International Journal of Research in Orthopaedics
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The effect of decompression with posterior spinal fusion on back and leg pain in lumbar canal stenosis
Get PDFBackground: Lumbar canal stenosis, characterized by pain, numbness and neurological claudication, causes gradually worsening back and leg pain, which can lead to neurologic compromise and patient distress. Posterior lumbar interbody fusion (PLIF) has been used for spinal fusion, with any of the decompression procedures. We aimed to examine the effects of decompression with PLIF on back pain, leg pain and neurological claudication in patients with lumbar canal stenosis.
Methods: In this observational study, total of 50 patients with lumbar canal stenosis who underwent PLIF at Bharati Hospital were included from January, 2020, to April, 2022. Selected patients had LS spine X-rays and MRIs. Neurological claudication, VAS scores for back and leg pain and Oswestry Disability Index were assessed at 3 months, 6 months, 9 months and 12 months post-op.
Results: The majority (19 (38%)) of the patients were between the ages of 50 and 60, with 23 men and 27 women in total. 50% of study participants had pain in both legs. Neurologic claudication decreased significantly from pre-op to post-op and at 3, 6, 9 and 12 months' follow up, none of the patients reported it. A significant decrease in the mean of VSB and VSL was reported at post-op, 3, 6, 9 and 12 months. The ODI score also decreased significantly at post-op, 3, 6, 9 and 12 months.
Conclusions: PLIF with interbody fusion and local graft with posterior instrumentation gave significantly improved clinical and functional outcomes by significantly reducing pain, as determined by the VAS scores for back and leg pain
Impact of COVID-19 lockdown on pain and physical function in patients with advanced hip and knee osteoarthritis
Get PDFBackground: Osteoarthritis is the most common degenerative disease of joints that impairs quality of life and leads to disability. Hence, this study aims to assess the impact of lockdown on pain and physical function in patients with advanced knee and hip Osteoarthritis.
Methods: A total of 86 patients between the age of 35 to 80 years with advanced hip and knee osteoarthritis were considered for the study during the second wave of COVID 19 lockdown. The subjects were contacted over phone call and a questionnaire was put forward after obtaining their consent. Subsequently the interviews were repeated in the fourth week and at the end of lockdown. The observers were blinded for the previous results. Visual analogue scale (VAS), Tegner activity scale (TAS), McMaster Universities Osteoarthritis questionnaire (WOMAC) scores of the patients were obtained. Comparative analysis was made based on these parameters at pre, during and after lockdown period.
Results: Positive, strong to very strong and significant Pearson’s correlation was seen between VAS and WOMAC scores at all the time intervals in both the groups (knee and hip) and overall. Negative, moderate to strong and significant correlation was seen between VAS and TAS scores. A weak, moderate and significant correlation was seen between WOMAC and TAS scores.
Conclusions: Our study depicts that the COVID-19 lockdown had a significant negative impact on patients with end-stage hip and knee osteoarthritis resulting in increased pain and deteriorating joint function with reduced quality of life. We suggest that virtual education in the form of web physiotherapy, online knee and hip schools and holistic self-management strategies are vital to improve pain and physical function
Functional outcomes of arthroscopic rotator cuff repair: transosseous technique versus single-row with anchors
Get PDFBackground: Transosseous repair (TO) has declined in popularity since the introduction of suture anchors and arthroscopic methods in 1985. Nevertheless, failure rates remain significant, at 12% to 40% and the cost of these devices is considerable. Consequently, interest has revived in arthroscopic transosseous technique, the aim of this study was to evaluate whether anchorless transosseous arthroscopic fixation achieves similar or better functional outcomes than single-row fixation with anchors in patients with rotator cuff tears.
Methods: 60 shoulders with complete rotator cuff tears were evaluated, divided into two groups based on fixation technique: Group 1 (transosseous) and Group 2 (single row with anchors). All patients had a minimum 12-month follow-up, including clinical assessments (VAS, range of motion) and functional questionnaires (ASES, Constant scores).
Results: No significant differences were found in VAS scores at 6 months (t=0.244, p=0.404) and 12 months (t=0.220, p=0.413). Additionally, there was no superiority of either group in motion ranges at 12 months (forward flexion t=0.732, p=0.234; external rotation t=1.608, p=0.057; abduction t=0.583, p=0.281). Both groups reported high postoperative satisfaction, with no differences in ASES (t=0.153, p=0.439) and constant scores (t=0.572, p=0.285) at 12 months.
Conclusions: The transosseous repair technique is as effective as single-row anchor repair for rotator cuff repair, achieving similar clinical and functional outcomes
Study of functional and radiological outcome of percutaneous bridge plating of extra articular fibula fracture for management of distal tibia type III open fracture
Get PDFBackground: Fractures of the distal tibia account for 7 to 9% of lower extremity fractures, with the fibula fractured in about 85% of these cases. Management of fibula fracture in the distal third fracture setting is essential as it facilitates the reduction of tibia fracture. The management of distal third tibia and fibula fracture vary from intramedullary nail in the tibia fracture and plating for the fibula fracture to dual plating with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the Tibia and fibula and depending on local tissue condition. This study aimed to evaluate the outcome of percutaneous bridge plating of fibula fracture in the setting of concomitant open type III distal tibia fracture.
Methods: A prospective clinical study of patients with distal tibia type III open fractures with extra-articular fibula fractures at the department of orthopaedics, SMS medical college, Jaipur, Rajasthan, India from June 2023 to May 2024 were subjected to percutaneous bridge plating for the fibula with appropriate management for the tibia fracture, Outcomes assessed using the lower extremity functional scale (LEFS), proportional length difference, talocrural angle, and fracture healing. Complications post-surgery was also evaluated.
Results: Studies have shown that appropriate fixation of the fibula aids in the reduction and stabilization of tibial fractures, improving overall outcomes. The use of percutaneous bridge plating offers benefits in terms of soft tissue preservation and mechanical stability.
Conclusions: The treatment chosen and the outcomes after a fracture seem to be satisfactory. Further studies and detailed analyses are required to establish long-term benefits and compare with other fixation methods
Functional outcome of subtalar arthrodesis using compression screws in cases of subtalar arthritis
Get PDFSubtalar arthritis, which frequently results from fractures that are inadequately reduced surrounding the talus or calcaneus, induces chronic pain, rigidity and functional impairment. Subtalar arthrodesis is a conventional therapy for subtalar arthritis. Subtalar arthrodesis employs compression screws to facilitate the joint fusion, which may serve as an alternative. We conducted a retrospective analysis of 20 patients having subtalar arthritis who underwent subtalar arthrodesis with compression screws between September 2022 and January 2024. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were the primary outcomes that were assessed before and after surgery. Seventeen out of twenty patients that performed subtalar arthrodesis were able to achieve an effective fixation at the arthrodesis location. The success rate was 85%, with 17 of the 20 patients achieving successful fusion. The AOFAS scores improved about a mean of 65 prior to surgery to 88 and 93 at six and 10 months postoperatively, correspondingly, with a mean time to fusion of 16 weeks. High fusion rates and substantial AOFAS score improvements are indicative of the efficacy of subtalar arthrodesis with compression screws in enhancing functional outcomes and alleviating pain in patients having subtalar arthritis
Safety and efficacy of the Prakash method in closed reduction of anterior shoulder dislocation
Get PDFIntroduction: Shoulder dislocation is a frequently encountered injury in daily medical practice. Among various types of shoulder dislocations, anterior shoulder dislocation is the most prevalent. Numerous techniques have been proposed for reducing a dislocated shoulder. The objective of this study was to evaluate the efficacy and safety of the Prakash technique in treating patients with anterior shoulder dislocation who sought treatment at our hospital's emergency department.
Methods: This was a prospective study conducted from March 2023 to July 2023 in the Department of Orthopedics in Government Medical College & Associated group of Hospitals, Kota. 50 shoulders fulfilling the inclusion criteria were included in this study, and observations were noted.
Results: After conducting a statistical analysis, it was observed that the new reduction method proved highly effective, successfully reducing 98% of the shoulders without the need for anesthesia. The study included a total of 50 patients, among whom 8 (16%) had left-sided shoulder dislocation, and 42 (84%) had right-sided shoulder dislocation. Notably, the reduction could be accomplished on the first attempt in 45 patients (90%), while a second attempt was required in 4 patients (8%). Fortunately, no complications were observed during the course of the study.
Conclusion: The Prakash method for reducing anterior shoulder dislocation has proven to be a straightforward and effective technique based on our study findings. Due to its success rate and the fact that it doesn't necessitate anesthesia, we strongly recommend that both orthopedic surgeons and emergency care providers familiarize themselves with this method. It can be a valuable addition to their skill set and provide a safe and efficient option for treating patients with anteriorly dislocated shoulders
Comparative analysis of in vitro biofilm formation in gram-positive and gram-negative pathogens from orthopaedic implant infections: a retrospective cross-sectional study in a tertiary care centre
Get PDFBackground: Orthopaedic implant infections (ODRI) remain a significant clinical challenge due to their association with persistent biofilm formation, which complicates treatment. 1.2 Objective: This study aimed to investigate the biofilm-forming potential of Gram-positive and Gram-negative pathogens isolated from orthopaedic implant infections in a tertiary care setting.
Methods: A retrospective cross-sectional study was conducted at the Krishna Institute of Medical Sciences, Secunderabad, India, from February 2023 to January 2024. Clinical samples from orthopaedic implant infections, were processed for bacterial culture and biofilm formation using the Tissue Culture Plate (TCP) method in triplicates. Bacterial identification was performed using the Vitek 2 Compact system.
Results: Of 87 patients diagnosed with orthopaedic implant infections, 62 (71.26%) were culture-positive, with 35 (56.45%) Gram-negative bacilli and 27 (43.54%) Gram-positive cocci. Biofilm formation was observed in 59.25% of Gram-positive isolates, with 18.51% strong biofilm producers, 40.74% moderate producers, and 40.74% weak/non-producers. Among Gram-negative isolates, 31.42% were biofilm producers, with 5.71% strong, 25.71% moderate, and 68.57% weak/non-producers. A higher prevalence of biofilm production was noted in Gram-positive organisms compared to Gram-negative bacteria.
Conclusion: The study highlights the higher propensity of Gram-positive bacteria to form biofilms, which may contribute to the persistence and chronicity of orthopaedic implant infections
Incidence and predictors of syndesmotic injuries in ankle fractures: a cross-sectional study correlating radiographic assessment with intraoperative findings
Get PDFBackground: Syndesmotic injuries are clinically significant ankle injuries that may lead to chronic instability and functional impairment when inadequately managed. While literature suggests these injuries occur in 10-20% of ankle fractures, their true incidence remains poorly characterized. This study aimed to determine the incidence of syndesmotic injuries in ankle fractures and evaluate the diagnostic accuracy of radiographic assessment compared to intraoperative findings.
Methods: This 18-month cross-sectional study conducted at a tertiary care center in Pune, India included 49 patients with ankle fractures requiring surgical intervention. Standardized radiographic evaluation was performed to assess syndesmotic parameters (tibiofibular clear space, tibiofibular overlap, and medial clear space). Fractures were classified using the Lauge-Hansen system, and intraoperative assessment was conducted using the Hook test as the reference standard. Statistical analysis included calculation of diagnostic accuracy metrics and multivariate logistic regression to identify independent predictors of syndesmotic injuries.
Results: Syndesmotic injuries were identified in 16 patients (32.7%, 95% CI: 19.9%-47.0%), with highest prevalence in Pronation-External Rotation fractures (46.7%) and those resulting from road traffic accidents (44.4%). Radiographic assessment demonstrated good diagnostic performance (sensitivity 87.5%, specificity 81.8%) compared to intraoperative findings. Multivariate analysis identified three independent predictors of syndesmotic injury: Pronation-External Rotation fracture pattern (OR 3.82, p=0.006), road traffic accident mechanism (OR 2.96, p=0.026), and tibiofibular clear space >6 mm (OR 8.35, p<0.001). Patients with syndesmotic injuries demonstrated significantly worse immediate post-operative pain scores (p<0.001) and functional outcomes (p<0.001).
Conclusions: Syndesmotic injuries are more common in ankle fractures than previously reported, particularly in high-energy trauma and specific fracture patterns. While systematic radiographic evaluation provides valuable diagnostic information, intraoperative assessment remains essential for definitive diagnosis. These findings emphasize the importance of maintaining a high index of suspicion for syndesmotic injuries in high-risk scenarios to optimize patient outcomes
Comparative analysis of TAD and CalTAD in predicting lag screw cutout risk in trochanteric fractures treated with intramedullary devices: a retrospective study
Get PDFBackground: Cutout is one of the common cause of mechanical failure after internal fixation of trochanteric fractures using intramedullary devices. Tip apex distance (TAD) and Calcar referenced tip apex distance (CalTAD) are the radiographic parameters to predict the cutout risk. The aim of the study is to compare CalTAD with TAD in predicting the screw cutout risk and also to assesses other parameters responsible for it.
Methods: A total of 100 patients were included in this retrospective study. For each patient the following data were recorded. Number of cutouts, AO/OTA classification, quality of the reduction, type of nail, center column diaphyseal angle, type of distal locking, post-operative weight-bearing, TAD, CalTAD values and the position of the screw in the femoral head according to the Cleveland system.
Results: The incidence of cutout across the sample was 6%. The median TAD in cutout group was 32.2±6.5 (Mean±SD) while in no cutout group it was 20.7±5.1(p<0.001). Similarly, the median CalTAD in cutout group was 33±5.6 (Mean±SD) while in no cutout group it was 21.1±4.6 (p<0.001). The highest value of sensitivity and specificity showed that the best cut off values of TAD is 30.06 (95% CI: 0.823-1.000, P<0.001) and Cal TAD is 30.93 (95% CI: 0.835-1.000, p<0.001).
Conclusions: In order to reduce the incidence of cutout it is advisable to achieve positive cortical reduction, placing the lag screw in centre-centre or centre-inferior in femoral head (Preferably in Cleveland Zone-5) and avoid TAD>30.06 and Cal TAD>30.93
Parallel tunnel ligamentopexy-a novel technique for medial collateral ligament deficiency in primary total knee arthroplasty: a case study
Get PDFManaging medial collateral ligament (MCL) deficiency in primary total knee arthroplasty (TKA) remains a challenge, often necessitating constrained implants or revision prostheses. We present an innovative technique, Parallel Tunnel Ligamentopexy, which stabilizes the MCL without requiring revision implants, thus preserving native structures and reducing bone loss. A 68-year-old male with severe varus deformity and grade 4 osteoarthritis of the left knee presented with progressive difficulty in ambulation and performing daily activities. Radiographic evaluation confirmed knee subluxation. The patient underwent left-sided TKA. Intraoperatively, a femoral attachment deficiency of the MCL was observed. Parallel tunnel ligamentopexy was performed by whip-stitching the residual MCL, creating two parallel 2-mm tunnels in the lateral distal femur, and securing the MCL using these tunnels. This approach was preferred over semitendinosus augmentation, given its reduced risk of supracondylar femoral fractures and improved suitability for osteoporotic bones. The patient was mobilized on postoperative day 1. The varus deformity was corrected, and knee stability was maintained. At six months follow-up, clinical and radiological evaluations demonstrated no signs of MCL laxity. The patient resumed daily activities independently, highlighting the efficacy of Parallel Tunnel Ligamentopexy in preserving knee stability without requiring a constrained implant. Parallel Tunnel Ligamentopexy is a cost-effective, biologically favorable solution for MCL deficiency in primary TKA. This technique avoids constrained implants, minimizes bone loss, and optimizes functional outcomes, particularly in osteoporotic patients