International Journal of Research in Orthopaedics
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Ipsilateral femoral shaft and medial Hoffa fracture in a 13-year-old male following road traffic accident
Get PDFHoffa fractures, particularly of the medial femoral condyle, are rare in pediatric populations. Their association with ipsilateral femoral shaft fractures is exceedingly uncommon. We present a case of a 13-year-old boy who sustained an ipsilateral femoral shaft fracture and medial Hoffa fracture following a high-energy road traffic accident (RTA). The shaft fracture was managed with closed reduction and titanium elastic nailing (TENs), and the medial Hoffa fracture was treated via open reduction and internal fixation with cannulated Herbert screws using a medial parapatellar approach. This report highlights the importance of high clinical suspicion and appropriate imaging to diagnose these rare injury patterns
Arthroscopic synovectomy with loose bodies removal in a case of synovial chondromatosis of knee joint
Get PDFSynovial chondromatosis is a rare condition which affects the synovial joints, tendon sheath, bursa. Mostly commonly seen in 3rd to 5th decade with male predominance. The exact etiology is unknown. usually manifest clinically as synovitis. Clinical evaluation with appropriate radiological evaluation is necessary for the diagnosis. Surgical intervention is appropriate either open or arthroscopic. It involves arthrosopic loose body removal with extensive synovectomy. Histopathological evaluation is required for confirmation of diagnosis. Long term follow up is neede
Evaluating the effectiveness of peroneus longus tendon as an autograft for primary anterior cruciate ligament reconstruction: a prospective study
Get PDFBackground: The most common significant ligamentous injury to the knee joint is an anterior cruciate ligament (ACL) tear. The ACL reconstruction aims to restore knee stability, allow the patient to return to regular activities, including sports, and delay the onset of osteoarthritis. The choice of graft plays a vital role and the most popular autograft for reconstruction is the hamstring tendon graft. Many Orthopaedic surgeons use peroneus longus tendon autograft, and it is biomechanically comparable to a hamstring tendon autograft. The aim of this study is to assess the functional outcome and donor site morbidity and analyses complications of using peroneus longus autograft in ACL reconstruction.
Methods: Study was conducted from October 2023 to March 2024 in Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka. Using Consecutive sampling technique, a total of 30 patients who fulfilled the criteria were included and observed prospectively for a period of 1 year. Functional scores were recorded preoperatively and 1 year after surgery using IKDC and lysholm scores. Donor site morbidities were assessed with AOFAS score and MRC grading- plantarflexion at ankle and eversion at subtalar joint.
Results: Ankle functions at donor site are preserved well in almost all patients with excellent AOFAS score and attained excellent functional outcome in lysholm as well as IKDC knee score.
Conclusion: Peroneus longus tendon serves as a suitable autograft option for ACL reconstruction, due to the convenience of its harvest, an aesthetically pleasing outcome, and the better postoperative knee scores. Additionally, the excision of the peroneus longus tendon has not resulted in ankle instability, making it viable for use as an autogenous graft in ACL reconstruction procedures
Fat embolism syndrome before surgical treatment of open tibial and fibular shaft fracture: a case report
Get PDFA 26-year-old male with no significant medical history sustained open fractures of the left tibia and fibula following a workplace accident. Initially alert and stable, he developed sudden neurological deterioration (GCS 9/15) 10 hours post-injury, without respiratory compromise or cutaneous signs. CT was unremarkable; diffusion-weighted MRI revealed widespread acute cerebral infarcts. No intracardiac shunt was found on echocardiography. Supportive care led to gradual neurological improvement, and successful surgical fixation followed. Isolated cerebral fat embolism can precede orthopedic intervention and present without classic signs. Early neuroimaging and high clinical vigilance are crucial for prompt diagnosis and management
Understanding split cord malformation: from pathophysiology to long-term outcomes
Get PDFSplit cord malformation (SCM) is a rare congenital anomaly of the spinal cord, frequently associated with tethered cord syndrome and orthopedic, urological, and neurological sequelae. Surgical management of SCM remains controversial, particularly regarding timing of intervention, selection criteria for asymptomatic cases, and expected outcomes for different SCM types. This systematic review aims to synthesize current evidence regarding surgical indications, techniques, outcomes, and prognostic factors in SCM treatment. We conducted a comprehensive systematic review of the literature, selecting 30 studies comprising over 1,200 patients who underwent surgery for SCM. Outcomes assessed included neurological, urological, and orthopedic status, complication rates, timing of surgery, and comparative outcomes between type I and type II SCM. Study quality was assessed using the Newcastle-Ottawa scale. Early surgical intervention, especially in type I SCM, was consistently associated with superior outcomes. Preoperative neurological status emerged as the strongest predictor of postoperative results, with early surgery preventing progression and facilitating functional improvement. Urological and orthopedic outcomes similarly benefited from timely intervention. Type II SCM demonstrated a more benign course, with selective surgical indications. Overall complication rates were low, with transient neurological worsening being the most common adverse event. Intraoperative neurophysiological monitoring contributed to enhanced surgical safety. Early surgical correction remains the cornerstone of SCM management, particularly in type I cases. Delayed intervention is associated with reduced potential for neurological recovery. Further prospective studies are needed to refine patient selection criteria, optimize long-term outcomes, and guide management of adult and type II SCM presentations
Diagnostic accuracy of ultrasound in common shoulder pathologies: a retrospective cohort study and literature review
Get PDFBackground: This study aims to evaluate the diagnostic accuracy of shoulder ultrasound in detecting common shoulder pathologies, including rotator cuff tears, AC joint diseases, glenohumeral joint diseases, subacromial impingement, and long head of biceps conditions. The research question focuses on comparing ultrasound findings with arthroscopy results.
Methods: We conducted a retrospective cohort study of 60 patients who underwent preoperative ultrasound followed by shoulder arthroscopy. Sensitivity, specificity, and diagnostic accuracy were calculated for each pathology, comparing ultrasound to arthroscopic findings.
Results: Ultrasound demonstrated high sensitivity (90%) for detecting rotator cuff tears but showed lower sensitivity and specificity for AC joint diseases, subacromial impingement, and glenohumeral joint diseases. Ultrasound was particularly limited in identifying early biceps tendon pathologies.
Conclusions: Ultrasound is highly sensitive for diagnosing rotator cuff tears and serves as a valuable initial diagnostic tool. However, it is less reliable for other shoulder pathologies, where additional imaging modalities may be needed to confirm diagnoses. Improved operator training could enhance diagnostic accuracy
A pulmonary embolism secondary to fracture tibia: a clinical case report
Get PDFPulmonary thromboembolism (PTE) occurs when a thrombus, typically originating from venous thromboembolism, obstructs the pulmonary arteries, disrupting blood flow to the lungs. The thrombus often becomes lodged at the bifurcation of the main pulmonary artery or within the lobar branches, causing hemodynamic instability. Although the thrombus most commonly originates in the lower extremities as deep vein thrombosis (DVT), it can occasionally arise from the pelvic veins, renal veins, upper extremity veins, or the right side of the heart. Various factors can contribute to the development of deep vein thrombosis, but in the context of long bone fractures, it Deep vein thrombosis (DVT) typically develops 7 to 10 days after an injury. However, in rare cases, pulmonary thromboembolism (PTE) has been observed within 72 hours of the trauma. Several theories have been proposed to explain the mechanisms behind the early onset of PTE in such instances. Presenting a case which involves a 34-year-old male who developed pulmonary thromboembolism (PTE) following a roadside accident, and had segmental closed fracture of the right tibial shaft
Isolated zone I vertical sacral fracture: a case report
Get PDFIsolated sacral fractures are not common. This is attributed to the lack of segmental motion of the sacral bones, and most sacral fractures are transversely oriented. However, vertically oriented sacral fractures are never isolated and are usually associated with pelvic ring fractures due to the shearing force of the pelvic ring. There are only a few case reports of such injury presented in isolation. We are reporting a case of isolated zone I vertical sacral fracture in a 25-year-old female following a road traffic accident with a lateral compression mechanism of injury. Only a few cases related to isolated sacral fractures have been reported in the literature. To our knowledge, there have only been a few reports of vertical sacral fracture following a lateral compression injury. Complete vertical sacral fracture with significant displacement in isolation is a rare injury, as it is usually associated with pelvic ring injuries. Surgical stabilization is an indication of such injury to restore the stability of the pelvic ring
Comparison of surgical approaches of total hip arthroplasty in Crowe 3/4 dysplastic hips in adults: a systematic review and meta-analysis
Get PDFDevelopmental dysplasia of the hip (DDH) presents unique challenges for total hip arthroplasty (THA) due to altered anatomy, requiring tailored surgical approaches. Differences in outcomes such as Harris Hip Score (HHS), leg length discrepancy (LLD), operative variables, and postoperative complications between THA approaches remain unclear. This meta-analysis aimed to evaluate variations in functional outcomes, operative data, and postoperative complications among THA approaches in adult patients with DDH, focusing on direct anterior (DAA), posterolateral (PLA), and anterolateral (ALA) approaches, as well as osteotomy versus non-osteotomy techniques. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we systematically searched PubMed, Cochrane, and manual sources for retrospective studies published until March 2024. An inverse variance pooling meta-analysis was conducted. Thirty-five studies (1501 hips; 1246 patients; mean age 46.9 years; mean follow-up 7 years) were included. HHS improved by 47.08 points with no significant differences between approaches (p=0.81) or osteotomy groups (p=0.96). LLD reduced by 3.50 cm overall, with the posterior approach achieving the greatest reduction (-3.67 cm, p=0.03). Operative time (148.47 minutes) and blood loss (832.74 ml) did not differ significantly between DAA and PLA (p=0.59 and p=0.08, respectively). Minor complications, including nerve palsy and non-union, were rare. Dislocation rates were higher with the posterior approach (2%, p=0.04), while infection rates were negligible (0%). THA approaches in DDH yield comparable functional and operative outcomes. The posterior approach achieved the greatest LLD reduction but had a higher risk of dislocation, highlighting the need for careful approach selection
A comparative study between closed interlocking intramedullary nailing and locking plate by minimally invasive plate-osteosynthesis in diaphyseal fracture of tibia
Get PDFBackground: Tibial shaft fractures are common and often lead to significant complications. This study aims to compare the efficacy of interlocking intramedullary nailing (IMN), and minimally invasive plate osteosynthesis (MIPO) in treating these fractures. The aim of the study was to compare the outcome between closed interlocking intramedullary nailing and locking plate by MIPO in diaphyseal fracture of tibia.
Methods: This prospective, comparative observational study was conducted at the Department of Orthopaedic Surgery, M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh, from October 2019 to March 2021, enrolling 30 patients with closed diaphyseal tibial fractures. Participants were randomly assigned to group A (interlocking intramedullary nailing) or group B (locking plate by MIPO). Data were analyzed using statistical package for the social sciences (SPSS) version 25, with p<0.05 considered significant.
Results: In a study of 30 patients with tibial fractures (group A: 15, group B: 15), group A had significantly shorter surgery times (105±17 versus 119±18 minutes, p=0.043) and achieved full weight-bearing earlier (93.3% versus 46.7% at 12 weeks, p=0.014). Both groups showed similar radiological union rates (93.3% versus 80.0%, p=0.598). Group A had more anterior knee pain (73.3% versus 0%, p=0.001), while group B had more wound infections (20.0% versus 6.7%, p=0.224). Functional outcomes were better in group A (93.3% excellent versus 66.7%, p=0.16).
Conclusions: Closed interlocking intramedullary nailing and locking plate by MIPO both are equally effective procedures for treating tibial diaphyseal fractures