International Journal of Research in Orthopaedics
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A prospective study on the use of percutaneous titanium elastic nails for paediatric femoral shaft fractures
Get PDFBackground: This study aimed to assess the efficacy and safety of using percutaneous titanium elastic nail (TEN) fixation in pediatric patients with femoral shaft fractures.
Methods: A prospective study was conducted on pediatric patients presenting with femoral shaft fractures between the ages of 6 to 14 years. Patients were treated with percutaneous titanium elastic nails and followed up for a minimum of 12 months. The primary outcomes assessed included fracture union time, functional outcome, and complications related to the procedure.
Results: A total of 28 pediatric patients with femoral shaft fractures were enrolled in the study. The patients had a mean age of 10.3 years, and the average time for fracture union was 10.5 weeks. Functional outcomes assessed using Flynn’s criteria scoring systems demonstrated excellent results in 67.8% of patients. Complications such as shortening (1 patient), superficial infection (1 patient), and skin irritation at entry site (2 patients) were observed. However, these complications were managed successfully with appropriate interventions.
Conclusions: Percutaneous titanium elastic nail fixation is an effective and safe treatment option for pediatric femoral shaft fractures, offering early mobilization, minimal soft tissue disruption, and favorable functional outcomes. Despite some complications, the overall success rate of the procedure underscores its suitability for managing femoral shaft fractures in pediatric patients. Further studies involving larger sample sizes and follow-up periods is necessary to confirm these findings and refine treatment protocols
Comparing the subvastus and medial parapatellar approaches in total knee replacement
Get PDFBackground: This study aimed to compare the outcomes of the subvastus and medial parapatellar approaches in total knee replacement (TKR), focusing on postoperative pain, knee function recovery, quadriceps strength, hospital stay, complications, and patient satisfaction.
Methods: This prospective comparative clinical trial was conducted over 18 months at a tertiary care hospital. A total of 120 patients, aged 50-75 years with knee osteoarthritis, were divided into two groups, group A (subvastus approach) and group B (medial parapatellar approach). Pain, range of motion (ROM), quadriceps strength, length of hospital stay, complications, and patient satisfaction were evaluated postoperatively at 1, 3, 6, and 12 months. Data were analyzed using SPSS, with significance set at p<0.05.
Results: Group A showed significantly lower pain at 1 and 3 months, with VAS scores of 4.1 and 2.8, respectively (p<0.05). ROM was significantly greater in Group A at 1 and 3 months (105.2° and 120.8°, p<0.05). Quadriceps strength improved faster in group A at 3 months (MMT score: 4.0, p=0.04). Group A also had a shorter hospital stay (4.5 vs 5.8 days, p=0.01). Complications and long-term satisfaction were similar across both groups.
Conclusion: The subvastus approach offers advantages in early recovery, including reduced pain, quicker ROM recovery, and shorter hospital stays. However, long-term outcomes are comparable between both approaches
Insights into acromioclavicular joint ganglionic cyst: diagnosis and management
Get PDFAcromioclavicular joint (ACJ) cysts are an uncommon and unusual sequela associated with shoulder pathophysiology1.It is a rare clinical entity that can affect patients’ cosmetic appearance as well as daily living activities. Limited number of case reports have been published till date in literature. This case report presents a rare example of a ganglion cyst taking origin from acromio clavicular joint in a 62-year-old female patient, outlining the clinical presentation, diagnostic approach, and successful surgical management
Anterior cruciate ligament reconstruction using peroneus longus tendon auto-graft: functional results
Get PDFBackground: The peroneus longus tendon is a promising autograft alternative to the others tendons in ACL reconstruction. It offers the advantages of being expendable, having adequate length and strength, sparing morbidity from other donor sites, and allows early rehabilitation.
Methods: The study was on 30 patients with isolated ACL complete tear treated by arthroscopic reconstruction using the PL tendon in Benha university hospital in the period from July 2022 till June 2023. The patients were assessed pre-operatively and post-operatively with the IKDC score and clinical tests of instability. The ankle was also assessed pre-operatively and post-operatively though AOFAS and clinical tests of instability. Patients were followed up for 12 months.
Results: The age of patients was 18-45 years. The preoperative IKDC score ranged 49-72 with a mean SD of±14.02. The post-operative IKDC score ranged 89-100 with a mean SD of±3.5 showing marked improvement of knee function with 93.3% of patients regained normal knee function. The pre-operative AOFAS score ranged 99-100 with a mean SD of±0.16 and the post-operative score ranged 89-100 with a mean SD of±3.5 denoting minimal affection of ankle functions.
Conclusions: The peroneus longus serves as a suitable autograft for ACL reconstruction as an alternative to the others tendons based on its ability to restore knee function and the minimal morbidity at the donor site
Masquelet technique for infected femur bone defect in low resource setting: a case report
Get PDFOur hospital is located on the east edge of Indonesia, in the rural city of Merauke, South Papua. In this setting, procedures to bridge large bone defects are limited. The Masquelet technique is a two-stage orthopaedic procedure to treat large bone defects. This technique has a promising future for treating large bone defects, especially in low-resource settings. A 27 years old male experienced a traffic accident. The patient went unconscious and was brought to a nearby hospital where he underwent open reduction and internal fixation of his right femur open fracture. In the 4th week after the trauma, he was diagnosed with osteomyelitis. After multiple procedures in other hospitals, in the 74th week, he arrived at our hospital in Merauke, South Papua. We used Masquelet technique to bridge the bone gap and treat the osteomyelitis. In the first stage, we did debridement and sequesterectomy, then filled the bone defect with antibiotic impregnated PMMA spacer. After 5 weeks, the infection had subsided and the second stage of Masquelet technique was done. We removed the spacer while preserving the membrane and filled the gap with iliac bone autograft and allograft mixture. Union was attained 56 weeks after stage 2. The patient and family are satisfied with the outcome. Masquelet technique is a promising technique with a good success rate for large bone defects, especially in infected bone cases. No need for microvascular and other specialized tools made Masquelet technique can be done in a low-resource setting
Outcomes of proximal fibular osteotomy in osteoarthritis knee
Get PDFThe need for management of mild to moderate osteoarthritis (OA) knee surgically with a new method that is relatively simple, less invasive, less expensive and suitable for Indian setting postulated to offer short to medium term relief and defers the need for a major surgery like total knee replacement was served by a novel surgical technique of proximal fibular osteotomy (PFO). The aim of this study is to evaluate the efficacy, functional outcomes and complications of PFO in OA of knee joint. Total 20 patients (33 knees) with OA knee operated by PFO were included in the study and were followed up at 1 month, 3 months and 6 months postoperatively. The outcomes of PFO were evaluated using VAS score, functional american knee society score and Kellgren Lawrence (KL) scale and the patients were evaluated post-operatively for development of any complication and it’s improvement at each follow up. The results showed significant improvement in efficacy and functional outcomes with respect to VAS score and functional American knee society score however there was no significant change in KL scale grading postoperative. Few patients developed EHL weakness and hypoaesthesia post-operatively which gradually improved at further follow ups. This study concludes that PFO is a safe and efficacious method of management of OA knee showing significant pain relief and improving functional outcomes of patient significantly
A comparative prospective study of retrograde nailing versus locked compression plating in distal third femur fractures
Get PDFBackground: Treatment of distal femur fractures is complicated by the fact that the majority of these fractures occur near to transverse neurovascular structures. Present study aimed to assess the outcome in patients undergoing retrograde nailing vs locked compression plating in distal third femur fractures.
Methods: The present prospective study was conducted among all the patients visiting Mamata general hospital Khammam with distal third femur fractures between age 18-80 years during the period of October 2020- September 2022. The patients were treated with retrograde nailing in group and locked compression plating in another group of patients with distal third femur fracture.
Results: On assessment of the clinical outcome during the follow-up period, there is significantly lower clinical outcome score among the patients in the nailing group compared to the plate. Similarly, the radiological scores between the groups, there is significantly higher mean score among the patients in the nail group compared to the plate group.
Conclusions: The present study showed a significant clinical outcome and radiological score among the patients treated with retrograde nailing compared to the patients treated with locking compression plating technique for distal third fracture of femur
Fixing of intertrochanteric fractures with proximal femoral nail antirotation 2 by a double incision technique: a retrospective analysis
Get PDFBackground: The incidence of hip fractures is projected to rise from 1.66 million in 1990 to 6.26 million by 2050. Internal fixation is the most prevalent surgical intervention for intertrochanteric fractures. Hip fractures represent a significant healthcare issue amongst the elderly. The aim of this study is to evaluate a double incision technique in comparison to the conventional incision for fixing intertrochanteric fractures using the standard proximal femoral nail antirotation (PFNA2).
Methods: This study took place at Dr. D. Y. Patil hospital in Navi Mumbai, India, from May 2023 to May 2024 employing an open-label, retrospective, randomized, and comparative methodology. A total of 100 patients with proven radiographic intertrochanteric fracture having undergone fixation with PFNA2 were analysed, with 50 undergoing the double incision and 50 serving as the stand control group.
Results: The minimally invasive technique with a modified incision using the standard proximal femoral nail A2 can reduce bleeding, enhance precision for the entry point of the guidewire, shorten the time required for the entry, decrease soft tissue injuries, and provide better aesthetic outcomes.
Conclusions: The current study delineates a minimally invasive surgical technique employing a double incision for the fixation of intertrochanteric fractures using the proximal femoral nail A2, underscoring its benefits
A comprehensive study of fingertip injuries at a tertiary care centre- fingertip injury outcome score subset pilot
Get PDFBackground: Fingertip injury outcome score (FIOS) is a specialized tool designed to assess functional and aesthetic outcomes after treatment of fingertip injuries. It helps both clinicians and researchers evaluate the effectiveness of treatment strategies and monitor patient recovery. This pilot study aims to evaluate the feasibility and effectiveness of a customized FIOS tool using retrospective fingertip injuries data from the hospital, before broader implementation
Methods: A retrospective analysis of 58 hand injury patient’s data admitted in hospital with fingertip injuries having tissue loss, between January 2023 and February 2024. A customized FIOS tool, focusing on specific aspects such as complications, aesthetic outcome, patient satisfaction, ability to perform daily tasks and pain, was applied to the collected data. Data analyzed to evaluate how well the FIOS outcome score reflected patient outcomes and clinical findings.
Results: The customized FIOS effectively captured key aspects of fingertip injury outcomes, including pain levels, functional recovery. 7% had poor outcome score and 80% of those with poor outcomes suffered injuries from the heavy instruments with complications like revision surgery. 22% of the patients had excellent outcome scores, 53.4% had good aesthetic outcome score.
Conclusion: This pilot study demonstrates that using a customized FIOS tool with retrospective data is a viable approach for evaluating fingertip injury outcomes. The findings suggest that the FIOS subset can provide valuable insights into functional and aesthetic recovery. This approach facilitates seamless data capture, minimize duplicated efforts, and reduce errors and discrepancies
3D imaging techniques for the diagnosis and surgical planning of complex limb fractures: a systematic review
Get PDFThis systematic study will investigate how 3D imaging techniques have improved diagnosis and planning of surgeries for complex limb fractures. These fractures are caused of high-energy trauma which presents unique challenges, so advanced imaging technologies can help to mitigate them. We strictly adhere PRISMA guidelines to ensure thorough analysis and inclusion of relevant literature. The search was conducted on Web of Science and PubMed were all thoroughly searched between 2010 and 2023. Keyword combinations such as "3D imaging," "complex limb fractures," and "surgical planning" were employed using Boolean operators and as a result, 26 studies were included following screening based on strict inclusion criteria. 56% of studies used CT scans, demonstrating a 32% increase in diagnosis accuracy over 2D techniques for complicated fractures. In 28% of cases MRI improved soft tissue evaluation. 3D printing was utilized in 16% of investigations and it improved postoperative alignment in 94% of cases and shortened operating times by 18%. We can conclude that 3D imaging greatly enhances surgical planning, patient outcomes, and diagnostic precision in complex limb fractures and it provides useful resources for surgeons and patients by improving fracture visualization, reducing operating time, and promoting quicker recovery