International Journal of Research in Orthopaedics
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Hibernoma of the thigh: a case report and literature review
Get PDFHibernoma is a rare benign tumor of brown fat. It presents as a voluminous slow growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumor, whose differential diagnosis of liposarcoma
Osteoid osteomas around the ankle managed with cost-effective and clinically efficient percutaneous drilling resection: a case report of two cases in the talus and distal tibial epiphysis
Get PDFOsteoid osteoma (OO) is a benign bone tumour characterised by constant pain which is worse at night and relieved by NSAIDs. On imaging, it is seen as a well demarcated rounded osteolytic lesion with a central nidus. It is rarely seen around the ankle joint, and it is easy to miss on primary plain radiographs, especially in children, leading to mid- or delayed diagnosis which is highlighted in this case report. Conservative management with NSAIDs and immobilisation is usually the first line of management. Upon failure of medical treatment, there are various surgical options ranging from open resection to minimally invasive image guided procedures. We present 2 cases of sub-periosteal OO around the ankle- one in the talus and other one in the distal tibial epiphysis. The first case is of a 17-year-old girl, was initially misdiagnosed on plain radiographs and magnetic resonance imaging (MRI) as right ankle synovitis elsewhere and treated with open synovectomy and debridement. She presented to us 4 months after the procedure with incessant right ankle pain not allowing her to perform her routine activities. The second case describes OO in the distal tibial epiphysis of the left ankle in a 12-year-old male child presenting with typical left hind foot pain. We managed both the OO with percutaneous drilling resection (PDR) under computed tomography (CT) guidance with complete resolution of symptoms and full weight bearing within 48 hours. A six-month follow-up reported birth children back to schooling and routine activities with a completely pain free ankle joint. OO around the ankle requires a high index of suspicion. Early diagnosis is often obscured by vague symptoms and complex anatomical location around the ankle. CT scan is considered to be the gold standard; effusion and peri-lesional edema masks the lesion on MRIs. PDR is a cost effective and easy surgical option producing consistent results with low rates of recurrences.
Integration of advanced imaging and surgical navigation in the treatment of unstable thoracolumbar spine fractures: a systematic review of functional, neurological and postoperative outcomes
Get PDFAdvanced imaging and surgical field have improved treatment and management of unstable thoracolumbar spine fractures significantly. Its emergence is boosting surgical accuracy, efficiency and its use has increased patient recovery rate. This systematic analysis is conducted to explore how these technologies affect functional, neurological and postoperative outcomes. Our aim is to evaluate and investigate previous evidences and various studies. This systematic analysis will be based entirely on retrospective analyses, randomized controlled trials, and other systematic reviews. While conducting methodology, we assessed several factors like pedicle screw placement accuracy, surgery time, radiation exposure and noted overall patient outcomes across different navigation systems like intraoperative CT navigation (iCT-Nav), 3D navigation, and augmented reality. The primary results of this systematic review revealed pedicle screw placement accuracy was high (up to 96.9% with iCT-Nav), with fewer revision surgeries needed. 3D navigation reduced fluoroscopy time significantly (p=0.0002) while still maintaining accuracy and evidence confirmed these techniques also helped lower blood loss (p<0.05) and improved spinal alignment without adding significant time to the surgery. Evidence showed radiation exposure remained an issue with varying levels of dose-length product (DLP) but it was dependent on the complexity of the procedures. Conservative management failed in 9.2% of cases while long-segment stabilization helped prevent further vertebral fractures. After all these results, we came to a conclusion that advanced imaging and navigation technologies have revolutionized thoracolumbar fracture management because its use has improved accuracy and patient outcomes which is confirmed. These technologies are also seen to reduce the need for revision surgeries and made minimally invasive surgeries more effective and also helped stabilize the spine in the long term. The challenges linked to these procedures are radiation exposure, standardization and costs which need to be carefully handled and need attention. Future research should explore what the role of artificial intelligence is and how it can work to bring maximum outcomes while making these technologies more accessible is also critical
Functional outcomes following total hip and knee arthroplasty
Get PDFBackground: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective treatments for advanced osteoarthritis (OA) and other joint disorders. Despite their efficacy, many patients experience residual functional limitations postoperatively. This study evaluates functional outcomes following unilateral THA and TKA, integrating patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs) over 12 weeks.
Methods: This prospective observational study, conducted at B. P. Koirala Institute of Health Sciences, Nepal, included adults scheduled for unilateral THA or TKA. Participants completed preoperative questionnaires assessing demographics, health status, joint disabilities, and baseline functional tests, including the 30-second chair stand test (30-s CST) and the HOOS/KOOS. Postoperative follow-ups were conducted at 2, 6, and 12 weeks, assessing functional outcomes, satisfaction, pain, and quality of life (QoL). Paired t-tests and repeated measures ANOVA was used for data analysis in SPSS version 26.0.
Results: The study included 38 patients; 24 THA and 14 TKA, with both groups showing significant postoperative improvements in all outcomes (HOOS/KOOS, 30-s CST, pain, and QoL). TKA patients demonstrated better early improvements in pain, symptoms, and physical function at 2 weeks. In contrast, THA patients had greater improvements in sports and recreation scores by 12 weeks. Self-reported QoL showed significant improvements, with no significant differences in age or BMI affecting outcomes. Pain catastrophizing decreased significantly in both groups. Gender differences were found in the THA group, where men improved better in most functional measures.
Conclusions: Both THA and TKA result in significant improvements in pain, physical function, and QoL, with PROMs and PBOMs playing complementary roles in tracking recovery highlighting the importance of integrating subjective and objective measures for holistic post-surgical evaluations and personalised rehabilitation strategies
Rare cause of neck pain and gait imbalance: a case report
Get PDFChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon cause of neck pain and radiculopathy that can be easily misdiagnosed. The lack of diagnostic criteria makes the diagnosis of such cases challenging. However, the correlation between clinical presentation with laboratory and radiological findings can help diagnose these patients. Surgical decompression is rarely indicated in the absence of any cause of neuronal compression. Medical treatment of CIDP is currently the main line of treatment. We are presenting a case of a 32-year-old male with no known medical conditions who presented to our spine clinic with a history of chronic neck pain associated with gradual and progressive left upper limb weakness and imbalance. Clinical imaging showed hypertrophied nerve roots of the cervical spine. The patient was treated with intravenous immunoglobulins and corticosteroids, which improved his symptoms significantly
Dual plate fixation for combined mid-clavicle fracture and acromioclavicular joint injury: a case report
Get PDFThis case report presents a rare injury involving a combined mid-clavicle fracture and acromioclavicular (AC) joint injury. While conservative management is typically recommended for Rockwood's grade I and II AC joint injuries, surgical intervention is commonly advised for grade IV, V, and VI injuries. However, there is limited literature addressing the management of mid-clavicle fractures in conjunction with ipsilateral AC joint injuries
En bloc resection of aneurysmal bone cyst at proximal fibula in skeletally immature individual presented with neuropraxia: a case report
Get PDFAneurysmal bone cysts (ABCs) are usually benign but locally destructive, blood-filled reactive lesion of the bone. Although a wider age group may be affected, usually they are seen in patients less than 20 years of age, with a more female preponderance. Most common sites include metaphysis of femur, proximal leg bone and then humerus. Aneurysmal bone cyst of proximal end of fibula is a rare and uncommon. Here, we report a case of 17-year-old female with classic histologic, clinical, and radiographic findings that was treated by en bloc resection
Clinical, functional and radiological outcome of retrograde femoral nailing in femoral shaft fractures: an observational study
Get PDFBackground: Femoral shaft fractures require prompt and effective management to prevent long-term disability. Retrograde intramedullary nailing (RIMN) offers a reliable alternative to antegrade nailing, particularly when proximal access is limited. This study evaluates the clinical, functional, and radiological outcomes of RIMN to inform optimal fracture management.
Methods: An ambispective observational study was conducted at the Asian Orthopaedic Institute, SIMS Hospital, Chennai, from February 2023 to February 2024. A total of 38 patients with femoral shaft fractures treated using RIMN were included. Functional outcomes were assessed using the lower extremity functional scale (LEFS), pain using the Visual Analogue Scale (VAS), and radiological outcomes based on time to union. All patients were operated on by the same surgeon and followed for six months postoperatively.
Results: The mean age was 42.3±0.9 years, with a female predominance (55%). Slip and fall was the most common cause (53%), and A1-type fractures were most frequent. The mean time to union was 14.5±4.4 weeks. LEFS scores improved from 23.76 to 63.29, VAS scores declined from 4.95 to 0.34, and knee ROM increased from 77.37° to 112.63° (p<0.001). One malunion was reported; no other complications occurred. No significant association was found between demographic variables and time to union.
Conclusion: RIMN is a safe and effective treatment for femoral shaft fractures, enabling early mobilization and favourable clinical outcomes
Early spinal decompression after documentation in the initial CES-S and CES-R stages of Cauda Equina syndrome: saving both the patient and the clinician
Get PDFBackground: Cauda equina syndrome (CES), described by Mixter Barr in 1934, is a rare and acute surgical emergency, and in our observation, the slower stages of bowel, bladder or limb dysfunction are more common than that claimed in the literature. This paper is to remind clinicians to document all the clinical changes of an evolving CES because patients could already be slipping into a progressive CES but will not reveal them unless inquired.
Methods: The IRT Programme for Medicos and Doctors (IRTP) of KRUSHI Orthopaedic Welfare Society, an NGO based in India, emphasises "preventive orthopedics", conducted this compilation study which is a mixed or ambispective study design of 650 patient data of which 450 patient data was from direct study in our KOWS research purview and 150 patients from various data bases like the Scopus, Web of Science, PubMed, JSTOR, and ScienceDirect.
Results: Incidence of early stages of CES may be missed if only bladder dysfunction is given importance while taking in the patient information by the clinician as only of 33% of the patients complain of bladder dysfunction whereas genital numbness is 47%, sexual dysfunction is of 53% of incidence when carefully enquired into.
Conclusions: The slower forms of cauda equina syndrome are usually missed by the clinicians if they trivialise the red flags of the autonomic dysfunction which are more frequent than that noticed and also the radiologist is equally responsible for not reporting enough about the redundant nerves (RND), the spinal canal diameters as smaller canals promote CES even with a smaller compression. If the clinician asks the right questions, the patients in these slower CES (S), CES(R) will never be missed. This article highlights the sigmoid curve pathophysiology and highlights the time frame and emphasis the early stages of CES(S) and CES (R) to be the best stages where the surgery is beneficial
Comparing the outcome of fixation of supracondylar femur fractures using retrograde intramedullary nailing and distal femur locking compression plate
Get PDFBackground: Supracondylar femur fractures typically occur as a result high energy trauma in young and in elderly after low energy trauma. Retrograde intramedullary nailing (RIMN) and distal femur locking compression plate (DFLCP) are widely used for fixation distal femur fractures. This study was done to compare the clinicoradiological outcome of fixation of supracondylar femur fractures using RIMN and DFLCP.
Methods: In our study with 26 patients fulfilling the criteria were enrolled and one group treated with RIMN while the other group treated with DFLCP and corresponding Functional and radiological assessment done on basis of Neer’s score.
Results: Fractures occurred primarily as a result of RTA in young and self-fall in elderly. Fracture type AO33-A1 was seen more commonly in both groups. The mean duration of surgery, blood loss and bone union time in the RIMN group minutes was less than that the DFLCP group. All fractures in the RIMN group united while three cases of non-union in DFLCP group, with one case of delayed union, one case of periprosthetic implant fracture, and one case of knee joint arthrosis. Local soft tissue complications were more common among DFLCP group. Functional and radiological assessment on basis of Neer’s score was found to be better in RIMN group than the DFLCP group.
Conclusions: RIMN is a better option in the operative treatment of supracondylar femur fractures found to be correct in terms of less soft tissue complications, shorter duration of surgery, less intraoperative blood loss, shorter duration of hospital stays, and fracture union