International Journal of Research in Orthopaedics
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Allograft sterilization and processing: impact on biomechanical strength
Get PDFThe allograft used for anterior cruciate ligament reconstruction (ACLR) must posses good biomechanical properties and it should have similar properties to the original tendon. During reconstruction the allograft must undergo proper sterilization and several sterilization methods have been used in the clinical practice. There are varations in the sterilization process and it has significant impact on the allograft tissue performance during ACL reconstruction. It is advisable to refrain from utilising grafts that have been exposed to radiation doses exceeding 15 kGy, as well as grafts that have undergone more than eight freeze-thaw cycles. Gamma radiation has disadvantages when compared to electron beam radiation in term of loss of mechanical strength
Limb salvage surgery for primary bone tumors: retrospective study in a tertiary care centre
Get PDFBackground: Limb salvage surgery is the standard of care for patients with primary bone tumors. The study retrospectively analyses a single center experience of use of endo-prosthesis for limb conservation in cases of primary bone tumors over a five-year period (2015-2020).
Methods: Total of 34 histologically proven primary bone tumor were retrospectively studied which included 25 males and 9 females who received limb salvage surgery for bone tumors at department of surgical oncology, Rajiv Gandhi Government general hospital, Madras medical college, Chennai.
Results: Median age at diagnosis was 23 years. Tumor localized to lower limb in 23 patients, and upper limb in 9 patients, pelvic bones in 3 cases. Tumors were malignant in 24 patients (70.4%) and benign in 10 patients (29.4%). The most common diagnosis was osteosarcoma17 patients (50%). The median resection length was 10 cm. High grade tumors (grade 2a and 2b and grade 3) was found in 14 cases (41.1%). 6 patients had prosthesis related complications. The mean follow-up was 5 years (range: 3-7). 27 (79.4%) patients of 34 were alive with the endo-prosthesis at the last follow-up.
Conclusions: The custom mega prosthesis favored by us in most of the cases in limb sparing surgery for bone tumors results in satisfactory results in terms of local tumor control and limb function
Evaluating the effectiveness of Baker's procedure in restoring functionality in neglected Achilles tendon injuries
Get PDFBackground: Neglected Achilles tendon injuries present a significant challenge in orthopedic practice, often requiring complex surgical interventions for effective treatment. This study aims to evaluate the functional outcomes of patients with neglected Achilles tendon injuries treated using Baker's procedure, a surgical technique designed for complex cases.
Methods: This prospective interventional study was conducted at multiple medical centers in Dhaka, Bangladesh, from January 1, 2012, to May 31, 2013. It included 42 patients aged 18 to 60 years with signs of old Tendo-Achilles rupture. Participants were selected based on specific inclusion and exclusion criteria and underwent Baker's Procedure. Postoperative assessments included pain levels, ankle stiffness, calf-muscle weakness, footwear restrictions, range of motion, and patient satisfaction, evaluated using the Juhana Leppilahti modified score.
Result: The majority of patients (85.71%) reported no pain post-treatment, while 14.29% experienced mild pain. Ankle stiffness was absent in 71.43% of the patients and mild in 28.57%. Calf-muscle weakness varied, with 64.29% showing no weakness, 28.57% mild weakness, and 7.14% moderate weakness. Footwear restrictions were minimal, with 92.86% reporting no restrictions. Active range of motion was normal (≤5°) in 64.29% of patients and mildly limited (6-10°) in 35.71%. Patient satisfaction was high, with 71.43% being 'Very satisfied' with their treatment outcomes.
Conclusions: The study demonstrates that Baker's Procedure is an effective surgical intervention for neglected Achilles tendon injuries, leading to significant pain relief, restored functional mobility, and high patient satisfaction. These findings suggest that with appropriate surgical and rehabilitative care, patients with complex Achilles tendon injuries can achieve favorable outcomes, emphasizing the importance of tailored surgical approaches in orthopedic practice
A study on functional outcome of distal end femur fracture in adults managed with locking compression plate
Get PDFBackground: We have evaluated the clinical outcome of surgery using locking compression plate in patients with fracture of distal end of femur in terms of union time, weight bearing and complications.
Methods: The present study was conducted in the department of orthopaedics, Bombay hospital, Indore (M. P.). With a prevalence of 3% of adult distal femoral fracture, the sample obtained was 30 with distal end femur fractures in the study. Protocol of surgery was followed in each patient. Postoperative rehabilitation was also adhered to in all patients.
Results: The mean age of 37.87±11.76 years with a male (25) predominance and more right-side involvement. RTA constituted 90% of the patients. According to AO/ASIF classification, type C1 (23.3%) and type A2 (20%) were the common fracture types seen. The radiological union was achieved in majority by 19-20 weeks. Full weight bearing was started by 15-16 weeks with mean of 18.93±2.02 weeks. In 43.3% patients knee flexion of more than 110 degree was achieved. Infection was seen in 10% patients and limb shortening (<10 mm) was seen in 6.7% patients. According to Neer’s scoring system, 56.7% patients had excellent, 33.3% patients had good, 3.3% patients had fair and 6.7% patients had poor functional outcome.
Conclusions: The treatment of fracture distal end of femur using locking compression plate was found to provide good to excellent functional outcome in majority of the patients, with low prevalence of complications
Skeletal involvement in Burkitt's lymphoma: a comprehensive review
Get PDFBurkitt's lymphoma, a highly aggressive form of non-Hodgkin lymphoma, exhibits a distinctive predilection for rapid growth and systemic dissemination. While its primary manifestation is often observed in the lymphatic system, orthopaedic involvement has been increasingly recognized. This review synthesizes current literature to comprehensively explore the orthopaedic implications of Burkitt's lymphoma, encompassing clinical presentation, diagnostic challenges, treatment modalities, and associated outcomes
Does patient-specific instrumentation in primary total knee arthroplasty improve long-term satisfaction or function? A randomized trial with a 9-year follow-up
Get PDFBackground: Patient-specific instrumentation (PSI) aims to increase the accuracy of total knee arthroplasty (TKA). However, the long-term benefit compared to conventional instrumentation (CI), is still controversial. This randomized controlled trial compares the long-term outcomes between PSI and CI in TKA.
Methods: Patients submitted to PSI or CI TKA with a minimum follow-up of 8 years were evaluated. Satisfaction levels, forgotten joint score (FJS) and Western Ontario and McMaster university osteoarthritis index (WOMAC) scores were compared. Regarding descriptive statistics, mean, standard deviation and frequencies were obtained. For inferential statistics we used the t test for independent samples the Mann-Whitney test and the Wilcoxon Test.
Results: A total of 50 TKA were included (48% CI; 52% PSI) with an average follow-up time of 9.3 years. At the final follow-up the WOMAC score was similar between groups (p=0.846; CI:26.8±22.5; PSI:26.8±25.3). Similarly, no differences were seen for the FJS (p=0.785; CI:59.6±35.1; PSI:57.1±36.2) or satisfaction (p=0.486; CI:8.1±2.8; PSI:9.1±1.4). However, at the final follow-up, the total WOMAC score had worse results when compared to the previous evaluations (p=0.013 for CI group; p=0.009 for PSI group). No significant differences in the satisfaction levels were detected regarding the initial and final evaluations (p=0.581 for CI group; p=0.936 for PSI group).
Conclusions: Nine years after TKA, PSI and CI patients reported similar levels of satisfaction and functioning. Both groups achieved similar results concerning the WOMAC, FJS scores and satisfaction levels. This study suggests that long-term satisfaction and functioning levels are similar in both PSI and CI
Outcome of mini open anterolateral rotator cuff repair by suture anchor
Get PDFBackground: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments.
Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated.
Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p<0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p<0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p<0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients.
Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies
An atypical manifestation of a common familiar tumour: the unforeseen occurrence of osteochondroma
Get PDFA solitary osteochondroma in the lesser trochanter is an exceedingly rare occurrence. The nature of osteochondromas as benign osteocartilaginous tumours is typically regarded as a developmental anomaly rather than a neoplastic condition. Patients afflicted with this condition may experience a range of symptoms dependent upon the size of the tumour, with limited range of motion being a common manifestation. The present case study pertains to a distinctive instance of a benign solitary osteochondroma of the lesser trochanter, which was diagnosed and treated through an excisional biopsy using a Hardinge approach
A study of functional outcome of intertrochanteric fractures operated with intraheal proximal hip stabilizing nail-multicentric study
Get PDFBackground: Modalities of fixation in intertrochanteric fractures have been a topic of debate since times immemorial. Our special aims at comparing the functional outcome of Intraheal™ proximal hip stabilizing nail (PHSN, GPC Medical Limited) fixation in 200 patients of intertrochanteric fractures.
Methods: 200 patients of intertrochanteric fracture fulfilling the inclusion criteria were included in our study. Preoperative AP and Lateral views of hip joint were taken for all patients. In post-operative period, the patients were reviewed at 2 weeks, 1 month, 3 months, 6 months, and 12 months by the operating surgeon. Functional assessment, radiological assessment of bony union and complications were evaluated in follow up period.
Results: 200 patients underwent Intraheal™ proximal hip stabilizing nail fixation. They were followed-up the patients at 2 weeks, 1, 3, 6 and at 12 months postoperatively AP and lateral pelvic X-rays were obtained at each follow-up, and implant position changes, all complications, and fixation failures were recorded. We included a total of 200 patients meeting the criteria in this study and follow up was done till 12 months postoperatively. Intra-operative complications, time of hospital stay, Varus fixation and fracture displacement were assessed.
Conclusion: Advantages noted with PHSN fixation were excellent Harris hip score, lesser screw cutout, early union rate. However, PHSN had greater incidence of anterior thigh pain at all intervals of follow-up. There were no significant local wound complications or duration of hospital stay
Rescuing the knee: arthroscopic extraction of a long-neglected glass fragment: a case report
Get PDFThe knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. While foreign bodies in the knee joint are unusual, especially those not originating from surgical procedures, extensive literature exists on the extraction of loose bodies and metallic objects from this articulation. However, documentation on uncommon intruders remains scarce. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Here we present a unique case involving a 22-year-old male who underwent arthroscopic retrieval of a neglected glass fragment from his knee joint. The patient sought medical attention five months after the initial injury due to sudden and severe pain onset. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions. Utilizing pre-operative radiological imaging enhances understanding of the anatomical placement, facilitates surgical orientation, and reduces operation time. A keen sense of suspicion and thorough history-taking are crucial in achieving an accurate diagnosis