International Journal of Research in Orthopaedics
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Modified thread technique, 2 threads 7 days in cases of wrist ganglions: a case series
Get PDFGanglion cysts are soft tissue swellings occurring most commonly in the hand or wrist, they are usually asymptomatic. The 70% cases of ganglion are observed on the dorsal side of wrist. Ganglion cysts arise from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury. Ganglion cysts have a recurrence rate of approximately 15% to 20%. Gang et al introduced the technique of treating ganglion by passing a silk thread to induce chronic inflammation leading to obliteration of the cyst. Three cases with wrist swelling without tenderness. On examination swelling is firm consistency, slightly mobile, not adherent to underlying or overlying structures, without local rise of temperature. Ultrasonography has confirmed the diagnosis of ganglion cyst. Modified thread technique has been planned. Patient has been followed on day 3, 5, 21, 90th day. Patient has no suture site complications, with no recurrence on 3 month follow up. The cyst was stabilised and a sterile silk/linen thread on a cutting needle was passed through the cyst and taken out from the opposite side from 3 O’clock to 9 O’clock position. Second thread was passed perpendicular to first one from 12 O’clock to 6 O’clock position. The contents of ganglion were expressed out by firm pressure. Thread was removed on the seventh day irrespective of presence or absence of yellowish discharge. Patients were followed up on the fifth day after thread removal. Patients were then followed at monthly intervals for first three months. Non-surgical techniques used are aspiration, sclerotherapy, steroid injection, hyaluronidase injection, immobilization and thread technique. These have high recurrence rates. Surgical excision has lower recurrence rates, but they have a high complication rate. The thread technique is being considered as a newer option since it has recurrence rates comparable to surgical excision and complication rates comparable to nonsurgical techniques
Osteosynthesis, arthroplasty or resection of the radial head-which guarantees the best results in Mason III radial head fractures?
Get PDFBackground: Fractures of the radial head are common, accounting for approximately one third of elbow fractures and 4% of all fractures. The most accepted classification is modified Mason, with type III being comminuted fractures, normally requiring surgery. There is currently no consensus on the most effective treatment method.
Methods: This study aims to compare the radiological and functional results of Mason III fractures, treated at our hospital between 2017 and 2022. During this period, 23 patients were surgically treated with osteosynthesis, arthroplasty or resection of the radial head. Inclusion criteria (isolated fractures of the radial head with follow-up of more than 6 months) and exclusion criteria (neurovascular, ligament injuries/ other associated fractures) were considered. Functional assessment was based on Broberg-Morrey elbow score; Mayo elbow performance score (MEPS) and QuickDASH.
Results: The differences in functional results between the various treatments were not statistically significant (p>0.05), despite the best results being seen in the arthroplasty group.
Conclusions: In our series there was a 47.82% complication rate. Five patients developed heterotopic ossification. Which was significantly higher than expected in the arthroplasty treatment group, with a statistically significant difference; but there was no translation in functional terms, since this group achieved the best functional scores. The group of patients who underwent osteosynthesis were those with the worst functional scores and the most complications (3 cases of post-traumatic arthrosis, 3 nonunions and 1 aseptic necrosis). Our series is small, but the results are similar to previous studies.
Functional outcome of femoral shaft fracture in pediatric patients treated by titanium elastic nailing system
Get PDFBackground: Pediatric femoral shaft fractures are common, typically occurring in early childhood due to low-energy incidents and during adolescence due to high-energy trauma. These fractures represent around 2.2% of all bone injuries in children, with an incidence of 20-25 per 100,000 children per year, and are more prevalent in boys.
This prospective study aims to assess the outcomes of treating pediatric femoral shaft fractures with TENs.
Methods: This prospective study at North Bengal Medical College and Hospital included Twenty-three patients, aged 4 to 12 years, with diaphyseal femur fractures treated using TENS (Titanium Elastic Nailing System) for one year, from January 2023 to December 2023.
Results: Most patients (52.17%) were 9-12, with a higher prevalence of males (73.91%). The most common fracture type was transverse (69.57%), predominantly on the right side (69.57%). Union rates were 21.74% at 8 weeks, 56.52% at 10, and 21.74% at 12 weeks. Complications included limb lengthening (21.74%) and malalignment (13.04%). Functional outcomes at 12 weeks post-operation were mostly excellent (60.87%) or satisfactory (30.43%), with one poor result (8.70%).
Conclusions: Titanium elastic nailing system (TENS) is effective for pediatric femoral shaft fractures, achieving high bone union rates and minimal complications. Most fractures healed within 10 weeks, and patients had excellent or satisfactory functional outcomes, supporting TENS as a beneficial treatment for children aged 4 to 14
Effect of platelet rich plasma versus triamcinolone versus placebo-normal saline in chronic plantar fasciitis: regenerative medicine in orthopaedics
Get PDFBackground: Heel pain is a common presenting condition in orthopaedic outpatient units. There are many causes of this condition, but one of the most common is plantar fasciitis. This study was conducted to find out the efficacy of a single injection of platelet-rich plasma versus steroids versus normal saline as a placebo in treating patients suffering from plantar fasciitis.
Methods: Randomized single-blinded placebo-controlled trial with 3 months and 6 months follow-up using visual analogue scale and FAOS (Foot and Ankle Outcome Score) was carried out at a tertiary care hospital for a total of 120 patients (40 patients in each group). First group injected with platelet rich plasma, second group with triamcinolone and third group with normal saline.
Results: Pain relief achieved in the platelet-rich plasma group and triamcinolone group was found to be statistically significant as compared to normal saline at both 3 months and 6 months follow-up. Steroid injection was associated with complications like depigmentation at the injection site and sub dermal atrophy. No complications were found with PRP or normal saline.
Conclusions: This study concludes that the efficacy of a single injection of platelet-rich plasma to relieve the pain of Plantar fasciitis is better than triamcinolone or placebo over a short-term follow-up period. However, more studies are required to evaluate the efficacy of PRP over the long term with multicentric study and comparison with the currently available treatment options
The untold story of a coughed-out screw: a case report
Get PDFA 70 years old male, case of Cervical Spondylotic Myelopathy (C3-C4, C4-C5) with complaints of difficulty in walking and weakness of upper and lower limbs for 6 months presented to the outdoor department. Patient had restricted and painful movements of cervical spine. Patient was evaluated and then operated for anterior cervical discectomy and fusion with bone grafting at C3-C4, C4-C5. After first surgery the, Pre-op VAS Score improved from 8 to 2 and the Nurick Score improved from grade 4 pre op to grade 2 postop. Once the union of graft appeared adequate, we tried to convince the patient for early removal of prominent and prouting implant as the proximal screws were backing out but patient refused surgery. He finally presented with a coughed-out screw in his mouth in emergency. After removal of implant the surgical wound healed well and he did not complaint of any difficulty in deglutition. Loosening of implants after anterior cervical spine fusion surgeries adds to the morbidity to the procedure. Proper sized low-profile implants with good locking mechanism can reduce the complication rates. Adequate pre-operative planning is a must for successful outcome of cervical spine surgeries
Chondroblastoma of the femoral head-surgical management, outcomes and clinical perspectives: a case report
Get PDFChondroblastoma is a rare benign tumor predominantly affecting the epiphyses of long bones, often presenting in the second decade of life. It is known for its potential to recur and cause joint complications despite its benign histology. This report details the case of a 12-year-old boy diagnosed with chondroblastoma of the femoral head, who underwent surgical treatment involving curettage and the use of synthetic hydroxyapatite (HA) bone substitutes. The patient presented with groin pain and limping, with imaging studies revealing an osteolytic lesion in the femoral head. A core needle biopsy confirmed the diagnosis. To manage the lesion, an anterolateral approach was used to perform extensive curettage, and the defect was filled with HA blocks. Postoperatively, the patient was managed with gradual weight-bearing and regular follow-ups. At five years, the patient exhibited normal hip function with no evidence of tumor recurrence, collapse of the femoral head, or osteoarthritis. This case demonstrates that the use of synthetic HA as a bone substitute in the treatment of chondroblastoma can effectively preserve joint integrity and function, providing a viable alternative to traditional grafting methods. The approach was successful in maintaining articular congruence and preventing complications, highlighting the potential benefits of synthetic materials in managing subchondral bone lesions
Is there a role for ischaemic pre-conditioning in orthopaedic and trauma surgery? A systematic review and meta-analysis of randomised controlled trials
Get PDFSurgical procedures using a tourniquet submit tissues to ischaemia and reperfusion on restoring blood flow. Ischaemia-reperfusion may lead to local or remote tissue damage resulting in pain and complications. We aimed to evaluate the effectiveness of ischaemic preconditioning with a tourniquet in preventing pain, disability, adverse events, inflammation and facilitating recovery and discharge in patients receiving orthopaedic and trauma surgery. We conducted a systematic review of randomised controlled trials investigating ischaemic preconditioning in patients undergoing trauma and orthopaedic surgery. We searched The Cochrane Library, Medline and Embase until January 2021. Where possible continuous data were pooled and meta-analysis performed. Ten RCTs met inclusion criteria, eight of which underwent meta-analysis. Three studies reported lower acute post-operative pain or morphine consumption in patients randomised to IPC. We found weak evidence for shorter length of stay in the intervention group (MD-0.54 days; 95%CI-1.11, 0.03; p=0.0615). Malondialdehyde levels were lower in patients randomised to IPC at two hours following tourniquet deflation (MD -1.39 nmol/ml; 95%CI-2.23, -0.55; p=0.0012). We found no between group differences in Tumour Necrosis Factor-α, Lactate or Interleukin-6. The mechanism behind IPC may be related to reduced lipid peroxidation rather than reduced inflammation. There is evidence IPC reduces post-operative pain following knee surgery that merits further study
Immediate versus early soft tissue coverage for severe open grade III B tibia fractures: a comparative clinical study
Get PDFControversy remains regarding timing in the management of grade III-B open tibia fractures. Many authors recommend an immediate definitive soft tissue coverage within a critical period of 12 hours, yet in many patients, this may be impossible due to concomitant injuries or delayed referral. The present case series aims to compare the role of immediate versus early soft tissue coverage for severe open grade III-B tibial fractures. 20 cases of tibial fractures of were divided into two groups; 10 cases each. Immediate group (within 12 hours) and early group (3-7 days), according to the soft tissue coverage time. Strict criteria for inclusion in the first group included debridement within 12 hours of injury, no sewage or organic contamination, the presence of bleeding skin margins, and the absence of systemic illness. All 20 cases had been treated by a debridement and soft-tissue cover with a muscle pedicle or fasio-cutanous flap. Functional outcome measures included deep infection rate, stable soft tissue coverage, number of inpatient’s stays, number of surgical procedures, and union time. The mean follow-up period was 24 months. Mean inpatient time was 30 and 41 days respectively. Mean surgical procedures were 2.2 and 3.4 respectively and union time was 26 versus 34 weeks. Mean inpatient time, mean surgical procedures per time and union time were pointedly less in the immediate flap coverage group which significantly improves results concerning early union, healing time, and cost of hospitalization and rehabilitation
Medial dorsal cutaneous nerve entrapment following inversion ankle sprain
Get PDFThe medial dorsal cutaneous nerve is one of the terminal branches of the superficial peroneal nerve that provides sensory innervation to the dorsum of the foot. It may be prone to injury by direct blow, iatrogenic surgical lesion or in rare situations secondary to ankle sprains. The authors report a case of persistent ankle pain in a female patient caused by a post- traumatic compressive neuropathy of the medial dorsal cutaneous nerve secondary to an ankle sprain which was successfully surgically treated with complete resolution of the symptoms
Importance of clinical and radiological assessment of patient of osteoarthritis knee foroptimum outcome in total knee replacement
Get PDFBackground: Total knee replacement (TKR) provides symptomatic relief in patients with severe arthritis by removing pathologic joint tissue and restoration of the joint anatomy and function by the replacing with metal or plastic components leading to more stable biomechanics. Inspite of all advances in the surgical techniques 1 out of 5 people who undergo TKA remain unsatisfied. Clinical and radiological grading of osteoarthritis of knee may be an important prognostic marker to assess the outcome following TKR.
Methods: Study conducted was retrospective study. Pre-op routine and clinical assessment data noted from departmental records. Correlation between ‘initial knee society score’ (KSSi) and ‘radiological severity’ in terms of (Kellgren-Lawrence) grade and varus angle with ‘change in knee society score’ (ΔKSS) assessed to reach at conclusion.
Results: Lower KSS values, higher KL grading, higher femorotibial angle and were associated significantly with higher change in KSS values, i.e. better outcome.
Conclusions: Severe OA knee with high FTA and higher KL grade has shown better outcome following TKA. In early stages it is better to manage the patient conservatively with medications and physiotherapy