International Journal of Research in Orthopaedics
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Diagnostic overview of nature and pathogenesis of shoulder dislocation
Get PDFBackground: Shoulder dislocation, soft tissue and bony injuries around shoulder has close relation and hence, detail investigation and diagnosis plays a crucial role in prognosis and further treatment.
Methods: The study of diagnostic arthroscopy aimed to determine the incidence of secondary intra-articular shoulder lesions in acute and chronic anterior shoulder instability patients. Study investigated the occurrence of intra-articular shoulder lesions in a series of 30 patients with acute and chronic traumatic anterior instability.
Results: Prospective observational study was done on patients with acute shoulder dislocation. After ab arthroscopic evaluation, majority 77% of patients had capsulo-labral detachments. 61% of first dislocations showed capsulo-labral detachment/Bankart lesions and all the recurrent dislocations had partial or complete capsule-labral detachment or Bankart lesions. Glenohumeral ligament integrity was disturbed in 58% of recurrent and that of 11% of first time shoulder dislocation cases. Hillsach lesions are in total of 57% of all soft tissue injuries. Bony Bankart lesions were found in 50% of recurrent dislocations. Rotator tears are mainly in recurrent dislocation cases mainly >40 years of age.
Conclusions: Patients with chronic shoulder instability are more likely to have secondary intra-articular lesions, compared to those with acute, likely due to the repeated episodes of dislocation or subluxation. These associated lesions are a consequence of the ongoing instability, which leads to additional damage within the joint. Early intervention plays an important role, as the conditions for surgical intervention are optimal after initial shoulder dislocation
Comprehensive reconstruction and rehabilitation of explosive hand trauma: a case report
Get PDFFirework-related hand injuries can be devastating, resulting from a combination of blast forces, thermal impact, and penetrating trauma. These injuries result in extensive soft tissue damage, fractures, and partial or complete amputations, thereby posing complex challenges for surgical management and rehabilitation. We report the case of a 23-year-old male technician who sustained a severe explosive hand injury from fireworks. Initial treatment focused on thorough wound irrigation, debridement, skeletal stabilization, and prompt initiation of prophylactic antibiotics. Multiple staged procedures were performed, including open reduction and internal fixation of carpometacarpal dislocations, nerve and tendon repairs, and flap reconstructions to restore soft tissue integrity. Despite the complexity and extent of the injury, a staged approach facilitated optimal wound healing and partial functional restoration of the hand. This case underscores the multifaceted nature of blast-related hand injuries, where extensive tissue damage, compromised vascularity, and contamination necessitate a multidisciplinary approach. The hand surgery team collaborated to ensure appropriate skeletal stabilization, nerve and tendon repair, and soft tissue coverage. Early and intensive rehabilitation, encompassing both physical and psychological support, was critical in optimizing recovery. Although functional limitations persisted, the combination of modern surgical techniques and structured rehabilitation yielded a satisfactory outcome relative to injury severity. Successful management of severe hand trauma from fireworks requires coordinated, staged surgical interventions, and comprehensive rehabilitation. While advances in reconstructive surgery improve outcomes, complete recovery may remain elusive in profound blast injuries. Public awareness and preventive measures are paramount to reducing the incidence of such injuries
Surgical management of chondromyxoid fibroma at meta-diaphyseal junction of proximal tibia: a case report
Get PDFChondromyxoid fibroma (CMF) is a rare, benign tumour of the bone. It represents less than 1% of all bone tumours. We present a case of a 20-year-old female who came with chief complaints of pain and swelling in right leg for 3 months. Radiograph showed features suggestive of large multiloculated osteolytic, radiolucent lesion with thinned out cortices in right proximal tibia. MRI showed exophytic lesion and features suggestive of osteosarcoma. USG guided biopsy reported as chondromyxoid fibroma. Patient underwent curettage of tumour followed by reconstruction with allograft and stabilized with internal fixation. Final histopathological report showed features suggestive of chondromyxoid fibroma. Patient made uneventful recovery with no signs of recurrence and good functional range of motion (ROM) of the knee joint after 2 years of follow up. Histopathology is the gold standard and mandatory for confirmation of the diagnosis. Curettage and filling the defect with polymethyl methacrylate (PMMA) or bone graft is the mainstay treatment of choice
Functional and radiological outcome of distal femur fracture with intra-articular extension fixed with variable angle-locking compression plate: a prospective study
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Background: Distal femur fractures, often resulting from high-velocity injuries, pose significant challenges due to their complexity. This study aims to evaluate the efficacy of variable angle-locking compression plate (VA-LCP) in treating these fractures, focusing on both functional and radiological outcomes.
Methods: This prospective observational study included 40 patients aged 20-70 years with distal femur fractures treated at R. L. Jalappa Hospital and Research Centre. Data on demographics, comorbidities, fracture type and outcomes were collected. Patients underwent open reduction and internal fixation with VA-LCP and were followed up at 1 month, 3 months and 6 months postoperatively.
Results: The study revealed significant improvements in functional outcomes as measured by NEER's score, with most patients showing substantial increases by 6 months post-op. The majority of fractures were successfully united within an average of 20 weeks. Complications were minimal and included superficial infections and knee stiffness in a few cases.
Conclusions: VA-LCP provides effective stabilization for distal femur fractures, enabling early mobilization and resulting in positive functional and radiological outcomes. This technique is particularly beneficial for complex intra-articular fractures
Clinical reflections on single event multilevel surgery in children with cerebral palsy: a case series of 10 patients
Get PDFSingle event multilevel surgery (SEMLS) is a comprehensive orthopedic surgical approach designed to correct multiple musculoskeletal deformities in a single operative session in patients with cerebral palsy (CP). This journal reflects on the principles, benefits, limitations, and a clinical case outcome of SEMLS, with emphasis on functional improvement and rehabilitation challenges. SEMLS remains a gold standard surgical approach in moderate to severe spastic CP cases with multilevel involvement. Long-term success hinges on meticulous planning, postoperative care, and patient compliance with rehabilitation protocols
The impact of putting a surgical drain in total knee arthroplasty on the postoperative hemoglobin level
Get PDFBackground: The use of suction drains following total knee arthroplasty (TKA) remains controversial, with conflicting evidence regarding their impact on postoperative blood loss and hemoglobin levels.1 To evaluate the impact of closed negative suction drainage on postoperative hemoglobin levels following primary unilateral total knee arthroplasty.
Methods: A retrospective cohort study was conducted involving 102 patients who underwent primary unilateral TKA. Patients were divided into two equal groups: 51 with closed suction drainage and 51 without drainage. Hemoglobin levels were measured preoperatively and 24 hours postoperatively. Statistical analysis was performed using SPSS with appropriate tests for continuous and categorical variables.
Results: No significant difference was observed in the hemoglobin drop between the drain group (1.1±0.6 g/dl) and the no-drain group (1.3±0.8 g/dl) (p=0.142). Both groups showed comparable preoperative hemoglobin levels and postoperative outcomes.
Conclusions: Closed negative suction drainage does not significantly impact postoperative hemoglobin levels within the first 24 hours following total knee arthroplasty, suggesting that routine drain use may not be essential for blood conservation in this patient population
Functional outcomes of medial open wedge high tibial osteotomy in rural Indian patients with medial compartment osteoarthritis and varus deformity: a prospective study
Get PDFBackground: Osteoarthritis of the knee is a leading cause of disability in rural India, were cultural practices and delayed presentation often complicate treatment. High tibial osteotomy (HTO) represents a joint-preserving alternative to total knee arthroplasty, particularly suitable for younger patients with medial compartment disease. This study aims to evaluate the functional outcomes of medial open wedge high tibial osteotomy in rural Indian patients with medial compartment osteoarthritis and varus deformity.
Methods: This 24-month prospective study at Dr. BVP Rural Medical College, Loni, Maharashtra, evaluated 50 patients with symptomatic medial compartment osteoarthritis undergoing medial open wedge HTO using TomoFix plates. Outcomes were assessed using Visual Analog Scale (VAS), Knee Society Score (KSS) and Knee Society Functional Score (KSFS) over 6-month follow-up.
Results: Significant improvements occurred across all measures. Mean VAS improved from 6.7±1.1 to 1.8±0.9 (p<0.001). KSS improved from 54.7±5.8 to 82.8±6.1 (p<0.001) and KSFS from 55.2±4.9 to 83.8±5.7 (p<0.001). Walking distance increased from 178±65 to 575±90 meters (p<0.001). Mechanical axis was corrected from 7.2°±1.3° varus to 2.1°±1.1° valgus. All patients achieved radiological union by 12 weeks. Minor complications occurred in 22% with no major complications.
Conclusions: Medial open wedge HTO provides significant functional improvement in rural Indian patients with medial compartment osteoarthritis, offering a cost-effective, culturally appropriate alternative to total knee arthroplasty while preserving traditional sitting postures and occupational activities
Current management approaches for anterior cruciate ligament tears in young athletes
Get PDFAnterior cruciate ligament (ACL) tears are among the most frequent serious knee injuries in young athletes and often lead to prolonged time away from sport and elevated risk of re‑injury. Purpose was to synthesize contemporary evidence (2015-2025) on diagnosis, operative and non‑operative management, rehabilitation, and return‑to‑sport (RTS) in adolescents and young adults with ACL tears. Narrative review informed by a structured search of PubMed/Medline and Google Scholar using MeSH terms ("anterior cruciate ligament/injuries", "anterior cruciate ligament/surgery", "athletes", "rehabilitation", "platelet-rich plasma", "anterolateral ligament"), limited to english language and human studies. Current guidelines recommend individualized treatment; when surgery is indicated, reconstruction is favored over primary repair due to lower revision risk. Graft choice should consider sport demands and age; evidence suggests slightly lower failure with bone-patellar tendon-bone (BTB) versus hamstrings in some cohorts, though patient‑reported outcomes are comparable. Adjunct procedures such as anterolateral augmentation (ALL/LET) may reduce graft failure and pivot shift in high‑risk patients. PRP shows mixed benefits, with possible modest improvements in early pain and stability but inconsistent long‑term effects. Criteria‑based rehabilitation with delayed RTS (≈9-12 months) and psychological readiness assessment lowers second‑injury risk. Management of ACL tears in young athletes should be individualized, balancing surgical technique, biologic adjuncts, and rigorous criteria‑based RTS testing that integrates strength, hop performance, movement quality, and psychological readiness
A comparative study of magnetic resonance imaging and arthroscopic findings in the diagnosis and management of meniscal lesions
Get PDFBackground: Meniscal injuries are the most common types of knee injuries, particularly in athletes and individuals with physically demanding activities. Meniscal lesions can be assessed by either magnetic resonance imaging (MRI) or arthroscopy. There is a pressing need to compare the findings of MRI and arthroscopy to optimize the diagnostic process, which is critical in determining the most appropriate treatment, whether conservative or surgical.
Methods: The aims of this study was to evaluate the MRI and arthroscopy findings in patients with meniscal injuries of knee joint and to compare and assess the clinical significance of MRI and arthroscopic findings in the management of Meniscal Injuries. Hospital based observational study conducted on 50 patients with knee injury ranging from 18 to 60 years after obtaining written informed consent. Participants recruited by non- probability convenience sampling. Those with local infections or neoplasms, those having contraindications to MRI and unfit for anaesthesia were excluded from the study. Data collected using semi- structured questionnaire after pilot testing. Data entered into Microsoft excel and analyzed using Stata 17.0. Diagnostic accuracy analysis viz., sensitivity and specificity assessments for MRI and arthroscopy were conducted.
Results: Mean age of study participants was 34.6 years and 70% were males. Grade III meniscal tears were the most common (42%). The sensitivity and specificity of MRI was 89.6% and 100% respectively indicating that it correctly identified a high proportion of true meniscal tears and ruled out meniscal injury in all patients without tear.
Conclusions: MRI is a highly accurate, non-invasive diagnostic tool for detecting meniscal injuries
Prediction of hamstring tendon autograft dimensions for anterior cruciate ligament reconstruction in the Bangladeshi population
Get PDFBackground: This study aimed to evaluate the predictive value of age, sex, height, weight, and body mass index (BMI) for estimating the length of semitendinosus and gracilis tendons, as well as the total graft diameter, in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Methods: A study was conducted involving 58 patients undergoing ACL reconstruction using hamstring tendon autografts. Preoperative data were collected and intraoperative measurements of semitendinosus, gracilis tendon lengths, and total graft diameter were recorded.
Results: For semitendinosus, longer tendons were associated with greater height (B=89.77, p=0.020) and BMI (B=2.452, p=0.044), while higher weight showed a negative effect (B=-0.841, p=0.047). Males had significantly longer semitendinosus tendons than females (B=1.796, p=0.028). Similar trends were observed for gracilis tendon length, where height (B=113.77, p=0.005), BMI (B=3.245, p=0.012), and sex (B=1.747, p=0.040) were positive predictors, and weight showed a negative association (B=-1.132, p=0.011). Age was not a significant predictor for either tendon length (p>0.5). Regarding total graft diameter, only sex emerged as a significant factor (B=0.295, p=0.049), with male patients having thicker grafts, while age, height, weight, and BMI had no significant effect (p>0.05).
Conclusions: Height and BMI are reliable positive predictors of hamstring tendon length, while weight shows a negative association. Male sex is consistently associated with longer and thicker tendons. Age does not significantly influence graft dimensions.