International Journal of Research in Orthopaedics
Not a member yet
2153 research outputs found
Sort by
The clinical outcome of fixation of posterior malleolus fragment in trimalleolar ankle fracture
Get PDFBackground: Trimalleolar ankle fractures are complex injuries that often require surgery. Posterior malleolus fixation is important to restore ankle stability and function. The aim of this study was to evaluate the clinical outcomes associated with posterior malleolus fixation in patients with ankle fractures in the malleolus ankle fracture.
Methods: From 2018 to 2024, clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, range of motion measurements, and radiographic evaluations. Complications and functional recovery were carefully recorded to analyze the effectiveness of posterior malleolus fixation in trimalleolus ankle fractures.
Results: All 100 patients were included in the study. The mean AOFAS score at final follow-up was 85, indicating a significant improvement compared with the preoperative score. Radiographic analysis showed satisfactory alignment and integration of the posterior malleolus fragments in 92% of cases. Complications included minor infections and delayed wound healing in a few cases; however, overall, most patients achieved good results, demonstrating improved ankle stability and functional recovery.
Conclusions: Posterior malleolus fixation in trimalleolar ankle fractures is associated with satisfactory clinical outcomes, increased stability and recovery from work. These findings support the importance of managing the malleolus during surgery for trimalleolus fractures. Further prospective studies are needed to validate these results and improve surgical techniques
Simultaneous anterior shoulder dislocation and Salter Harris type 2 fracture in Senegalese wrestling match
Get PDFAnterior shoulder dislocation with proximal humerus fracture in children is rare. We report the case of a 16 years old boy with anterior shoulder dislocation and proximal humerus fracture separation Salter Harris type 2. A 16 years old boy, right-handed, was involved in a wrestling accident. He was received for delayed left shoulder traumatism associated with a filling of the deltopectoral groove, an emptiness of the glenoid cavity without axillary nerve impairment. Anterior shoulder dislocation with Proximal humerus fracture-separation type 2 Salter Harris was made. The dislocation was reduced through external manoeuver. A Kirschner wire fixation was done for both the fracture and the glenohumeral joint. At the last follow up, the shoulder was painless, stable, with satisfactory motion. The consolidation was obtained. Anterior shoulder dislocation with proximal humerus fracture separation Salter Harris type 2 is rare. Good management restores shoulder motion and function.
Randomized and double-blinded controlled trial: percutaneous trigger finger release concomitant steroid injection versus percutaneous trigger finger release alone
Get PDFBackground: Corticosteroid injection is a common nonoperative treatment that provides immediate pain relief but carries a risk of recurrence. Percutaneous A1 pulley release is a minimally invasive alternative to open surgery, offering comparable outcomes. However, postoperative pain remains a concern. This study evaluated the effect of combining corticosteroid injection with percutaneous A1 pulley release on postoperative pain control compared to percutaneous release alone. Objective was to compare early postoperative pain control, quality of life, and complications between percutaneous A1 pulley release alone and with corticosteroid injection.
Methods: This was a randomized, double-blinded controlled trial including 76 patients diagnosed with trigger finger. Participants were randomly assigned to group A (percutaneous A1 pulley release with corticosteroid injection, n=36) or group B (percutaneous A1 pulley release alone, n=40). Primary outcome measures included postoperative pain scores (visual analog scale, VAS), while secondary outcomes assessed quality of life (quick disabilities of the arm, shoulder, and hand score, qDASH), patient satisfaction, and complications.
Results: A total of 76 patients were enrolled, with no significant differences in baseline characteristics between groups. Pain scores (VAS) decreased in both groups from day 1 to day 3 (group A: 5.33 to 4.11; group B: 6.90 to 5.00, p>0.05). However, group A exhibited significantly lower pain scores from postoperative day 4 to 6 (1.78 versus 4.00, p<0.05), a trend that persisted through weeks 1 and 2, as well as at 1 and 2 months postoperatively. Quality of life (qDASH) and patient satisfaction were slightly higher in group A, but differences were not statistically significant (p>0.05). No major complications (e.g., infection, nerve injury, tendon rupture, recurrent triggering, or bowstringing) were reported in either group.
Conclusions: The addition of corticosteroid injection to percutaneous A1 pulley release significantly improves early postoperative pain control without affecting functional recovery or patient satisfaction. These findings support the safety and efficacy of corticosteroid injection in reducing postoperative discomfort. Future studies should explore long-term outcomes, recurrence rates, and return-to-work effects
Bilateral neck of femur fracture induced by osteomalacia secondary to phosphaturic mesenchymal tumor of paranasal sinus: a case report
Get PDFPhosphaturic mesenchymal tumors (PMTs) are rare, often occult neoplasms that cause tumor-induced osteomalacia (TIO) due to excessive fibroblast growth factor 23 (FGF23) secretion, leading to phosphate wasting, hypophosphatemia, and impaired bone mineralization. This results in progressive skeletal fragility and increased fracture risk. We present a 53-year-old male with bilateral femoral neck fractures following a trivial fall, accompanied by generalized myalgia. MRI of the hip and pelvis revealed bilateral femoral neck fractures with sclerotic changes in the superior and inferior pubic rami, sacral ala, and bilateral iliac wings. Laboratory investigations confirmed severe hypophosphatemia and osteomalacia. Further imaging and biopsy identified a phosphaturic mesenchymal tumor in the right anterior ethmoidal sinus as the underlying cause. The patient underwent bilateral femoral neck fracture fixation with cannulated cancellous (CC) screws, along with vitamin D and phosphate supplementation. The PMT was surgically resected to correct the metabolic disorder. Postoperatively, the patient demonstrated significant clinical and biochemical improvement. This case highlights the critical need to consider PMT in patients presenting with unexplained fractures and persistent hypophosphatemia. Early detection, surgical resection of the tumor, and appropriate metabolic correction are essential for optimal recovery and fracture healing
Comparison of the patients undergoing total knee arthroplasty with and without drain in terms of functional outcome, hemoglobin drop and infection rate
Get PDFBackground: There is still no consensus about use of post-op drain in TKA. We compared postoperative outcomes of TKA with drain and without drain in terms of hemoglobin drop, functional outcome and infection.
Methods: An observational cohort study was conducted at a tertiary hospital between March 2023, and March 2024. Men and women with primary OA knee and age more than 40 years were included. Patients on antiplatelets, with acute and active infection, revision TKA, malignancy were excluded.
Results: 90 patients were included age range 50-80 years. Males to female ratio was 74.4:25.6. Of 90 patients, 45 (50%) received a drain. The drain group had greater hemoglobin drops. There was no statistically significant difference in functional outcome by KOOS score and WOMAC score in both groups. There was no significant difference in occurrence of infection in both groups.
Conclusions: This comparative study aimed to assess the outcomes of total knee arthroplasty (TKA) with and without drain insertion, focusing on hemoglobin drop, functional outcomes measured by (KOOS) and (WOMAC) scores, and infection rates. In conclusion, my study supports reconsidering routine drain use in TKA procedures, as omitting drains was associated with a notable reduction in hemoglobin drop without compromising functional outcomes or increasing infection risks. Surgeons should carefully weigh the potential benefits of reduced blood loss against the need for drainage and associated risks, considering individual patient factors and surgical circumstances
Association of serum metallic ion levels in patients with total joint arthroplasty with their adverse effects: a comparative cross-sectional study
Get PDFBackground: Metallic implants used in joint arthroplasty release ions gradually sometimes resulting in their toxicity. Hence, data regarding exact correlation between serum metallic ion levels and toxicity occurrence is still lacking.
Methods: A total of 90 adult subjects, each with a single total joint arthroplasty (TJA between 1 to 5 years), or without were recruited. The serum levels of Cr, Co, Ni, & Mo in above 2 groups were estimated and correlated with signs and symptoms related to Cr, Co, Ni, & Mo ion toxicity Unpaired Student's t-test, Chi-square test and Pearson correlation coefficient were used to analyses data. A p value<0.05 was considered significant.
Results: The mean serum levels of Cr (21.53±7448 µg/l vs. 19.03±0.3372 µg/l; p=0.0026), Ni (9.643±0.2486 µg/l vs. 9.303±0.2729 µg/l; p=0.83), Co (5.482±0.20 µg/l vs. 5.573±0.21 µg/l; p=0.76), and Mo (5.573±0.2159 µg/l vs. 5.290±0.2208 µg/l; p=0.36) in subjects with implants were higher than in subjects without implants. Five subjects reported six adverse effects (AE) specifically numbness in hands (4), fatigue (1), and bone pain (1), which showed no significant association or correlation with the mean serum levels of the metallic ions.
Conclusion: Results showed increased mean serum chromium levels post one year of implant surgery, while mean serum levels of Co, Ni, and Mo did not demonstrate any significant elevation. No correlation between serum levels of Cr, Co, Ni, and Mo, duration of implant, and observed AE was seen. Causality assessment between reported AE and metal ions (Cr, Co, Ni, and Mo) levels was “possible.
Outcome of dynamization in delayed union of femoral shaft fracture
Get PDFBackground: Delayed union in femoral shaft fractures presents a significant clinical challenge despite the widespread success of intramedullary nailing (IMN). Nail dynamization is a minimally invasive and cost-effective intervention that promotes healing by increasing interfragmentary motion. This study evaluates the clinical and radiological outcomes of nail dynamization in delayed union cases and identifies key prognostic factors influencing healing.
Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh, between March 2019 and March 2024. Twenty-four patients with delayed union of femoral shaft fractures, initially treated with static interlocking IMN, underwent dynamization. Radiological and functional outcomes were assessed, and statistical analyses were performed to identify predictors of union.
Results: The mean time from nailing to dynamization was 21.1±2.6 weeks, with a mean union time of 21.4±1.4 weeks. 79.17% of patients achieved union, while 20.83% progressed to nonunion. Earlier dynamization correlated significantly with higher union rates (p=0.01). Smoking was a major risk factor for nonunion (p=0.047), with 93.33% of nonunion cases occurring in smokers. FHI was a strong predictor of union (p=0.002), with higher FHI values associated with successful healing. Functional outcomes were excellent in 62.50% of patients, and 66.67% reported no pain at the final follow-up.
Conclusion: Nail dynamization is a clinically effective and low-cost intervention for delayed union of femoral shaft fractures. Timely dynamization and higher FHI values significantly predict successful healing, while smoking negatively impacts outcomes. These findings highlight the need for early intervention and patient-specific treatment strategies to optimize fracture healing.
The hidden cost of delay: meniscal and osteochondral damage in neglected ACL tears
Get PDFBackground: Neglected anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The effects of untreated ACL tears and its impact on the meniscus and cartilage was evaluated in this study over a two year time period, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. The study emphasized the importance of early treatment of ACL injury to prevent damage to the meniscal and cartilaginous tissue and secondary osteoarthritis.
Methods: This study examined 385 patients who underwent arthroscopic ACL reconstruction between 2022 and 2024. Researchers analyzed arthroscopic findings, MRI scans, and patient records from the time of surgery. The focus was on identifying severe meniscal and osteochondral lesions that could adversely impact patient outcomes. These lesions were classified as meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The study also investigated statistical correlations between MLAO, OLAO, time since injury, and Tegner activity levels.
Results: The occurrence of MLAO and OLAO increased significantly as the duration between injury and surgery lengthened (p=0.001, p<0.05). However, no statistically significant correlation was found between the Tegner activity score and the risk of MLAO or OLAO (p=0.317, p=0.184, p>0.05).
Conclusions: A delay in ACL reconstruction can result in a higher occurrence of meniscal and osteochondral lesions, negatively influencing surgical results
Functional outcome study for operatively managed cases of rotator cuff tear: managed by mini open repair
Get PDFBackground: Rotator cuff tears (RCTs) are common musculoskeletal injuries impacting quality of life due to pain and functional limitation. The mini-open repair technique offers an alternative to arthroscopic repair with high success and accessibility. Objective of this study was to evaluate anatomical and functional outcomes of mini-open repair for rotator cuff tears.
Methods: A prospective observational study was conducted on 30 patients operated by mini-open rotator cuff repair at a tertiary care hospital between 2022–2024. Preoperative and postoperative evaluations included ROM, UCLA score, and VAS at six months follow-up.
Results: Mean age was 54.1 years, with male predominance. Dominant limb was involved in 67%. Significant improvements were observed in abduction (mean 76.7° to 147.1°), forward flexion (82.2° to 157.2°), external rotation (28.7° to 56.3°), and internal rotation. Mean UCLA score improved from 13.4 to 31.2 (p<0.001).
Conclusions: Mini-open rotator cuff repair offers excellent pain relief, improved range of motion, and patient satisfaction in the short term. It remains a viable and effective option, especially in resource-limited settings
Deep infection rate in primary total knee arthroplasty: a case series from Oman
Get PDFThe aim of this report is to assess deep infection rate in total knee arthroplasty (TKA), in a clean theatre, but without using laminar flow. This report is a retrospective case series of TKA conducted in the same hospital and same single operating room, by a single surgeon, to assess the percentage of post operative deep infection, that needed surgical intervention between June 2016 and December 2023. Infection rate was compared to the rate reported in the literature. A total of 430 knee replacements were reviewed, with data obtained from the electronic medical record system. All of these cases were performed under strict vigilance to prevent infection, all were given pre operative prophylactic antibiotics, and all had a surgical drain that was removed at the first post operative day. Prosthetic joint infections (PJI) was defined as a TKA that needed further surgical intervention for a clinical picture and investigations suggestive of deep infection. In this report, four patients out of a total of 430 patients (0.93%), who underwent primary TKA had developed PJIs as defined. Patient’s age ranged from 57 to 71 years (mean 66 years), with three females and one male patient. Two patients underwent staged revision TKA after confirmation of PJI, while other two patients underwent debridement, change of insert, and implant retention. This report has concluded a rate of deep infection that is comparable to the reported rate in the literature, despite that no laminar flow was used in this case series. Using a surgical drain did not seem to increase the infection rate. Two of the infected cases were from bacteria that cannot be surgically acquired, making the surgically acquired rate of infection even lower (0.47%)