction, the fracture was fixed with an interlocking nail and went on to unite uneventfully. At 3-year follow up, patient was walking pain free and exhibited a good knee range of motion.

Total knee arthroplasty in pigmented villonodular synovitis: a case report and its management

Anand Kumar, Sanjay Singh Rawat, Ram Prasad Meena, Ekaansh Karir — Thu, 26 Dec 2024 00:00:00 +0530

Pigmented villonodular synovitis (PVNS) is a benign yet potentially aggressive proliferative lesion of the synovium, which can lead to significant morbidity, particularly when associated with osteoarthritis. This case report presents a 48-year-old male with a 2-year history of knee swelling and pain, exacerbated over the last 6 months, resulting in impaired daily activities. Clinical examination and imaging revealed severe osteoarthritis and soft tissue swelling around the knee. Surgical intervention involved total synovectomy and total knee arthroplasty, performed concurrently. The patient exhibited favorable postoperative outcomes, achieving full range of motion and resolution of symptoms. This case underscores the importance of recognizing PVNS as a contributor to knee osteoarthritis and highlights effective surgical management strategies to improve patient quality of life. Follow-up care is crucial to monitor for potential recurrence of the disease.

The dark side of cartilage: ochronosis unmasked during femoral neck fracture surgery

Thu, 26 Dec 2024 00:00:00 +0530

Alkaptonuria is a rare autosomal recessive disorder caused by a deficiency in homogentisic acid oxidase, leading to the accumulation of homogentisic acid in connective tissues. It is characterized by bluish-black pigmentation of cartilage and other connective tissues, with progressive joint degeneration and early-onset osteoarthritis. Ochronosis typically becomes symptomatic after the age of 30, affecting larger joints and the spine. A 75-year-old female presented with a transcervical femoral neck fracture and a right distal end radius fracture following a fall. During hip surgery, intraoperative findings included blackish discoloration of the femoral head and acetabulum. The patient had a history of stooped posture and calcified intervertebral discs. Further examination revealed ochronotic pigmentation of the sclera and ear cartilage, and a urine test confirmed the diagnosis of ochronosis. Postoperative recovery was uneventful. Ochronosis should be considered in the differential diagnosis of patients with calcified intervertebral discs and early-onset joint degeneration. The condition is typically asymptomatic until joint involvement occurs. Current treatment options are limited, though nitisinone and dietary modifications show some promise. This case highlights the importance of recognizing ochronosis in patients with joint degeneration, particularly when intraoperative findings reveal characteristic pigmentation.

Sub-acute post traumatic ascending myelopathy with superimposed infection in a diabetic: a case report

Shreya Shenoy, C. S. Vishnu Prasath, Manish R., Sargunan Bala — Thu, 26 Dec 2024 00:00:00 +0530

Subacute posttraumatic ascending myelopathy (SPAM) is a rare entity associated with trauma to the spinal cord, usually at the level of the thoracic spine. Patient presents with neurological deterioration 4 or more levels above the site of primary injury. It usually follows an episode of fever unrelated to infection. A 43-year-old diabetic male patient with history of blunt trauma to thoracic spine with T5 flexion distraction injury with ASIA A neurology, underwent T3-T6 posterior instrumented stabilisation. Four weeks following this, he presented with signs of encephalopathy with CSF culture showing Acinetobacter baumanii. Though the patient had improvement with culture- sensitivity appropriate antibiotics, he developed ascending neurological deficits on day 3 of admission. On repeat MRI, he showed cord oedema up to C3. He was started on steroids and showed remarkable clinical improvement. SPAM must be kept as a differential in the diagnosis of a postoperative event with similar clinical picture.

Golf ball near elbow: a rare presentation of a giant ulnar nerve Schwannoma

Prajwal P. Thumati, Shivanand S., Radhakrishna A. M., Veeresh N. — Thu, 26 Dec 2024 00:00:00 +0530

Schwannoma is a type of peripheral nerve sheath tumor but can produce a mass effect with increase in size, spontaneous pain, paresthesia and motor weakness being the main complaints. A 60-year-old male patient presented with swelling in the left forearm since the past 8 months and numbness and tingling sensation in the hand for 1 month. Examination revealed a solitary lesion in the ulnar aspect of left proximal forearm with glove and stocking type of neuropathy, wasting of hypothenar eminence and amputation of left 5th digit, with hypopigmented lesions over the forearm and leg. Slit skin smear and biopsy of hypopigmented lesion was done to rule out leprosy. Ultrasonography (USG) and contrast-enhanced magnetic resonance imaging (CE-MRI) of left forearm lesion revealed homogenously enhancing lesion involving the proximal portion of left forearm - suggestive of peripheral nerve sheath tumor. Hence the patient was treated with excision and biopsy. Histopathological examination revealed a giant Schwannoma (6×4×3.5 cm) of the ulnar nerve with typical findings of spindle shaped cells few verocay bodies. Despite rare, tumors should be taken into account in the differential diagnosis in such presentations. It is important to remember that Schwannoma, in these cases, is the most common tumor. The simple removal of the tumor after careful dissection is generally enough since the recurrence and malignant transformation rates are low.

From numbness to diagnosis: a case of median nerve schwannoma

Nandu Krishnan, Jatinder Kumar Singla, Rajat Gupta, Vishal Gautam — Thu, 26 Dec 2024 00:00:00 +0530

Schwannomas are a common entity, but upper limb schwannomas are rarely encountered. Even in hand, ulnar nerve schwannomas are more commonly reported than median nerve schwannomas. Hence, we present a case report of median nerve schwannoma in a 54-year-old woman. She presented with a benign swelling of 3 cm associated with numbness and pain. On examination, Tinels sign was positive. MRI revealed a well-defined swelling that was hypointense on T1 and hyperintense on T2 STIR images. The swelling was marginally excised, and histopathology revealed the presence of Antoni A and B cells, consistent with Schwannoma. The patient was completely asymptomatic at 1-month follow-up. This case report stands as a testament to how early diagnosis and treatment can help in alleviating the physical as well as psychological stress in such patients.