International Journal of Research in Orthopaedics
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A study on submuscular bridge plating in paediatric femoral diaphyseal fracture
Get PDFBackground: Pediatric femoral diaphyseal fractures represent a significant orthopedic challenge, often resulting from falls or motor vehicle accidents. Conservative treatments like traction and spica casting suit younger children, but surgery is preferred for older children to reduce hospitalization and immobility. This study aimed to assess the efficacy and safety of submuscular bridge plating (SBP) as a treatment modality for pediatric femoral diaphyseal fractures.
Methods: This prospective study was conducted at Sylhet MAG Osmani Medical College Hospital between February 2023 and February 2024, involving 40 patients aged 6–15 years. The study included closed fractures (AO 32A123) and excluded open fractures, pathological fractures, supracondylar extensions, and infections. A minimally invasive technique with dynamic compression plates was used, with follow-ups at 6 weeks and 3 months.
Results: The study cohort had an average age of 10.4 years, with a male predominance (75%). Injuries were primarily caused by falls (60%) and road traffic accidents (30%). Fracture patterns ranged from oblique (40%) to comminuted (15%), with most located in the middle third of the femoral shaft. Postoperative complications occurred in 25% of cases, including superficial wound infections (15%) and deep infections requiring intervention (10%). Callus formation was observed at an average of 7.2 weeks, with minimal limb length discrepancies (mean: 1.2 cm). Functional outcomes, assessed using the Flynn score, were excellent in 85% of cases.
Conclusions: Submuscular bridge plating demonstrates a reliable and effective solution for managing pediatric femoral diaphyseal fractures, offering excellent functional outcomes and low complication rates.
Adenocarcinoma of humerus shaft treated with en bloc excision and long locking compression plate with fibular strut and iliac bone grafting: a case report
Get PDFAdenocarcinoma of the humerus shaft is a rare malignant tumor, often secondary to metastasis from a primary site such as the lung, breast, or gastrointestinal tract. Management of these cases is challenging due to the complex anatomy, the need to preserve limb function, and the high risk of recurrence. This case report highlights a unique approach involving en bloc excision, long locking compression plate (LCP) fixation, fibular strut grafting, and iliac bone grafting. A 55-year-old female presented with persistent pain and swelling in the midshaft of right humerus, accompanied by reduced range of motion. Imaging revealed a lytic lesion, and biopsy confirmed metastatic adenocarcinoma. After a multidisciplinary evaluation, an en bloc excision of the tumor was performed. Reconstruction involved internal fixation with a long LCP, augmented by a vascularized fibular strut graft and autologous iliac bone grafting. Postoperative care included adjuvant chemotherapy and physiotherapy. Postoperative outcomes were favorable, with evidence of graft integration and functional recovery at six months, alongside significant pain reduction and absence of local recurrence at one-year follow-up. The combination of biological and mechanical reconstruction techniques provided durable outcomes and restored limb function. This report underscores the importance of a multidisciplinary approach and highlights the efficacy of autograft-based biological reconstruction in managing extensive diaphyseal defects. The chosen method demonstrates a viable alternative to endoprosthetic reconstruction, particularly in patients with long-term survival potential
Functional and radiological outcomes of Madelung and Madelung-like deformities corrected with corrective osteotomies of radius with or without ulnar shortening
Get PDFBackground: Madelung deformity results from a bony and ligamentous dysplasia at the wrist, leading to palmar displacement of the hand on a shortened, bowed forearm. It is commonly associated with dorsal subluxation and prominence of the ulnar head, which collectively contribute to restricted wrist range of motion.
Methods: This study included 15 patients diagnosed with Madelung and Madelung-like deformity, with a mean age of 15 years (range: 10–21 years). All patients underwent clinical and radiographic evaluations. Various surgical techniques were employed, including dorsolateral closed-wedge osteotomy, open-wedge osteotomy, and dome osteotomy. Functional outcomes were assessed using the Modified Mayo wrist score, both pre- and post-operatively.
Results: Postoperative analysis revealed statistically significant improvements in wrist range of motion, pain relief, grip strength, radial inclination, and carpal slip. The modified Mayo wrist scores also demonstrated significant postoperative improvement.
Conclusions: Our findings suggest that surgical intervention plays a pivotal role in restoring wrist function by enhancing range of motion, increasing grip strength, and alleviating pain, ultimately contributing to improved functional outcomes and patient quality of life
Outcome of closed intramedullary fixation of femoral shaft fracture by titanium elastic nail in children
Get PDFBackground: Femoral shaft fractures are most common fractures in paediatric orthopaedic age group. The best treatment between six to fourteen years of age is a matter of debate. Titanium flexible elastic intramedullary nailing has become a well-accepted method of treatment of paediatric femoral shaft fractures. This study aims to evaluate the functional outcome of treatment of femoral shaft fracture by closed intramedullary titanium elastic nail (TEN) in children age between 6 to 14 years.
Methods: This prospective observational study was conducted over a period of two years from July 2017 to June 2019. Thirty children (23 boys, 7 girls) aged 6-14 years with femoral diaphyseal fractures were stabilized with retrograde titanium elastic nail. The results were evaluated by using Flynn’s TEN scoring criteria. Two nails were used in each fracture.
Results: Mean age was 11.1±1.8 years with male female ratio 3.3:1. Male patients were predominant in this study. Type of fracture were observed that 10(33.3%) cases were oblique, 18 (60.0%) cases were transverse and spiral 2 (6.7%). Radiological union in all cases were achieved in a mean time of 9.6±1.9 weeks. Objective evaluation showed that 21 (70.0%) patients had knee flexion >130°, 7 (23.3%) had restricted motion of 120–130°, and 2 (6.7%) had a range of 100–120°. The results were excellent in 23 patients (76.7%), satisfactory in 7 patients (23.3%) and there was no poor result.
Conclusions: TEN fixation of paediatric femoral shaft fractures is an excellent method of treatment in children aged 6-14 years
Modular custom prosthetic reconstruction of proximal tibia giant cell tumor: a case report and review of literature
Get PDFGiant cell tumors (GCTs) of bone are primary bone tumors that are benign in nature. They are biologically aggressive and have metastatic potential after malignant transformation. They occur in skeletally mature individual mainly in 3rd decade of life. Here, we present a case of a 29-year-old female diagnosed with right proximal tibia GCT, managed with en bloc excision and custom mega prosthesis arthroplasty
Knee arthrodesis with ring fixator for lower limb salvage after necrotizing fasciitis involving extensor apparatus
Get PDFNecrotizing fasciitis (NF) is a rare but severe infection with high morbidity and mortality, requiring urgent and aggressive intervention. This case describes a 64-year-old male who presented with septic arthritis of the knee complicated by NF and Streptococcal toxic shock syndrome. Despite early surgical debridement and empiric antibiotic therapy, the infection progressed, resulting in extensive necrosis of the knee extensor apparatus and exposure of the knee joint. Knee arthrodesis with a circular external fixator was performed, allowing for joint stabilization, soft tissue closure with skin grafts, and comprehensive functional rehabilitation. Six months post-discharge, the patient achieved pain-free, independent ambulation, avoiding amputation. This case underscores the feasibility of knee arthrodesis with a circular external fixator as a viable option for limb salvage in severe NF cases
Mid-term functional and structural analysis arthroscopic single-row repair in full thickness rotator cuff tear
Get PDFBackground: Purpose is to analyse functional scores and structural integration of cuff in Full thickness cuff tear patients treated with single row Arthroscopic rotator cuff repair (SR-ARCR) making it cost effective surgery in developing countries. Additionally, evaluation of Fatty atrophy, Glenohumeral arthritis, importance of subscapularis repair and role of biceps tenotomy was done.
Methods: 60 rotator cuff repairs with minimum 12 months follow-up and all treated by SR-ARCR. Functional Assessment by Constant Murley Score (CMS), UCLA score and structural assessment by Sugaya grading.
Results: Mean follow-up 35.93± 26.24 months with post operative mean constant murley (CMS) was 94.83±7.78 (p<0.001), mean UCLA 33.82±6.7 (p<0.001). Active forward flexion (AFF) 166.5±11.62(p<0.001), External rotation 79.17±10.13 (p<0.001), Muscle strength (0-25) 22.78±3.32(p<0.001), VAS 1.2±0.75(p<0.001), restoration of Acromio-humeral-distance (AHD) to 8.8±1.79(p<0.001). Sugaya 1(85%) having CMS 97.06±5.21 (p<0.001), Sugaya 2(10%) having CMS 82.67±9.42(p<0.001), Sugaya 3 (5%) having 81.33±6.35 (p<0.001).
Conclusion: Single row arthroscopic rotator cuff repair offers excellent outcomes cost effectively by reducing number of anchors and with supervised physiotherapy and rehabilitation protocols. Good structural integration of rotator cuff ensures better functional outcomes. Repair of Subscapularis to balance force couple, biceps tenotomy to decrease pain and medialised repair to decrease tension of repaired cuff improves functional scores. Restoration of acromio-humeral-distance decreases progression of gleno-humeral arthritis
Management of fracture shaft femur with ipsilateral un-united neck femur fracture with femoral neck system in situ, with review of fixation options
Get PDFIpsilateral fractures of the femoral neck and shaft are rare but complex injuries that require meticulous planning and surgical execution. The presence of a previously fixed but ununited femoral neck fracture using a novel implant, such as the femoral neck system (FNS), further complicates management. We present the case of a 23-year-old male who sustained a mid-shaft femur fracture following a road traffic accident. Notably, the patient had undergone surgical fixation of an ipsilateral femoral neck fracture two months prior using FNS. Radiographs revealed non-union of the femoral neck with early signs of avascular necrosis, along with a fresh shaft fracture. Surgical management included removal of the FNS and closed reduction with internal fixation using a cephalomedullary (sirus) nail. Proximal femoral fixation was augmented using two locking screws through the nail and one additional screw outside the nail. The patient had an uneventful postoperative recovery. At four-month follow-up, radiographs showed progressive union of both femoral neck and shaft fractures, with no radiographic signs of implant failure or further head collapse. This case illustrates the surgical challenges in managing sequential ipsilateral femoral fractures with prior implant in situ. Timely revision of the FNS and stabilization with a cephalomedullary nail allowed for successful outcome. Such complex cases require individualized surgical planning, and the combination of appropriate fixation techniques can yield satisfactory healing and functional recovery
Comparative study of the role of pronator quadratus repair versus no pronator quadratus repair in volar plate fixation of distal radius fractures
Get PDFBackground: There is a controversy regarding the merits of repairing pronator quadratus (PQ) following volar plate fixation of distal radius fracture via Henry’s approach. The aim of this study was to evaluate and compare the post-operative functional outcome between those with PQ repair vs those without PQ repair.
Methods: The 41 patients (33 males and 8 females) were included in this randomized controlled trial as per our inclusion and exclusion criteria. Of these 21 patients were in group A in which PQ repair was done and 20 patients were in group B in which PQ repair was not done. Both groups were compared with DASH score, wrist range of motion, post-operative pain and grip strength.
Results: The patients were followed up for minimum 1 year. Patients in both the groups shared similar baseline and demographic characteristics. There was no significant difference in the mean DASH score and mean grip strength at any point of time in follow up. However, wrist flexion at 6 weeks was better in group A (p=0.03) along with post-operative pain at 2nd and 6th week (p=0.035, 0.039).
Conclusions: PQ repair during volar plating of distal radius fractures does not provide any significant better functional outcome, range of motion and grip strength, especially in long run. But it reduced early post-operative pain significantly
Impact of anxiety, depression, and stress among knee osteoarthritis patients: a percentage-based study
Get PDFBackground: Mental health challenges play an important role in pain and progression of knee osteoarthritis (KOA). Two prevalent psychological comorbidities that affect patients' quality of life (QoL) are anxiety and depression. The functional condition of patients with KOA may be influenced by feelings of depression and anxiety.
Methods: The study was conducted on 108 individuals diagnosed with osteoarthritis knee according to European League Against Rheumatism (EULAR) classification knee OA. Age, gender, and body mass index (BMI) were recorded, pain and functional activities were assessed using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and depression, anxiety and stress scales-21 (DASS-21) was used for stress, anxiety, and depression.
Results: The 108 patients with osteoarthritis knee were included in the study. The mean age of patients was 55.92±0.8 years, and the mean BMI was 27.24±0.4 kg/m2. The majority of patients with knee OA had typical levels of stress (64.75%), anxiety (39.57%), and depression (50.36%). There was mild to severe degrees of stress (17.27–10.79%), anxiety (9.35–22.30%), and depression (20.14–22.30%). Anxiety had a higher prevalence of severe to extremely severe cases (28.78%) than depression (11.52%) and stress (7.19%), indicating the psychological load experienced by a subgroup of patients.
Conclusions: According to the findings, to maximize patient care and rehabilitation, psychological support, especially for anxiety, should be incorporated into the treatment of KOA