International Journal of Research in Orthopaedics
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Comparison of arthroscopic capsule release and manipulation under anaesthesia for frozen shoulder: a prospective randomized single blinded interventional study
Get PDFBackground: Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain, affecting approximately 2% of the population. Despite its prevalence, the exact aetiology remains unclear, leading to varied treatment protocols. Among the available interventions, manipulation under anaesthesia (MUA) and arthroscopic capsular release (ACR) are widely used for refractory cases, though comparative data on their outcomes are limited. Aim: To compare early clinical outcomes, complications and pain relief between MUA and ACR in patients with refractory adhesive capsulitis.
Methods: A prospective, randomized, single-blinded study was conducted from November 2020 to April 2022 at a tertiary care hospital. Forty-four patients with refractory adhesive capsulitis were randomized into two groups: MUA (n=22) and ACR(n=22). Preoperative evaluations included clinical and ultra-sonographic examinations. Postoperative outcomes were assessed at 2, 4 and 12 weeks using the Visual Analogue Scale (VAS), Oxford Shoulder Score (OSS) and range of motion (ROM) measurements.
Results: Both groups demonstrated significant improvements in pain and ROM. However, ACR yielded superior results, with a greater reduction in VAS scores (8 to 1in ACR vs. 8 to 3 in MUA) and better ROM at 12 weeks. Forward flexion improved from80º to 180º in the ACR group, compared to 70º to 170º in the MUA group. External and internal rotation improvements were also significantly greater in the ACR group.
Conclusions: Arthroscopic capsular release, combined with an exercise regimen, provides significantly better pain relief and functional recovery compared to MUA in refractory adhesive capsulitis.
Diagnostic accuracy of digital imaging and computed tomography in calcaneal fracture evaluation
Get PDFBackground: Initially, suspected calcaneal fractures are typically evaluated using conventional radiography. However, contemporary classification systems for calcaneal fractures rely heavily on computed tomography (CT) due to its ability to provide three-dimensional imaging, which offers a more comprehensive assessment than traditional two-dimensional plain radiography. This study aimed to investigate and compare the diagnostic efficacy of digital X-ray imaging versus computed tomography in evaluating calcaneal fractures.
Methods: This study was conducted S.M.S Medical College Jaipur on 40 patients with isolated calcaneal trauma and was diagnosed radiologically by plain X-ray and CT to have calcaneal fractures. lateral view images was obtained to measure the Böhler’s angle, the angle of Gissane, the inclination angle and the facet height. Each angle was measured by two different interpreters (a senior radiologist and a resident) in order to verify accuracy.
Results: A statistically significant difference was observed between Digital X-ray and CT image findings in both intra-articular fractures and total fractures. Specifically, significant differences were noted in the measurements of Bohler's angle, the angle of Gissane and facet height, whereas no significant difference was found in the inclination angle. These findings highlight the superior diagnostic accuracy of CT imaging in assessing calcaneal fractures.
Conclusions: Computed Tomography (CT) scanning has emerged as a indispensable, non-invasive diagnostic tool, widely adopted for its exceptional utility in accurately identifying, classifying and informing treatment strategies for both extra-articular and intra-articular calcaneal fractures, thereby revolutionizing the management of these complex injuries
A comparative study between intravenous alone and combined intravenous and intra-articular administration of tranexamic acid in primary total knee replacement patients
Get PDFBackground: With the better understanding of the total knee arthroplasty, the number of patients with extremes of ages and advanced comorbidities undergoing total knee arthroplasty are increasing. The most common post-operative complication remains the blood loss. The intravenous use of tranexamic acid was initially thought to decrease the blood loos. Over the past years, intra-articular administration of Tranexamic acid is also being used to reduce the blood loss. Now there is an increasing trend to combine the intravenous and intra-articular route for tranexamic acid in patients undergoing total knee arthroplasty. There are very few studies that evaluates or compares the intravenous and combination of intravenous and intra-articular route of tranexamic acid in total knee arthroplasty patients.
Methods: Two Hundred and two patients with severe knee osteoarthrosis planned for total knee arthroplasty were selected in accordance to inclusion and exclusion criteria. Patients were divided into Group A and B and was administered with combination of intravenous and intra-articular tranexamic acid for Group A patients and intravenous tranexamic acid for Group B patients .The outcome was measured in terms of blood loss in post-operative day one calculated using classical Nadir Method.
Results: The blood loss were found to be 328.04±178.9 ml in Group A and 362.88±220.408 ml in Group B. The p value was found to be greater than 0.005 and hence the difference in post-operative blood loss in both group was not statistically significant.
Conclusions: There is no difference between the combination of Intra-venous Transexmic and Intra-articular Tranexamic acid when compared with intravenous Tranexamic acid in reducing blood loss in patients undergoing total knee arthroplasty
Surgical outcome of brachial plexus surgery: our experience
Get PDFBackground: Brachial plexus injuries (BPIs) result in significant functional impairments, especially in developing countries like Bangladesh, where road traffic accidents are common. Advances in microsurgical techniques, such as nerve transfers and grafting, have improved outcomes. This study aims to evaluate the surgical outcomes of BPIs and contribute to optimizing treatment strategies for better recovery and functional restoration in patients with these complex injuries. To evaluate surgical outcomes, assess functional recovery and compare various surgical techniques for BPI management.
Methods: This prospective observational study, conducted from May 2013 to March 2025, included 95 patients with post-traumatic BPIs from four major hospitals. Surgical interventions, including nerve transfers and grafting, were performed based on injury type. Preoperative and postoperative data were collected, including motor function assessment and patient rehabilitation outcomes, with follow-up at regular intervals for recovery monitoring.
Results: The study included 95 patients with brachial plexus injuries, predominantly in the 18–30 age group (63.16%) and male (63.16%). The most common injury type was upper brachial plexus (42.1%), followed by global injuries (21.1%). Nerve transfers, especially Oberlin II, were the most performed surgery (31.6%). Postoperatively, 42.1% achieved good motor recovery (Grade 4), while 26.3% had excellent recovery (Grade 5). The follow-up ranged from 0–25+ months.
Conclusions: Microsurgical techniques have improved brachial plexus injury management, but full upper limb function recovery remains suboptimal, especially in global injuries.
Functional outcome of intramedullary screw fixation of fifth metatarsal Jones fracture
Get PDFBackground: Management of fractures of the base of 5th metatarsal has long been a topic of debate, particularly regarding the effectiveness of operative and non-operative treatment approaches. This study aimed to evaluate the outcomes of internal fixation using an intramedullary screw in management of Jones fracture.
Methods: Twenty-one patients diagnosed with Jones fracture were surgically fixed with intramedullary screw and were evaluated on the basis of union time and the American Orthopaedic Foot and Ankle Society score at 6 weeks and 12 weeks.
Results: Overall union time of the study patients was 6.76 weeks (SD=0.768). There was a non-significant relationship between age and union time (r=0.146, p=0.528) in the patients. The overall mean AOFAS score at 6 weeks increased from 87.43±5.005 to overall mean score 94.09±2.364 at 12 weeks after treatment. There was a significant negative correlation between age and AOFAS at 6-weeks (r=-0.673, p<0.001) and at 12-weeks (r=-0.542, p=0.011) post treatment.
Conclusions: The treatment with surgical screw fixation is safe and effective method for treatment of acute Jones fracture and can be strongly recommended in those who want to return to normal activity earlier.
Outcome of closed tibial diaphyseal fracture managed by intramedullary interlocking nail through suprapatellar approach
Get PDFBackground: Tibial fractures are among the most common long-bone injuries, and their subcutaneous location makes management challenging. Intramedullary fixation is the preferred treatment for diaphyseal tibial fractures, though the optimal approach remains debated. The suprapatellar approach is increasingly favored by surgeons.
Methods: A prospective observational study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, from September 2021 to March. Thirty-three patients with closed diaphyseal tibial fractures meeting the selection criteria were treated with intramedullary interlocking nails using a suprapatellar approach and followed up for 12 months.
Results: The mean age was 38.3±11.6 years, with 70% male patients. The mean duration from injury to surgery was 13.4±3.3 days. Anterior knee pain occurred in only 5 patients (15.2%). The mean VAS score was 0.5±1.1 (range 0–4). Union time averaged 17.9±3.5 weeks; delayed union occurred in 2 cases (6.1%) and nonunion in 1 case (3%). The mean arc of knee motion was 130.3±8.6 degrees. Functional outcome assessed via Lysholm knee score averaged 93.8±8.9. Outcomes were excellent in 72.7%, good in 18.2%, and fair in 9.1% of patients.
Conclusions: Intramedullary nailing using the suprapatellar approach for tibial diaphyseal fractures demonstrates favorable outcomes, including high Lysholm scores, low complication rates, reliable union, improved knee motion, and reduced anterior knee pain
Evaluation of the result of open reduction and internal fixation of transverse fracture of acetabulum by reconstruction plate and screws through Kocher-Langenbeck approach
Get PDFBackground: Acetabular fracture occurs from high-velocity injury and affects young, economically productive populations. Previously, treatment was inadequate, leaving patients with incapacitating pain and limited movement. Proper management in our setup is needed to save lives and minimize long-term complications. This study evaluated the outcome of open reduction and internal fixation of transverse acetabular fractures.
Methods: This prospective observational study was conducted at Dhaka Medical College Hospital from July 2017 to June 2019. A total of fifty patients with transverse fracture of acetabulum within 3 weeks of incidence were enrolled in this study. Radiological and functional outcomes were evaluated six months post-surgery using Matta's radiographic criteria and Merle d'Aubigne and Postel criteria. Effects of age, gender, hip dislocation, fracture displacement, reduction quality and trauma on surgery time were evaluated.
Results: Mean age was 36.2±14.12 years. Male and female ratio was 48:2. Mean follow-up 8.5±1.7 months, range 6-12 months. According to Matta's criteria, 24 patients had excellent, 8 good and 18 fair radiological outcomes. Per Merle d'Aubigne and Postel criteria, 20 patients had excellent, 10 good, 2 fair and 18 poor functional outcomes. Overall, 38 patients (76%) showed satisfactory and 12 patients (24%) unsatisfactory outcomes. Heterotrophic ossification occurred in 1(4.0%) patient. 20 patients achieved anatomic (0, 1 mm) reduction, 3 achieved imperfect (2,3 mm) reduction and 2 achieved poor (>3 mm) reduction.
Conclusions: Open reduction and internal fixation of transverse acetabular fracture is a satisfactory treatment method
Association between haemoglobin A1C/albumin ratio and deep postoperative infection after total joint arthroplasty: a single centre study
Get PDFBackground: Till the time in modern practice in a centre where total joint arthroplasty (TJA) including hip and knee mainly is being done in high volume (>100 TJA in a month), there are no guiding parameters to estimate the risk of developing periprosthetic infections in diabetes mellitus. This study aims to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus (DM) and to investigate the predictive significance of the HbA1c/albumin ratio, so that a guideline can be given to avoid such dreaded complication in diabetic patients.
Methods: Between January 2019 and January 2023, 490 patients who underwent total joint arthroplasty were analysed.187 diabetic patients were included in the study. 28 of them had periprosthetic infection. Six risk factors (Hba1c/albumin, age, BMI, ASA, length of hospital stay, and surgical duration) were analysed.
Results: The rate of HbA1c/albumin was 13.9 times higher than the patients with ≤2.35 cut off value. (Hba1c/albumin ratio (odds ratio (OR)=13.9, 95% CI: 3.18-67.1, p: 0.01). BMI (OR=1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR=0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR=1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR=0.503, 95% CI: 0.109-2.314, p: 0.378) was not found to be a significant risk factor for periprosthetic infection.
Conclusions: In view of our observation in present study we analysed that the HbA1c/albumin ratio has a reliable prognostic indicator than other risk factors in determining the chances of catching the risk of periprosthetic infection after TJA. HbA1c/albumin ratio is a cost effective and easily available parameter to many centres without posing much cost burden. Patients with an HbA1c/albumin cut-off ratio above 2.35 mg/dl in TJA better should avoided from surgery and should be followed more closely for the risk of periprosthetic infection after TJA
Outcome of dome osteotomy for correction of angular deformity around knee: a case series
Get PDFAngular deformities around the knee, such as genu valgum, genu varum, and recurvatum, can lead to significant functional impairments and pain. Dome osteotomy is a surgical procedure designed to correct these deformities by providing high adjustability, stability, and avoiding limb length discrepancies. This retrospective cohort study involved 20 patients, aged 16 to 23 years, who underwent dome osteotomy for knee deformities between January 1, 2023, and December 31, 2023. The study was conducted at a government tertiary care center and medical college. Preoperative assessments included detailed medical history, physical examination, and radiographic evaluations. The surgical technique involved a cylindrical bone cut centered at the CORA, with postoperative management including immobilization and gradual weight-bearing.The mean preoperative intermalleolar distance (IMD) was 14.52 cm, which improved to 6.85 cm postoperatively (p<0.0001). The clinical tibiofemoral angle improved significantly in both bilateral (from 20.35 degrees to 12.92 degrees, p<0.0001) and unilateral cases (from 18.67 degrees to 8.67 degrees, p<0.004). Patients reported significant pain relief, improved stability, and enhanced mobility during follow-ups. Dome osteotomy is an effective and reliable surgical technique for correcting angular knee deformities. Its high adjustability, stability, and avoidance of limb length discrepancies contribute to significant improvements in clinical and radiological outcomes, enhancing patient quality of life and preventing long-term complications
Results of surgical management of unstable proximal humeral fractures by proximal humeral locking plate
Get PDFBackground: Unstable fractures of the proximal humerus present a significant surgical challenge despite the variety of treatment options available. One effective surgical method for managing these fractures is the use of a proximal humerus locking plate. This approach provides stability and support to the fracture site, facilitating proper healing and potentially improving patient outcomes. The aim of this study was to evaluate the outcome of treatment of unstable proximal humeral fractures with proximal humeral locking plate.
Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 100 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study.
Results: The mean age of patients with unstable proximal humerus fractures was 41.53 years, ranging from 23 to 78 years. Most patients were male and primarily in business occupations. Fracture types included three-part fractures (53%), four-part fractures (7%), and fracture dislocations (40%). The mean time to plate fixation was 18 days, with a range of 2 to 78 days. High-velocity accidents caused 93% of injuries. Complications included avascular necrosis (7%), screw loosening (7%), and subacromial impingement (13%), with no reoperations needed.
Conclusions: The result of the study demonstrates that the proximal humeral locking plate provides sufficient fracture stabilization in the treatment of unstable proximal humeral fractures.