International Journal of Research in Orthopaedics
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Hoffa’s fat pad ganglion cyst protruding from lateral retinacular rent: a case report
Get PDFGanglion cyst in and around the knee are quite rare occurrences. They are usually encountered as incidental findings in magnetic resonance imaging (MRI), or in arthroscopy. They may originate from both the cruciate ligaments and the menisci, from the popliteus tendon and alar folds, infrapatellar fat pad of Hoffa, and subchondral bone cysts. Those cysts which arise from fat pad, present as palpable mass at the anterior aspect of the knee. 45-year male, presented with a painless gradually increasing swelling at the anterior aspect of the left knee of 11 months’ duration. Patient complaints of discomfort in the left knee, occasional pain on walking, and climbing stairs. MRI scan revealed a multilobulated, cyst with septations within the anterior aspect of the knee joint, just inferolateral to the patella, with deep extension into the infrapatellar fat pad, and superficial extension into the subcutaneous space across the retinaculum. Proper preoperative evaluation of MR images of these cases is very important. Subcutaneous extension through lateral retinaculum renders these cyst incomplete resection via arthroscopic excision. There-fore open excision was performed
Comparison between malleolar locking plate and metaphyseal locking plate for the management of the distal tibial fracture
Get PDFBackground: A pilon fracture is a distal tibial metaphyseal fracture that involves the ankle joint. Distal tibia fractures include extra-articular fractures of the metaphysis and the more severe intraarticular tibial plafond or pilon fractures. Several treatment methods have been recommended for the treatment of these injuries, with a recent emphasis on minimally invasive techniques. This research studies the outcome of a malleolar locking plate (M) versus a metaphyseal locking plate (P) in the management of distal tibial (Pilon) fracture.
Methods: Distal tibial M and P were used to treat 80 cases of tibial pilon fracture. The study examined the use of anterior/ anteromedial approach for tibia and posterolateral/ lateral fibular fixation.
Results: The male to female gender ratio was 2.63 in M and 1.35 in P. Mean age was 57.03±15.93 (M) and 52.1±12.788 (P). Surgeries were mostly done within 1 day to 1 week. Mean hospital stay was 6.43±4.545 (M) and 4.93±4.676 (P). The mean lower extremity functional score (LEFS) was 66.55 (M) and 67.15 (P) with 83.56% maximal function. 3 P cases had infections. No infections were seen in M group at the end of the 12th week follow-up.
Conclusions: The results of the study indicate that there is no significant difference in terms of LEFS criteria, union, fracture alignment, range of motion (knee and ankle), infection, and other outcome measures between M fixation and P in the treatment of distal tibia fracture in adults
Functional outcome of treatment of fracture intertrochanteric femur by using proximal femoral nail antirotation II
Get PDFBackground: The elderly are most frequently affected by intertrochanteric fractures, which have a major effect on the medical community and society at large. In 2003, AO introduced the proximal femoral nail anti-rotation device, which was further improved and named proximal femoral nail antirotation II (PFNA II) in 2009.
Methods: This study was conducted from December 2020 to August 2022. The 60 cases of proximal femoral nail anti-rotation II-managed intertrochanteric femur fractures were assessed.
Results: In the present study, 24 patients (40%) had type IV (Evan’s) fractures. Right hip was involved in 30 patients (50%). Meantime for clinic-radiological union was 20 weeks. There was complication rate of 2.08% as helical blade protrusion and non-union, 2.08% as helical blade protrusion, 2.08% as blade backout, 4.17% as superficial infection and 4.17% as lateral wall fracture. Seven patients expired postoperatively within 3 months while 5 patients lost during follow Up. After a 6-month follow-up, the Harris hip grade was used to evaluate 48 instances. Of these, 8 cases (16.67%) had an excellent score, 29 cases (60.42%) had a good score, 7 cases (14.58%) had a fair score, and 4 cases (8.33%) had a poor score. Thirty-seven of the 48 cases had reached the one-year follow-up mark. Thus, of the 37 patients assessed, 11 cases (29.73%) had excellent Harris hip grades, 19 cases (51.35%) had good scores, 4 cases (10.81%) had fair scores, and 3 cases (8.11%) had poor scores at the end of a one-year follow-up.
Conclusions: Even in rural populations, PFN A-II is a better, safer implant with a low rate of complications for treating stable and unstable intertrochanteric femur fractures
Bilateral total knee arthroplasty-analysis of risk factors for blood loss and blood transfusion
Get PDFBackground: Total knee arthroplasty in general is a safe and successful surgical procedure for end stage arthritis of the knee joint to relieve pain, correct the deformity and restore function in the joint. However, it is often associated with significant blood loss. In such cases, blood transfusion is not uncommon.
Methods: 100 patients who underwent simultaneous bilateral TKA from April 2022 to December 2022 at Sant Parmanand Hospital, New Delhi were taken up for the study.
Results: In this study among 100 patients who underwent simultaneous bilateral total knee replacement, 9% of the cases required blood transfusion. Preoperative haemoglobin (<12.64 gm/dl) continues to be a predictor in blood transfusions. A haemoglobin level of less than 10.34 gm/dl preoperatively, a postoperative haemoglobin day 1 level of less than 8.56gm/dl and a postoperative day 3 level of less than 7.49 gm/dl increases the necessity for blood transfusion in simultaneously performed bilateral TKAs.
Conclusions: Asthma, Diabetes mellitus and patients on blood thinners are three major comorbidities than can cause increased blood loss. Age, gender, BMI and comorbidities are not related to the need for blood transfusion. Patients on blood thinners are at an increased risk for blood transfusion if they have a lower preoperative haemoglobin. Checking haemoglobin values on postoperative day 1 and day 3 are significant in terms of the need for blood transfusion
Effectiveness of teriparatide in enhancing bone formation and reducing aseptic loosening risks post-hip arthroplasty in patients with avascular necrosis
Get PDFBackground: The hip joint's critical role in weight-bearing and mobility is often compromised by avascular necrosis (AVN), leading to osteoarthritis (OA). This study evaluates the impact of teriparatide, a synthetic parathyroid hormone analog, on bone formation and the risk of aseptic loosening in post-hip arthroplasty patients affected by AVN.
Methods: In this retrospective, single-centre study, 26 patients who underwent hip replacement surgery due to AVN between November 2021 and November 2023 were included. Participants were selected based on specific inclusion and exclusion criteria and received daily subcutaneous injections of teriparatide (20 μg) for six months. The study focused on assessing the efficacy of Teriparatide in mitigating prosthetic loosening and enhancing bone formation post-hip arthroplasty, alongside monitoring for adverse events.
Results: The cohort had a mean age of 37.63 years, predominantly male (77%). The median time for post-surgical pain onset was 31 days. After 3 months of teriparatide therapy, all patients showed a significant reduction in joint pain and swelling, with improved mobility. Radiographic evaluations demonstrated a decrease in previously observed radiolucent lines, indicating successful prosthesis integration. At the 6-month mark, tomosynthesis revealed no space between either the femoral head or hip components and the osteotomy load surfaces. No adverse events were reported during the therapy period.
Conclusions: Teriparatide-is a promising therapeutic agent for enhancing surgical outcomes in post-hip arthroplasty in patients with AVN. Its role in promoting bone formation and reducing aseptic loosening risks is significant, suggesting its potential in improving patient recovery and pre-empting postoperative complications
Evaluation of functional and radiological outcome of core decompression with autologous corticocancellous bone grafting and intralesional zolendronic acid in early stages of avascular necrosis of femoral head
Get PDFBackground: Avascular necrosis (AVN) of the femoral head is a progressive condition leading to bone necrosis, collapse, and joint dysfunction. Core decompression with autologous corticocancellous bone grafting is a common treatment option for early-stage AVN. This study aimed to compare the functional and radiological outcomes of core decompression with autologous corticocancellous bone grafting alone versus the same procedure with the addition of intralesional zolendronic acid in patients with early-stage AVN.
Methods: A randomized controlled trial was conducted with 20 patients (26 hips) diagnosed with early-stage AVN (Ficat stages I and II). Patients were randomly allocated into two groups. Group A underwent core decompression with bone grafting, while group B received the same procedure with the addition of zolendronic acid. Functional outcomes were assessed using the Harris hip score (HHS), pain relief was measured using the visual analog scale (VAS), and radiological progression was evaluated using MRI scans at 3, 6, and 12 months postoperatively. SPSS version 23 was used for data analysis.
Results: Group B demonstrated significantly greater improvements in pain relief and functional outcomes at all follow-up intervals (p<0.05). The mean HHS in group B improved from 50.5±8.0 preoperatively to 88.0±5.5 at 12 months, while group A showed an improvement from 49.0±7.7 to 79.2±6.6.
Conclusions: The addition of Zolendronic acid to core decompression and autologous corticocancellous bone grafting significantly enhances both functional and radiological outcomes in patients with early-stage AVN
Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy
Get PDFBackground: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy.
Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test.
Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p<0.0005).
Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes
Functional outcome of Schatzker type V and VI tibial plateau fractures managed by open reduction and internal fixation using dual plates
Get PDFBackground: High-energy bicondylar tibial plateau fractures (Schatzker type V and VI) occur as a result of road traffic accidents, falls from height, and sports injuries, and mostly affect the younger age group in productive life years. This study aimed to evaluate the functional outcome of high-energy tibial plateau fractures (Schatzker type V and VI) treated by dual plating through anterolateral and posteromedial incisions.
Methods: This was a hospital-based clinical trial study conducted in the department of orthopaedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from January 2018 to December 2019. Our study included 50 adult patients of both genders with high-energy tibial plateau fractures through a consecutive sampling technique. The knee function of the patients was evaluated according to the Oxford knee scoring system.
Results: Out of 50 cases, 38 cases (76%) were male and 12 cases (24%) were female with a mean±SD age was 43.95±10.89 years. All the cases (100%) were due to RTA, 70% had Schatzker type VI and 30% had type V injury. Mean±SD time interval from injury to fixation was 11.05±3.20. The average duration of operation in minutes was 107.0 (±12.07). At the final follow-up, 41 (82%) and 05 (10%) patients had excellent and good outcomes respectively.
Conclusions: Open reduction and internal fixation in high-energy tibial plateau fractures using dual plates through two incisions can provide excellent to good functional results and minimal soft tissue complications in appropriately selected cases
Evaluation of safety and functional outcomes after rotator cuff repair using Sironix suture anchor
Get PDFBackground: Arthroscopic rotator cuff repair procedures are performed to maximize clinical and functional outcomes. The surgical sector is experiencing a surge in repair surgeries involving arthroscopic repair of torn tendons using surgical implants. The study aimed to evaluate the safety and functional outcomes of rotator cuff tear repair using Sironix suture anchors.
Methods: Patients with a mean age of 53.8 years who underwent arthroscopic rotator cuff repair using a Sironix suture anchor between January 2019 and June 2022 were included in this retrospective observational study. Postoperatively, patients were assessed using the American shoulder and elbow surgeons score (ASES), level of activity using the simple shoulder test questionnaire (SST), quality of life using the shoulder pain and disability index scale (SPADI), the single assessment numerical evaluation score (SANE), and adverse events associated with study devices.
Results: Significant and clinically relevant ASES, SST, SPADI, and SANE scores were observed in all patients. The mean (SD) values of total ASES, SST, and SPADI scores were 91.6 (6.21), 94.1 (10.74), and 1.3 (2.48), respectively. The mean (SD) value of total SANE score in the affected joint was 95.8 (7.70), and the opposite side was 99.0 (3.04). No serious adverse events were reported.
Conclusions: Sironix suture anchors (CEPTRE® knotted UHMWPE suture PEEK anchor, CEPTRE® knotted UHMWPE suture PLDLA-βTCP anchor, VIPLOK® knotless PEEK anchor with titanium tip and VIPLOK® knotless PLDLA-βTCP anchor with titanium tip) have proven to be both safe and effective in repairing rotator cuff tears, enhancing shoulder function without any serious adverse effects
Tumors around the ankle: a reconstructive challenge
Get PDFTumors around the ankle can be either bone or soft tissue sarcomas. The aggressive nature of these tumors and the complex anatomy of the ankle mortice make for a challenging reconstructive ladder. We have explored four different histological tumors which required tailor made resection and reconstruction. All our patients had reasonably good functional outcomes