SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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The TONK score: a tool for assessing quality in trauma and orthopaedic note-keeping
No full textIntroduction: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months.
Patients and Methods: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen’s Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback.
Results: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department.
Conclusions: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training
Anatomic variation of palmaris longus and flexor digitorum superficialis of little finger in Indian population
No full textIntroduction: Palmaris longus and flexor digitorum superficialis of the little finger are highly variable anatomically. The tendons vary in different parts of the globe and different regions of the same country. Many studies have negated an association between the tendons. However, most of the studies have a sample size of less than 500 subjects.
Aims and objectives: The aim was to study the tendons in the Indian population and study the association, if any between the tendons and to test functional significance of the tendons using the Michigan Hand Outcomes Questionnaire.
Methods and material: It was a single centre cross-sectional study with a sample size of 1500 in the age group of 20–60 years. The subjects were tested for the presence of the tendons and their functionality was assessed by Michigan Hand Outcomes Questionnaire. The data was tabulated and was assessed using SPSS 13.0 software.
Results: Palmaris longus was bilaterally absent in 10.9% and flexor digitorum superficialis of the little finger was bilaterally absent in 42% of the cases. There was a statistically significant association between the tendons when considered bilaterally. The tendons did not have any bearing on the functionality as assessed by the Michigan Hand Outcomes Questionnaire.
Conclusions: There is significant variability in the palmaris longus and flexor digitorum superficialis tendon to the little finger not only in the different countries but in different regions of the same country. However despite the various clinical and medicolegal aspects concerning both the tendons, they do not have much bearing on the functionality of the hand
Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate – functional and radiological outcome in a prospective case-controlled series
No full textIntroduction: Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used.
Aims: To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group.
Methods: Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score.
Results: Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05).
Conclusion: DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively
Giant cell tumor of the capitate: an unusual case with 10 years follow-up
No full textGiant cell tumor of the small bones, particularly the carpal bones of the hand, is exceedingly rare. We present a case report of giant cell tumor of the capitate in a 24 year-old female with 10 years postoperative follow-up. Although carpal bones are extremely unusual location, orthopedic surgeons should always keep in mind that differential diagnosis must include giant cell tumor of bone whenever an expansile osteolytic lesion with well-defined but nonsclerotic margins is identified in a young adult with closed physes
Midflexion instability in primary total knee replacement: a review
No full textIntroduction: Midflexion instability in primary total knee replacement (TKR) is an evolving concept. Successful treatment of instability requires an understanding of the different types of instability.
Methods: A literature review was performed to identify information pertinent to midflexion instability in primary total knee replacement, utilising PRISMA guidelines. Databases searched included Embase, Medline, All of the Cochrane Library, PubMed and cross references.
Results: Three factors, i.e., elevated joint line, multiradii femoral component and medial collateral ligament (MCL) laxity, were identified to influence midflexion instability. Literature suggested mediolateral instability at 30–60° of flexion as diagnostic of midflexion instability. Literature search also revealed paucity in clinical studies analysing midflexion instability. Most of the evidence was obtained from cadaveric studies for elevated joint line and MCL laxity. Clinical studies on multiradii femoral component were limited by their small study size and early followup period.
Conclusion: Elevated joint line, multiradii femoral component and MCL laxity have been suggested to cause midflexion laxity in primary TKR. Due to limitations in available evidence, this review was unable to raise the strength of overall evidence. Future well-designed clinical studies are essential to make definitive conclusions. This review serves as a baseline for future researchers and creates awareness for routine assessment of midflexion instability in primary total knee replacement
Late-onset superior mesenteric artery syndrome four years following scoliosis surgery – a case report
No full textBackground: Superior mesenteric artery (SMA) syndrome has been reported as an uncommon condition of external vascular compression of the SMA particularly after rapid weight loss, body casts, or after corrective surgery for spinal deformities, usually within the first few weeks after surgery.
Methods: This is a retrospective report of a case of a non-verbal autistic female patient who started to develop SMA syndrome at the age of 16, 4 years after posterior spinal fusion surgery for scoliosis. She was treated conservatively by increasing oral caloric intake, which resulted in increased body weight and relief of symptoms.
Results: Seen at 10 years’ follow up, the patient is doing well, and is functional within the limits of her suboptimal cognitive and verbal conditions. She maintains good trunk balance with solid spinal fusion and intact instrumentation at latest follow up.
Conclusion: Spinal surgeons should maintain a high index of suspicion for diagnosis of SMA syndrome even years after scoliosis surgery, especially for patients with communication problems, like the case we present here. Appropriate conservative measures can succeed in relieving the symptoms, increasing body weight, and preventing complications including the risk of death
Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft
No full textPurpose: The proximal femur is one of the most common locations for benign bone tumors and tumor like conditions. We describe the clinical outcomes of the surgical treatment of benign lesions of the proximal femur including femoral neck using compression hip screw and synthetic bone graft.
Methods: Thirteen patients with benign bone tumors or tumor like conditions of the proximal femur including femoral neck were surgically treated. Their average age at the time of presentation was 35 years and the average follow-up time was 76 months.
Results: The average intraoperative blood loss was 1088 mL and intraoperative blood transfusion was required in eight patients. The average operative time was 167 minutes. All patients required one week and 12 weeks after surgery before full weight-bearing was allowed. All patients had regained full physical function without pain by the final follow-up. No patient sustained a pathological fracture of the femur following the procedure. All patients achieved partial or complete radiographic consolidation of the lesion within one year except one patient who developed a local tumor recurrence in 11 months. Post-operative superficial wound infection was observed in one patient, which resolved with intravenous antibiotics. Chronic hip pain was observed in one patient due to the irritation of tensor fascia lata muscle by the tube plate.
Conclusion: We suggest that the treatment of benign bone lesion of the proximal femur using compression hip screw and synthetic bone graft is a safe and effective method
Hip arthroscopy and osteoarthritis: Where are the limits and indications?
No full textThe use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage
Analysis of the effectiveness of a non-governmental organization in supporting clubfoot clinic at a tertiary care center
No full textBackground: Since December 2011, a non-governmental organization (NGO) has been associated with our clubfoot clinic. Debates related to the effectiveness of NGOs in clinical milieu have raged on for a long time. The aim of this study was to analyze the effectiveness of an NGO in supporting the running of a clubfoot clinic in a tertiary care center.
Methods: A descriptive, observational study was conducted from October to December 2014. The three main conceptualizations of effectiveness namely goals, resources and reputation were evaluated for this study, and to analyze them, we compared our treatment data with other published reports, and devised a ten-point questionnaire looking into the working of the NGO. This questionnaire was given to all parents (49) of children with clubfoot attending the clinic and also to an independent observer who was present at the time of patients’ interactions with the counselor. The significance of patients’ and observers’ response was tested by Wilcoxon matched-pairs signed-rank test.
Results: 138 cases with 228 feet were registered in the clubfoot clinic till the end of our study. The average number of visits by the patients was 6.67 and 69.47% of cases required tenotomy during the course of treatment. Of the 49 patients, 33 (67.35%) graded the role of the NGO as excellent, while the rest showed a good response; 28 observers (57.14%) responded as excellent. The average score of parents towards role of the NGO was significantly higher than the observer’s score.
Conclusions: The NGO associated with our clubfoot clinic successfully supported formal health care professionals
Does dorsal capsule interposition improve the results of proximal row carpectomy in Kienböck’s disease? One year randomized trial
No full textIntroduction: Proximal row carpectomy (PRC) is an option as a salvage procedure in late stage Kienböck’s disease. In this study, we hypothesize that interposition of a dorsal capsular flap following PRC improves functional outcomes. No comparative study is available to assess whether interposition is effective from the functional perspective. This study aims to determine whether the addition of this procedure may improve functional outcomes at a one year assessment.
Methods: Thirty adult patients with IIIA and IIIB Lichtman stages, aged 18–54 years, were randomized into two study groups. Fourteen patients were allocated to the “no interposition group” and 16 to the “interposition” group. DASH questionnaire was used to evaluate quality of life. Cooney’s system was used to assess pain, functional state, range of motion, and grip strength. Complications were also assessed. Final followup and clinical assessment occurred after 12 months.
Results: After 12 months and no patient losses, outcomes were similar in both groups. DASH scores (41.9 (7.5) vs. 42.9 (12.8), p = 0.79)), Cooney’s system (poor results, 0.6 vs. 0.14, p = 0.54), and complications were similar between groups. In conclusion, the inclusion of a dorsal capsular flap does not improve functional outcomes in PRC. Low rates of complications were found in both groups