International Journal of Research in Orthopaedics
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Outcome of talonavicular arthritis treated with platelet rich plasma injection: a case report
Get PDFOsteoarthritis of the talonavicular (TN) joint, which can result from inflammatory, degenerative, or post-traumatic arthritis, is frequently reported. TN arthritis causes pain, swelling, and stiffness in the joint. Early diagnosis is crucial, typically using X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRIs) to detect joint damage. Treatment often involves pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs). If these methods don't provide relief, isolated fusion (arthrodesis) of the TN joint is often recommended as a treatment option. There are no published reports describing the use of platelet rich plasma (PRP) for treating TN arthritis. A 45-year-old female presented with persistent right foot pain for one year following a twisting injury. Radiographs showed joint space narrowing, osteopenia, and peripheral osteophytes at the TN joint. PRP was prepared using a two-step centrifugation process and injected under C-arm guidance into the TN joint. The patient was followed for two years and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, which improved from 68 to 90. No adverse events were reported. This case highlights the potential of PRP as a minimally invasive treatment option in early-stage TN arthritis. It adds to the growing evidence supporting intra-articular PRP injections for small joint osteoarthritis, as also supported by recent studies on ankle and talar cartilage degeneration. PRP may serve as a safe and effective alternative to surgery in selected patients with TN arthritis. Further research is warranted to establish standardized treatment protocols
Subtrochanteric femur fracture with pre-existing ipsilateral hip arthritis treated with long stem total hip arthroplasty: a case report
Get PDFHigh velocity trauma involving fractures of lower limbs is one of the most common causes of morbidities in young and working population in developing countries. Amongst these injuries, subtrochanteric femur fractures are the one that cause significant impact on the lifestyle. The strong deforming forces across the fracture makes it difficult to achieve the reduction. The entire outcome depends on the adequate reduction and the stable fixation of the fracture. The longer duration required for the recovery causes significant morbidity and imparts financial burden on the families. Additionally, the presence of hip arthritis worsens the situation and limits the use of implants like intra-medullary nails. Arthroplasty has been defined in the literature for such situations. Arthroplasty remains one of the good options in such patients that address both fracture as well as arthritis providing a stable, mobile and painless hip. Here, we report a case of hip arthritis with subtrochanteric femur fracture treated with total hip arthroplasty.
Outcome of single event multi-level surgery in the treatment of spastic cerebral palsy involving lower limbs
Get PDFBackground: Spastic cerebral palsy (CP) is a leading cause of childhood physical disability, characterized by muscle stiffness and movement limitations, primarily affecting the lower limbs. Single Event Multi-Level Surgery (SEMLS) is considered a gold-standard surgical intervention for managing musculoskeletal deformities associated with spastic CP. However, limited data exist on the effectiveness of SEMLS in low- and middle-income countries (LMICs) like Bangladesh. This study aimed to evaluate the outcomes of SEMLS in children with spastic cerebral palsy involving the lower limbs, focusing on improvements in gait patterns, gross motor function, range of motion (ROM) and postoperative complications.
Methods: A quasi-experimental study was conducted at the National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. A total of 36 children aged 7–16 years with spastic hemiplegic or diplegic CP underwent SEMLS. Outcomes were assessed using gait analysis, GMFCS levels, ROM measurements and complication rates.
Results: Postoperative outcomes demonstrated significant improvements in gait, with 72.22% achieving near-normal gait and 27.78% attaining normal gait. A substantial shift was observed in GMFCS levels, with 63.89% of participants improving to level I. Statistically significant improvements were also recorded in hip, knee and ankle ROM (p<0.001), with minimal postoperative complications observed.
Conclusions: SEMLS is an effective surgical intervention for improving mobility, joint function and overall quality of life in children with spastic cerebral palsy, particularly in resource-constrained settings
Extensor hallucis longus tendon rupture and reconstruction using allograft tendon: a case report and literature review
Get PDFThis case report examined tendon reconstruction using allograft as a treatment approach for chronic extensor hallucis longus (EHL) tendon ruptures, an area with limited existing research. Two cases were discussed to evaluate this method’s effectiveness. The first case involved a 27-years-old male (Patient A) with an EHL tendon tear with retraction up to 2.2 cm and an additional 1.6 cm gap in the extensor hallucis brevis (EHB) tendon confirmed on imaging. The second case was a 28-years-old female (Patient B) with a spontaneous rupture of the left EHL tendon tear with retraction to the tarsometatarsal joint and proximal attenuation extending to the ankle joint. Both patients received reconstruction with an allograft, performed using Kessler’s technique, reinforced with epitenon sutures. Postoperatively, they remained non-weight bearing for four weeks with early range of motion. At the 3-months follow-up, both patients demonstrated active hallux extension and full range of motion, reporting no discomfort during daily activities. Improvements were noted on the American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale and Foot and Ankle ability Measure (FAAM) scores, including the Activities of Daily Living and Sports subscales.
Assessment of the role of manipulation under anaesthesia in knee stiffness following total knee arthroplasty
Get PDFAbout 3-4% of all total knee arthroplasty (TKA) patients develop unfortunately develop stiff knee. There is inadequate understanding of risk factors and a lack of consensus regarding its management protocol. This study aims to assess the risk factors and outcome of manipulation under anaesthesia to treat stiff knee following TKA. 18 knees with stiffness following primary TKA were enrolled in this study who underwent manipulation under anesthesia (MUA) between January 2023 and April 2024. Patient demographics, type of surgery (conventional or robotic), contributing factors and knee motion before and after manipulation were assessed from hospital records. Final FFD and arc of motion was recorded in a follow-up clinic. Female patients were significantly more affected than male. Delayed physiotherapy due to comorbidities was associated with stiffness. 72.22% stiff knee patients had conventional surgery while rest had robotic assisted surgery. Manipulation under anaesthesia led to mean 31.11degree improvement in arc of motion immediate post manipulation and 26.39 degree in final follow-up. There was no complication during MUA. MUA is safe, effective and noninvasive and can be considered as a first line treatment for stiff knee following TKA
Study of effect of zoledronic acid on back pain in patients with osteoporosis
Get PDFBackground: The objective of the study was to assess functional result in back pain treated with a Zoledronic acid.
Methods: A prospective observational study was conducted over period of 18 months. SMIMER-Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India. Thirty-eight patients with various stages of back pain treated with zoledronic acid fulfilling selection criteria admitted in department of orthopaedics in tertiary health care hospital in Surat. Follow up was done after 2nd and 6th month and recording of pain relief in term of VAS and MODQ score.
Results: We expected that Patients after receiving Zoledronic acid shows an appreciable and statistically significant improvement in back pain & related complains as well as improvement in monthly follow-up period compared to previous status based on VAS score & MODQ.
Conclusions: Our findings have shown that there is a statistically significant improvement in complain of back pain over period of 6 months as compared to previous status of patient.
Beyond the terrible triad: a rare case of complex elbow injury and its surgical approach
Get PDFThis case report presents a rare and complex elbow injury that expands the conventional scope of the "terrible triad" pattern. A 21-year-old male sustained high-energy trauma resulting in posterior elbow dislocation, radial head and coronoid process fractures, intra-articular distal humerus fractures involving the trochlea and capitellum, and a midshaft ulna fracture. Surgical management was performed using the posterior trans olecranon approach. The ulnar shaft fracture was stabilized by using a locking reconstruction plate and interfragmentary screw fixation. Intra-articular fractures were reduced and fixed using Herbert screws followed by dual-column plating of the distal humerus. The lateral collateral ligament was repaired, and olecranon osteotomy was fixed with tension-band wiring. A structured rehabilitation protocol was implemented postoperatively. At nine months, the patient returned to light activity with fair range of motion and no complications. This case highlights the importance of individualized surgical planning and early rehabilitation in managing complex elbow injuries that transcend the traditional definition of the terrible triad. The use of a trans-olecranon approach, stable fracture fixation, and anatomical articular reconstruction are the key elements for achieving satisfactory functional outcomes
Functional and radiological outcomes in revision total knee arthroplasty
Get PDFBackground: Following a primary total knee arthroplasty, patients with rheumatoid arthritis and osteoarthritis are reported to have comparable clinical prognoses and overall failure rates. Information on revision techniques is limited, despite the fact that the causes of failure and survivorship for primary total knee arthroplasty (TKA) have been well investigated. This study, which investigated the radiological and functional outcomes of revision total knee arthroplasty, was conducted as a consequence of these factors.
Methods: This observational study was conducted in the Department of Orthopedics in Sapthagiri institute of medical sciences and research centre among cases who underwent revision TKA during November 2022 to June 2023. A total of forty cases who underwent RTKA during the study period were included in the study. After taking the written informed consent, principal investigator assessed the detailed history of the participants and clinically examined the patients. Pre and post-operative functional and radiological outcomes were measured. The data was entered in excel sheet and analyzed using statistical package for the social sciences (SPSS) - version 19.
Results: Pre op and post-operative HSS score, KS score including the sub-scales like objective knee score, patient satisfaction score, patient expectations core and functional activity score and radiological outcome scores were found to be statistically improved post-operatively. Also, pain was markedly reduced postoperatively based on VAS scale. However, only one case died who underwent two stages TKA, which was not statistically significant.
Conclusions: We infer that further improvement in prevention and management of infection following TKA can helps to prevent the proportion of cases requiring RTKA and thus much attention is warranted on this dreaded complication
Comparative utility of dual spectral computed tomography and functional magnetic resonance imaging in the preoperative evaluation of unstable fractures of the craniocervical complex: a systematic review of diagnostic accuracy and neurosurgical outcomes
Get PDFThis systematic review critically appraises the sensitivity and clinical applicability of dual-energy computed tomography (DECT) compared with functional magnetic resonance imaging (fMRI) in evaluating unstable fractures involving the craniocervical complex and vertebral muscles. Nine studies were included, comprising retrospective cohorts, prospective diagnostic trials, and meta-analyses, with sample sizes ranging from 8 to 515 patients and heterogeneous fracture types. DECT demonstrated strong diagnostic performance in several contexts. For bone marrow edema (BME), DECT achieved 89% sensitivity, 98% specificity, and an AUC of 0.96 (p<0.001). In intervertebral disc injuries, sensitivity and specificity were 0.85 and 0.75, with significant attenuation differences (p<0.001). For pelvic fractures, DECT reached 89.5% sensitivity and 84.6% specificity, with moderate inter-rater reliability (kappa=0.516). Optimization with electron density imaging improved hematoma detection, raising sensitivity and specificity above 80% (kappa=0.82; p=0.04). Meta-analytic results confirmed overall sensitivity, specificity, and accuracy of 86.2%, 91.2%, and 89.3%, respectively. Nonetheless, MRI clearly outperformed CT in detecting ligamentous injuries and occult trauma, with a negative predictive value of 100% for cervical instability. Limitations of the current evidence include small samples, retrospective designs, interobserver variability, and incomplete subgroup analyses. Despite these, DECT remains a promising adjunct or alternative when MRI access is limited, particularly for BME and fracture line imaging. Future multicenter studies are needed to standardize protocols and strengthen generalizability
A retrospective study on magnetic resonance imaging findings in knee injuries
Get PDFBackground: Magnetic resonance imaging (MRI) is a noninvasive and accurate tool for diagnosing internal knee injuries after trauma. It reliably detects anterior cruciate ligament (ACL) tears, meniscal injuries, collateral ligament damage, and bone contusions, which often coexist in traumatic knee injury. This study aimed to evaluate the prevalence and types of MRI-detected knee injuries and their associations with patient age and gender.
Methods: This retrospective observational study included 132 patients who underwent knee MRI following trauma at a radiology department. Patients of all ages and genders were included unless their MRIs showed only degenerative changes or incomplete data. MRI reports were reviewed for ligamentous injuries [ACL, posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL)], meniscal tears, and bone contusions. Data on age and gender were recorded and analysed.
Results: Among 132 patients, 70.45% were male and 29.55% were female, with the largest age groups being 21-30 years (30.3%) and 41-50 years (31.82%). ACL injuries were present in 78.78% of cases, meniscus injuries in 61.36%, PCL injuries in 39.39%, bone contusions in 14.39%, MCL injuries in 8.33%, and LCL injuries in 3.78%. Complete ACL tears accounted for 41.35% of all ACL injury cases. Significant associations were found between age and ACL injury (p=0.002), meniscus injury (p=0.001), bone contusion (p=0.046), and LCL injuries (p=0.044). No significant differences were observed between gender for any injury type.
Conclusions: Our study highlights MRI's effectiveness in detecting and classifying traumatic knee injuries. ACL tears, often accompanied by meniscal and PCL injuries, were the most common. Injury patterns varied with age but not gender, emphasising MRI’s role in early diagnosis and age-specific management