International Journal of Research in Orthopaedics
Not a member yet
2153 research outputs found
Sort by
A rare case of proximal arm neurofibroma causing ulnar nerve compression: successful surgical intervention and recovery
Get PDFCompressive neuropathy of the ulnar nerve due to a neurofibroma above the elbow is extremely rare, with few cases reported worldwide. A young male presented with a progressively enlarging swelling and increasing pain in the right upper arm. Over time, the patient developed symptoms indicative of ulnar nerve compression, including numbness, tingling, and weakness in the hand and forearm. Physical examination and diagnostic imaging revealed the presence of a neurofibroma compressing the ulnar nerve above the elbow. The patient also exhibited generalized features consistent with neurofibromatosis, such as multiple café-au-lait spots and cutaneous neurofibromas. Given the severity of the symptoms and the confirmed diagnosis, the patient underwent surgical excision of the neurofibroma along with neurolysis to decompress the ulnar nerve. The surgical intervention aimed to relieve pain and improve sensory and motor function. The surgical procedure was successful, resulting in significant pain relief and marked improvement in sensory and motor functions. Postoperatively, the patient reported substantial symptomatic relief and regained functional use of the affected limb. This case underscores the importance of considering rare causes of ulnar nerve compression, such as neurofibromas, particularly in patients with underlying neurofibromatosis. It also highlights the effectiveness of surgical removal and nerve decompression in resolving symptoms and restoring function in such complex cases
Functional outcomes of displaced metastatic fractures of proximal femur: comparison between prosthetic replacement and intramedullary nailing
Get PDFBackground: Surgical treatments for proximal femur metastasis include prosthetic replacement (PR) and intramedullary nailing (IMN). Controversy persists regarding the most appropriate surgical option, and previous studies have mixed outcomes of patients with both displaced and impending fractures. This study aimed to assess the early functional outcomes in patients undergoing PR or IMN specifically for displaced metastatic fractures.
Methods: A retrospective cohort study was conducted on patients with displaced metastatic proximal femur fractures treated surgically between January 2013 and March 2023. Patients with metastases confined to the femoral head or neck without trochanteric extension, which is not an indication for IMN, were excluded. Patients were divided into PR and IMN groups. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score at three months postoperatively.
Results: Seventeen patients (10 females, 7 males; mean age 63.1±10.7 years) were treated with PR, and 31 patients (18 females, 13 males, mean age 61.4±11.3 years) were treated with IMN. Preoperative MSTS scores were similar between PR and IMN groups (3.8±2.6 vs. 2.9±1.6, p=0.179). Postoperatively, PR group had significantly higher MSTS scores (16.6±7.0 vs. 12.8±5.1, p=0.045), with better scores in function (p=0.028), supports (p=0.005), and walking (p=0.032). PR group had longer operative time (142 vs. 90 min) and greater blood loss (650 vs. 200 ml) compared to IMN group.
Conclusions: Patients with displaced proximal femur fractures from metastatic lesions had significantly higher MSTS scores with PR than with IMN at three months postoperatively
Osteomyelitis or myositis ossificans: a diagnosis in disguise in a case of hereditary sensory and autonomic neuropathy type 4
Get PDFHereditary Sensory and Autonomic Neuropathy Type IV (HSAN-IV), also known as Congenital Insensitivity to Pain with Anhidrosis (CIPA), is an extremely rare condition with loss of peripheral unmyelinated and small myelinated nerve fibres, leading to the absence of pain sensation and inability to sweat. Affected patients require careful care in order to prevent debilitating consequences and potential morbidity as a result of recurrent trauma and self-mutilating behaviour. We report a case of 4 years and 10 months old boy who has been diagnosed with HSAN-IV at 6 months of age, which was confirmed by genetic testing. This study was conducted in the largest tertiary medical complex in the Kingdom of Bahrain. He had multiple hospital presentations with various upper and lower extremity injuries requiring a multidisciplinary approach for different management strategies. The diagnosis can be extremely challenging due to an exhausting list of differential diagnosis and limited number of cases provided in the literature
Evaluation of primary high-grade osteosarcoma by surgical resection in PT Birta city hospital
Get PDFBackground: Classic OS had a 20% five-year survival rate during most of the 20th century. Adjuvant chemotherapy was first used to treat OS in the 1970s, raising survival rates to 50%. The standard course of treatment for OS includes surgery, neoadjuvant chemotherapy, and adjuvant chemotherapy. When treating a patient with soft tissue and bone sarcomas, the extent of surgical procedures is frequently described using surgical oncologic classifications. Radical resection refers to the removal of the whole bone or compartment harboring the tumor, whereas wide resection refers to the removal of the affected area of the bones with a cuff of healthy tissue.
Methods: The study conducted a retrospective analysis of 120 patients who visited to orthopedic outpatient department of PT Birta city hospital and research center, Nepal from October 2019 to November 2022. Radical resection was defined as the removal of the entire affected bone, while wide resection was described as partial bone excision. The baseline characteristics of the patients were analyzed and the data regarding radical and wide resection in osteosarcoma (OS) was evaluated.
Results: The analyzed report shows that 65/120 (54.1%) radical resections and 55/120 (45.8%) wide excisions were the extent of the resection. On the other hand, a central review of the extent of resection data revealed 100/120 (83.3%) wide excisions and 20/120 (16.6%) radical resections.
Conclusions: OS is currently treated with extensive resection, neoadjuvant chemotherapy, and adjuvant chemotherapy, with a strict emphasis on the overall intensity of treatment and prompt restart of post-resection chemotherapy
Improving cosmetic and functional outcome in case of post burn contracture of hand and fingers by using de-epithelized plantar skin graft
Get PDFBackground: Burn scar contractures in the fingers and hand often lead to debilitating functional and cosmetic issues. Various surgical approaches exist, but achieving optimal outcomes remains a challenge. While grafting glabrous split-thickness skin from the foot's plantar aspect is a well-established method, it remains underutilized, with conventional grafts leading to complications, especially in darker-skinned individuals.
Method: This study involved 35 patients with McCauley grade II and III hand burn contractures, spanning various age groups and genders. Surgical procedures encompassed scar removal, contracture release, and plantar skin graft application. Post-operatively, patients received dressing, splinting, and physiotherapy. Donor site healing was evaluated at the 3-week mark.
Results: Remarkably, all patients exhibited successful donor site healing within 3 weeks. The surgical technique effectively addressed contractures, enhancing range of motion and function. Post-operative care, featuring physiotherapy, coconut oil massages, and pressure garment use for at least 6 months, significantly contributed to post-burn hand and finger contracture management.
Conclusions: De-epithelized plantar skin grafts offer a promising avenue for enhancing both aesthetics and function in individuals with post-burn hand and finger contractures. This technique minimizes complications common with traditional grafts while promoting successful donor site healing and improved range of motion. The study underscores the significance of using like-for-like reconstruction to achieve the best possible results in managing post-burn contractures.
Role of ortho-pantho-graphic X-ray in the diagnosis of osteoporosis
Get PDFBackground: Osteoporosis affects people, especially old age, as postmenopausal women and remains unnoticeable until the patient presents with a fracture. Osteoporosis in human begins started with the loss of bone mass that increases with age, this is related to the decrease in bone density and an increase in porosity that will cause fractures in this osteoporotic bone. Objective was to assess the usefulness of orthopanthographic (OPG) in the early detection of osteoporosis.
Methods: This is an analytic across-sectional test validation study, was done in Hawari Hospital-Benghazi, Libya which considered a referral General Hospital affiliated with University of Benghazi. This study was done during a period from March 2022 to July 2023. Sixty women were selected, divided into osteoporotic and non osteoporotic groups depending on the clinical and laboratory investigations under the supervision of an orthopedic consultant in the outpatient clinic. Panoramic radiographic X-rays were taken for evaluation and estimation of the mandibular cortex on the basis of (Mental index, Klemetti index, and Panoramic mandibular index) as a diagnostic tool to differentiate normal from osteoporotic patient, all three indices correlated significantly with bone mineral density and used as useful indicators for detected the osteopenia and osteoporosis.
Results: We calculated values of the three indices (Mental index, Klemetti index, and Panoramic mandibular index) values were low especially in the osteoporotic group, as well the values of mental index and panoramic mandibular index were low compared with low bone mineral density of the patient and klemetti index with: C2, C3 categories (moderate and severe erosion) most common observed in the osteoporotic patient.
Conclusions: Orthopanthographic X-rays provide a valuable tool for early detection and assessment of osteoporosis (preclinical stage) especially when characterized by a decrease in bone mineral density
Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study
Get PDFBackground: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score.
Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score.
Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2).
Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection
Expert opinion on the clinical use of calcium and vitamin D supplements in osteoporosis in Indian settings
Get PDFBackground: Several clinical studies demonstrated that calcium intake decreases the risk of osteoporosis and osteoporotic fractures. However, understanding the prescription practice of calcium supplements employed in Indian contexts may help in improving patient management and developing evidence-based recommendations for optimizing the treatment. So, this study aimed to gather clinicians’ perspective regarding the use of calcium and vitamin D supplements for the management of osteoporosis in Indian settings.
Methods: The current survey involved 17 questions pertaining to current feedback, clinical observations, and clinical experience of specialists on osteoporosis management and the use of calcium and vitamin D supplements.
Results: According to 30%, 26%, 25%, and 19% of the experts, higher dietary sodium (salt) intake was generally associated with negative calcium balance and bone mineral loss, increased risk of fracture, decreased calcium excretion in the urine and decreased dietary calcium absorption. Calcium and vitamin D were recommended by 78% of the respondents for the management of osteoporosis. Approximately 72% of the respondents stated calcium aspartate anhydrous as the preferred calcium supplement to manage osteoporosis. Around 49% of the respondents reported a reduced risk of bone fractures among those who consume more calcium than the average amount. Further 48%, 30%, and 25% of the respondents indicated that calcium aspartate anhydrous have better absorption, better bioavailability, and better gastrointestinal tolerability.
Conclusions: According to the expert’s opinion, both calcium and vitamin D administration in conjunction with maintaining a balanced sodium intake were recommended for managing osteoporosis.
Pixee knee+ augmented reality assisted navigation for total knee arthroplasty in an ambulatory surgical center
Get PDFTotal knee arthroplasty (TKA) requires precise alignment for optimal post-operative outcomes and prosthesis longevity. Recently, augmented reality (AR) has emerged as a promising technology in surgical procedures, including TKA. This case series evaluates the feasibility and accuracy of the knee+ augmented reality-assisted navigation (ARAN) system by Pixee Medical in an ambulatory surgical center (ASC) setting. Our study involved 17 consecutive TKA patients performed with the knee+ ARAN system at an ASC from August 2022 to October 2022. Demographic data, including sex, age, ASA score, height, weight, and BMI, were recorded. Postoperative measurements of the mechanical distal femoral angle (MDFA), mechanical distal tibial angle (MDTA), posterior tibial slope (PTS), femoral-tibial angle (FTA), and posterior femoral flexion (PFF) were compared to the ideal intraoperative angles. Outliers were defined as deviations greater than 3° from the planned angles. In this study, 15 out of 17 TKAs utilizing the Pixee knee+ ARAN system were analyzed. All mean post-operative radiographic measurements were within clinically acceptable ranges. The study also found that surgeries using the knee+ system had a slightly longer incision-to-closing time relative to the control group of patients undergoing normal TKA. Our results indicate clinically acceptable accuracy and precision in alignment with the knee+ ARAN system, albeit with a slight increase in surgery duration. This is the first study evaluating the knee+ ARAN system in an ASC setting indicates its suitability for outpatient centers, highlighting its precision, portability, and cost-effectiveness. Larger studies utilizing outcome measures can further assess the system’s advantages and disadvantages
Supervised machine learning to predict non-home discharge following surgical treatment of pelvic fractures
Get PDFBackground: Decision-tree-based machine learning (ML) algorithms such as random forest (RF) are useful for their ability to predict outcomes and rank variables according to their utility in the decision-making process. This study utilizes RF to identify important predictors of discharge to facility following surgical stabilization of pelvis fractures, a traumatic injury that often precludes mortality and diminished quality of life.
Methods: The American College of Surgeons national surgical quality improvement program (ACS-NSQIP) database was queried for patients aged 16 to 70 undergoing surgical fixation of pelvis fractures between 2008 and 2018. Outcome of interest was discharge home versus to facility. RF was trained with surgical variables, comorbidities, and other patient factors and tasked with predicting discharge location. Permutation feature importance (PFI) was then generated to identify important variables.
Results: Out of 492 patients, 184 patients were discharged to facility, and 308 patients were discharged home. RF identified age, American Society of Anesthesiologists (ASA) classification, and preoperative hematocrit as top predictors for discharge to facility. Patients being discharged home were younger, had lower ASA scores, and had higher preoperative hematocrit.
Conclusions: RF identified age, ASA classification, and preoperative hematocrit as top predictors for discharge destination following pelvic surgery. Knowledge of the impact of these variables can inform preoperative planning for both patients and their care team, while highlighting the opportunity to address preoperative hematocrit to both reduce cost and improve quality of care