International Journal of Research in Orthopaedics
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Comparative study of functional outcome and complication in low profile recon plates vs anatomical anteromedial distal tibial plate in extra articular distal 4th tibia fibula fracture
Get PDFBackground: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as intramedullary nailing, open reduction and internal fixation (ORIF) with conventional plate osteosynthesis and external fixation have reported good functional outcomes but had a high complication rate. We decided to review the results of treatment of extra articular distal 4th tibia fracture using low profile plates.
Methods: The 30 patients with distal 1/4rd tibia extra-articular fractures with or without associated fibula fractures were treated with anatomical anteromedial distal tibia plate vs low profile recon plate. The present prospective study was conducted in department of orthopaedics, MGMMC and M. Y. hospital, Indore between January 2023- May 2024.
Results: All fractures had excellent clinical and functional outcome, with an average operative time of 49 minutes. The age of the patients ranged from 18 to 60 years (mean 42.7 years). Assessment on basis of Karstorm and Oleruad score at 6-month post treatment showed that majority of patients had excellent score (56.7%). Poor outcome was reported in only 3.3% patient. Most common complication was ankle stiffness in both type of plating groups followed by deep infection.
Conclusions: Both types plate showed similar functional outcome. However, low profile recon plate had lesser complications as compared to anatomical plates i.e., hardware like sensation, wound dehiscence ankle stiffness, deep infection and screw breakage
Epidemiology of humerus shaft fractures in children-observational study of 50 patients
Get PDFBackground: Objective was to study the epidemiology of humerus shaft fracture in children.
Methods: This was an observational study of 50 cases of humeral diaphyseal fractures in children aged between 5 to 15 years reporting to tertiary care center over a period of 18 months. Each patient was categorized with respect to age, sex, mode of trauma, side injured, type of fracture, associated injuries, modality of treatment given.
Results: Most patients belonged to upper lower class (66 %), and 80% patient belonged to rural population. Boys (60%) were more prone to have humerus shaft fracture than girls. Mean age of the patient were 10.12 years (±2.6 SD). Most common mode of trauma was accidental fall on arm (68%). Traumatic fracture was noted in 94% of cases while 6 % cases were having pathological fracture. Most patients were having middle third shaft fracture (40%), followed by distal third (30%) and lastly proximal third (22%), and left side involvement (58%) was more. Out of the 50 patients, poly trauma was observed in 4 cases, multiple bone fracture was noted in 2 cases, while 2 patients were having fibrous dysplasia and 1 with bony cyst as an associated cause of pathological fracture and 1 patient had radial nerve injury pre-operatively.
Conclusions: The findings of this study provide valuable insights into the epidemiology of humerus shaft fractures in children in respect to age, sex, socio-economic status, mode of trauma. These data can help understand the risk factors and help in preventing the incidence. Most of these fracture can be managed successfully with retrograde titanium elastic nailing system (TENS) nailing with minimal complications.
Essential amino acids in total knee and hip joint replacement: a narrative review
Get PDFThe increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA
Unstable trochanteric fractures treated with proximal femoral nail show functional outcomes independent of the fracture type
Get PDFBackground: The proximal femoral nail has replaced the sliding hip screw devices and gamma nails as the implant of choice for unstable trochanteric fracture (AO 31A2-A3). In our study we aimed to find a correlation between fracture type, time taken for radiographic union and their functional outcome according to Harris Hip score at 6 months after PFN fixation of such fractures.
Methods: We assessed 38 patients sustaining unstable (AO 31A2-A3) trochanteric fractures. All the fractures were treated with short PFN. Functional outcome was assessed according to the HHS at sixth month follow-up.
Results: No statistically significant association was found between HHS with fracture type (p=0.184) and bone union time (p=0.587). The association between bone union time and fracture type was found to be statistically significant (p=0.007).
Conclusions: Functional outcome (HHS) does not depend upon the fracture type
Chondroblastoma of the anterior process of calcaneus: a case report:
Get PDFChondroblastoma of the calcaneus is a fairly uncommon tumour. Despite being a benign and indolent lesion, chondroblastoma of the calcaneus can lead to functional limitations, due to its location in such a weight-bearing bone. This report presents a rare case of chondroblastoma affecting the anterior process of the calcaneus, which was successfully treated with extended curettage and synthetic bone graft substitute, resulting in favourable functional outcomes at 13 months post-surgery. This case underscores the importance of timely recognition and appropriate management of this uncommon tumour to achieve optimal patient outcomes
Surgical and functional outcome of management of anterior column with posterior hemitransverse fracture of acetabulum
Get PDFFractures of acetabulum are relatively uncommon, but as they involve the major weight bearing joint in lower extremity, they assume great clinical importance. The displaced acetabular fracture fragments result in hip joint incongruity which in turn leads to abnormal pressure distribution over the articular cartilage surface. This may lead to accelerated breakdown of the articular cartilage, resulting in disabling irreversible arthritis of hip joint. The aim of treatment of these difficult acetabular fractures is concentric reduction of femur head under the weight bearing dome of acetabulum resulting in anatomic reduction and followed by a stable fixation. This can be achieved only by adequately exposing the acetabulum and by rigid internal fixation. In our series 20 patients were included. Majority of the patients were males with mean age of 43.85±16.88 years. Most common mechanism of injury was road traffic accident. Right side was most affected. Most of the cases were isolated injuries. Majority of the cases had no complications. At the final follow up, most of the cases had Excellent follow-up according to Modified Merle d’Aubigne and Postel score. Surgical management of Anterior column with posterior hemitransverse fracture of acetabulum gives excellent outcomes with least number of complications
Conversion of the primary aneurysmal bone cyst into osteogenic sarcoma following treatment with percutaneous sclerotherapy using polidocanol injection
Get PDFThe intralesional injection of sclerosing agents has been identified as a safe method for treating primary aneurysmal bone cysts (ABC). However, to the best of our knowledge, there have been no reported instances in the literature of a primary ABC transforming into osteogenic sarcoma following complete healing facilitated by an intralesional sclerosing agent, such as polidocanol. We present the case of a 20-year-old female diagnosed with a histologically proven primary ABC located at the distal end of the tibia. She underwent a series of 5 intralesional injections of 3% polidocanol (hydroxypolyaethoxydodecan) and achieved complete clinical and radiological healing. However, after 10 years, her symptoms resurfaced, and subsequent histological examinations revealed osteogenic sarcoma. Surgical excision was performed, followed by bone grafting and ankle arthrodesis. This case suggests that intralesional alcohol injections might not prevent the inherent potential for malignant transformation of primary ABCs. To ascertain whether such injections increase the risk of sarcomatous conversion, further long-term follow-up studies are imperative
Incidence of K-wire fixation of upper limb fractures for road traffic accidents in Bangladesh
Get PDFBackground: Road traffic accidents (RTAs) are a significant public health issue globally, particularly in developing countries like Bangladesh. This study focuses on the epidemiological and clinical aspects of upper limb fractures resulting from RTAs, with an emphasis on the treatment modalities employed.
Methods: This retrospective observational study analyzed hospital records of 40 patients with upper limb fractures due to RTAs at Chakaria Unique Hospital, Cox’s Bazar, Bangladesh, within the period of 1 year, from February 2023 to January 2024. The study included cases with comprehensive documentation of fractures resulting specifically from RTAs. Excluded were injuries not related to upper limb fractures and those not caused by RTAs. The focus was on patient demographics, the nature of the fractures, treatment methods (particularly K-wire fixation), and documented outcomes.
Results: The majority of the patients were young males, with the highest incidence in the 21-30 age group (40.00%). Two-wheeler vehicles were the leading cause of these injuries (57.50%). Treatment modalities varied, with open reduction and internal fixation (ORIF) combined with K-wire fixation being the most prevalent (35.00%). Other methods included ORIF alone and ORIF with plate-screw, each accounting for 25.00% of cases. Right-sided injuries were more common (57.50%) than left-sided (42.50%).
Conclusions: The study highlights the predominance of upper limb fractures in younger males due to two-wheeler accidents. The preference for combined ORIF and K-wire fixation in treatment reflects the complexity of these injuries. The findings call for enhanced road safety measures and further research into optimized treatment protocols for upper limb fractures in Bangladesh
Assessment of clinical, functional and radiological outcomes in patients with fracture of distal end radius managed with close reduction and internal fixation with multiple percutaneous K wires: a prospective, single centre study
Get PDFBackground: Distal end radius fractures are one of the commonest fractures, occurring in all the age groups. Different treatment modalities have been described in the literature ranging from conservative to operative including close/open reduction to external fixation. Our prospective study aimed at evaluating the outcomes and complications in these fractures managed by close means with multiple percutaneous K wires.
Methods: All the patients with distal end radius fracture were treated with close reduction and internal fixation with multiple percutaneous K wires. They were then evaluated clinically with visual analogue scale (VAS) score, functionally with Mayo wrist score and radiologically with Sarmiento’s modification of Lindstrom’s criteria on the follow ups.
Results: The study included a total of 152 patients (88 females and 64 males) with mean age being 49.5±10.4 years, with fall on outstretched hand being the most common mode of injury, and dorsal displacement (73.7%) being the most common X-ray finding. Maximum patients in the study had A2.2 fracture (80 patients) followed by C1.2 fracture type (36 patients). There was clinically and statistically significant improvement in the mean VAS scores on follow ups. Excellent functional and radiological outcomes were seen in 124 patients and 108 patients respectively.
Conclusions: Close reduction and internal fixation with multiple percutaneous K wires is a cost effective and easy method to treat all distal end radius fractures, provided good anatomical reduction is achieved before the wires are put
Current status of graft choice in adults for anterior cruciate ligament reconstruction: a systematic review and meta-analysis
Get PDFThe anterior cruciate ligament (ACL) is a frequently performed surgical procedure in the field of sports medicine, and graft selection is an essential aspect of ACL reconstruction (ACLR) that has been shown to optimize post-operative rehabilitation, facilitate return to full sporting function and reduce the risk of complications. However, there needs to be more agreement regarding optimal graft choice. The present study aims to identify the optimal graft choice in the adult population undergoing ACLR. The current systematic review explores the electronic database of online libraries of academic institutions from 2011 to 30 September 2022 and compared the clinical outcomes of autograft and allograft for ACLR, which provides an evidence-based approach for graft selection. The findings of our present study delineate that ACLR in adult populations with autograft is the most promising choice for ligament tear over allograft based on lower failure rate, reduced complications, and high cost-effectiveness. However, there was no significant difference in overall IKDC, pivot shift, Lachman test, and Tegner activity. This critical analysis recommends that for an adult population, ACLR with autograft can provide better clinical results than an allograft, but further studies carried out about other parameters affecting the long-term stability, quick return, and physical therapy adopted outside the supervision of the respective surgeon would be required