International Journal of Research in Orthopaedics
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Functional outcome of intracapsular neck of femur fracture treated in elderly with bipolar hemiarthroplasty at tertiary health care center
Get PDFBackground: Fractures of the neck of the femur are common in the elderly and are expected to rise significantly due to increased life expectancy. While conservative management has limited indications, surgical intervention remains the standard of care. Among surgical options, open reduction and internal fixation have shown high failure rates due to nonunion and avascular necrosis, leading to revision surgeries and increased morbidity. Aim of study was to evaluate the functional outcomes of intracapsular neck of femur fractures in elderly patients treated with cemented bipolar hemiarthroplasty.
Methods: This prospective observational study was conducted at a tertiary care hospital and included 60 patients aged 60 years and above with intracapsular femoral neck fractures. All patients underwent cemented bipolar hemiarthroplasty. Functional and clinical outcomes were assessed using the Harris hip score (HHS) during follow-up visits. Patient consent and comprehensive clinical evaluations were obtained on admission.
Results: The mean patient age was 69.88 years, with 55% females. According to Garden’s classification, 11.7% had grade I/II, 53.3% grade III, and 35% grade IV fractures. At 3 months post-surgery, 45% had poor, 43.3% fair, and 11.7% good functional outcomes.
Conclusions: Cemented bipolar hemiarthroplasty for intracapsular femoral neck fractures in the elderly offers favorable functional outcomes, reduces complications associated with prolonged immobilization, and facilitates early rehabilitation and return to activity
Clinical efficacy of single intra-articular platelet-rich plasma injections in mild to moderate knee osteoarthritis: a prospective study
Get PDFBackground: Knee osteoarthritis (OA) is a degenerative joint disease that significantly impacts mobility and quality of life, particularly in older adults. Conventional treatments often provide limited relief, leading to interest in regenerative therapies like platelet-rich plasma (PRP) injections. This study aims to evaluate the clinical effects of a single intra-articular PRP injection in patients with mild to moderate knee OA.
Methods: A prospective, randomized study was conducted with 56 patients aged 40 to 70 years diagnosed with primary knee OA (Kellgren-Lawrence grades 1 and 2). Participants were treated with a single intra-articular PRP injection, prepared using the double-spin technique. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, and follow-up assessments were performed at 1 week, 4 weeks, 8 weeks, 12 weeks, and 6 months post-injection.
Results: Significant improvements in both pain and function were observed. The mean VAS score decreased from 7 at baseline to 4 at 12 weeks, and to 3 at 6 months. The mean WOMAC score improved from 53 at baseline to 30 at 12 weeks, and 24 at 6 months. These changes were statistically significant (p <0.05). No major adverse events were reported during the study period.
Conclusion: A single intra-articular PRP injection significantly reduces pain and improves function in patients with mild to moderate knee OA. PRP therapy is a promising treatment option for managing knee OA, offering an alternative to more invasive procedures. Further studies are needed to explore the long-term effects and optimal treatment protocols.
Comparative analysis of tension band wiring and cannulated cancellous screws for displaced medial malleolus fractures: a prospective study
Get PDFBackground: The displaced medial malleolus fractures require surgical intervention, and the management includes tension band wiring (TBW) and cannulated cancellous screws (CCS).
Methods: This prospective randomized study was conducted from December 2019 to December 2022. Sixty patients with closed displaced medial malleolus fractures were randomized into two groups: group A (TBW) and group B (CCS). Patients were evaluated based on radiological fracture union and functional outcomes assessed using the modified Olerud and Molander ankle score (OMAS). Follow-ups were conducted for two years to assess healing, range of motion, complications, and functional outcomes.
Results: Mean age was 41.46 years in group A (TBW) and 39.4 years in group B (CCS). Radiological union was achieved faster in group B (10.4 weeks) compared to group A (11.53 weeks, p=0.003). Functional outcomes showed excellent scores in 16.67% of group A patients and 30% of group B patients. Group B had fewer complications, with only one case of screw loosening compared to a higher rate of hardware prominence (30%) and exertional pain (10%) in group A, necessitating implant removal in 12 patients. No significant differences in range of motion were observed, although group B demonstrated slightly better functional outcomes.
Conclusions: Both TBW and CCS effectively achieve fracture union in displaced medial malleolus fractures. However, CCS fixation demonstrates superior functional outcomes, faster union rates, and fewer complications compared to TBW. Lower risk of hardware-related issues and reduced need for secondary surgeries, CCS is recommended as a preferred method for the surgical management of displaced medial malleolus fractures.
Incidence and risk factors of adjacent segment disease following short segment posterior instrumentation in Bahraini patients: a five-year retrospective analysis
Get PDFBackground: Despite advances in spinal surgery, adjacent segment disease (ASD) and adjacent disc degeneration (ADD) remain notable postoperative complications following spinal fusion, mainly due to suspected increased biomechanical stress that leads to adjacent disc degeneration. This research focuses on the Bahraini population, utilizing MRI to compare pre-op and post-op Adjacent disc conditions to identify the incidence and risk factors of ASD and ADD after short segment spinal fusion.
Methods: A retrospective cohort study conducted over a five-year period at Salmaniya Medical Complex, the largest tertiary care center in the Kingdom of Bahrain. Reviewing pre-operative and post-operative MRI scans of 41 symptomatic patients who underwent short segment spinal fusion between 2014 and 2019. Patients were selected based on specific pre-operative and post-operative criteria developed by the orthopaedic team and were followed up to October 2023. Statistical analyses were performed using R software.
Results: The analysis of 41 patients revealed a significant incidence of adjacent segment changes and the main risk factor that showed significance was advancing age. While other reported risk factors like level of fusion and number of fused segments did not significantly correlate with advancing ADD or ASD. There was no statistically significant association between hypertension, diabetes or multiple comorbidities and worsening conditions for either ASD or ADD post operation.
Conclusions: The findings from our study contribute to the understanding of ASD and ADD after lumbar fusion surgeries, particularly in highlighting the significance of age. These insights can aid surgeons in better anticipating the risks associated with specific demographic and clinical profiles. More controlled studies on larger populations will help delineate more concrete risk factors
Humeral lengthening by Ilizarov technique due post neonatal septic arthritis: a case report
Get PDFSeptic arthritis is an acute infection that occurs more frequently in children, is monoarticular, and most frequently affects the knee and hip. The main long-term sequelae of shoulder septic arthritis is shortening of the humerus and deformity of the affected joint. Humeral lengthening, whether unilateral or bilateral, is a valid method that improves the outcome following arm shortening and deformity correction. We presented the case of a teenager with sequelae of septic arthritis of the shoulder. He had dysmetria of the upper limbs of 120 mm, with shortening of the left humerus and humeral head subluxation. He underwent humerus osteotomy and humeral lengthening according to the Ilizarov technique. Currently, he presents some dysmetria, but have normal mobility. Radiologically we achieved 80 mm lengthening and reduce the humeral head, which was initially dislocated. Diagnosis of neonatal septic arthritis requires a high index of clinical suspicion. Humeral lengthening in post-septic shortening with the application of Ilizarov fixator is an effective, safe, reliable method
Complications and associated risk factors of open reduction and internal fixation among adult patients with tibial plateau fractures
Get PDFBackground: Tibial plateau fractures are complex injuries that often require open reduction and internal fixation (ORIF) for optimal recovery. However, complications and risk factors associated with ORIF can significantly impact patient outcomes. This study aimed to evaluate the complications and associated risk factors of open reduction and internal fixation and their effect on functional recovery in adult patients with tibial plateau fractures.
Methods: This prospective observational study was conducted in the Department of Orthopaedics and Traumatology, Chittagong Medical College Hospital, Chattogram, Bangladesh, from January 2018 to December 2019. This study included 50 adult patients of both genders with high-energy tibial plateau fractures through a consecutive sampling technique. Functional outcomes were assessed over six months and statistical associations with risk factors were examined.
Results: The mean age of patients was 43.95±10.89 years, with a male predominance (76%). The most common fracture type was Type VI (72%) and the majority were closed fractures (84%). The average time from injury to surgery was 11.05±3.203 days, with a mean operative duration of 107±12.074 minutes. At six months, 82% of patients achieved excellent functional outcomes, while 10% had good and 4% each had moderate and poor outcomes. The mean fracture union time was 15.39±1.614 weeks. Infection significantly affected recovery (p=0.008), with 92.7% of infection-free patients achieving excellent results, whereas 33.3% of those with superficial infections had moderate outcomes and all patients with deep infections had poor outcomes. Gender also had a significant impact (p=0.047), with 80.4% of males achieving excellent outcomes compared to 19.5% of females.
Conclusions: The findings show that ORIF in tibial plateau fractures generally results in favorable outcomes, but factors like gender and post-operative infections significantly influence recovery. Effective infection control and individualized patient management may enhance surgical success and functional outcomes
Clinical benefits of undenatured chicken collagen type II Unstergen® as a nutritional therapy in the management of osteoarthritis: a double-blind, placebo controlled clinical study
Get PDFBackground: Osteoarthritis (OA) is a degenerative joint disease affecting millions globally, often leading to pain and reduced mobility. Nutraceuticals like undenatured chicken collagen are gaining attention for their potential in symptom relief. This proof-of-concept study evaluates the clinical efficacy of Unstergen® of Titan Biotech Limited in the management of OA.
Methods: This randomised, double-blind, placebo-controlled study studies 48 adults with OA. Subjects received 40 mg/day of Unstergen® (n=32) or placebo (n=16) once a day for 90 days. Outcomes were assessed using WOMAC score, pain scale, quality of life questionnaire (QoL) for all and global rating of change scale (GROC) using X ray of target joint for a cohort of 12 subjects.
Results: Unstergen group demonstrated statistically significant reduction of 20.39% in Western Ontario and McMaster universities osteoarthritis index (WOMAC) scores and 37.77% in pain numerical rating scale (Pain NRS) compared to 7.24% and 8.70% reduction in the placebo arm, respectively. The 90.32% subjects reported improvement in QoL compared to placebo (p<0.05). The 87.50% subjects were deemed to have marked improvement on their X ray while no subject in the placebo arm showed improvement after 90 days. No adverse event was attributed to Unstergen and was deemed clinically safe.
Conclusions: Unstergen® demonstrated significant improvement in pain, function and QoL; highlighting its role as a novel nutraceutical supplementation therapy for OA
Endoscopic calcaneoplasty with flexor hallucis longus transfer for the management of Haglund syndrome
Get PDFHaglund syndrome consists of a triad of posterosuperior calcaneal exostosis (Haglund deformity), retrocalcaneal bursitis, and insertional Achilles tendinopathy. Endoscopic resection of this prominence along with flexor hallucis longus (FHL) transfer is a novel technique for the treatment of Haglund syndrome. The purpose of this study is to evaluate the outcome of 10 patients presenting with Haglund disease treated by an endoscopic Haglund resection and FHL transfer. In this study, from April 2023 to August 2024, we have taken up 10 patients presenting with heel pain, diagnosed as insertional Achilles tendinopathy (IAT) with Haglund’s based on clinical findings of tenderness along Achilles tendon 2 cm proximal to the point of insertion and radiographs, with failed conservative treatment. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. A mean of 71.2 preoperative AOFAS-hind foot score which showed a significant improvement postoperatively to 3 (VAS), 82 (AOFAS) at the end of 1.5 months, 2 (VAS), 96 (AOFAS) at the end of 4 months and 1 (VAS), 97 (AOFAS) at 6 months respectively. Endoscopic calcaneoplasty with FHL transfer is a minimally invasive technique which has led to a significant improvement in preoperative and postoperative AOFAS scores and has resulted in faster recovery times with less complications
Comprehensive management of high-grade knee injuries: a case report and surgical technique on patellar tendon rupture with multi ligament injury following self reduced posterior dislocation of knee
Get PDFKnee dislocations and patellar tendon ruptures are rare but complex injuries. Incidence of patellar tendon rupture is approximately 0.5% of the general population each year. These injuries are often present with a wide range of symptoms, depending on the structures involved. Significant soft tissue damage is almost always present, frequently accompanied by multi-ligamentous injuries and bony involvement. The potential for neurovascular compromise, particularly injury to the popliteal artery, adds to the urgency of prompt diagnosis and management and are considered as surgical emergencies. Delayed diagnosis or inadequate treatment can lead to devastating complications. A 42-year-old male presented with a high-grade knee injury diagnosed with a complete patellar tendon rupture, complete anterior cruciate ligament (ACL) disruption, and partial posterior cruciate ligament (PCL) tear, along with complex tears in both the medial, lateral menisci and osteochondral fractures, posing challenges for surgical planning. Single stage surgical intervention was planned. ACL reconstruction with peroneus longus tendon graft, medial meniscal balancing, lateral meniscal root repair and semitendinosus graft was harvested with an open stripper with insertion kept intact for patellar tendon repair with augmentation. PCL and collateral ligaments were managed conservatively since they found stable. A tailored rehabilitation protocol focused on early mobilization and progressive strengthening was implemented postoperatively. This case highlights the complexity of high-grade knee injuries involving multiple structures and the importance of thorough evaluation and surgical intervention. The tailored rehabilitation protocol facilitated recovery, leading to significant improvements in range of motion (ROM) and functionality. Individualized management strategies are crucial for addressing these complexities, ultimately enhancing patient outcomes and minimizing complications
A case of post-COVID Aspergillus fumigatus spondylodiscitis
Get PDFSpondylodiscitis caused by Aspergillus fumigatus is rare, particularly in immunocompetent individuals. This case highlights a unique instance of post-COVID Aspergillus spondylodiscitis, emphasizing the potential role of COVID-19-related immune dysregulation in predisposing patients to opportunistic fungal infections. A 75-year-old man with a history of hypertension, hypothyroidism, and severe COVID-19 (requiring ICU admission and steroid therapy) presented with chronic low back pain and acute bilateral lower limb weakness. Imaging revealed L1-L2 disc space narrowing, vertebral destruction, and epidural compression. Histopathological and microbiological analyses confirmed Aspergillus fumigatus infection. The patient underwent surgical decompression, debridement, and posterior stabilization, followed by intravenous voriconazole therapy, resulting in significant clinical improvement. This case underscores the importance of considering fungal etiologies in spondylodiscitis, especially in post-COVID patients with persistent symptoms. A multidisciplinary approach involving radiological, microbiological, and histopathological evaluation is critical for timely diagnosis and management. Combined surgical and antifungal therapy yielded favorable outcomes, aligning with existing literature recommendations. Further research is needed to explore the link between COVID-19 and opportunistic fungal infections.