International Journal of Research in Orthopaedics
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Anterior fibulocalcaneus muscle: a must-see when performing arthroscopic Brostrom
Get PDFAccessory muscles of the ankle and hindfoot are rare anatomical variants that are typically asymptomatic but may become clinically significant following trauma or surgery. The anterior fibulocalcaneus muscle (AFCM) is a rare accessory muscle, with limited documentation in the literature and no previously reported symptomatic cases requiring surgical intervention. The authors present the case of a 32-year-old man with persistent lateral ankle pain and instability following high-energy trauma and surgical fixation of a medial malleolar fracture. Despite appropriate bone healing, the patient’s symptoms persisted until MRI identified an accessory muscle tendon consistent with the AFCM, originating from the distal fibula and inserting onto the anterolateral calcaneus. Its superficial trajectory over the anterior talofibular ligament (ATFL) risked intraoperative misidentification as part of the lateral ligament complex, potentially leading to inadvertent preservation or tensioning during repair. Surgical excision of the AFCM tendon, combined with lateral ligament repair, resulted in complete resolution of symptoms and full functional recovery. This case highlights the importance of considering accessory musculature that can mimic or obscure native ligaments and complicate surgical management of chronic post-traumatic ankle pain, and demonstrates that surgical excision can be effective when such variants are implicated
Static antibiotic loaded cement spacer application in 2-stage management of native and prosthetic hip joint infections: a case series and review of the literature
Get PDFTwo-stage revision including interval cement spacer application is the gold standard treatment for both prosthetic and native hip infection with joint destruction. We present a summarised case series of our experience of successfully treating 8 infected joints in 6 patients treated with 2-stage revision using interval static spacers. Two patients with 3 native joint infections and 4 patients with 5 prosthetic joint infections were treated with 2-stage arthroplasty with interval static spacer application consisting of static block spacers or cement beads. There were 2 females and 4 males. Mean age is 40.5 years and range 24-60 years. Mean interval between the first and second stage is 8weeks. One case has not undergone the second stage as he is unable to fund the operation. Organisms cultured include methicillin- sensitive staphylococcus aureus, enterococcus. All underwent cementless hip reconstruction with one patient undergoing hybrid hip reconstruction. At mean 36-month follow-up (range 30-44 months) all patients have normalized inflammatory markers and improvement in Oxford hip score (OHS) from pre-operative mean 16.6 (range 15-19) and post-operative mean OHS 43.7 (range 35-50). Patients continue to be followed up. We recommend this cement spacer option as part of a 2-stage procedure when faced with moderate to severe acetabular bone loss. It is effective in treating native or prosthetic hip joint infections and joint infections in patients with sickle cell haemoglobinopathy
Anatomic repair of a chronic distal biceps tendon rupture: a case report
Get PDFChronic distal biceps tendon ruptures, common in weightlifting, pose significant challenges for surgical repair due to the high demands placed on the biceps muscle. Traditional repair techniques, such as direct suture fixation, may be inadequate for athletic patients. This case report presents a novel approach using the modified Boyd-Anderson two-incision technique, incorporating an endobutton and fiberloop to enhance tendon stability and functional recovery. A 40-year-old male weightlifter with a chronic distal biceps rupture underwent surgical repair after physical examination and imaging confirmed the injury. The modified Boyd-Anderson technique, involving two incisions, allowed optimal tendon exposure. An endobutton was used to secure the tendon to the radial tuberosity, while a fiberloop reinforced the repair. The procedure, performed under general anesthesia, minimized soft tissue damage. Postoperative rehabilitation focused on strength training and follow-up at 2 months showed significant improvement in range of motion, strength and overall function, enabling the patient to return to daily activities. This technique, with its use of the endobutton and fiberloop, provides a promising option for anatomical repair of chronic distal biceps ruptures in athletic individuals, offering effective restoration of function and strength. It underscores the importance of customized surgical approaches for tendon repair in active patients.
The role of matrix rhythm therapy in managing and breaking tissue adhesions
Get PDFThis article explores the potential of Matrix Rhythm Therapy (MRT) in addressing tissue adhesions, focusing on its relevance as a non-invasive and effective treatment modality. A systematic review of current literature was conducted using databases such as PubMed, Scopus, and Web of Science. Search terms included "Matrix Rhythm Therapy," "tissue adhesions," "non-invasive treatments," and "mobility improvement." MRT demonstrates promising results in breaking tissue adhesions, improving mobility, and reducing pain by restoring cell matrix dynamics and tissue elasticity. MRT represents a viable adjunct or alternative to conventional treatments for tissue adhesions. Further research is required to standardize protocols and validate its efficacy across diverse clinical scenarios
Comparative analysis of suprapatellar vs infrapatellar approaches in intramedullary nailing for distal tibia fractures
Get PDFBackground: The current study delves into the clinical and functional outcomes of suprapatellar (SP) and infrapatellar (IP) intramedullary nailing techniques in treating distal tibia fractures, utilizing data accrued from King George’s Medical University, Department of Orthopaedics, between Jan 2022 to August 2023.
Methods: A retrospective analysis was carried out involving two groups of patients who underwent either SP or IP nailing techniques. Several parameters including surgical time, blood loss, pain score and functional outcomes were evaluated. Functional outcomes were assessed on the basis of AOFAS scores.
Results: The SP group demonstrated a reduced mean surgical time (85.7±14.8 minutes) compared to the IP group (96.3±16.7 minutes, p=0.011). Moreover, the SP group reported lower pain scores (20.2±3.9) than the IP group (27.5±3.6, p<0.001) and exhibited better functional outcomes as evidenced by higher AOFAS scores (94.1±4.3 vs 88.5±4.7, p<0.001). However, no significant difference was noted in blood loss or fracture healing time between the two groups.
Conclusions: The study underscores the potential superiority of the suprapatellar approach in terms of reduced surgical time, lower pain scores and better functional outcomes. Despite this, the infrapatellar approach had a higher incidence of fracture deformities, necessitating a cautious approach when selecting surgical strategies. Further research with larger sample sizes is warranted to substantiate these preliminary findings
Functional outcome of medial patella femoral ligament reconstruction: a prospective study of novel hamstring sparing technique without patella anchors
Get PDFBackground: A composite graft made of medial retinaculum and quadriceps tendon can be used instead of hamstring graft for medial patellofemoral reconstruction in recurrent dislocation of patella. Our study aims at determining the functional outcome of MPFL reconstruction with this composite graft.
Methods: This is a unicentric, prospective observational study conducted in 60 patients with recurrent dislocation of patella with normal Q angle and without trochlear dysplasia. A composite graft composed of medial patella retinaculum and quadriceps was harvested, one end was sutured at medial superior 2/3rd junction of patella with ethibond. The other end of graft fixed at schottles point with a bio screw. Patients were followed up at 6 weeks, 3 months, 6 months and then yearly. A preoperative and post operative Lysholm score and Kujala score were used for comparison.
Results: There was a significant improvement in Kujala and Lysholm scores. Only 3 out of 60 patients developed further instability that was managed non surgically. There was no statistically significant association with ligamentous laxity and the outcome.
Conclusion: Considering the donor site morbidity and patella fracture this novel hamstring sparing MPFL reconstruction is superior, and outcomes are comparable with previous techniques
Surgical encounter with radial nerve dysmorphogenesis in the arm: a case-based analysis and its operative implications
Get PDFRadial nerve palsy is a well-recognized complication of mid-shaft humeral fractures, with an incidence of 7% to 17%. Although most cases resolve spontaneously, anatomical variations in the radial nerve may complicate surgical management and increase the risk of iatrogenic injury. We report the case of a 42-year-old male who sustained a closed mid-shaft fracture of the left humerus following a road traffic accident, presenting with partial wrist and finger drop and diminished sensation over the first webspace in the dorsum of the hand. Surgical fixation was performed via posterior approach. Intraoperatively, multiple aberrant radial nerve branches with an unusual intramuscular course were identified in the posterior aspect of arm. Careful dissection with decompression and preservation of these aberrant branches were done without tension. The patient showed progressive neurological improvement over the ensuing weeks. By two months postoperatively, there was complete recovery of motor and sensory function in the radial nerve distribution with the patient resuming normal activities. This case highlights the significance of preoperative preparedness and intraoperative vigilance in the presence of radial nerve palsy associated with humeral shaft fractures. Awareness of potential anatomical variations in the radial nerve branching pattern is critical for preventing iatrogenic injury and ensuring favorable neurological outcomes
Evaluating functional recovery following proximal femoral nail fixation in proximal femoral fractures: a study from a developing nation
Get PDFBackground: Intramedullary fixation systems have become increasingly favoured over conventional dynamic hip screws in the treatment of proximal femoral fractures. This shift is attributed to several key benefits, including reduced soft tissue trauma, shorter operative times, and enhanced biomechanical properties.
Methods: A prospective randomised study was carried out at Dayanand Medical College and Hospital Ludhiana, India between January 2016 and January 2017, with proximal femoral fractures. Exclusion criteria included paediatric cases, pathological or neglected fractures, periprosthetic fractures, and femoral neck fractures. The primary aim was to evaluate fracture union and functional recovery, while secondary outcomes focused on identifying any postoperative complications.
Results: Among the 35 participants (19 males and 16 females), the average age was 59.8 years. Subtrochanteric fractures were more prevalent in older individuals, with a higher incidence on the left side. Domestic falls accounted for 52% of the injuries, while 48% resulted from road traffic accidents. The surgical procedure involved an average blood loss of 197 ml and lasted approximately 142 minutes. Fracture union was achieved in 95.23% of the cases, while implant failure was observed in 9.52%. Functional assessments showed that 68% of patients had excellent to good recovery outcomes, with minimal complications reported postoperatively.
Conclusions: Proximal femoral nail (PFN) provides secure fixation with high union rate and positive functional outcomes reinforcing its preference over traditional extramedullary fixation methods. Further comparative analyses are required with larger sample sizes to refine the choice of fixation for different fracture types
Improving surgical outcomes through non-technical skills: the case for better training and national evaluation
Get PDFEffective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness—enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes
Outcome of minimally invasive transforaminal lumbar interbody fusion for the treatment of low grade (grade I and II) spondylolisthesis in obese patients
Get PDFBackground: Spondylolisthesis in obese patient is one of the causes of back pain, severe morbidity, and impairment. This study examines low-grade spondylolisthesis patients' pain relief, functional improvement, fusion rates, and complications after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Methods: This study was conducted in the Department of Orthopedic Surgery at BSMMU, Dhaka, from July 2023 to June 2024. 30 low-grade spondylolisthesis patients were included according to selection criteria. Functional outcomes were assessed by Visual Analogue Scale score, Oswestry disability index, Modified Macnab’s Criteria. Interbody fusion was evaluated by Bridwell interbody fusion grading system and also perioperative events were noted. Mean, standard deviation, Frequency and percentage were used to test qualitative data with chi-square. SPSS 26 data analyses will consider p-values <0.05 significant.
Results: 23.33% patients were day laborer and housewives. Most commonly involved level was L5/S1 (60%), followed by L4/L5, (40 peri-operative complications were seen in 4 (13.33%) patients where in 2 (6.67%) patients had seroma, 1(3.33%) patient had discitis and 1(3.33%) patient had foot drop. One patient had discitis and 1 patient had foot drop. VAS score and Oswestry Disability Index Score had showed significant improvement in post-operative follow up (at 6 months) compared to pre-operative status (p<0.05). Overall, excellent improvement was seen in 40% of cases according to modified Macnab’s criteria on 6 months of post-operative follow up.
Conclusions: MIS TLIF is a safe, efficient, and cost-effective technique when performed accurately. The reduced surgical invasiveness, shortened hospital stay, and rapid return to employment represent substantial advantages of MIS TLIF.