International Journal of Research in Orthopaedics
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The study of functional outcome of k-wire fixation with link joints in proximal humerus fractures
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Background: Proximal humeral fractures are the common type of osteoporotic fractures seen in elderly patients. The objective was to evaluate the functional outcome of a novel modification of percutaneous k-wire fixation technique using Neer’s classification. In this technique, the transfixing K wires were linked together with a link joint which functions as an external fixator, easily available and cheap compared to MIROS (Minimally invasive reduction and osteosyntesis system) and also has additional advantage of trans fixation.
Methods: The prospective study was conducted in MBS and new medical college, Kota, India over a 24 months period, we treated 25 patients of minimally displaced two-, three- and four-part fractures, 14 patients (56%) were males and 11 patients (44%) were females. Mean age of the patients were 50.52±14.46 years, the mean surgical time was 30.4 min. mean fluoroscopy time was 42.64 seconds, all k wire and link joints removed at 9.5 weeks. mean clinical union was 7.94 weeks.
Results: Final constant score at 18 months was 80.28±4.09. Mean abduction was 129.6±30.6 degrees, the mean anterior forward flexion was 125.5±25degrees. 2 patients developed pin tract infection, 1 patient developed stiffness .4 patients (16%) had fair results, 18 patients (72%) had good results and 3 patients (12%) had excellent results.
Conclusions: The modified novel method that takes advantage of the minimal invasive approach for treating proximal humeral fractures by Kirschner wire mutual linking technique with link joints, providing a great deal of flexibility in the fixation construct's composition which is cost effective and provide even more stability.
Functional outcome of distal femoral fractures treated with distal femoral locking compression plate: a cross-sectional study
Get PDFBackground: Despite advances in fixation techniques, distal femoral fractures still pose significant challenges for orthopedic surgeons. Effective treatment hinges on a detailed understanding of local anatomy, accurate clinical and imaging assessments, recognition of the fracture morphology, and the judicious choice of a fixation device suited to the particular case. Locking compression plates (LCPs), with their numerous advantages such as enhanced stability, fixed-angle screw locking, and minimal disruption to periosteal blood supply have proven to be highly effective in addressing these challenges and are especially valuable in osteoporotic bone.
Methods: This cross-sectional study was conducted at a tertiary care institution in Tripura between October 2016 and September 2019, comprising 60 patients with distal femoral fractures who underwent open reduction and internal fixation utilizing a distal femoral locking compression plate (DF-LCP). The functional outcome was assessed using Neer’s criteria.
Results: The study included 60 patients, of whom 42 were male and 18 were female. The majority of fractures (70%) were attributed to road traffic accidents. The mean duration for radiological evidence of fracture union was 17.2 weeks. According to Neer’s criteria, the final functional outcome of the knee was rated as excellent in 34 patients (56.7%), good in 20 patients (33.3%), fair in 5 patients (8.33%), and poor in 1 patient (1.67%).
Conclusions: Surgical fixation of distal femoral fractures with distal femoral LCP provides good functional outcome and is one of the best modalities of treatment available for these kinds of fractures especially in severely comminated and in osteoporotic cases
Correlation between clinical, MRI and arthroscopic findings in various shoulder joint disorders
Get PDFBackground: Shoulder joint is the most freely moveable, but a relatively unstable joint in the body. The most commonly used currently prevalent diagnostic tools for shoulder joint disorders are clinical examination, Magnetic Resonant Imaging (MRI) and the gold standard arthroscopy. All have their inherent advantages and disadvantages and none is an all-inclusive tool. Furthermore, the current literature lacks studies comparing all the three diagnostic tools together or has just included one or two of the wide array of shoulder joint disorders. Therefore, this study was undertaken to identify correlation between all three diagnostic methods in arriving at a diagnosis in various shoulder disorders taking arthroscopy as a gold standard.
Methods: The study was a prospective descriptive study carried out at a tertiary care hospital over period of 2 years. 33 symptomatic shoulder patients underwent standardized history, physical examination and MRI prior to diagnostic/therapeutic arthroscopy procedure. Shoulder arthroscopy considered as the gold standard, was used as a benchmark for comparing and confirming the results of clinical and radiological findings using the standard statistical data analysis.
Results: Amongst clinical and radiological (MRI) findings; clinical examination was found to be superior to MRI in diagnosing adhesive capsulitis and bicipital tendinitis; MRI was found to be superior to clinical examination for diagnosing rotator cuff tears and Gleno-Humeral (GH) arthritis; both were equivocal in diagnosing Sub-Acromial Impingement Syndrome (SAIS), GH instability and Superior Labrum Anterior Posterior (SLAP) lesions.
Conclusions: No modality in isolation is accurate and a combination of various available diagnostic tools gives the best precision in diagnosing shoulder joint disorders
Chronic tendo-Achilles ruptures treated by suture anchor repair and augmentation with flexor hallucis longus tendon transfer, fixed with ACL screw
Get PDFDifferent surgical procedures have been used for treatment of chronic ruptures of the Achilles tendon with varying results. This study assesses the functional outcomes and complications of chronic insertional tears of Achilles tendon. 10 patients with chronic ruptures of the Achilles tendon were followed for a mean period of 10.3 months. Only ruptures at or near (within 1 cm) insertion were included. They were treated by direct repair of tendon to calcaneum by suture anchor. Flexor hallucis longus (FHL) tendon transfer fixed to calcaneal tunnel with an interference screw was used to augment the repair. Outcome was assessed by AOFAS Ankle-Hindfoot (AHS) score. The mean preoperative score of 41.2 improved to 85.4 at final follow-up out of a total 100 points. We achieved excellent results in 80% and good outcome in 20% cases. No re-ruptures were noted. In insertional chronic ruptures of Achilles tendon, FHL transfer to calcaneum with interference screw fixation and repair of Achilles tendon with suture anchor is a reliable technique with good outcome and is recommended
An unstable knee with gross varus deformity treated with unconstrained total knee replacement with long tibial stem: a case report
Get PDFSevere varus deformity of the knee poses a technical challenge in balancing the flexion and extension gaps. Bone defects are a challenging problem encountered with severe varus deformity of knee during primary total knee arthroplasty (TKA). In this case report we have achieved good stability and alignment with unconstrained posterior stabilised TKA in unstable knee with severe varus deformity and with significant bone loss without preferring constrained options as these have concerns for longevity and difficult revision surgery. 72 years male had complaints of severe pain, swelling, deformity in both knees since 1 year and bed ridden from 6 months. History of similar complaints from past 10 years. Physical examination revealed severe varus deformity, diffuse swelling, tenderness, restricted range of movements, crepitus in bilateral knee joints. Pre anaesthetic check-up revealed patient was known coronary artery disease, on pacemaker since 7 years so anaesthetist advised to go for staged total knee replacement. Total knee replacement using unconstrained posterior stabilised implants with a long tibial stem was done, extreme varus deformity was corrected, osteophytes loose bodies removed, posteromedial tibial bone defect was repaired with cement and screw construct. It is concluded that in extreme varus deformity of the knee, if proper step-wise release is done, we can balance the knee without using constraint implants. Bone defects can be reconstructed using cement or augment. In this case, we used cement and screw construct, and the results were satisfactory. The increasing amount of evidence that supports the use of long-stem total knee replacement for complex knee osteoarthritis (OA) presentations is strengthened by this case report. While an extended period of observation is required to assess the longevity of implants
Comparative study to assess the outcome of surgical management of humerus shaft fracture: anterior bridge plating versus humerus intramedullary nailing
Get PDFBackground: Aims and objectives of the study were to assess the outcomes of surgical management of humeral shaft fractures using anterior bridge plating (ABP) versus humeral intramedullary nailing (HIN) in terms of functional recovery and complication rates.
Methods: A prospective observational and interventional study was conducted from July 2022 to June 2024 at the tertiary care hospital. Sample size of 40 patients was taken.
Results: The study included 40 patients, with similar demographics between the groups. We divided the cases in two groups (HIN group A and ABP group B). Out of 40 patients, 23 were male and 17 were female. Postoperative follow-up at 24 weeks indicated improved functional outcomes assessed by UCLA score system for the ABP group B, with 65% achieving excellent, 25% good, 10% fair and 0% poor as compared to 55% good, 30% fair, and 15% poor in the HIN group A. In terms of complication, in the group A, one (5%) patient had radial nerve palsy, 3 (15%) nonunion, 1 (5%) delayed union and 1 (5%) superficial infection whereas in group B, no radial nerve palsy and nonunion, but 3 (15%) patients have delayed union and 1 (5%) superficial infection.
Conclusions: Anterior bridge plating demonstrated superior functional recovery compared to intramedullary nailing in patients with humerus shaft fractures, suggesting it may be the preferred surgical option for better patient outcomes but no significant difference in complications like delayed union and infection. Further research is warranted to validate these findings and refine treatment guidelines
Result of management of closed distal radial fracture by Ayjaz Azim foundation mini external fixator
Get PDFBackground: Distal radius fractures are one of the most common orthopedic conditions and intra-articular types (AO/ASIF type C) are difficult to treat. While various treatment options exist, external fixation remains valuable, particularly in the developing world. The present study evaluated the efficacy of the Ayjaz Azim foundation (AAF) mini external fixator for the treatment of closed, complete articular distal radius fractures.
Methods: This study evaluated outcomes in 32 patients with closed intra-articular distal radial fractures by purposive sampling. Patients between 18 and 60 years, within two weeks of injury, received standardized surgery. Structured questionnaires were used to collect data, and outcomes at 12 weeks after surgery were assessed using Sarmiento's radiological criteria and the Green and O'Brien functional scoring system. Statistical analysis was performed with SPSS v26, and significance was at p<0.05.
Results: The study population (41.63±12.39 years) had a predominance of males (78.1%), and the most common injury mechanism was motor vehicle accidents (68.75%). Surgery was performed in 90.6% of patients within 24 hours of trauma. Radiologically, 62.5% had excellent results, 31.3% good, and 6.3% fair. The mean loss of volar tilt was 5.03°±3.84°, radial shortening 2.47 mm±2.27 mm, and radial inclination 4.03°±3.27°. Functionally, 62.5% had excellent results, 21.9% good, 12.5% fair, and 3.1% poor. Pin tract infection occurred in 16% of the cases and post-removal stiffness in 62.5% of patients. Radiological and functional results had a good correlation (r=0.876, p<0.001).
Conclusions: AAF mini external fixator is a useful tool for the treatment of AO/ASIF type C distal radius fractures, with 94% patients showing satisfactory results. The technique is reliable for anatomical reconstruction and functional rehabilitation with acceptable complication rates and is a well-suited treatment method worthy of consideration, particularly in regions with limited resources
Evaluation of surgical treatment of recent diaphyseal fractures of the humerus in adults based on 42 cases
Get PDFBackground: Humeral shaft fractures (HDF) in adults account for 2% of all fractures. Surgical treatment can be either closed or open.
Methods: This was a retrospective, descriptive and evaluative study conducted from January 2020 to December 31, 2023, at Centre Hospitalier National Matlaboul Fawzaini de TOUBA (CHNMFT) on 42 cases. The exclusion criteria were all patients under 15 years of age receiving orthopaedic treatment.
Results: The average age of our patients was 40 years, with a male predominance. The most common circumstances were road traffic accidents (32 cases). According to the AO classification, type A fractures were the majority (32 cases). According to the surgical technique, pinning was the most common (22 cases). No complications were noted and all our patient’s achieved union within 12 to 24 weeks. At a mean follow-up of 13.5 months, according to the modified Stewart and Hundley classification, 61% of our patients were classified as Good versus 32% as Very Good.
Conclusions: FDHs in adults are very common. The radial nerve remains the dread of every surgeon and surgical treatment yields the best results.
Return to sport after lumbar spine surgery: a comprehensive review
Get PDFSpinal pathologies are a significant challenge for athletes, often affecting performance and threatening career longevity. This review summarizes current evidence on return-to-sport (RTS) outcomes following lumbar spine surgeries, focusing on procedures such as microdiscectomy, spinal fusion and stabilization. Lumbar microdiscectomy demonstrates high RTS rates, with recovery averaging 5-6 months, while lumbar fusion poses greater challenges, particularly in high-impact sports, with recovery often exceeding 8-12 months. Pediatric and adolescent athletes show promising RTS outcomes, with up to 96% resuming pre-surgical performance within a year. Key factors influencing successful RTS include the type of surgery, sport-specific demands and adherence to structured rehabilitation protocols emphasizing trunk stabilization and core strength
Surgical versus conservative management in lumbar disc herniation with neurological deficit
Get PDFBackground: Lumbar disc herniation (LDH) with neurological deficit is a universal problem. Decision making between conservative or surgical treatment for LDH with neurological deficit remains still controversial. The objective of this study was to assess neurological outcomes for LDH with neurological deficit treated with surgical or conservative treatment.
Methods: Total 40 patients, 20 (50%) treated surgically and 20 (50%) conservatively, 18 to 55 years with neurological deficit due to LDH, irrespective of sex, established clinical symptoms, signs and radiologically evidenced (X-ray L/S spine and magnetic resonance imaging (MRI) of lumbar spine) were included and prospectively studied in Bangladesh medical University from August 2024 to June 2025. Outcomes were measured by visual analog scale (VAS) for back and leg pain and disability by Oswestry disability index (ODI) and satisfaction by modified Macnab criteria.
Results: 21 (52.5%) male and 19 (47.5%) female, 65% patients had right sided neurological deficit. At final follow up, VAS score for back and leg pain were significantly decline in both operative and conservative management and were 0.85±0.66, 1.00±0.63 and 1.85±.55, 1.65±0.67 respectively. Initially the ODI score for operative and conservatively treated patients were 62±4.92 and 61.6±2.86 and 6 months after these were 14.5±6.30 and 20±4.80 (p=0.0036). At final follow up, 90% of patients were satisfied with surgical treatment versus 55% treated conservatively (p=0.035).
Conclusions: Management of LDH with neurological deficit shows better outcome by surgically than conservatively treated patients at final follow up