International Journal of Research in Orthopaedics
Not a member yet
2153 research outputs found
Sort by
Synovial hemangioma: an unusual cause of chronic anterior knee pain in children
Get PDFSynovial hemangioma is an uncommon cause of chronic anterior knee pain. The non-specific clinical presentation leads to delay in diagnosis. MRI is diagnostic and should be considered early in evaluation to plan treatment and prevent functional disability. We present a case of unilateral synovial hemangioma of the knee in a child with pain, swelling and restricted knee mobility. Arthroscopy can be diagnostic and therapeutic in such cases.
Functional outcome of Latarjet procedure in anterior recurrent shoulder instability
Get PDFThe Latarjet procedure is a surgical technique which was described by Michel Latarjet in France in 1954. He described it as an open stabilization technique of the glenohumeral joint in patients with recurrent anterior glenohumeral instability. It is a procedure of combination of coracoid process bone graft and a form of stability provided by the conjoined and subscapularis tendons. The benefits of the procedure are provision of stability, restoration of range of shoulder motion, preservation of shoulder muscle strength and return to premorbid activities of daily living. Patients with recurrent anterior shoulder dislocation with bone loss the bone blocking technique of Laterjet is the technique of choice. This technique has been effective in 98% of patients in avoiding recurrence without losing external rotation. Hence, present study was aimed to determine the functional outcome of open Laterjet procedure for recurrent shoulder dislocation. Case series was conducted based on post-operative Laterjet cases in a government tertiary care centre and medical college, involving 20 patients who underwent Latarjet’s procedure, with duration 1st January 2023 to 31st December 2023 patients of either gender or age more than 18 years with recurrent anterior shoulder dislocation. Ethical clearance was obtained from the institutional ethics committee. The indication for the Laterjet procedure was defined with preoperative clinical findings proving recurrence of anterior shoulder instability and confirming the cause of dislocations with radiographs and MRI scans. In the included subject’s complete history, physical examination and relevant investigations were done. The incidence of poor, fair, good, and very good outcomes was found to be 1 (5%), 2 (10%), 14 (70%), and 3 (15%) respectively. There was significant improvement in shoulder motion and reduction in pain after 6th month's follow-up. We reported re-dislocation in 1 patient. Mean VAS (Visual analogue scale) for pain among the patients in the study also reduced from pre-operative value of 7.2 to 6.5, 4.5 and 1.5 at 6 week, 3 months and 6 months postop respectively and this reduction in pain was found to be highly significant. Recurrent anterior shoulder dislocation can be effectively treated by open Latarjet technique being a safe and reliable treatment alternative with good functional outcomes. Surgeons should be aware that these procedures are technically demanding
Evaluation of the results of cubitus varus deformity by stepcut osteotomy
Get PDFBackground: A gunstock deformity or varus elbow is the commonest late deformity in supracondylar fractures of the humerus. The elbow is bowed outward making a bow elbow or cubitus varus deformity. The aim of this study was to evaluate the effectiveness of the step cut osteotomy technique for correcting cubitus varus deformity following supracondylar fractures of the humerus
Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka and 250 beded General Hospital, Kushtia, Bangladesh from July 2010 to June 2018.
Results: The majority 36 patients (75% of total) were aged between 11 to 20 years, 8 patients (16.67% of total) were aged 10 years or younger and 4 patients (8.33% of total) were aged between 21 to 30 years respectively with female male ration 1:5. Majority 44 patients (91.67% of total) were students and 4 patients (8.33% of total) were workers respectively. Left side involvement was in 32 (66.67%) and right side in 16 (33.33%) cases. In our study 20 (42%) cases result was excellent, good in 16 (33%) cases and poor in 12 (25%) cases respectively.
Conclusions: This study demonstrates that the corrective osteotomy of cubitus varus deformity using the stepcut technique is a satisfactory method of treatment.
Thin lateral wall cortex intertrochanteric proximal femur fractures: a comparative study between past and present
Get PDFBackground: There has been a growing recognition of the significance of preserving the integrity of the lateral wall of the proximal femur, in addition to the previously emphasized importance of the posteromedial portion in predicting fracture stability. Consequently, this study aimed to compare the outcomes of various fixation methods employed in treating intertrochanteric proximal femur fractures with a thin lateral wall.
Methods: This retrospective study assessed 225 cases of treated intertrochanteric fractures with a thin lateral cortex, examining radiological outcomes at different follow-up intervals to evaluate the efficacy of different treatments. The study compared Dynamic Hip Screw (DHS), Dynamic Condylar Screw (DCS), and Proximal Femoral Nail (PFN) in terms of healing, mortality, and complications.
Results: The average age of patients was 79.75 years, with 61.3% having comorbidities. The three treatment modalities showed similar healing times, revision rates, and mortality rates. The one-year mortality rate stood at 26%. PFN consistently maintained a favorable position during follow-up assessments. While DHS initially exhibited excellent reduction on postoperative X-rays, less than half of the fractures maintained acceptable reduction during the first follow-up due to shaft medialization (32%) and varus collapse (24%). DHS treatment was also frequently associated with nonunion, with intraoperative lateral wall fractures occurring in 15.4% of cases. DCS was found to be the least effective treatment, being commonly associated with varus collapse.
Conclusions: In treating intertrochanteric fractures with a thin lateral wall component, PFN demonstrated superior outcomes in terms of reduction and lower complication rates compared to other fixation methods. Therefore, PFN should be the preferred choice, while DHS and DCS should be avoided for this fracture pattern
Long-term outcomes of caudal epidural steroid injection in failed back surgery syndrome patients with loss of resistance technique
Get PDFBackground: Failed back surgery syndrome (FBSS) is a complicated issue with various treatment approaches. This retrospective study assesses the success and safety of caudal epidural steroid injection (CESI) in FBSS patients utilizing the loss of resistance (LOR) strategy, focusing on long-term outcomes lasting up to two years.
Methods: The 75 FBSS patients had CESI with triamcinolone and normal saline under local anesthesia. The visual analog score (VAS), Oswestry disability index (ODI), and patient satisfaction score (PSS) were measured at pre-intervention and 3, 6, 12, 18, and 24 months following the procedure.
Result: Majority of patients (57.33%) reported bilateral sciatica, with recurrent disc herniation (54.67%) being the most prevalent MRI finding. Significant improvements (p<0.001) in VAS, ODI, and PSS scores were seen in all subsequent periods. Furthermore, no significant issues reported, demonstrating the safety and effectiveness of CESI with LOR.
Conclusions: CESI with the LOR technique is helpful treatment in FBSS at three, six, twelve, eighteen, and twenty-four months. It is easy to perform, less technically demanding, has low complications, and lower costs than surgery. A CESI may offer an alternative approach to managing FBSS for short-term and long-term outcomes
Restoring stability - 4 in 1 quadriceps plasty for habitual patella dislocation in a ten-year-old child: a case report
Get PDFComplex clinical and surgical challenges accompany both congenital or fixed dislocations and obligatory or habitual patellar dislocations. Habitual dislocation of the patella is the most severe type of patellar instability and frequently call for surgical intervention. Various surgical procedures have been documented to address habitual patellar dislocation. Since no approach is 100% effective, a combined approach of techniques is recommended for the surgical treatment of habitual patellar dislocation. This article aims to describe the 4-in-1 quadriceps plasty procedure used to stabilize a 10-year-old child's fixed and habitual patellar dislocation
Biological knee joint reconstruction using patella following giant cell tumor excision: a case report
Get PDFA 20-year-old female patient presented to us with a large expansile swelling over right knee diagnosed clinically and confirmed histopathological and radiologically to be Giant Cell Tumor of upper end of Tibia involving both condyles with a breach in the posterior cortex. In this case report we tried to retain the joint function by biological reconstruction using the Patella after the wide excision of the tumor mass. A radical excision of the upper end of the Tibia was done. The Patella was used as an articular surface supported by ipsilateral Fibula and cortico-cancellous bone chips from the ipsilateral iliac crest as struts and complemented with synthetic bone graft pieces. Thus, the joint was reconstructed biologically. The case was followed for 1 year. The tumor was excised in toto, the knee joint was restored by the Patella and the bone graft struts. The results were discussed in detail
Management of congenital talipes equinovarus by Ponseti technique and percutaneous needle tenotomy
Get PDFBackground: This study evaluates the Ponseti technique combined with percutaneous needle tenotomy for treating congenital talipes equinovarus (CTEV), or clubfoot, assessing efficacy, complications, and outcomes. Conducted at a tertiary medical center in Hyderabad from 2021 to 2024, it included patients of all ages presenting with CTEV.
Methods: This is a prospective and retrospective study. The Ponseti method, a conservative approach involving serial casting and gentle foot manipulation, was applied, with percutaneous needle tenotomy used for achilles tendon lengthening when necessary. Compared to traditional surgical methods, this minimally invasive approach is associated with fewer complications and improved correction rates. Patients were assessed using Pirani scores, with data on cast numbers, tenotomy needs, and relapses.
Results: The study demonstrated significant efficacy, particularly when treatment began early, reducing the number of casts required. Needle tenotomy, preferable over blade tenotomy, was particularly effective in India and among patients from lower socioeconomic backgrounds, proved more effective than blade tenotomy. The approach was associated with fewer complications and better correction rates.
Conclusions: The Ponseti technique is an effective, accessible, and economical option with minimal complications. Early diagnosis and intervention were found essential for optimal outcomes. Further research is suggested to refine treatment protocols for older children and severe deformities
A prospective cohort study investigating functional recovery in patients with avascular necrosis hip following total hip arthroplasty using a direct anterior versus direct posterior surgical approach in Indian population
Get PDFBackground: This study examines the comparative outcomes of the Direct Anterior Approach (DAA) and Direct Posterior Approach (DPP) in patients undergoing Total Hip Arthroplasty (THA) for Avascular Necrosis of the hip.
Methods: A total of thirty patients were divided equally between the two surgical methods, with half number of patients undergoing DAA and half undergoing DPP. Key performance metrics, including Modified Harris Hip Score (MHHS), blood loss, operative time and length of hospital stay, were analysed to determine which approach offered superior postoperative recovery and patient satisfaction. A convenient sampling technique was used in our study. Epi Info 2023 software was used for statistical analysis of data. The study was conducted in Government medical college and associated group of hospitals. The study was conducted from 01/06/2022 to 30/06/2023.
Results: It shows that both approaches led to significant improvements in Modified Harris Hip Score (MHHS) postoperatively, with no statistically significant difference in the final hip function at various follow-up intervals. However, DAA required a smaller incision, making it cosmetically favourable but resulted in greater blood loss and longer operative time due to its technical complexity. DPP, on the other hand, was associated with faster operative time and slightly lower blood loss but had a higher risk of postoperative dislocation. Despite these differences, there was no significant difference in hospital stay duration or overall complication rates between the two groups.
Conclusions: While both DAA and DPP are effective for THA, the choice of approach may depend on surgeon expertise and patient-specific factors, with DAA offering better cosmetic outcomes and DPP offering a technically easier procedure with fewer blood loss complications. Further long-term studies are suggested to analyse any potential differences in complication rates beyond the early postoperative period
Total knee arthroplasty in pigmented villonodular synovitis: a case report and its management
Get PDFPigmented villonodular synovitis (PVNS) is a benign yet potentially aggressive proliferative lesion of the synovium, which can lead to significant morbidity, particularly when associated with osteoarthritis. This case report presents a 48-year-old male with a 2-year history of knee swelling and pain, exacerbated over the last 6 months, resulting in impaired daily activities. Clinical examination and imaging revealed severe osteoarthritis and soft tissue swelling around the knee. Surgical intervention involved total synovectomy and total knee arthroplasty, performed concurrently. The patient exhibited favorable postoperative outcomes, achieving full range of motion and resolution of symptoms. This case underscores the importance of recognizing PVNS as a contributor to knee osteoarthritis and highlights effective surgical management strategies to improve patient quality of life. Follow-up care is crucial to monitor for potential recurrence of the disease