International Journal of Research in Orthopaedics
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Subungual osteochondroma of great toe: a unique presentation
Get PDFOsteochondroma is routinely encountered in daily practice. It is often considered as developmental aberration rather than a true neoplasm. It arises due to enchondral growth from cortex adjacent to metaphysis. Osteochondroma is usually encountered in femur, fibula and humerus in more than fifty percent of cases. It is rarely encountered in phalanges of toes and fingers. In very few cases this tumor affects small bones, localizing to the distal phalanx and producing deformity of the overlying nail. These cases are termed subungual osteochondromas and are altogether with subungual exostosis the most common bony lesions affecting the nail unit. Osteochondromas of the nail unit are often asymptomatic and present as firm nodules, nail deformity, tender on palpation. Many of these cases are associated with history of trauma. A 11-year-old male presented to us with an abnormal outgrowth of right great toe. The out growth was preceded by a history of trauma 10 days before the presentation. The swelling surface consisted of granulation tissue and bleeding spots were found on the surface. The swelling is fixed to the underlying bone and seems to have caused the destruction of nail plate. Biopsy revealed osteochondroma of the great toe with no malignant transformation and atypical cells
Efficacy and safety of tablet Ligashot in patients with ligament injury of knee and shoulder
Get PDFBackground: Ligament injuries of knee and shoulder disrupts joint homeostasis and leads to an imbalance between joint mobility and stability. Many drugs are available in the market for treating ligament injury grade 1 and 2 along with standard of care but there is still need for drugs with least adverse effects. So, in this study, an attempt has been done with tablet Ligashot, a nutraceutical for treating grade 1 and 2 ligament injury of knee and shoulder.
Methods: This is an outcome, quasi-experimental study where patients with ligament injury of knee and shoulder were given tablet Ligashot daily for 3 months. A total of 30 male and female patients were included in the study. Changes from baseline to 12 weeks in pain intensity measured by pain visual analogue scale (VAS) and inflammatory markers (ESR, Hs CRP), MRI changes, time to return to pre-injury level of activity, patient reported physical function and quality of life (QoL) were assessed.
Results: There was a statistically significant improvement after 12 weeks of treatment compared to baseline in VAS pain scale, time to return to pre-injury level of activity, patient reported physical function and in QoL questionnaire. There was also a statistically significant reduction in inflammatory markers-ESR and Hs-CRP (p<0.001).
Conclusions: Ligashot tablet has proved to be safe and effective in the management of ligament injury of knee, shoulder joint by reducing inflammation, pain. It also improves visco-elasticity and participant's functional capacity without causing any major side effects
Study of operative outcomes of proximal tibia fractures treated with locking plates
Get PDFBackground: In this study we have studied the functional outcome of proximal tibial fractures treated by open reduction and internal fixation treated with locking compression plates after a minimum follow up period of 6 months.
Methods: We conducted the study of 50 patients that aimed at assessing the functional outcomes of radiologically confirmed proximal tibia fracture (both intra articular and extra articular) treated using locking compression plates, between July 2020 to May 2022 at Department of Orthopaedics in our Institute. The Schatzker classification was used for classifying the fractures and planning the treatment strategy using plain radiographs and CT scan films. The treatment modality was decided after classifying the type of fracture, the displacement, and the amount of depression of the tibial plateau, in our study, we included only those patients who were undergone ORIF or MIPPO for definitive treatment.
Results: Maximum number of patients (total 12) were in age group of 41-50 years (24%). Out of total 51 proximal tibia fractures, 4 (7.8%) were of type 1 variety, 12 (23.52%) were of type 2 variety, 2 (5.8%) were of type 3 variety, 4 (7.8%) were of type 4 variety, 6 (11.76%) were of type 5 variety and 9 (17.64%) were of type 6 variety according to Schatzker classification. out of 50 patients treated with locking compression plates, 26 patients (52%) showed excellent outcome with score between 28-30; 17 patients (34%) showed good outcome with score between 24-27; 7 patients (14%) showed fair results with score between 20-23, according to Modified Rasmussen’s scoring system.
Conclusions: Locking compression plates (LCP) for the treatment of the proximal tibia fractures including difficult fracture situations seem to be good implant of choice for better post operative outcomes
Revision arthrodesis in a failed knee arthrodesis for a giant cell tumor excision of distal femur: a case report
Get PDFGiant cell tumor is a benign tumor with locally aggressive behaviour. It is common in 20–40 years of age group. Common location of the tumor includes distal end of femur, proximal end of tibia. It is slightly more common in females than males. We present a case of forty-four years-old lady with a persistent swelling over her left knee and was diagnosed with a distal femur giant cell tumor. After a wide excision, dual free fibula grafting and arthrodesis of the knee with a long nail was performed. However, she experienced pain and progressive deformity three years after surgery. X-rays revealed the failure of union of the free fibula graft to the residual femur and the breakage of the nail at that site. A revision arthrodesis was performed with removal of implant and stabilizing the non-united ends with dual plating with bone grafting from lateral tibial condyle and bone graft substitutes. She was discharged with left side non weight bearing mobilization with walker support and was started on full weight-bearing mobilization after one year with satisfactory union on X-rays
Study of clinical and functional outcome of malleoli fracture
Get PDFBackground: Ankle fractures are a common orthopedic injury, accounting for 9% of all fractures, with an increasing incidence among both young and elderly populations. These fractures often result from road traffic accidents, falls, and sports injuries. Malleolar fractures, involving the bony prominences of the ankle, are particularly prevalent and necessitate accurate reduction and stable internal fixation to prevent complications such as post-traumatic arthritis and restricted motion. This study aims to assess the functional outcomes and results of surgical treatment of malleolar fractures.
Methods: The study utilized Lauge-Hansen’s classification to analyze the mechanism of injury in 32 patients with ankle fractures. Surgical techniques included the fixation of syndesmotic injuries with anatomical fibular plates, (AFP) posterior malleolus fractures with percutaneous screws or Ellis plates, and medial malleolus fractures with tension band wiring (TBW). The outcomes were measured in terms of union time, range of motion, and stability.
Results: The most common injury mechanism was supination external rotation (SER) in 14 patients, followed by pronation external rotation (PER) in 7 patients, pronation abduction (PAB) in 6 patients, and supination adduction (SAD) in 5 patients. Syndesmotic injuries were found in 7 patients, all treated surgically except one. Posterior malleolus fractures were present in 3 patients and treated with screws or plates. Fixation of medial malleolus fractures with TBW showed better union rates and improved range of motion compared to screw fixation. Lateral malleolar fractures treated with AFP provided additional stability. The average union time was 6 to 8 weeks.
Conclusions: Anatomical reduction and stable internal fixation are crucial for the successful treatment of malleolar fractures. TBW for medial malleolus fractures and AFP for lateral malleolar fractures provide favorable outcomes. However, a larger sample size and longer follow-up duration are required to further evaluate the outcomes of ankle injuries, particularly in older patients with osteoporosis and comorbidities
Results of distraction and ligamentotaxis in thoracolumbar fractures without decompression
Get PDFBackground: Thoracolumbar fractures are common spinal injuries often requiring surgical intervention. Traditionally, decompression surgery has been used to relieve neural pressure. This study evaluates the effectiveness of ligamentotaxis with pedicular screw fixation, which minimizes the need for decompression, in treating thoracolumbar fractures.
Methods: A retrospective cohort study was conducted at a Government Medical College, Aurangabad involving 30 patients aged 18 and older with thoracolumbar fractures treated with ligamentotaxis and pedicular screw fixation. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American spinal injury association (ASIA) impairment scale for neurological function, and forward flexion degrees for spinal mobility. Patients were followed up for 12 months post-operatively.
Results: Significant pain reduction was observed, with VAS scores decreasing from 8.5 pre-operatively to 2.5 at 12 months (p<0.001). Neurological function improved, with many patients advancing from ASIA category A pre-operatively to category D by 12 months (p<0.001). Spinal mobility showed considerable recovery, with forward flexion increasing from 0 degrees pre-operatively to 80 degrees at 12 months (p<0.001).
Conclusion: Ligamentotaxis with pedicular screw fixation is an effective treatment for thoracolumbar fractures, providing substantial pain relief, neurological improvement, and restored spinal function. While outcomes are generally positive, patient selection remains critical to avoid poor neurological results. Further research is needed to refine indications and optimize treatment protocols
Correlation between magnetic resonance imaging and arthroscopic findings in superior labral from anterior to posterior injuries of shoulder joint
Get PDFBackground: The aim of our study was to identify the accuracy of the magnetic resonance imaging (MRI) in detecting superior labral from anterior to posterior (SLAP) lesions when compared to arthroscopic findings, considering arthroscopy as the gold standard.
Methods: This is a retrospective study conducted between January 2015 to July 2021 that focuses on SLAP lesions to evaluate the accuracy of its magnetic resonance imaging (MRI) reporting. All patients who had shoulder arthroscopy were included, and their intra-operative pathology was recorded and compared to their pre-operative MRI reports. Accuracy was assessed by calculating the sensitivity and specificity of MRI in comparison to the standard shoulder arthroscopy.
Results: 60 patients were included in the study. In diagnosing SLAP lesions this study showed that MRI was 54% sensitivity, 67% specificity with 79% positive predictive value and 39% negative predictive value. Accuracy was found to be 55%.
Conclusions: In this study, the MRI did not detect SLAP lesions at a rate as high as arthroscopy, which is considered the gold standard. When performing arthroscopy, it is important to be diligent in detecting actual SLAP lesions that may not have been identified by traditional MRI scans
Comparative study of lateral entry versus crossed entry pinning for paediatric supracondylar humerus fractures: a case series
Get PDFClosed reduction and percutaneous pin fixation techniques have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. Commonly lateral pinning and cross pinning techniques are utilised for fixation. However, controversy exists regarding the selection of the appropriate procedure. A prospective study with 24 cases of displaced fracture supracondylar humerus, treated by lateral pinning and cross pinning, was conducted between August 2022 and May 2024 at Department of Orthopaedics at J.J.M. Medical College, Davangere. Patients were treated with either the lateral entry pin alone or the cross pinning with a combination of lateral entry pin and medial entry pin. Age, gender, fractured side, duration of surgery, postoperative complications, surgical approach, direction of pin application (lateral or cross), and Modified Flynn grading system grade was noted for study outcome. No difference was found between lateral pinning and crossed pinning groups in terms of the grade of the modified Flynn grading system and complications like iatrogenic ulnar nerve damage, loss of reduction. Pin tract infection was seen in one patient
Evaluation for results of the treatment with diversities of modality in comminuted sub trochanteric fracture of femur in children
Get PDFBackground: The diaphyseal femoral fractures account for around 2% of all pediatric fractures. Treatment includes conservative or surgical methods, but the choice of treatment differs depending on the child's age, fracture pattern, other concomitant fractures and the socioeconomic situation of the family. The study aimed to assess the result of the treatment with a diversity of modality in comminuted sub trochanteric fracture of the femur in paediatric patients.
Methods: This was a prospective randomized comparative study with a prospective follow-up that took place at the department of orthopedics at President Abdul Hamid medical college and hospital, Kishoreganj, Bangladesh from May 2022 to May 2024. The 110 patients with diaphyseal femur fracture and were 0-18 years old were included in the study and 48 participated in the outcome follow-up.
Results: Out of 110 patients 55 were males and 55 females. Conservative treatment was the most common treatment. The mean age of incurring this type of fracture was 7.45 years. Mainly, injury among all kids who fall from above standing level. The majority of the younger children received conservative treatment.
Conclusions: The treatment chosen and the outcomes after a fracture seem to be satisfactory. It is important for future studies to include a large number of patients and to examine not only the clinical outcomes, but also the social and economic aspects
Sub-acute post traumatic ascending myelopathy with superimposed infection in a diabetic: a case report
Get PDFSubacute posttraumatic ascending myelopathy (SPAM) is a rare entity associated with trauma to the spinal cord, usually at the level of the thoracic spine. Patient presents with neurological deterioration 4 or more levels above the site of primary injury. It usually follows an episode of fever unrelated to infection. A 43-year-old diabetic male patient with history of blunt trauma to thoracic spine with T5 flexion distraction injury with ASIA A neurology, underwent T3-T6 posterior instrumented stabilisation. Four weeks following this, he presented with signs of encephalopathy with CSF culture showing Acinetobacter baumanii. Though the patient had improvement with culture- sensitivity appropriate antibiotics, he developed ascending neurological deficits on day 3 of admission. On repeat MRI, he showed cord oedema up to C3. He was started on steroids and showed remarkable clinical improvement. SPAM must be kept as a differential in the diagnosis of a postoperative event with similar clinical picture