International Journal of Research in Orthopaedics
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Bilateral simultaneous neck of femur fractures from a single injury in a high-risk patient
Get PDFSimultaneous bilateral neck of femur fractures resulting from a single traumatic event are exceptionally rare. Often these patients have underlying metabolic bone disorders like renal osteodystrophy, osteomalacia, long term steroid intake, osteoporosis, hyperparathyroidism etc. We present a unique case of bilateral neck femur fractures in a patient with no history or objective proof of metabolic bone disease. This case underscores the significance of recognizing atypical presentations and the need for individualized management. A 70-year-old male patient presented with altered sensorium, disorientation, and bilateral hip fractures following a self-fall at home. The absence of metabolic bone abnormalities, along with pre-existing systemic hypertension and coronary artery disease, made this presentation remarkable. Diagnostic workup revealed hyponatremic encephalopathy, further complicating the high-risk surgical status of the patient. A two-stage approach with bipolar uncemented hemiarthroplasty was chosen, and early mobilization was initiated. Remarkably, the patient returned to pre-injury mobility soon after surgery, illustrating the successful outcome. This case highlights the rarity of simultaneous bilateral neck of femur fractures in patients even without metabolic bone disease, emphasizing the need for careful evaluation and customized management. The collaborative efforts of surgeons, physicians, and anesthetists were pivotal in achieving a positive outcome, demonstrating the remarkable potential of multidisciplinary teamwork in challenging medical scenarios. This case serves as a testament to the dedication and expertise of the medical community in the face of extraordinary challenges
Comparison of clinical and functional outcomes in patients operated with standard offset stem versus high offset stem in total hip replacement: a retrospective study
Get PDFBackground: Femoral offset restoration in total hip replacement is crucial for normal anatomy and reduced joint forces, with potential implications for implant longevity and complications. This study compares standard and high offset stem total hip replacement outcomes for better restoration of native offset, also to improve understanding of clinical and functional outcomes particularly regarding implant selection in total hip replacements.
Methods: The study will include 40 patients who underwent THR, divided into standard offset and high offset stem groups. Preoperative data, including history and clinical examination, was collected. Post-operative recovery, satisfaction, and pain levels will be assessed through serial follow-ups at 6, 12, and 18 weeks, along with clinical improvement measured by Harris hip score. Analysis at 18 weeks will evaluate the outcomes of standard vs. high offset stem surgeries.
Results: Group A exhibited significantly higher proportions of patients with a Harris hip score >90 (excellent) compared to Group B (70% vs. 25%) and significantly lower proportions with scores indicating poor, fair, and good outcomes (<70: 0% vs. 10%, 70-79: 5% vs. 15%, 80-89: 25% vs. 50%, respectively; p=0.02).
Conclusions: This study confirms that increasing femoral offset with high-offset stems improves functional outcomes and biomechanics in total hip arthroplasty, emphasizing the need for patient-specific anatomical consideration
Terrible triad of elbow: a case managed with radial head prosthesis
Get PDFThe terrible triad of elbow consists of radial head fracture, coronoid process of ulna fracture, and posterior or posterolateral humero-ulnar joint dislocation. Favorable outcomes are expected in cases with early surgical intervention. Here we present a 48-year-old male patient with terrible triad of elbow injury following road traffic accident who underwent radial head replacement with temporary ulno-humeral transfixing K-wire. We came to a conclusion that planned and staged anatomical restoration of ligamentous and bony structures of the elbow with combative rehabilitation will give the best possible outcome
Comparative analysis of clinical and functional outcomes in late adolescents with genu valgum undergoing corrective osteotomy: a study of K-wire fixation versus plate osteosynthesis
Get PDFBackground: Knee alignment typically transitions from varus to valgus during growth, stabilizing around 6° valgus by age 11, with interventions necessary for exaggerated valgus in adolescence. Surgical options for genu valgum correction involve osteotomy or guided growth procedures, with distal femur osteotomy being common in late adolescents and adults, though limited literature exists on outcomes with Kirschner wires (K-wires) and plate fixation. A prospective study is proposed to assess clinical, radiological, and functional outcomes in correcting genu valgum from the distal femur.
Methods: A prospective, randomized, single-center clinical trial with 50 patients with genu valgum deformity not responsive to conservative management. Patients underwent thorough pre-operative evaluation followed by medial closed wedge osteotomy with K-wire or plate fixation. Assessment at 24 weeks included Bostman et al knee scoring, visual analog scale (VAS), passive range of motion evaluation, Likert scale and findings were compared.
Results: Cohort of 50 patients, comprising 55% females and 45% males, with a mean age of 20.76 years, no significant differences were observed in age distribution or gender between the two treatment groups (K wire fixation and plate osteosynthesis). At 24 weeks, there were no significant differences between the groups in terms of Bostman knee score, VAS score, or range of motion, indicating similar outcomes with both treatment modalities.
Conclusions: Distal femoral medial closing wedge osteotomy with K-wire fixation offers a cost-effective and practical solution for genu valgum correction, particularly beneficial in resource-limited settings like India, providing comparable outcomes to plate fixation in late adolescents
Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population
Get PDFBackground: Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis.
Methods: This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction.
Results: In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management.
Conclusions: In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results
A case control study to compare the effect of dynamisation of tibia nail in union of tibia shaft fracture versus non-dynamisation
Get PDFBackground: Tibial shaft fractures are commonly treated with intramedullary nails (IMN), with union rates of 90-100%, but complications such as delayed union occur in up to 40%. The rise of technology and urbanization has led to an increase in road traffic injuries and deaths. The treatment of distal tibia fractures has undergone various modifications over the years, with emphasis on preserving local biology and soft tissue handling.
Methods: A retrospective case-control study involving 132 patients with closed or open grade 1 tibia shaft fractures was conducted from September 2021 to May 2022. Patients received tibia IMN with either dynamic locking (group A) or static (group B). Patients were evaluated for fracture healing and clinical condition, with variables including presence or absence of union and time to union. Follow-up clinical evaluations were conducted monthly for six months.
Results: The association between union of bones seen at 1.5 and 3 months between group A and group B was extremely statistically significant (p<0.0001).
Conclusions: Intramedullary nailing with dynamic nailing assemblies is safe and effective for closed or type I open tibial fractures with limited comminution. This approach may reduce complications and re-operations and allow for early weight-bearing. Proper management of tibial fractures requires an interprofessional team.
A study of outcome of diaphyseal fractures of radius and ulna in paediatric age group treated with titanium elastic nailing system
Get PDFA study of outcome of diaphyseal fractures of radius and ulna in paediatric age group treated with titanium elastic nailing system. The current study is an attempt to find out the functional outcome, radiological union, and complications of paediatric diaphyseal radius and ulna fracture treated with titanium elastic nail. This is a prospective study of twenty-five patients of age group 6 years to 16 years diagnosed with a diaphyseal fracture of radius and ulna treated with percutaneous nailing with titanium elastic nails in Department of Orthopaedics, S Nijalingappa Medical College and HSK Hospital, Bagalkot between November 2019 to April 2022. Clinical, functional and radiological outcomes were assessed with Anderson et al criteria for 6 months. In terms of union and range of motion using Anderson et al criteria 20 patients had excellent results, 2 patients had satisfactory results and one patient had an unsatisfactory result. There were no cases of poor results. Five cases had complications like Nail prominence, elbow stiffness, olecranon bursitis and super skin infection. The radiological union was achieved in a mean time of 8.24±2.62 weeks. Complications resolved after implant removal. Titanium elastic nail system showed excellent results in terms of bony union, functional outcome with minimal complications which resolve after nail exit. Therefore, titanium elastic nail system should be considered as an effective alternative of conservative management for forearm fractures in pediatric age group
Arthroscopic excision of giant cell tumour at femoral attachment of anterior cruciate ligament and simultaneous anterior cruciate ligament reconstruction: a case report
Get PDFGiant cell tumors (GCT) are typically noncancerous bone tissue growths that have a slow growth rate, occurring more frequently in the age group of 15-40 years. They are mainly found in the distal femur, proximal tibia, and tendons of hand. Magnetic resonance imaging (MRI) is gold standard for diagnosis. The preferred method of treatment is surgical excision performed under direct visualization. Here we present a rare case involving a GCT located in the distal femur at the attachment of anterior cruciate ligament (ACL) concomitant with a tear in the ACL. The patient presented with pain and instability of left knee while walking following trauma. MRI revealed a chronic partial tear of ACL and altered signal area in lateral condyle of femur at the attachment of ACL. CT guided biopsy showed osteoclastoma over postero-medial aspect of lateral condyle of left femur. Diagnostic arthroscopy showed lax and torn ACL. Soft mass with reddish pink appearance was noted. Arthroscopic excision was done under direct vision and ACL was reconstructed with Semi-tendinosis graft. A simultaneous minimally invasive approach to treating a GCT and ACL tear can offer significant benefits in terms of reduced recovery time, improved functional outcomes, and potentially lower recurrence rates
Prevention of screw penetration of the dorsal cortex in volar plating of distal end radius fracture by using dorsal tangential view
Get PDFBackground: The dorsal cortex penetration by a screw can leads to irritation and attritional extensor tendon injury in volar plating of distal end radius fracture. Our method in this study was to use dorsal tangential view (DTV) intraoperatively to detect screw protrusions in the dorsal cortex and replace these screws with screws of appropriate size.
Methods: We have enrolled 60 patients from in patient department of orthopaedics in a rural tertiary care institute (Indian Institute of Medical Science and Research Warudi, Ta. Badnapur, Dist. Jalna, Maharashtra) having distal end radius fracture above 18 years of age planned for volar plating. DTV other than standard PA, lateral view was taken to evaluate the dorsal cortex penetration.
Results: Seven patients required AP and lateral view while 14 patients needed DTV with 80% power (α=0.05, β=0.2).
Conclusions: Our study concluded that additional DTV apart from standard AP and lateral view will detect the dorsal penetration of screws and can be changed intraoperatively. Thus, DTV is advised to minimise the iatrogenic extensor tendon injury by dorsal screw penetration which might be missed in lateral view
Outcome of radial head and neck fractures with radial head replacement
Get PDFRadial head and neck fractures are a significant concern in elbow injuries, often stemming from incidents like falls or accidents, which can severely affect elbow stability and function. This study, conducted at Shadan Institute of Medical Sciences in Hyderabad, India, focused on 15 patients with severe radial head fractures classified as Mason type III and IV. The research aimed to evaluate the effectiveness of radial head replacement utilizing implants from leading manufacturers such as DePuy Synthes® and Zimmer Biomet®. The surgical procedures were carried out successfully without any notable intraoperative complications, with an average surgery duration of 60 minutes. Postoperative complications, though relatively rare, included issues such as elbow stiffness and peri-prosthetic osteolysis, which were manageable. However, the majority of patients exhibited improved functional outcomes, as indicated by excellent Mayo elbow performance scores during the 6-month follow-up. This intervention not only enhances elbow stability but also facilitates soft tissue healing and promotes better range of motion. Consequently, radial head replacement emerges as a highly effective approach for managing severe radial head fractures, leading to considerable improvements in patient outcomes and quality of life.