International Journal of Research in Orthopaedics
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Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction
Get PDFBackground: The anterior cruciate ligament (ACL) is commonly injured in the knee joint, necessitating surgical reconstruction where quadrupled hamstring tendon autografts are frequently utilized for their favourable outcomes. Predicting the appropriate dimensions of these grafts is essential for surgical success. This study aims to investigate whether simple anthropometric measurements-height, weight, body mass index (BMI), thigh length, and circumference-can predict the length and diameter of quadrupled hamstring tendons used in ACL reconstruction.
Methods: This cross-sectional study included 45 patients undergoing ACL reconstruction with quadrupled hamstring autografts at department of orthopaedics, Renai Medicity Kerala, India. Preoperative anthropometric measurements were correlated with intraop graft dimensions using Pearson correlation and SPSS statistical software (version 22).
Results: Taller patients exhibited a positive correlation with graft diameter (p=0.028). Height and thigh length correlated positively with both gracilis and semitendinosus tendon lengths (p<0.001). Thigh circumference correlated positively with semitendinosus length (p=0.005), while weight, BMI, and other measures did not significantly correlate with graft dimensions.
Conclusions: Anthropometric measurements, particularly height and thigh length, serve as valuable predictors for hamstring graft dimensions in ACL reconstruction. These findings may assist surgeons in selecting appropriate grafts and optimizing surgical outcomes
Artificial intelligence and orthopaedics
Get PDFArtificial intelligence is the next big thing in human history. It is set to affect large and small industries, entertainment, agriculture, literature, research, and healthcare. The field of Artificial intelligence includes machine learning and deep learning, which denote an increased level of specialization. These changes are also set to influence orthopedic trauma, from diagnostics, clinical assessment, surgical intervention, rehabilitation, and outcome prediction. Some of these fields will be affected more than others. We carried out a narrative review of artificial intelligence and orthopaedic surgery to provide an updated overview of the current and future applications. AI is set to revolutionize radiological diagnostics, outcome measurement, and rehabilitation in orthopedic trauma. However, concerns about clinical decision-making and intervention remain. Ethical concerns, regulation, and superiority over traditional methods of treatment also need to be assessed. Until then, the role of AI in orthopaedic trauma remains in the realm of possibilities
Hip fractures redefined - ERAS protocol’s impact: the Indian scenario
Get PDFThis article delves into the profound impact of enhanced recovery after surgery (ERAS) protocols on the management of hip fractures within the Indian healthcare landscape. Hip fractures, particularly prevalent among the elderly, represent a significant clinical challenge, often leading to high rates of morbidity and mortality. The integration of the geriatric fracture center (GFC) model with ERAS protocols offers a sophisticated, multidisciplinary approach that prioritizes early surgical intervention, comprehensive geriatric care, and standardized, evidence-based practices. This synergy has the potential to significantly enhance patient outcomes by reducing hospital stays, minimizing complications, and expediting recovery
Clinical outcomes of post-surgery osteoporosis treatment in elderly intertrochanteric fracture patients: a prospective study
Get PDFBackground: This study aims to evaluate the clinical and functional outcomes of administering zoledronic acid in elderly patients undergoing surgical management of hip fractures. The goal is to assess the impact on mortality, postoperative complications, and functional recovery as measured by the modified Harris hip score.
Methods: A prospective study was conducted over 18 months at a tertiary care center in New Delhi, India, involving 42 patients aged 60 and above with intertrochanteric femur fractures. Patients received surgical fixation and standard postoperative care. Zoledronic acid (5 mg) was administered intravenously three months post-surgery. Data on demographics, injury-to-surgery interval, fracture type, DEXA score, and functional outcomes were collected at follow-ups of 6 weeks, 3 months, 6 months, and 12 months.
Results: The mean age of participants was 72.67 years. Zoledronic acid administration was associated with a 9.5% mortality rate. Functional outcomes, measured by the modified Harris hip score, significantly improved from a mean of 42.14 at 6 weeks to 77.68 at 12 months (p<0.001). Younger patients (<70 years) had significantly better scores at 3 months compared to older patients (>80 years). However, no significant differences were observed at 6 and 12 months. The mean modified Harris hip scores did not differ significantly between patients with osteopenia and osteoporosis at any time point. Additionally, the type of surgical fixation (intramedullary versus extramedullary) showed no significant impact on functional outcomes.
Conclusions: Zoledronic acid administration in elderly hip fracture patients may reduce mortality and enhance functional recovery. The study supports its use in postoperative care to improve outcomes, although larger, randomized controlled studies are needed to confirm these findings. The results suggest that zoledronic acid can be an effective adjunct therapy in managing osteoporosis-related hip fractures in the geriatric population
Impact of ayurvedic panchakarma therapy on osteoarthritis
Get PDFOsteoarthritis is the leading cause of chronic pain and disability in adults, imparting a substantial economic burden on both society and individuals. This case series explored the impact of Ayurvedic Panchakarma therapy on knee osteoarthritis. Data from procedures conducted between March 2022 and January 2024 at a clinic in Maharashtra, India was collected. Patients of either gender who were clinically diagnosed with osteoarthritis grade 2 and underwent Knee Rejuvenation Therapy were included in this analysis. Follow-up was conducted after 1 month and at 90 days. Baseline data was compared with follow-up data. A total of 16 patients with mean age of 57.63 ± 10.20 years were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) score (day 1: 20.31±11.18, after 1 month: 49.94±10.85, day 90: 71.31±5.89, p=0.00), pain (day 1: 25.44±14.03, after 1 month: 57.81±10.66, day 90: 80.63±5.78, p=0.00), symptoms (day 1: 30.69±14.59, after 1 month: 55.75±12.94, day 90: 83.00±6.04, p=0.00), sports (day 1: 2.81±6.84, after 1 month: 25.31±15.05, day 90: 39.69±15.76, p=0.00), function (day 1: 31.25±16.69, after 1 month: 58.94±12.34, day 90: 78.81±7.98, p=0.00), and quality of life (day 1: 14.13±14.83, after 1 month: 52.00±10.78, after 1 month: 73.50±4.50, p=0.00) increased from baseline to the 90-day follow-up. Ayurvedic treatment is effective in improving the KOOS score and reducing the severity of arthritis in diagnosed osteoarthritis patients
Evaluation of split flexor carpi ulnaris tendon transfer for fingers and thumb extension, pronator teres transfer for wrist extension in high radial nerve palsy
Get PDFBackground: The radial nerve is the largest terminal branch of the brachial plexus. Loss of radial nerve function creates a significant disability in the hand. The grip is severely impaired following loss of radial nerve function as a result of loss of extension of wrist, metacarpophalangeal joints of fingers and interphalangeal joints of the thumb.
Methods: Prospective, quasi experimental study carried out for 3 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Forty-eight patients of high radial nerve palsy were selected for tendon transfer (split FCU tendon to EDC and EPL) and PT transferred to ECRB.
Results: Mean age of the patients was 28.92 years (range 15-45 years), significantly higher in 26-35 years age group. There was preponderance of injury to the dominant right side (58.33%) than the none-dominant left side (41.67%). Motor vehicle accident (66.67%) was the common cause of injury followed by assault (33.33%). Out of 48 patients, 28 patients score 8-9 (excellent), 16 patients score 7 (good), 4 patients scores 5 (fair). So that, total 44 patients achieved satisfactory outcome (91.67%) and 4 patients achieved unsatisfactory outcome (8.33%). All patients can extend their wrist, fingers and thumb. Beyond this, all patients can flex their fingers up to mid palmar crease and thumb can be extended separately-independent of EDC function.
Conclusions: Transfer of split FCU tendon to EDC and EPL for fingers and thumb extension in irreparable and neglected long standing high radial nerve palsy results significant functional outcome
Perioperative antibiotics prophylaxis for only 24 hours in orthopaedic surgeries
Get PDFBackground: The objective was to analyse the incidence of surgical site infection in patients undergoing elective orthopaedic surgeries procedure when antibiotics prophylaxis is done for 24 hours only.
Methods: Between June 2020 and January 2022, 50 cases of orthopedic trauma as well as soft tissue surgeries, who were given perioperative antibiotics for only 24 hours post-surgery at our institution, were included in the study. All 50 patients who received 24 hours antibiotics only after surgery were compared with those who received the same for longer duration. Statistics calculated on MS excel.
Results: Rate of infection in this study was 4% which is comparable to other studies but the rate of infection in the present study in cases of open reduction internal fixation was higher (12%) compared to other studies (2%).
Conclusions: 24 hours antibiotics is sufficient in key hole surgeries like closed reduction internal fixation and soft tissue surgery. However, it does not seem to be sufficient in cases of open reduction internal fixation which last for more than 1.5 hours
Musculoskeletal ultrasound as a diagnostic tool in quadriceps tendon rupture
Get PDFQuadriceps tendon ruptures are relatively rare injuries, particularly in young adults, and their diagnosis can be challenging. This case report presents a case of traumatic quadriceps tendon rupture in a young adult and highlights the use of ultrasound Imaging as a diagnostic tool. Quadriceps rupture is uncommon in young adults in contrast to patellar tendon rupture but in this case young patient presented with acute knee pain and an inability to extend the leg after a sudden H/o fall, leading to a loss of continuity between the quadriceps muscle and the patella. Musculoskeletal Ultrasound examination revealed a complete tear of the quadriceps tendon, confirming the diagnosis. The patient underwent surgical repair and achieved a favorable outcome with appropriate rehabilitation. This case report emphasizes the importance of considering quadriceps tendon rupture in the differential diagnosis of acute knee injuries and highlights the value of ultrasound in making an accurate and timely diagnosis.
Post-resection complication of large dumbbell-shaped extradural schwannoma: a case report and literature review
Get PDFPrimary spinal tumors are rare neoplasms with an incidence of 0.3 to 0.5 cases/1 lakh population. Schwannomas are the most common benign tumors of the spinal cord, arising from the nerve sheath cells accounting for 25% of all the spinal tumors. Complete surgical resection of the tumor is the treatment of choice in spinal schwannomas. Post resection complications are uncommon based on the factors affecting the tumor. In this case report, patient with extradural spinal schwannoma located at thoracic region was resected. She was complicated with paraplegia post operatively and successfully recovered following the standard protocol and rehabilitation
Effectiveness of abduction orthoses in the management of developmental hip dysplasia: a comparative retrospective study
Get PDFBackground: Developmental dysplasia of the hip (DDH) is a disorder marked by abnormal hip alignment or structure, often calling for orthopedic treatment. The purpose of this research was to compare the Aro and Milgram splints, two types of orthopedic splints, for use in treating diabetic foot disease.
Methods: Between three and four months of age, 53 patients were identified with hip dysplasia in a retrospective observational analysis. Beginning at six months of age, patients received treatment with either the aro splint or the milgram splint. At six and twelve months after the start of therapy, radiographic measures of the acetabular angle were made. Statistical analysis was done to assess the efficacy of the two splints and compare treatment results.
Results: The aro and milgram splints both reduced acetabular angles, and there was no discernible difference between them in terms of reaching the ideal angle. Most patients needed to get therapy for around five months to achieve the ideal angle. With both splints, there were notable decreases in acetabular angles, even though some patients were unable to achieve this angle. Eighty-one percent of the patients were female, which is consistent with established DDH demographics.
Conclusions: These findings suggest that both splints can lower acetabular angles and treat hip dysplasia in DDH patients. Both the aro and milgram splints lower acetabular angles and reverse hip dysplasia in DDH patients. Using either splint may enhance hip stability and function. Both splints are effective DDH therapeutic alternatives, according to these results.