International Journal of Research in Orthopaedics
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Study on the efficiency of locking plate surgery with that of inter locking nail treatment in management of proximal humerus fracture in P. T. Birta City Hospital and Research Center
Get PDFBackground: Proximal humeral fractures (PHFs) commonly exhibit a bimodal distribution based on trauma energy levels, affecting mainly those over 65 through low-energy falls, often indicating osteoporosis. Treatment approaches for displaced PHFs vary, with locking plates offering high stability but posing risks to blood supply and nerves. The efficacy of surgical versus conservative treatments remains debated, especially for complex fractures, with studies linking surgical options like intramedullary nailing and locking plates to mixed outcomes, including possible shoulder limitations. Aims and objectives were to evaluate the efficiency of locking plate surgery with that of interlocking nail in treatment in management of PHF.
Methods: A prospective investigation was carried out on patients who visited our hospital's outpatient department. A general anaesthetic and brachial plexus block were delivered throughout the patients' procedures. Each operation was performed by the same team, which was proficient in both approaches. The study conducted t-test and Chi-square to analyze the data.
Results: The analysis found no significant demographic differences between the two groups (p>0.05). The non-operative group had significantly lower blood loss (71.8±10.5 ml) than the locking plate group (134.2±16.9 ml, p=0.000). Visual analog score (VAS) and Constant-Murley scores indicated greater shoulder function improvements for the locking plate group at three months (p<0.001), although no significant differences were observed at the final follow-up (p>0.05). Postoperative complications did not significantly differ between groups (p=0.337).
Conclusions: Locking plates reduce fractures faster than interlocking intramedullary nails. Both internal fixation techniques for proximal humerus fracture had similar pain and shoulder function scores
A rare case of trapezium osteochondroma: unveiling a unique tumour with clinical implications
Get PDFOsteochondroma is a benign bone tumour commonly found on the metaphysis of long bones. The presentation of osteochondroma on the trapezoid bone, a carpal bone in the wrist, is exceptionally rare. To our knowledge, no such cases have been reported in India. This report details a rare case of osteochondroma located on the trapezoid bone and its successful surgical management. A 55-year-old female presented with pain and swelling in the wrist. Radiological imaging, including X-rays and MRI, revealed a well-defined, pedunculated mass arising from the trapezoid bone. The patient underwent surgical resection of the tumour. Histopathological examination confirmed the diagnosis of osteochondroma. Postoperatively, the patient experienced significant relief from symptoms and showed no evidence of tumour recurrence during follow-up. This case contributes to the limited body of literature on osteochondromas in rare locations, particularly on the trapezoid bone. It illustrates the successful outcome of surgical treatment for rare bone tumours and emphasizes the need for heightened awareness and comprehensive diagnostic approaches in similar cases
Knee injury and osteoarthritis outcome score comparing functional outcome in 30 anterior cruciate ligament reconstruction patients with quadriceps, hamstrings and peroneus longus grafts
Get PDFBackground: Anterior cruciate ligament (ACL) tears are prevalent, affecting 30–78 per 100,000 individuals annually. Graft options include hamstring tendon, bone-patellar-tendon-bone, and quadriceps tendon. Hamstring tendon grafts offer advantages, including less patellofemoral crepitation, anterior knee pain, extension loss, reduced donor site morbidity, and smaller incisions. The peroneus longus tendon graft has gained favor due to fewer knee joint complications. Research shows studies comparing hamstring tendon (HT) and peroneus longus tendon (PLT) grafts revealed no significant differences in pre- and 1-year post-surgery outcomes. Recent randomized controlled trials (RCTs) comparing quadriceps tendon (QT) and HT clinical outcomes found no significant differences in functional outcomes, PROs, laxity testing, or revision rates, although two studies reported higher knee flexor strength in the QT group and greater knee extensor strength in the HT group.
Methods: Authors planned for prospective study in tertiary care government hospital, Solapur from 1 July 2023 to 1 July 2024 with Inclusion criteria of 20-50 years, Intact collateral ligaments, Intact Posterior cruciate ligaments, Playing sports as recreational activity.
Results: 30 cases operated for ACL reconstruction at our institute with three graft choices namely QT, HT, PL and knee osteoarthritis outcome score given at 3 months, 6 months, and 1 year with KOOS/symptoms, pain, daily living, sports, quality of life all noted separately and compared within the groups and outside the groups.
Conclusion: To compare functional scores in post operative ACL reconstruction with QT, HT, PL larger volume of sample, longer follow up and more detailed arthroscopy specific scoring system is required.
Peadiatric amputation from traditional bone setters’ gangrene in Ibadan: a malady
Get PDFBackground: Pediatric amputations resulting from gangrene pose a significant medical challenge, especially in resource-limited settings. In Nigeria, traditional bone setters (TBS) often serve as the first point of contact for musculoskeletal injuries, but their practices can lead to severe complications, including gangrene. Our hospital manages many of such cases. This study aims to explore the epidemiology, clinical presentation, and outcomes of pediatric patients who developed gangrene requiring amputation following TBS treatment, with the goal of informing public health strategies and improving pediatric care quality.
Methods: The study is a retrospective study which seek to extract the data from the hospital record all the patient who underwent amputation due to gangrene after initial TBS treatment. All the case notes were retrieved and data was extracted and analyzed using descriptive statistics. The study adhered to ethical standards and anonymized data to protect patient confidentiality, ensuring the study's integrity.
Results: The study involved 33 pediatric patients aged 8.3 years, with a significant gender disparity. Most patients were from the Yoruba ethnic group and practiced Islam. 87.9% of parents had no formal education. Gangrene was most common in the left hand, and falls were the leading cause of initial injury. The average surgery time was 81.2 minutes, with a 13-day hospital stay. Post-operative complications occurred in 43.5% of patients, with surgical site infections (SSI) being the most common. Only 8.7% received occupational therapy.
Conclusions: The study highlights post-operative care challenges in pediatric amputations, including high complications and limited access to services. It suggests targeted interventions, infection control, and public health campaigns to improve outcomes. Future research should include long-term follow-up studies
A comparative study of clinical and radiological outcomes of open tibia fractures, managed with uncoated versus antibiotic coated intramedullary interlocking nail
Get PDFBackground: Open tibia fractures are a significant clinical challenge, especially in densely populated regions like Jaipur, Rajasthan, where elevated trauma incidence and diverse healthcare access issues compound treatment intricacies. This study compares the clinical and radiological outcomes of open tibia fractures managed with conventional uncoated intramedullary nails versus antibiotic-coated intramedullary interlocking nails. The introduction of antibiotic-coated nails aims to reduce the incidence of infection, a major concern in open fractures due to the direct exposure of the fracture site to the external environment.
Methods: A prospective, observational study was conducted at the department of orthopedics, SMS Hospital, Jaipur, focusing on a cohort of 100 patients with open tibia fractures treated from January 2016 to December 2018. Patients were included based on specific criteria, including the type of fracture and the treatment received, either with uncoated or antibiotic-coated intramedullary nails. Data were collected retrospectively from hospital and operation charts, with radiographs and clinical information reviewed independently by two authors.
Results: The comparison revealed a lower infection rate and a higher rate of bone union at 12 months in the group treated with antibiotic-coated nails versus the uncoated group. Specifically, the antibiotic-coated group showed a 10% lower infection rate and a 10% higher bone union rate.
Conclusions: The use of antibiotic-coated intramedullary nails for the treatment of open tibia fractures demonstrates a promising reduction in infection rates and improved bone healing, offering a significant advantage over traditional uncoated nails in managing these complex injuries
Surgical and functional outcomes of vancouver type B2 postoperative periprosthetic femoral fracture treated with revision arthroplasty and coxa femoral bypass
Get PDFAs the number of total hip arthroplasties have steadily increased, one would expect a concomitant increase in catastrophic postoperative events such as periprosthetic fractures. This study evaluates the surgical and functional outcome, along with the associated complication rates in patients undergoing revision arthroplasty following Vancouver type B2 post-operative periprosthetic femoral fracture. We studied 14 Clinically and radiologically diagnosed patients with Vancouver type B2 Post-operative Periprosthetic femoral fracture. The post-operative VAS score has decreased to 2.23±0.92 from a pre-operative score of 8.30±0.9, p<0.001. The average Harris Hip Score has improved from 44.05±7.71 pre-operatively to 83.63±7.75 post-operatively at 6 months, p<0.001. At 6-month follow-up, we had 57% excellent results, 29% good results, 7% fair results, and 7% poor results based on Harris Hip Score. The revision arthroplasty of Vancouver type B2 post-operative periprosthetic femoral fracture with revision arthroplasty and coxa femoral bypass has excellent-good surgical as well as functional outcomes in terms of regaining abductor function by an increase in range of motion at the affected hip joint, significant pain relief leading to improved quality of life after surgery at short term follow up period
Comparative study of fully threaded and partially threaded cancellous cannulated screws versus partially threaded cancellous cannulated screws in femoral neck fractures in adults
Get PDFBackground: Femoral neck fractures constitute a significant portion of orthopaedic trauma, with intra-capsular fractures representing 50% of all hip fractures, their incidence is projected to rise dramatically due to the aging population. These fractures, particularly in the elderly, lead to high morbidity and mortality. Optimal surgical treatment for femoral neck fractures remains debated, especially in younger adults.
Methods: This hospital-based prospective comparative study was conducted over one year. Patients aged 18-60 years with femoral neck fractures were randomized into two groups: Group A were operated using combination of fully threaded and partially threaded cancellous cannulated screws and group B using partially threaded cancellous cannulated screws. Functional outcomes were assessed using the Harris hip score (HHS) and visual analog scale (VAS) for pain, and radiological union times were recorded. Complications such as non-union, screw back-out, and infection were also evaluated.
Results: The study included 30 patients, with 15 in each group. Group A showed significantly better HHS at 6 months (88.53±7.46) compared to group B (77.69±13.35) (p<0.05). VAS scores were lower in group A, indicating less pain, though the difference was not statistically significant. Radiological union time was shorter in group A (12.55±2.39 weeks) compared to group B (13.89±5.29 weeks) (p<0.05). Group A had fewer complications, with no cases of screw back-out compared to four in group B.
Conclusions: The combination of fully threaded and partially threaded cancellous cannulated screws when used appropriately offers better functional outcomes, faster radiological union, and fewer complications compared to partially threaded screws alone in femoral neck fractures in young adults
Escherichia coli mono articular septic arthritis of shoulder joint in an elderly female
Get PDFSeptic arthritis of the shoulder joint is a very rare entity to encounter in clinical practice. Escherichia coli (E. coli) pathogen isolation is only seen to occur in individuals with multiple comorbidities. We report a similar case of gram-negative E. coli urosepsis in a veteran female that transmitted hematogenously to the shoulder joint and how a prompt diagnosis and treatment prevented extension and damage of the joint space.
Trauma outcomes at higher-level trauma centres compared with lower-level trauma centres: a systematic review and meta-analysis
Get PDFThe introduction of trauma systems has helped reduce mortality in severely injured patients. This fall in mortality, however, appears to be concentrated in higher-level trauma centres (TCs) in comparison to lower-level TCs, but the evidence is inconsistent. Therefore, we undertook a systematic review with the aim of comparing outcomes in lower-level TCs (i.e. level III and IV trauma centres) with higher-level TCs (i.e. level I and II centres). This systematic review was performed in accordance with the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). The review was registered on PROSPERO (CRD42019111933). Mortality data were combined using the Mantel-Haenszel random-effects method for meta-analysis, using Review Manager (RevMan v5.3.5). We found 28 eligible articles from an initial total of 10,816 identified abstracts. Our meta-analysis revealed no evidence of a difference in mortality risk in severely injured patients between lower-level and higher-level TCs (RR 1.55; 95% CI 0.97 to 2.50; p=0.07), but there was considerable heterogeneity (I2=92%) in the dataset. The risk of death in lower-level TCs in patients with neurological trauma, however, was statistically lower than in higher-level TCs (RR 0.80; 95% CI 0.73 to 0.86; I2=78%; p<00001). There was a higher risk of death in patients with neurological trauma managed at higher-level TCs and this is likely to be due to the higher severity of injury (intracranial and extracranial) sustained by patients at higher-level TCs. However, the high level of heterogeneity in the risk estimates of evaluated studies reduces the certainty of our interpretations
Extra skeletal chondroma a rare presentation in the big toe of a pediatric patient: a case report
Get PDFExtra-skeletal chondroma is a rare benign tumor of juxta-articular soft tissues rarely seen in pediatric cases. It is formed mainly of hyaline cartilage and presented as a painless swelling. It is not well evident on conventional X-rays radiography. MRI is the preferred diagnostic modality. Surgical excision is the recommended form of treatment for symptomatic cases. We are reporting a case of this rare tumor in the big toe of a child