International Journal of Research in Orthopaedics
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One year old misdiagnosed penetrating injury of sacrum with a retained knife: a case report and review of literature
Get PDFPenetrating injuries to the spine, although less common than blunt trauma from motor vehicle accidents, are important causes of injury to the spinal cord. They are essentially of two varieties-gunshot or stab wounds. Gunshot injuries to the spine are more commonly described and are associated with a higher incidence of neurological damage. On the contrary, the prognosis is better in stab wounds where surgery plays a greater role. Here we report a case of a 31 year old male with a history of penetrating injury with knife in lower back 1 year ago comes with complaints of pain and pus discharge since 2 weeks. On detailed history taking, clinical examination and investigations it was found that knife was left in situ which was causing symptoms. Surgical exploration was done. Foreign body (knife) was removed keeping all the neurovascular complications in check. Post operatively patient is doing good with no neurological deficits. A timely intervention in removing foreign body is necessary for preventing for complications
Functional outcome in case of surgically and conservatively treated bilateral distal end radius and scaphoid fracture: a rare case report
Get PDFBilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.
Age wise comparative analysis of patients undergoing total knee arthroplasty: a multicenter indigenous experience
Get PDFBackground: This study assesses the mid-term clinical and functional outcomes, implant survivorship and impact of age on patients implanted with either cruciate retaining/posterior stabilized (CR/PS) total knee system (TKS).
Method: This is an ongoing, prospective, multicentre, real-world study enrolling 300 patients: younger adults (<55 years; n=69), older adults (55 years to <65 years; n=92) and elders (≥65 years; n=139). Primary safety endpoints: implant survivorship and cumulative revision rate. Secondary endpoints: Knee Society Score (KSS), Western Ontario and McMaster universities osteoarthritis (WOMAC) score, range of motion (ROM), SF-36 questionnaire for assessment of quality of life (QoL), radiographic analysis, and any adverse events at 6 weeks, 6 months, 1-3 years.
Results: Primary endpoint demonstrated absence of any revision across all age categories during the 3 years study period. Secondary outcomes KSS (clinical and functional) showed non-significant difference among elderly (91.13±7.90 and 98.18±4.62, respectively) in comparison to young adults (91.03±8.61 and 98.91±3.75, respectively). All three age-groups showed significant improvement in ROM (p<0.001) till 3 years 121.05°±7.74°, 123.22°±4.26°, and 122.43°±5.8° respectively, with no differences among the age groups. We observed that WOMAC and SF-36 QoL scores improved with each follow-up (p<0.001) across all age groups. Radiographs showed no implant wear or osteolysis during the investigation.
Conclusions: Age seems to play no notable role on the post-TKA outcomes. Over a 3-year period, we observed marked enhancements in patient measures such as ROM, KSS, WOMAC, and QoL indicating and strongly affirming the safety and efficacy of CR/PS TKS prostheses.
Beneath the white coat: decoding stress among Indian medical postgraduates
Get PDFStress among medical postgraduates in India has reached alarming levels, with significant implications for individual well-being and the healthcare system. This review aims to explore the multifaceted nature of stress among Indian medical postgraduates, encompassing factors such as increasing suicide rates among doctors, senior toxicity, loss of quality doctors, and its role in doctor migration. Through an analysis of recent articles from reputable journals, this review examines the prevalence, causes, manifestations, and consequences of stress in this population, alongside strategies for mitigation and intervention
Functional outcome of autologus platelet rich plasma injection as treatment for patients with plantar fascitis
Get PDFBackground: Plantar fasciitis (PF) is the most common cause of pain that occurs in the heel, and approximately 11% to 15% of adults having foot symptoms require an expert care. Heel pain and tenderness are some of the common symptoms. Many conservatives methods are available, Platelet rich plasma is one of the safe and effective therapy in relieving symptoms. To describe the functional outcome of autologus platelet rich plasma as treatment for patients with plantar fasciitis. To describe any complications associated with the procedure.
Methods: It is a prospective observational study 45 patients with chronic Plantar fasciitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at regular intervals post treatment. The PRP was prepared from venous whole blood.
Results: Pain score was assessed at the time of injection. The mean pain score of all the patients was 8.614. Percentage pain relief showed 48% had 100% pain relief, 33% had more than 50% pain relief and 6% had less than 50% pain relief from the study.
Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of Plantar fasciitis. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months
Evaluation of the results of sub axial cervical spine injury with incomplete neurology treated by posterior lateral mass fixation with screws and rod and fusion by bone graft
Get PDFBackground: The cervical spine is a highly mobile segment of the spinal column, liable to a variety of diseases and susceptible to trauma. Lateral mass screw fixation has become the method of choice in stabilizing subaxial cervical spine among other posterior cervical fixation techniques. This study aimed to assess the radiological efficacy of the cervical lateral mass screw insertion and rod fixation by Yoon's method.
Methods: This was a prospective observational study conducted in the Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, over a period of two years from July 2014 to June 2016. We included 100 patients who will be admitted with a diagnosis of unstable cervical spine injury during period of study.
Results: The mean age of the patients was (36.87±7.45) years. Majority of the patients were male (80%). Bearing load on the head was the most common (40%) cause. Most commonly involved level of injury was C5/C6 (30%) and type of injury was Fracture Subluxation (35%). Hemorrhage (15%) was the most common per operative complication followed by neck pain (12%), superficial infection (10%), screw pull out (10%), and post-operative khyphotic deformity (10%). Evaluation of final outcome revealed 67% and 33% patients had satisfactory & unsatisfactory results respectively.
Conclusions: The lateral mass screw insertion and rod fixation is a safe and reliable technique with low rate of complication related to instruments. This method enhances neurological recovery, reduce pain and improve working status with early rehabilitation
Widespread skeletal brown tumor with rare elbow involvement and associated hydronephrosis in a case of primary hyperparathyroidism
Get PDFWe report a rare case of primary hyperparathyroidism in a 32-year-old female caused by a parathyroid adenoma. The patient initially complained of left elbow pain. Imaging revealed multiple skeletal brown tumors affecting unusual sites such as the elbow, as well as multifocal involvement of the vertebrae, sternum, radius, ulna, humerus, femurs, pelvic girdle, and scapulae. An abdominal ultrasound further revealed hydronephrosis and renal calculi in the right kidney. This case highlights the uncommon widespread skeletal distribution and involvement of atypical sites by brown tumors, along with the rare complication of hydronephrosis
Clinico-radiological outcomes of proximal humerus fractures using locking compression plates among adults in a tertiary care hospital: an observational study
Get PDFBackground: Proximal humerus fractures represent 45% of humerus fractures and are the third most common fracture in the elderly due to trivial falls and weakened cancellous bone, and in the young population due to high-energy trauma. These fractures can be disabling and require surgical expertise for a good functional outcome. This study analyzes the clinico-radiological and functional outcomes of adult patients with proximal humerus fractures treated with locking compression plates.
Methods: A prospective observational study was conducted on patients with proximal humerus fractures treated with locking compression plates from June 2022 to June 2023 at SIMS Hospital, Chennai. Functional outcomes were measured using the SPADI score and radiological union of fractures at follow-ups of 2, 6, 12, and 24 weeks.
Results: In this study, 34 patients underwent ORIF with locking compression plates. All fractures healed completely without secondary procedures, nonunion, malunion, or implant failure. No postoperative complications were observed. The average time for radiological union was 14.5±2.4 weeks. The SPADI scores at 2, 6, 12, and 24 weeks were 82, 63.26, 22.26, and 4.06, respectively, showing statistically significant improvement (p < 0.05).
Conclusions: ORIF with locking compression plates, combined with proper anatomical reduction and suture augmentation of the rotator cuff, yields early ROM return and good functional outcomes. This method achieves earlier radiological union compared to other methods, making it the preferred choice for proximal humerus fractures across all age groups
Impact of teardrop angle correction on functional outcomes in die punch fractures of the distal radius: retrospective study
Get PDFBackground: Anatomic reduction of die punch fractures of the distal radius is crucial to optimize functional outcomes. The teardrop angle, formed by the volar cortex and articular surface, reflects distal radius alignment and articular congruity. This study evaluated the relationship between teardrop angle correction and clinical/functional results following surgical fixation of these injuries.
Methods: This retrospective study included patients undergoing open reduction and internal fixation for die punch distal radius fractures between 2015-2020. Patients were divided into two groups based on teardrop angle correction: group 1 (≤10°) and group 2 (>10°). Disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist evaluation (PRWE) scores, range of motion, and grip strength were assessed at final follow-up (minimum 12 months). Multivariate analysis identified predictors of functional outcomes.
Results: 60 patients were included (32 in group 1, 28 in group 2). Groups were similar in baseline demographics and injury characteristics. Group 2 (>10° correction) had significantly better outcomes including lower DASH scores (14.5 versus 24.6, p=0.003), lower PRWE scores (21.6 versus 36.8, p=0.002), greater grip strength (84.6% versus 71.2%, p=0.005), increased flexion (62.5° versus 52.7°, p=0.004), and extension range of motion (55.8° versus 43.5°, p<0.001). On multivariate analysis, greater teardrop angle correction was an independent predictor of improved DASH and PRWE scores.
Conclusions: Obtaining >10° of teardrop angle correction during surgical fixation of die punch distal radius fractures correlated with superior functional outcome scores, grip strength, and mobility compared to ≤10° of correction. These findings emphasize the importance of restoring distal radius anatomy and articular congruity in this injury pattern. Precise intraoperative correction of the teardrop angle deformity should be a key goal
Functional outcome of intertan nailing in intertrochanteric fractures: a retrospective study utilizing Oxford hip score
Get PDFBackground: This study evaluates the functional outcome of intertan nailing in intertrochanteric fractures in terms of the Oxford Hip Score (OHS).
Methods: Twenty-eight patients (10 males, 18 females, mean age: 75.2 years, range: 60-94 years) were analyzed. Mean follow-up period was 6 months (3–8 months) and 5 patients were lost to follow-up.
Results: The overall average OHS was 37.2, with scores varying from 22 to 47. Nine patients had OHS scores above 40, indicating satisfactory function, while 10 patients scored between 30-39, denoting mild loss of function. Four patients had OHS scores of 20–29, indicating a moderate to severe loss of function.
Conclusions: These findings indicate the varied functional outcomes of intertan nailing in intertrochanteric fractures and highlight the importance of individualized treatment strategies