International Journal of Research in Orthopaedics
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Outside in and all inside approach for repair of meniscal tears: post-operative subjective evaluation: a retrospective study
Get PDFBackground: Assess clinical outcomes after using outside-in, all-inside or combination of both approaches for meniscal repair.
Methods: 86 patients with diagnosed meniscal tears, operated between January 2017 and January 2019 by one surgeon in Northway Clinic, Vilnius and Vilnius Clinical Hospital were surveyed. The meniscal repair techniques used included all-inside, outside-in, or a combination. Clinical outcomes were evaluated using the International Knee Documentation Committee Subjective Knee Evaluation Form, with meniscal retear indicating failure. Ethical approval was deemed unnecessary for this project. Descriptive statistical analyses were performed using IBM SPSS Statistics 29.01.
Results: Patients undergoing the outside-in approach scored 89.4±12.5 on the IKDC questionnaire, compared to 88.5±16.6 for all-inside and 82.8±20.3 for both techniques combined (p=0.194). Kaplan–Meier analysis showed a 5.6-year survival rate of 80.9% with the all-inside approach. Subjective knee function assessment indicated scores of 8.50±1.9 for outside-in, 8.49±1.4 for all-inside, and 8.16±1.95 for both techniques. Cox proportional hazards model analysis suggested that older age and higher BMI trended towards reduced reoperation risk (hazard ratio, 0.93 and 0.98; p=0.246 and p=0.832, respectively).
Conclusions: Self-reported outcomes in this study evaluated by IKDC questionnaire and subjective function assessment emphasize that both all-inside, outside-in or combination of the techniques provide similar results. All adverse outcomes defined as meniscal retears were observed using all-inside technique
Outcome of posterior decompression by L1 laminectomy, transpedicular fixation, posterolateral fusion in burst fracture L1 with incomplete spinal cord injury
Get PDFIntroduction: Burst fractures are more severe than compression fractures as the bones spread out in all directions and may damage the spinal cord, leading to paralysis or nerve injury. This study aims to find the surgical outcomes of Posterior Decompression by L1 Laminectomy in terms of burst fracture with incomplete spinal cord injury.
Methods: 48 adult patients with burst fractures with incomplete spinal injury came to NITR from June 2023 to May 2024. In this non-randomized clinical trial, the outcomes of decompression by L1 laminectomy were analysed by using the canal encroachment ratio, while deformity correction was assessed using the sagittal Cobb angle and the percentage of anterior vertebral height for the treatment of L1 burst fracture with incomplete spinal cord injury.
Results: The patients were followed up for an average of 12 months. The mean operation time was 154.53 minutes, mean intraoperative blood loss of 48.84 mL, and the mean incision length was 7.78 cm. The canal encroachment ratio decreased significantly, as well as the sagittal Cobb angle, and anterior vertebral percentage height increased. Oswestry Disability Index, and American Spinal Injury Association impairment scale classification were significant.
Conclusions: Posterior decompression combined with Transpedicular Fixation and Posterolateral Fusion in the treatment of Burst Fracture L1 with Incomplete Spinal Cord Injury is safe and effective
Efficacy of hypertonic dextrose (prolotherapy) in early knee osteoarthritis: a short term outcome
Get PDFBackground: Knee osteoarthritis (OA) is a prevalent, painful, and progressive condition significantly affecting patients' quality of life and imposing a social and economic burden. Traditionally managed through symptom relief and joint function improvement, research is increasingly focusing on disease-modifying treatments. Dextrose prolotherapy, a low-cost alternative involving the injection of a hypertonic solution, has shown promise despite limited acceptance in current guidelines.
Methods: This prospective cohort study, approved by the Institutional Ethical Board of Jamia Hamdard University, assessed the effects of 12.5% hypertonic dextrose prolotherapy in 92 patients with knee OA. Patients received injections at multiple sites over a 6-week period. Outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores at baseline, 4, 8, 16, and 24 weeks.
Results: Significant improvements were observed in both WOMAC and VAS scores. WOMAC scores decreased from 53.83 to 26.70 (p<0.0001), and VAS scores dropped from 7.12 to 3.06 (p<0.0001) at the 24-week follow-up. No major complications were noted, with minimal adverse effects reported. Improvement was consistent across all OA grades.
Conclusions: Dextrose prolotherapy demonstrated substantial, sustained improvements in pain and function in knee OA patients. Given its safety, low cost, and efficacy, it represents a viable therapeutic option, especially in resource-constrained settings. Further high-quality randomized controlled trials are needed to confirm these findings and optimize treatment protocols
Evaluation of functional outcome of cemented bipolar prosthesis in femoral neck fracture in old age patients
Get PDFBackground: Older adults are at a higher risk of proximal femur fractures, particularly femoral neck and intertrochanteric fractures, often due to falls, trauma, or osteoporosis. Managing these fractures in osteoporotic bones is challenging, as they are associated with complications such as pressure sores, deep vein thrombosis, and hypostatic pneumonia. This study aimed to evaluate the outcomes of treating femoral neck fractures in elderly patients using cemented bipolar prosthesis.
Methods: A quasi-experimental study was conducted on 40 patients aged 60 to 84 years who underwent cemented bipolar hemiarthroplasty within 21 days of fracture from January 2019 to December 2019. Post-operative functional outcomes were assessed using the Harris hip score (HHS) at 3, 12, and 24 weeks, both clinically and radiologically.
Results: Of the 40 patients, 65% were female, and 52.5% had left-sided fractures. The majority (55%) experienced trivial falls. The HHS improved significantly from a mean of 43.73±6.78 at 3 weeks to 82.56±9.13 at 6 months. Garden type 3 fractures were the most common (70%). Functional outcomes were graded as good in 72.5% of patients, excellent in 17.5%, and fair in 5%, while 2.5% had a poor outcome. One patient (2.5%) died due to pulmonary embolism.
Conclusions: Cemented bipolar hemiarthroplasty in elderly patients with femoral neck fractures is a safe and effective treatment, promoting early mobilization and reducing the risk of complications such as bed sores, deep vein thrombosis, and hypostatic pneumonia
Short-term clinical outcomes on a new dual-taper wedge femoral stem in total hip replacement
Get PDFBackground: Short femoral stems have become increasingly popular in total hip arthroplasty (THA), offering potential advantages such as bone preservation and improved load transfer. The Everglade stem (Signature orthopedics Australia), a novel dual-tapered design, aims to enhance initial stability while minimizing complications such as subsidence and fracture. This study evaluates the short-term clinical and radiological outcomes of the Everglade stem.
Methods: We conducted a retrospective review of 100 consecutive patients (41 men, 59 women; mean age 68 years) who underwent THA using the Everglade stem at the Delray beach surgical center, a physician-owned ambulatory surgical center (ASC), between December 2022 and January 2023. Pre-operative and post-operative hip disability and osteoarthritis outcome score (HOOS-Jr) data were collected. Radiological outcomes, including stem subsidence, periprosthetic fracture, and osteolysis, were assessed at the 6-week and 6-month follow-ups.
Results: The median follow-up was 161.5 days (IQR 43-187). The mean HOOS-Jr score improved from 57.07 pre-operatively to 86.03 at 6 weeks and 92.7 at the latest follow-up. No cases of stem subsidence, periprosthetic fracture, or osteolysis were observed at any follow-up. There were no stem revisions or postoperative infections.
Conclusions: The Everglade stem demonstrated promising short-term outcomes, with significant improvements in patient-reported functional scores and no radiological complications. Longer-term studies are needed to evaluate the stem’s durability and long-term performance
Indications, outcomes, and complications of orthopaedic implant removal: a prospective observational study
Get PDFBackground: Orthopaedic implant removal is a common procedure, but its indications and outcomes remain debated. This study aimed to examine the indications, outcomes, and complications of implant removal in a tertiary care center.
Methods: A prospective observational study was conducted on 66 patients undergoing implant removal between February 2022 and February 2024. Patient demographics, indications for removal, time to removal, and complications were recorded. Follow-ups were conducted at 6 weeks, 3 months, and 6 months post-removal.
Results: The study included 47 males and 19 females, with 74% adults and 26% paediatric patients. Pain was the most common indication for removal (42%), followed by elective removal (36%). Most implants (33%) were removed after 2 years. Complications were minimal, with 4.5% incomplete removals and 1.5% failure to remove. No intraoperative fractures or postoperative infections were observed. Patients generally reported improvement in symptoms or psychological well-being following implant removal.
Conclusion: Implant removal should be approached selectively, with careful consideration of indications and potential complications. Pain relief and improved function were common outcomes, but risks such as incomplete removal should be considered. The study supports individualized decision-making in implant management, emphasizing the need for thorough preoperative planning and skilled surgical execution
A comparative study of anatomical plate fixation versus intramedullary nailing of middle-third clavicle fractures in Al-ameen medical college hospital
Get PDFBackground: Clavicle fractures constitute 5% of adult fractures. About 80% involve the midshaft, with more than 70% displaced. Many plate and intramedullary fixation systems have been used. However, the best fixation method is still debated. Surgery includes ORIF with Anatomical Plate and CRIF with TENS. Each technique has its own advantages and disadvantages.
Methods: 40 patients with displaced middle-third clavicle fractures were prospectively randomly assigned to two groups, Group-A (plating group) and Group-B (nailing group), with an equal number of 20 patients in each. The outcomes were evaluated based on Union-time, Complications, Visual-Analog-Scale for pain. The assessment of shoulder function was conducted using the DASH score.
Results: 9 (45%) of Group A patients achieved union in 6-7 months and 11 (55%) in 8 months, mean union time being 7.5 months. 4 (20%) had implant prominence, 3 (15%) had hypertrophic scar, 1 (5%) had plate-end protrusion post-union, and 2 (10%) had surgical site infection managed by intravenous antibiotics. In group B, 16 (80%) patients achieved union by 6-7 months and 4 (20%) by 8 months, mean union-time being 7.1 months. 3 (15%) patients had nail-end prominence, 3 (15%) had nail-end irritation by 4 months, one (5%) had nail-end protrusion by 6 months, and one (5%) had medial migration by 8 months. No surgical site infection occurred.
Conclusion: Plating provides firm fixation, greater rotational stability for displaced middle-third clavicular fractures. Complications with plating like scarring, implant prominence, irritation are significantly lesser in nailing. Both fixations provide good functional outcome
Staged tricortical bone graft with internal fixation in complex distal humerus fracture: a prospective study
Get PDFBackground: Complex distal humerus fractures present a significant challenge in orthopaedic surgery. This study evaluates the efficacy of staged tricortical bone graft combined with internal fixation in these fractures.
Methods: A prospective study involving 50 patients with complex distal humerus fractures treated with staged tricortical bone graft and internal fixation was conducted. The primary outcomes measured were radiographic union and functional recovery using DASH and MEPS scores over a 12-month period.
Results: Radiographic union was achieved in 100% of patients at 12 months. Significant improvements in functional outcomes were noted, with DASH and MEPS scores improving from 75.3 and 55.4 at baseline to 20.1 and 95.0, respectively, at 12 months (p<0.001). The complication rate included an 8% incidence of postoperative infection and a 6% rate of non-union. Subgroup analysis indicated slightly better outcomes in patients under 50 years.
Conclusion: Staged tricortical bone graft combined with internal fixation demonstrates high efficacy in treating complex distal humerus fractures, offering high union rates and significant functional improvements. While the results are promising, further research is needed for broader validation
Blount’s disease treatment outcome with Taylor spartial frame in low resource settings
Get PDFBackground: Blount's disease is a developmental condition defined by abnormal growth of the proximal posteromedial tibial physis, which causes progressive lower limb deformity. The deformity is primarily characterized by tibia vara, procurvatum, internal tibial torsion and limb shortening. To evaluate the outcome of treatment of Blount’s disease using circular external fixation Taylor spartial frame (TSF).
Methods: The limb deformity correction unit of the Orthopaedics and Trauma Department of University College Hospital, Ibadan conducted a 5-year retrospective assessment of patients who had Blount's disease correction using the TSF device between January 2019 and July 2023. The data was analyzed using the Social Sciences Statistical Package, Version 19.
Results: 42 patients were recruited with 68 limbs. 26 patients (62%) had both right and left lower limb deformities. The majority were young adolescent in the age group of 11–15 years. And a male-to-female ratio of 1:2.81. They all had TSF frame application, fibulotomy and metaphyseal (proximal tibia) corticotomy and subsequently had graduated adjustment of the frame until correction is achieved, following the prescription generated from the TSF software. The highest complication observed was pin site infection in 10 patients (23.8%).
Conclusions: The TSF device is considered one of the most reliable methods of achieving safe and accurate correction of the multi-planar deformities associated with severe and recurrent Blount’s disease
Clinico-radiological assessment of vascularized muscle pedicle bone graft in scaphoid non-union
Get PDFBackground: The aim of this study was to assess the clinico-radiological outcome of vascularised muscle pedicle bone graft in scaphoid non-union.
Methods: 16 men and 8 women with non-union of the scaphoid involving the proximal pole (n=6), waist (n=14), and distal pole (n=4) were randomly assigned to receive a vascularized muscle pedicle bone transplant with Herbert screw fixation. Their ages ranged from 18 to 45 (mean 32). Eight months was the average non-union period (range: 4–12 months).
Results: The mean follow-up duration was 18 months. 20 out of 24 were united. In 16 out of 24 cases, the scapholunate and radiolunate angles were corrected. 4 of 24 did not achieve union, and 3 of those were associated with proximal pole absorption. During pedicle dissection, there was no iatrogenic fracture or hardware malfunction.
Conclusions: Scaphoid non-union has been successfully treated with vascularized bone grafts, particularly in cases where the non-union has an avascular proximal pole or has not healed following prior surgery