International Journal of Research in Orthopaedics
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A rare case of giant cell tumor in navicular bone: a case report
Get PDFGiant cell tumor (GCT) is a benign but locally aggressive lesion of the bone. They are common in skeletally mature individuals with a slight female preponderance. Rare unusual presentations can occur. This case report describes a rare case of GCT of bone in the right navicular bone in a 25-year-old male patient who presented with complaints of pain and swelling in right foot and difficulty in walking. The diagnosis was made with radiological investigations and was then confirmed with histopathological evaluation. The lesion was managed with extensive curettage and bone grafting. Patient had complete resolution of symptoms post-surgery with no signs of local recurrence at 18-months follow-up
Ossification of the medial collateral and lateral collateral ligament of knee in a 19-year-old female
Get PDFThis case report discusses an uncommon presentation of Pellegrini-Stieda syndrome (PSS), characterized by ossification of the medial collateral ligament (MCL) of the knee, extending to the lateral collateral ligament (LCL) in a 19-year-old female patient. Typically, PSS involves post-traumatic calcification of the MCL, but this case uniquely presents ossification in both the MCL and LCL, a phenomenon not widely documented. The patient, a young laborer from a lower socio-economic background, developed knee pain and restricted movement following a fall. Diagnostic imaging revealed the unusual ossifications, leading to a diagnosis of PSS. The patient was treated with steroid injections under fluoroscopic guidance, resulting in significant improvement in knee mobility. This report highlights the importance of recognizing atypical presentations of PSS for accurate diagnosis and treatment, emphasizing the need for further research into the underlying mechanisms and optimal management strategies for such cases
Key-risk factors for fracture-related infection after ankle surgery: a retrospective study
Get PDFBackground: Fracture-related infection (FRI) is a serious complication following ankle fracture surgery, with significant implications for patient outcomes. This study aimed to identify the key risk factors associated with FRI in a cohort of patients undergoing surgical fixation of ankle fractures.
Methods: A retrospective analysis was conducted on 261 patients who underwent open reduction and internal fixation (ORIF) for ankle fractures between 2019 and 2021. Patient demographics, comorbidities, and surgical details were extracted from medical records. The primary outcome was the development of FRI within one year postoperatively. Logistic regression analysis was used to identify independent predictors of infection.
Results: The mean age of the patients was 61.8 years (SD=16.5), with 69.3% being female. The overall infection rate was 8%. Significant predictors of FRI included smoking (OR=13.643, p=0.002), peripheral vascular disease (OR=17.684, p<0.001), and diabetes mellitus (OR=11.309, p=0.002). Gender, congestive heart failure, obesity, and age were not statistically significant predictors of infection.
Conclusion: This study identifies smoking, peripheral vascular disease, and diabetes mellitus as significant risk factors for FRI following ankle fracture surgery. These findings underscore the importance of targeted interventions to manage these comorbidities in high-risk patients to reduce the incidence of postoperative infections. Further research is needed to explore the role of other potential factors and to develop effective prevention strategies
Golf ball near elbow: a rare presentation of a giant ulnar nerve Schwannoma
Get PDFSchwannoma is a type of peripheral nerve sheath tumor but can produce a mass effect with increase in size, spontaneous pain, paresthesia and motor weakness being the main complaints. A 60-year-old male patient presented with swelling in the left forearm since the past 8 months and numbness and tingling sensation in the hand for 1 month. Examination revealed a solitary lesion in the ulnar aspect of left proximal forearm with glove and stocking type of neuropathy, wasting of hypothenar eminence and amputation of left 5th digit, with hypopigmented lesions over the forearm and leg. Slit skin smear and biopsy of hypopigmented lesion was done to rule out leprosy. Ultrasonography (USG) and contrast-enhanced magnetic resonance imaging (CE-MRI) of left forearm lesion revealed homogenously enhancing lesion involving the proximal portion of left forearm - suggestive of peripheral nerve sheath tumor. Hence the patient was treated with excision and biopsy. Histopathological examination revealed a giant Schwannoma (6×4×3.5 cm) of the ulnar nerve with typical findings of spindle shaped cells few verocay bodies. Despite rare, tumors should be taken into account in the differential diagnosis in such presentations. It is important to remember that Schwannoma, in these cases, is the most common tumor. The simple removal of the tumor after careful dissection is generally enough since the recurrence and malignant transformation rates are low
Primary chondrosarcoma of bone: a clinicopathological and oncological outcome analysis
Get PDFChondrosarcomas are a heterogenous group of cartilaginous matrix-producing malignant neoplasms. They have varied morphological features and different clinical behaviors. The tumors usually range from benign low-grade tumors or intermediate atypical cartilaginous tumors (ACTs), to malignant, aggressive high-grade tumors. A multidisciplinary team at a tertiary sarcoma centre allows for optimal management of these patients. To determine the clinicopathological and survival outcomes of patients of chondrosarcoma, we report a total of 20 cases in the last 10 years at our institution. Our results have shown that chondrosarcomas occurred in different age groups and most common location was in axial skeleton. Most common histological type was conventional chondrosarcoma and majority were high grade tumors. All patients had undergone surgery and majority of the patients were alive after many years of treatment with an overall survival of 85%. Long term survival of patients is attributed to completeness of surgical resection.
Revealing the therapeutic potential of teriparatide: a review
Get PDFTeriparatide is an FDA-approved medication for osteoporosis that presents promising results in treating various musculoskeletal conditions. It helps in improving the bone mineral density and preventing fractures in individuals with osteoporosis. Its effectiveness in treating non-union and delayed union fractures, atypical femoral fractures, and spinal fusion procedures makes it valuable in improving bone healing and reducing complications. Teriparatide also improves bone density and strength in individuals with osteogenesis imperfecta, helps prevent and treat hypocalcaemia post-thyroidectomy, and helps in the management of hypoparathyroidism. In MRONJ, teriparatide improves lesion resolution and reduces bony defects. Furthermore, it potentially prevents bone metastasis in cancer patients without stimulating tumour growth. Nevertheless, teriparatide may cause short-term side effects like nausea and long-term concerns pertaining to the risk of osteosarcoma. Recent European alliance of associations for rheumatology guidelines have highlighted teriparatide's superior effectiveness in achieving bone mineral density thresholds and reducing fracture risks. Further clinical trials are necessary to determine optimal dosages and treatment durations of teriparatide. The off-label use of teriparatide should be considered only under the guidance of a healthcare professional when standard options are unavailable or inadequate
Gender difference in foot progression angle in patients with osteoarthritis knee: an observational cross-sectional study
Get PDFBackground: An essential clinical parameter related to gait is foot progression angle (FPA). The objective of this study was to evaluate foot progression angle difference between Kl grade 2 and 3 in osteoarthritis knee patients and understanding biomechanical factors associated knee OA.
Methods: Study was conducted on 108 patients diagnose with osteoarthritis knee according to EULAR classification knee OA. Age, gender and BMI were recorded, gait analysis was done to evaluate difference in FPA between OA knee patients with KL grade 2 and 3.
Results: The 108 patient, 68 female and 40 males with osteoarthritis knee were included in study. Mean age of patients was 55.92±0.8 year, mean BMI was 27.24±0.4 kg/m2. Mean and SD of FPA in male 7.31±3.60 and in female 8.31± 4.18 in patients with Kl grade 2 and 3 mean difference between male and female FPA is -0.99 with 95% CI, p=0.43 and t=0.78. In KL grade 3, FPA mean and SD of male 6.79±2.80 and female 7.62±9.10, t=0.9, mean difference -0.83 with 95% CI and p=0.6925.
Conclusions: This study suggests, females in comparison to males have less FPA and therefore, females are more prone in progression of knee OA. Potential confounders including age, gender, BMI disease severity did not alter magnitude, although 95% CI
Tibial tuberosity fracture in adult as an unusual pattern of injury
Get PDFTibial tuberosity avulsion is an uncommon fracture in adults, such lesions typically seen in adolescent male with well-developed quadriceps, ligaments when they are stronger than growth plate. We described a case of 51-year-old gentlemen had direct trauma to left knee, no risk factors were identified, not able to walk, difficulty in straight leg raise test, radiograph of left knee showed tibial tuberosity avulsion fracture. The fracture was treated with open reduction and internal fixation, f/u with successful rehabilitation which results in good range of motion and excellent function at knee joint. The aim of study is present unusual and rare case of tibial tuberosity Avulsion fracture in adult, early diagnosis, surgical mode of treatment, post-surgery rehabilitation and possible complications
Intra-articular autologous conditioned plasma reduces pain in early osteoarthritis and improves stiffness in advanced osteoarthritis knee: a prospective observation
Get PDFBackground: In this study, we aimed to investigate the effects of single-dose intra-articular autologous conditioned plasma injection as the treatment for early and advanced osteoarthritis knee.
Methods: A single centre-based prospective observational analysis was conducted among patients who opt for conservative management by intra-articular autologous conditioned plasma Injection between July 2022 to June 2023. Total 46 patients were included and analysed in study on 1, 3, and 6 months’ follow-up after ACP injection. The WOMAC score and its sub scores were analysed and compared pre-procedure and on subsequent follow ups.
Results: A total of 46 patients were analysed in the study, with male predominance of 56.5% with mean BMI of 27.37±5.35. On KL grading, 34.8% patients had KL grade II Osteoarthritis, 52.2% had grade III and 13.0% had grade IV. On comparison of WOMAC score and its sub-scales, all the values were found to be statically significant while comparing before injection (p value <0.0001) and one month follow up and before injection and six months’ follow-up (p value <0.0001).
Conclusions: Six months following intra-articular autologous conditioned plasma injection, there was a noteworthy decrease in pain in early stages of osteoarthritis and improvement in knee stiffness in advanced stages of osteoarthritis as compared to the pre-treatment state
Evaluation of safety, clinical outcomes, and patient-reported outcomes after meniscus repair using surestitch all inside meniscal repair implant: a retrospective and observational study
Get PDFBackground: Anterior cruciate ligament (ACL) injuries and meniscus injuries frequently co-occur, underscoring the interconnected nature of knee joint structures. Meniscus injuries, often caused by sports trauma or degenerative changes, necessitate careful management to preserve joint function and prevent complications like osteoarthritis. This retrospective observational study evaluates the safety, clinical outcomes, and patient-reported outcomes of meniscus repair using Surestitch all inside meniscal repair implant, a contemporary solution designed to optimize meniscal repair.
Methods: The study, approved by the institutional ethics committee, included patients aged 18-80 years who underwent meniscus repair with Surestitch between October 2020 and July 2022. Data on demographics, surgical details, and outcomes were collected from medical records and telephonic follow-ups.
Results: Among 36 subjects, the mean age was 36.89 years. The mean (SD) duration of follow-up was 364 days (127). There was no meniscus repair failure noted in any of the patients. Functional patient-reported outcomes assessed using international knee documentation committee (IKDC) with a score of (60.15±12.40), and Lysholm scores (77.03±14.45) demonstrated favorable results. The knee injury and osteoarthritis outcome score (KOOS) of (54.63) further indicated positive knee health across domains. There were no adverse events or reoperations.
Conclusions: The study demonstrated favorable safety, clinical outcomes, and patient-reported outcomes, yielding satisfactory results, and consequently establishing the safety and effectiveness of the Surestitch All inside meniscal repair implant in meniscus repair