International Journal of Research in Orthopaedics

Predictive factors of malunion and nonunion at the Aristide le Dantec hospital

Fri, 28 Apr 2023 00:00:00 +0000

Background: Malunion and nonunion are late complications that can occur during the fracture healing process. The aim of this study was to determine the predictive factors for malunion and nonunion

Methods: This was a retrospective study over a period of 43 months. Predictive factors were sought from patient, fracture and initial management data

Results: We recorded 72 consolidation disorders in 69 patients. malunion accounted for 54.1% and nonunion for 45.9%. The study population was divided as follows: 53 men and 16 women. The average age was 37.8 years. The patients lived in urban areas in 81.2% of cases. Comorbidities were present in 14.5%. The circumstances of fracture occurrence were dominated by traffic accidents, especially for 39 patients. The initial fracture was closed in 91.3%. Long bones were involved in 97.2% of cases, with a diaphyseal location in 52.8%. The fracture was simple in 79.1%, with 84.7% of the fractures being transverse. The tibia was the bone most affected by malunion (53.8%). Nonunion occurred in the humerus, femur and tibia in 27.3% each. Initial treatment was undertaken in 91.3% of patients.

Conclusions: Malunion and nonunion are a reality in our daily practice. These consolidation problems occur in young patients who are victims of road traffic accidents. Diaphyseal fractures of long bones with a transverse line have been the most frequently incriminated. conservative treatment and traditional practice have favoured the development of these complications.

Functional outcome of intertrochanteric fractures treated with trochanteric stabilizing plates

Fri, 31 Mar 2023 00:00:00 +0000

Background: Intertrochanteric fractures account for significant percentage of health care costs and result in high rates of morbidity and mortality. Since higher rate of mortality and complications most fractures can be successfully treated with trochanteric stabilizing plates. This study was conducted to assess functional outcome in intertrochanteric fracture femur treated with trochanteric stabilizing plates and define ideal mode of fixation for such fractures. Trochanter stabilizing plate (TSP) is modular extension of dynamic hip screw (DHS) that is mounted on lateral femoral wall to stabilize greater trochanter. It provides the flexibility to achieve plate to bone apposition as well as axial compression or angular stability because of three screw fixations at the proximal fragment. TSF can provide a stress shield for the lateral trochanteric wall and prevent lateral migration of proximal fragments. Thus, TSF does not fail at the screw bone interface and provide a strong anchor in osteoporotic bone. The multiple locking screw holes of the TSF provide various options to tackle complex fracture pattern. It functions as an internalized external fixator and minimizes the pressure on the periosteum and encourages biological healing.

Methods: A total of 30 subjects of intertrochanteric fractures undergoing treatment with trochanteric stabilizing plates were taken up for the study after informed consent.

Results: Significant results were obtained using Harris hip score (HHS) at different postoperative follow up time intervals with good outcome and low complication rate.

Conclusions: Trochanteric buttress plate creates biomechanically stable construct by incorporating the comminuted trochanter it restores the proximal femoral anatomy, ensuring anatomical reduction hence subsequently reduces limb length discrepancy. We thus conclude this is an effective technique and has excellent functional and radiological outcomes with minimal complication and early rehabilitation rates. As Intertrochanteric fractures of the hip is a very common condition affecting a large number of patients of variable demographics and racial background, a more widespread study is required for a more conclusive study.

Assessment of the functional results of hemiarthroplasty in geriatric individuals with unstable intertrochanteric femur fractures

Sushant S. Tuse, Prashant Bhutani, Aamir Matin — Tue, 11 Apr 2023 00:00:00 +0000

Background: The objective of our study is to measure early weight bearing, mobilization, rapid rehabilitation, complications in unstable intertrochanteric femur after hemiarthroplasty fractures in elderly patients.

Methods: Prospective and retrospective, non-randomized study was conducted to assess functional results of hemiarthroplasty in elderly individuals with unstable intertrochanteric femur fractures following surgery in patients who underwent surgery from 2019 to 2021 in department of orthopaedics of Seth Nandlal Dhoot Hospital, Aurangabad. Out of total 44 participants, there were 16 males and 28 females with mean age of 79.54 years of study participants. The patients were evaluated radiologically with routine X-rays i.e. pelvis with both hip joint anteroposterior (AP) view and affected side hip lateral view and clinically early weight bearing, mobilization, rapid rehabilitation and complication with Harris hip score.

Results: In our study we observed good result of 86.53±5.73 mean Harris hip score at the end of 1 year was following surgery in 44 study participants who underwent hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients.

Conclusions: Primary hemiarthroplasty offers an essentially pain-free movable joint and is a preferable mode of treatment for older osteoporotic patients who suffers from unstable intertrochanteric femur fractures. Hemiarthroplasty allows for early mobilization and offers rapid stability and mobility, preventing the issues associated with recumbency. Hemiarthroplasty has a lower rate of complications and revision surgery than fixation. According to the Harris hip score, primary bipolar hemiarthroplasty results in a good functional outcome, but long-term monitoring is necessary.

A comparative study between intraarticular infiltration of platelet rich plasma and hyaluronic acid in osteoarthritis knee

Manju Jayaram, Channappa T. S., Yatish R., Shivskumar H. B., Shuvam Singh — Tue, 11 Apr 2023 00:00:00 +0000

Background: Osteoarthritis (OA) is the most common progressive musculoskeletal condition that can affect joints, but it mainly affects the hips and knees as predominant weight-bearing joints and is characterized by structural modifications to primarily articular cartilage and subchondral bone, Hoffa’s fat pad, synovia, ligaments and muscles, leading to the concept of OA as a whole joint disease. Hence the present study was undertaken to evaluate the outcomes of platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular injections in patients with OA in terms of pain by numerical pain score and VAS and to evaluate the outcomes of PRP and HA intra-articular injections in patients with OA in terms of functional outcome by WOMAC scores.

Methods: The study was a prospective hospital-based study in Kempegowda Institute of Medical Sciences between 2020 to 2022. The study was conducted on 100 patients, more than the age of 50 years of either gender with grade I-III OA of the knee fulfilling the inclusion and exclusion criteria. Patients were followed up at 6, 12 and 24 weeks for data collection and data was analyzed after follow-up visits were completed for all patients.

Results: On intragroup analysis, there was significant reduction in the mean WOMAC score in both the study groups across time-points (p<0.05). On intragroup analysis, there was significant reduction in the mean VAS score in both the study groups across time-points (p<0.05). On intergroup analysis at any time point of follow-up, the mean WOMAC score was noted to be statistically comparable between the study groups (p>0.05).

Conclusions: In patients with symptomatic knee OA, intra-articular HA and PRP provide short term improvement in pain and function. Both the therapy agents for OA were associated with equivalent safety, with no complications.

Risk factors affecting the outcome of management of intertrochanteric fractures with dynamic hip screw in elderly patients: a retrospective, observational study

Nanasaheb D. Bhosale, Deepak Naikwade — Tue, 11 Apr 2023 00:00:00 +0000

Background: Among the different fixation procedures for intertrochanteric fractures, dynamic hip screw fixation is the most used therapy. Present study evaluated the risk factors affecting the outcome of intertrochanteric fractures managed by dynamic hip screw fixation.

Methods: This was an observational retrospective study conducted between March 2021 and February 2022. Patients with intertrochanteric fractures aged >60 years presenting within a week after incurring the fractures were enrolled. Evan’s and AO/OTA classification were used to categorize patients. “Failed” surgery was considered based on one of the following radiographic criteria. Functional outcomes were assessed at 6-months by Harris hip score (HHS).

Results: 40 patients were enrolled, majority being females (n=22, 55%) with mean age of 67.79±4.76 years. Commonest mode of injury was fall while standing (n=32, 80%). Based on Evans classification, majority cases were stable fractures (n=25, 62.5%). By the AO/OTA classification, majority patients were under A2 class (n=22, 55%). The 30 cases (75%) had outstanding to good outcomes based on HHS assessment. 8 patients (20%) had “failed” surgical outcomes of which commonest presentations were >20 mm lag screw pull-out (n=4, 10%) and mal union (n=2, 5%). Mean age, and number of obese patients were found to be significantly greater in the “failed fracture” subgroup, versus “united fracture” subgroup (p<0.05). Significantly greater number of cases in “failed fracture” subgroup belonged to Evans’ class IV or V, and to A3 class of AO/OTA classification (p<0.05).

Conclusions: Patient factors like greater age, obesity and intertrochanteric unstable fractures as indicated by Evans’ and AO/OTA classification were risk factors affecting the outcome of intertrochanteric fractures, managed with dynamic hip screw.

Biomechanical analysis of the effect of ‘intermediate screws’ in short segment posterior fixation of unstable burst fractures of thoracolumbar spine in calf spine model

Azad Sait, Monosha Priyadarshini, N. Arunai Nambi Raj, Kenny Samuel David — Sat, 15 Apr 2023 00:00:00 +0000

Background: Efforts in preserving motion levels in unstable thoracolumbar burst fractures steered to short segment fixation. However, short segment spanning fixation in clinical scenario reported high failure rates. Augmentation of spanning fixation by inserting intermediate screws into the fracture level is proposed to enhance stability. An experimental comparative study was performed to assess the biomechanical role of the ‘intermediate screws.’

Methods: Five calf spine specimens were freshly prepared to record the biomechanical characteristics, range of motion (ROM), and stiffness. CT scan confirmed an unstable burst fracture in each specimen. Each specimen was instrumented with short-segment posterior fixation with an intermediate screw. The same test protocols were repeated with and without intermediate screws.

Results: Intermediate screws contribute to 20.2%, 16.5%, 14.5% and 23% decrease in ROM and 15.4%, 25.6%, 48.3%, and 160.2% increase in construct stiffness.

Conclusions: Intermediate screws significantly increase the construct stiffness and decrease the ROM.

Outcome of treatment of intra-articular distal end radius fractures by volar locking plate versus bridging external fixator augmented by single K-wire through radial styloid

Vishal Prakash, Neelu Singh, Vinay Prabhat — Sat, 15 Apr 2023 00:00:00 +0000

Background: Distal radius fractures are common injuries occurring more frequently than any other fracture, and remain one of the most frequent skeletal injuries treated by orthopaedic or trauma surgeons. They are considered the most common fracture of the upper extremity.

The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low-profile internal fixation plates and implants, arthroscopically assisted reduction, and grafting techniques including bone-graft substitutes all have contributed to improving fracture stability and outcome.

Methods: This is a prospective study consisting of 30 patients, who were treated with volar locking plate or K-wire augmented external fixation for intra-articular commented distal radius fractures (AO type C) at Rajendra institute of medical sciences between November 2020 and January 2023. The 15 patients were treated with open reduction using the volar approach and locking plate were used while 15 patients were treated with closed reduction under fluoroscopy, distraction with the external fixator (Joshi type external fixator) along with K-wire fixation for additional stability used.

Result: The ORIF with plating group showed better functional outcomes in Green and O'Brien compared to ex fix group. The radiographic results in the ORIF group were more favorable than in the EF group.

Conclusions: We found that both ORIF with plating and external fixation represent treatment choices for distal radius fractures. ORIF had better functional and radiological outcomes according to Green and O'Brien and Sarmiento scoring systems when compared to external fixation. ORIF had less incidence of complications compared with external fixation.

Functional assessment of bipolar hemiarthroplasty versus total hip replacement in trans cervical neck fracture of femur in elderly patients a prospective observational study

Subith S., Abhijit Charthal, Shubham Dakhode, Ketan Naik — Fri, 28 Apr 2023 00:00:00 +0000

Background: Bipolar hemiarthroplasty and total hip arthroplasty are widely accepted methods of treatment for displaced femoral neck fracture in elderly patients. This study is to compare the functional outcomes of bipolar hemiarthroplasty and total hip arthroplasty in such patients.

Methods: This is a prospective study in which data of all patients with age more than 60 with trans cervical neck of femur fracture undergoing total hip arthroplasty and bipolar hemiarthroplasty in a tertiary care centre in Mumbai is studied. They were followed up and compared with the Modified Harris Hip Score. The results were compared between the two groups for statistical significance.

Results: There was a significant difference seen in pain and gait at 6 and 12 months between two groups with better scores in the total hip arthroplasty group. Better functional activities were seen at 3 and 6 months in the total hip arthroplasty group. A significant difference was seen in the Total Modified Harris Hip Score at 3, 6 and 12 months and was better in the total hip arthroplasty group as compared to the hemiarthroplasty group.

Conclusions: Bipolar hemiarthroplasty is the preferred approach after a displaced femoral neck fracture in the elderly population, but due to potential complications like inguinal pain and low functional outcome, total hip replacement should be considered as the first line of surgical management for the neck of femur fracture in such patients. It has been found to have a good functional outcome, fewer gait disturbances and less post-operative pain.

A comparative study of outcome of tension band wiring and hook plating in fracture olecranon

Pranav Mahajan, Ishan Khanna, Kundan Kushwah, Kanhaiya Yadav — Fri, 28 Apr 2023 00:00:00 +0000

Background: Olecranon fractures are common upper limb fracture accounting for 40% of the fractures around elbow. Anatomic reduction and restoration of the joint surface is required for good outcome and to prevent post-traumatic arthritis. This study was directed towards the functional results and complications of surgical management of olecranon fracture treated with hook plate fixation and tension band wiring.

Methods: This prospective comparative study was done at a tertiary care centre from 2019 to 2022. This study consisted of 30 patients of fracture olecranon of which 15 were treated with tension band wiring and 15 with hook plate. All patients were followed up with minimum follow up of six months and evaluated for their functional outcome using Mayo elbow performance score.

Results: In this study, the average age was 34 years in TBW group and 37 years in hook plate group. The mean Mayo elbow performance score after 6 months in TBW group was 88.33 (excellent) and in plate group was 90 (excellent). Superficial infection was present in 2 patients of the TBW group. Elbow stiffness was present in 2 patients of TBW group. Hardware impingement was present in one patient in each of TBW group and plate group.

Conclusions: To achieve early movements and to prevent complications like traumatic arthritis and joint stiffness we need a perfect anatomical reduction in intra-articular fractures of the olecranon. This study showed no significant difference in functional outcome with both the techniques, but the complications are more with TBW.

Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study

Fri, 28 Apr 2023 00:00:00 +0000

Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults.

Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period.

Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection.

Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing.

Assessment patient satisfaction after total knee replacement in Indian population

Mohan M. Desai, Pratik Y. Shahare, Ranjit Chopade, Pranav Shere — Fri, 28 Apr 2023 00:00:00 +0000

Background: We aim to assess the satisfaction of patients after total Knee replacement in Indian population. Tоtаl knee Аrthrорlаsty is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. Knee reрlасement surgeries helрs tо restоre nоrmаl meсhаniсs during level wаlking аs well аs mоre demanding аnd соmрlex асtivities suсh аs stаir negоtiаtiоn. Раtient sаtisfасtiоn rаtes fоr the рrосedure hаve been reроrted between 81-97%. However, this leаves а signifiсаnt роrtiоn оf the TKR рорulаtiоn аs dissаtisfied with the оutсоmes оf the reрlасed knee.

Methods: Patients were assessed at opd visit or with telephonic conversation and scores are calculated and mentioned in excel sheet. Post surgery satisfaction (PSS) score is the score created to measure the satisfaction after total hip replacement. This score contains different questionnaires. These questions include inquiry about relief of pain, ability to do daily routine activities, requirement of walking aids etc. Score contains total 7 questions.

Results: Out of 55 patients we found through this study that about 92.7% were classified as satisfied while 7.3% patients were dissatisfied. Satisfaction rate is more as compared to dissatisfaction rate.

Conclusions: In present study we have tried to eliminate other factors responsible for dissatisfaction such as hospital ward cleanliness, hospital administration, patient and hospital staff communication. we recommend total knee replacement surgery for end stage arthritis and it is more beneficial to the patients in terms of improvement in post-operative pain and function.

Radiological and functional outcome of conservatively managed middle one third clavicle fractures

Mohan M. Desai, Pranav P. Shere, Ranjit Chopade, Pratik Y. Shahare — Fri, 28 Apr 2023 00:00:00 +0000

Background: We aim to assess radiological and functional outcome of conservatively managed middle one third clavicle fractures in Indian population. Clavicle fractures represent 2% to 10% of all fractures. In middle third clavicle fractures, conservative management is the commonest approach. In uncomplicated non displaced midshaft fractures, patients treated non operatively with these conservative measures have fewer complications and a timely recovery as those treated operatively. Conservative management is a simpler yet effective mode of management in middle one third clavicle fractures.

Methods: Patients managed conservatively for clavicle fractures were assessed on OPD basis with follow up chest X-ray with bilateral shoulder AP view for radiological signs of union and assessing percent shortening and two questionnaires. Constant shoulder score which assess pain, degree of function, range of motion and muscular force and, simple shoulder test, self administered questionnaire defining one or more affirmative answers to find the satisfaction after treatment modality which were tabulated in Microsoft excel sheets.

Results: Out of the 55 patients enrolled in the study 52 showed signs of union at 6 months follow up with mean fracture union time of 13.9 weeks. At 6 months follow up Mean Constant Shoulder score was 87.1 with excellent outcome in 67.67 percent patients and using Simple Shoulder Test satisfaction rate was found to be 78.18 percent.

Conclusions: Solid evidence in favour of non-operative treatment for fractures with remaining contact of the bone fragments. Non-surgical management of middle third clavicle fractures yield excellent results. Clear indications for conservative treatment versus surgical fixation of displaced midshaft fractures have not finally been established yet. We recommend conservative management for uncomplicated middle one third clavicle fractures.

Does multidetector computed tomography unravel the hidden domains of conventional radiography in calcaneal fractures?

Javaid Iqbal, Moonisah Rafiq, Abid Hussain — Fri, 28 Apr 2023 00:00:00 +0000

Background: The most often fractured bone among the tarsal bones is the calcaneum. The first assessment of the suspected calcaneum fracture is conventional radiography. The modern assessment of calcaneal fractures is mainly based on multidetector computed tomography, because of its three-dimensional nature and Volume rendering techniques. The objective of this study was to compare the diagnostic value of Multidetector CT with Conventional radiography in Calcaneal fractures taking operative data as reference standard.

Methods: The patients suspected for calcaneal fracture were subjected to conventional radiography and computed tomographic imaging and results were compared in terms of Sensitivity, specificity, positive predictive value, negative predictive value and Diagnostic accuracy, taking operative/MRI findings as reference standard.

Results: We included 68 cases in our study The Sensitivity, specificity and diagnostic accuracy were 92.6%, 33.33%, 82.3% and 98.3%, 71.4%, 95.5% for conventional radiography and MDCT respectively.

Conclusions: We settled that MDCT is far ahead of the conventional radiography in complete depiction, diagnosis, characterization and treatment formulation for calcaneal fractures.

Comparison of functional outcomes of pertrochanteric fractures of the femur managed with dynamic hip screw with a locking side plate versus proximal femoral nail

Fri, 28 Apr 2023 00:00:00 +0000

Background: In current practice, proximal femoral nail (PFN) and dynamic hip screw (DHS) with locking side plate are the implant of choice in stable trochanteric fractures. Most of the deficiencies of the standard DHS have been addressed by the introduction of the Locking side plate. There are plenty of studies comparing standard DHS and PFN. But studies comparing locking DHS and PFN are scarce in current literature. This study aimed to compare the outcomes of both implants in stable pertrochanteric fractures.

Methods: The objective of this study was to assess and compare the clinical outcomes of using locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2017 and April 2019. The modified Harris hip score was used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes.

Results: Among the DHS group, the mean Harris hip score was 83.05, with excellent results observed in 2 patients (10%), good results in 12 patients (60%), fair results in 5 patients (25%), and poor results in 1 patient (5%). In comparison, the PFN group had a mean Harris hip score of 85.50, with excellent results seen in 6 patients (30%), good results in 10 patients (50%), fair results in 3 patients (5%), and poor results in 1 patient (5%).

Conclusions: The DHS group had more patients with good and fair outcomes, while the PFN group had more patients with excellent and good outcomes. Based on these findings, we can conclude that both the PFN and DHS with locking side plate are similarly effective in treating stable intertrochanteric fractures.

A study on the functional and radiological outcome with complications in the management of proximal humerus fractures operated with proximal humerus internal locking osteosynthesis system

Manideep Banerjee, Rajeev Biswas, Archak Roy — Fri, 28 Apr 2023 00:00:00 +0000

Background: A number of opinions exist regarding the management of proximal humerus fractures starting from conservative to tension band-wiring to internal fixation with plates. The aim of this study is to assess the functional outcome, the radiological outcome and the complications associated with the management of proximal humerus fractures treated with proximal humerus interlocking osteosynthesis system (PHILOS).

Methods: A prospective descriptive study was undertaken comprising of 40 patients. Closed proximal humerus fractures meeting Neer’s criteria for operative displacement were enrolled. Patients underwent open reduction internal fixation with PHILOS plate. Post-operative radiological outcome was estimated with follow-up x-rays, functional outcome using the Constant and Murley score.

Results: 60% patients were female, with the most common mode of injury being fall at a ground level. Late complications were noted in 25% of patients, which were malunion 5%, joint stiffness 10%, joint instability 5% and heterotopic ossification 5%. The mean Constant and Murley score was 79.5 and it was found to be statistically significant to the type of fracture according to the Neer’s classification (Kruskal Wallis test, p=0.005). Joint stiffness was also found to be statistically significantly correlated to the type of fracture pattern (Chi square test, p=0.016). The average time to union was 10 weeks.

Conclusions: Thus, by this study it can be expressed due to appropriate articular reduction by open reduction and by the use of a fixed angle implant like the PHILOS plate, operative management of proximal humerus fractures by the said implant is a viable option to enable quick and early rehabilitation of patients.

Assessment of foot deformities in patients with type 2 diabetes mellitus

Ritesh A. Pandey, Priyank Deepak — Fri, 28 Apr 2023 00:00:00 +0000

Background: Affection of lower extremity in diabetic patients leads to development of several foot deformities. The knowledge so far about the particulars of foot deformity in diabetic population is limited. The current study aimed to assess prevalence of foot deformities in known diabetics and to compare it with non-diabetic population. It also aimed to know its association with various risk factors.

Methods: Foot was evaluated for presence of deformity in 80 patients with type 2 diabetes mellitus and was compared with the control group of 80 non-diabetic individuals. Type of deformity was noted and its prevalence was compared between the two groups. Statistical analysis was done to see the association of foot deformity with various risk factors.

Results: Prevalence of foot deformity was more in diabetics as compared to normal population (p<0.004). Forefoot was involved in majority of cases (84.93%) and nail deformities were most commonly seen (38.35%). Deformities were less common in patients who were aware of diabetic foot care measures (p<0.004) and were more common in presence of diabetic neuropathy, vasculopathy and uncontrolled glycaemic index.

Conclusions: All patients with diabetes should be screened for presence of neuropathy as this is the most common factor for development of a foot deformity and hence a foot ulcer. Other helpful screening measures include assessment for peripheral vascular disease and monitoring of glycaemic index (HbA1c). Patients should be educated about the diabetic foot care measures to avoid potential complications.

Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Rahul Kumar Goyal, Manoj Kumar Meena, Mohit Agarwal, Naveen Sathiyaseelan — Fri, 28 Apr 2023 00:00:00 +0000

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment.

Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors.

Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed.

Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons.

Bilateral simultaneous rotational ankle fractures: case series and literature review

Bander S. Alrashedan, Elham A. Alghamdi, Norah I. Alromaih — Fri, 28 Apr 2023 00:00:00 +0000

Bilateral Simultaneous rotational ankle injuries are rare entities with little number of cases reported in literature. Unlike axial type ankle fractures, they tend to happen as a result of pivoting trauma on the supportive limb. We conducted a case series and literature review of patients who presented with simultaneous bilateral ankle injuries and discussed their presentation and imaging. A total of Four cases in our institute and 6 separate cases reported in literature were found who sustained bilateral simultaneous rotational ankle fractures. There were 10 cases, nine of which were simultaneous and symmetrical ankle injuries. Injuries found were; Maisonneuve fracture, Tillaux fracture, Syndesmotic injury, Lauge-Hansen’s supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PA). Four cases were presented in our institute over the last 10 years. A single case was asymmetrical in nature given the presence of an associated distal tibial metaphyseal fracture. Bilateral rotational ankle injuries are rare entity presenting simultaneously unlike axial type ankle fractures. When they present, they are likely caused by higher mechanism of injury than typical unilateral rotational ankle fractures. SER injuries are the most commonly found mechanism in both unilateral and bilateral ankle injuries.

Case series of results of intertrochanteric femur fracture treated with hemiarthroplasty

Mayur Kantilal Kalariya, Hiren K. Shah — Fri, 28 Apr 2023 00:00:00 +0000

Intertrochanteric femoral fractures are one of those mysteries which become more and more mysterious with advancing knowledge and better imaging modalities. 20 patient of intertrochanteric fracture treated with hemiarthroplasty prospective study done at GCS Medical College and Hospital. Good result obtain in term of early mobilization. The conclusion is that in comminuted fractures. 31A2.2, 31A2.3 by hemiarthroplasty give good result.

Results of unicompartmental osteoarthritis knee treated with high tibial osteotomy: a case series

Pranjal Tahbildar, Shabeer B. S., Kiran Sonowal, Imdadur Rahman Sarkar — Fri, 28 Apr 2023 00:00:00 +0000

High tibial osteotomy (HTO) being a re-emerged common procedure in orthopaedic practice now, which is safe and relatively simple and cost-effective technique requiring careful selection of subjects and precision of technique. Background: In isolated medial unicompartmental osteoarthritis (OA) of knee, in a physiologically young and high demanding individual, where preservation of knee is required, unicompartmental knee arthroplasty and total knee arthroplasty are not considered as treatment options. HTO is an excellent treatment option where the requirement of technical skills and infrastructure are less and high-volume low-cost surgeries can be performed with minimum instrumentation. 20 selected patients with unicompartmental OA of knee who attended the OPD of orthopaedics, Jorhat Medical College and Hospital were the subjects of this study, during the period of study from June 2020 to May 2021. In our study, average age was 55.9 years; higher incidence among females; higher incidence of OA in left knee; 80% of cases presented at Kellgren and Lawrence grade 2 and 3; most of the cases were having BMI within normal range and varus deformity of knee; plate and screw fixation after HTO provides more rigid fixation than staples alone. In this study, we got 60% good and 30% fair results after 6 months to 1 year of follow-up. Successful HTO is a very effective alternative low-cost surgery that makes it possible to delay or avoid knee arthroplasty in well selected patients.

Orthopaedic residency in the time of COVID-19: navigating a new normal

Arjun Ganesh, M. Mohan Kumar — Fri, 28 Apr 2023 00:00:00 +0000

The pandemic had affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialties of orthopaedics.

Complete transection of permanent pacemaker lead by a dislocated left shoulder prosthesis

Abhinav Nair, Sudheer Akkena, Mazin Al Salihy, Rohan, Anand Pillai — Fri, 28 Apr 2023 00:00:00 +0000

A case of complete transection of the leads of a permanent pacemaker (PPM) by a dislocated left shoulder prosthesis is reported. An 86 year old woman with a history of B-cell lymphoma diagnosed subsequent to a pathological fracture of the humerus in 2010 was managed by a left shoulder replacement. Subsequently, she underwent chemotherapy for the B-cell lymphoma and the malignant lesion was reported to have resolved. In addition, she further went on to have a PPM- left sided DDDR inserted in 2015 for chronotropic incompetence. Following a mechanical fall she had in 2021, it was found that the PPM leads had been damaged, transected, potentially infected and failing to capture along with a displaced left shoulder prosthesis which was the likely culprit for the PPM damage. A decision was made to not remove the dislocated prosthesis by the multidisciplinary team managing her. This case highlights the importance of an understanding of the complications of shoulder surgeries, including approach adopted for surgery in patients with pacemaker in-situ and the need for regular follow up and imaging.

Long-term results of a post-partum bilateral Garden 4 femoral neck fracture in a young woman with transient osteoporosis treated with closed reduction and internal fixation

Fri, 28 Apr 2023 00:00:00 +0000

Bilateral femoral neck fractures are very rare conditions. In our knowledge, only five cases were reported of bilateral acute femoral neck fracture secondary to transient osteoporosis. The present case is the first with a long-term follow up after treatment with closed reduction and internal fixation. A 32-year-old women was admitted to the emergency orthopedic clinic due to severe pain in both hips and an inability to walk one-day post-partum. Clinical examination revealed bilateral externally rotated legs and X-ray showed bilateral Garden 4 displaced subcapital fracture of the neck of the femur. The patient was operated on urgently by closed reduction and internal fixation. Osteoporosis was found in the measurements of bone mineral density and bisphosphonate with vitamin D medication was started. 6 years after surgery the patient can carry out her daily activities without limitation. His Harris hip score was 97 points/right and 95 points/left; and the X-ray was normal regarding osteoarthritis and avascular necrosis. Internal fixation should be the primary choice for the treatment of a bilateral femoral neck fractures with a high degree of displacement in young adults even with reversible poor bone quality condition such transient osteoporosis.

Post traumatic volar complex dislocation of first metacarpophalangeal joint: a case study

Rajesh Kishanrao Ambulgekar, Priyanka Tanaji Ahire — Tue, 11 Apr 2023 00:00:00 +0000

First metacarpophalangeal (MCP) joint dislocations are very uncommon injuries. These dislocations are classified as volar or dorsal, and then as simple or complicated, based on the direction of the dislocation and its reducibility. Dorsal being the most common approach as it is safer. It is found that reduction was stable and started with immobilisation for 15 days followed by physiotherapy. Postoperatively patient was having range of motion (25-50 deg) and post operative 2 months patient was able to do daily activities with his affected hand with VAS score of 1. Complex metacarpophangeal joint dislocations needs operative management combined with postoperative physiotherapy to achieve good clinical outcomes so as to reduce the risk of arthritis and decreased grip force.

Video-assisted thoracoscopic surgery for rib chondrosarcoma: unique surgical technique

Vipin Goel , Bushra Khan, Snigdha Rampally — Fri, 28 Apr 2023 00:00:00 +0000

Chondrosarcoma's of the rib are a rare presentations and hence there's a lot to be explored for the best method of surgical intervention. This case highlights how we used VATS for excision of a rib chondrosarcoma and reconstructed the defect using prolene mesh and PMMC flap.

Extensor indicis proprius to extensor pollicis longus transfer in spontaneous rupture of extensor pollicis longus following non displaced fracture distal end radius

E. G. Mohan Kumar, Dr Yathisha Kumar GM, Muhammed Noorudheen — Fri, 28 Apr 2023 00:00:00 +0000

Exact incidence of extensor pollicis longus (EPL) ruptures following distal radius fracture is not known. Peculiarly it’s common in nondisplaced fracture of the distal radius with an incidence of EPL rupture of 0.2-5%. Cortical irregularities from distal radius fractures or osteophytes easily abrade the tendon, causing gradual attrition and ultimately rupture. Compromised blood supply is also related to EPL rupture which is supported by microcirculatory anatomic studies. We present a case of 49 year old female who presented with spontaneous rupture of the EPL following a nondisplaced fracture of the distal radius managed by extensor indicis proprius (EIP) transfer. EIP transfer gives promising outcome. Optimum tension of the tendon is crucial for good functional outcome. We recommend suturing the tendon with thumb in extension and wrist in neutral position for optimum tension of tendon to avoid extensor lag and to prevent loss of IP flexion.

Two rare cases of management of proximal phalanx spina ventosa

Neetin Mahajan, Tushar C. Patil, Sunny Sangma, Kartik P. Pande — Fri, 28 Apr 2023 00:00:00 +0000

Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. Here we presented two rare cases of spina ventosa in a 10 years old female and a 16 years old male patients. In both cases there was swelling of digits with stiffness. The radiographs were suggestive of chronic osteolytic infection with cortical destruction and diffuse sclerosis. We managed them with adequate surgical debridement, splintage and anti-tubercular therapy with good functional recovery. Spina ventosa or tubercular dactylitis is a rare condition and is often missed on diagnosis due to vague non-specific presentation, unavailability of rapid diagnostic tests and can be confused with other mimicking diseases. Any swelling over small tubular bones of hand or feet should raise the suspicion of spina ventosa, especially in endemic countries for tuberculosis. In neglected chronic infections, surgical debridement, curettage and splintage followed by anti-tubercular therapy based on histo-pathological reports is the treatment of choice with high protein diet and vitamin D supplementation ensures good outcome.

Malignant transformation of a recurrent giant cell tumor of bone with lung metastasis: a case report

T. S. Channappa, H. B. Shivakumar, Manju Jayaram, Yatish R., Surya Teja — Fri, 28 Apr 2023 00:00:00 +0000

Giant cell tumors (GCT) are benign tumors with potential for aggressive behaviour and capacity to metastasize. It is a locally destructive tumor that occurs predominantly in long bones of adolescents and young adults in the epiphysis. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi-nucleated giant cells with homogenous distribution. There are varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favour an intralesional approach that preserves anatomy of bone. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Malignant transformation without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Here we reported a case of recurrent GCT of tibia that at the time of final recurrence was found to have undergone malignant transformation over a period of 6 years following several limb salvaging procedures. Concurrent metastases were found in the lung, but these were non-transformed GCT following which the patient has undergone above knee amputation.

Closed atraumatic flexor hallucis longus tendon rupture following hallux valgus correction repaired using a turn down flap

Abhinav Nair, Rajkumar Jayachandran, Nisha Nadar, Anand Pillai — Fri, 28 Apr 2023 00:00:00 +0000

A case report of closed atraumatic rupture of flexor hallucis longus (FHL) tendon few months after hallux valgus correction in a high functioning individual is presented. There have been only two cases of FHL tendon rupture reported following hallux valgus correction in literature till now. Our patient underwent Hallux valgus corrective osteotomy, 4 months after which he presented with rupture of the FHL tendon, he subsequently underwent successful surgical turn down flap repair with good clinical outcome. Closed atraumatic rupture of FHL tendon as an isolated injury is a rare event evidenced by systematic review reporting only 10 cases in literature till now. Low clinical suspicion of FHL rupture in closed foot injuries could be one factor resulting in fewer cases being reported in literature. Acute rupture of FHL tendon following open foot injuries and partial closed rupture due to tendinitis in dancers have been reported frequently in literature. In conclusion, we emphasize careful handling of FHL tendon while performing corrective osteotomy of the hallux in any patient. Although, turn down flap is a well-documented technique to bridge gaps and repair chronic tendo-achilles rupture, we were able to replicate the same technique in our patient and produce good functional result using this effective tendon repair technique to bridge segmental gap as evidence by return of almost normal power of great toe plantar flexion.

Patellar tendon mid-substance tear after total knee arthroplasty: a case report

Sanjeev Jindal, Abhishek Bansal, Vivek Bansal — Fri, 28 Apr 2023 00:00:00 +0000

Extensor mechanism of knee plays important role in successful long term functional outcome after total knee arthroplasty (TKA). Any injury to extensor mechanism during or after surgery can cause functional disability which can be devastating for patients. Patellar tendon injuries are not very common after TKA. The author reported a rare case of patellar tendon mid-substance tear after TKA, which was successfully managed by reconstruction using grafts without any implant.

A case report of open infected clavicle fracture treated with locking compression plate as an external fixator

Mayur S. Nannaware, Aliasger H. Moaiyadi, Sahil A. Chhabra, Kisan R. Patond — Fri, 28 Apr 2023 00:00:00 +0000

46 year old male presented to emergency department 8 days after fall from bike sustaining trauma to right shoulder and head. On examination revealed that he had open right clavicle fracture (Gustilo and Anderson grade II). Patient was treated with locking compression plate (LCP) as an external fixator. Postoperative follow up was uneventful with no signs of infection and good functional outcome.

Isolated calcaneal tuberculous osteomyelitis in a 13-year female: a diagnostic dilemma: rare case report and review of literature

Kunal Chaudhari, Nadir Z. Shah, Eknath D. Pawar, Ankit Marfatia — Fri, 28 Apr 2023 00:00:00 +0000

Foot and ankle involvement in osteoarticular tuberculosis is uncommon and isolated calcaneal tubercular osteomyelitis of foot bones sparing nearby joints with an osteolytic defect is even more rare. Worsening of the disease can occur over a time involving nearby joints and small bones if diagnostic and therapeutic phase are delayed. We present a retrospective study of osteolytic variety of foot calcaneal bone tuberculosis. We present a case report of 13-year female with isolated osteolytic variety of calcaneal tuberculous osteomyelitis to highlight the clinical, radiological features and management challenges of the condition. Biopsy was done to confirm tissue diagnosis based on Gene Xpert, AFB staining, MGIT culture, and histopathology. Surgical intervention was done in form of debridement and sinus tract removal as a diagnostic and therapeutic purpose to prevent further involvement of a nearby joints and small bone with cystic destruction. Isolated calcaneal tubercular osteomyelitis cases are still found to be seen in our environment though considered a rare. When tuberculous pathology is limited to the isolated calcaneal bone sparing the other joints, the prognosis is better than in osteoarticular disease, as there is less deformity, and hence, less residual pain and disability.