International Journal of Research in Orthopaedics
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A case report of a rare incidence adnexal nodular hidradenoma mimicking as simple ganglion cyst in hand
Get PDFSoft tissue swelling of hand is a common condition presenting in orthopedic outpatient department (OPD). Simple ganglion cyst is the most prevalent presenting disorder among the various differential diagnoses for this ailment, which include ganglion cyst, inclusion cyst, giant cell tumor of tendon sheath, enchondroma, carpal bossing, leiomyoma, and adnexal tumors. A 75-year-old male patient presented with soft tissue swelling over dorsum of his left hand, which was insidious in onset and painless in nature at initial stages, but over the past 6 months it grew over to become of approximately 7×3 cm in size, and now causing slight pain and discomfort to patient. Primary investigation like X-ray, ultrasonography and magnetic resonance imaging (MRI) was done. Clinical and radiological investigation was suggestive of simple ganglion cyst. So patient was operated for it as surgical excision and tissue biopsy was sent for histological examination to arrive at definitive diagnosis of the condition and further line of management. Histological finding of tissue biopsy was suggestive of adnexal nodular hidradenoma with nodular and cystic areas of differentiation. Thus, before drawing a final diagnosis, a rare tumor like adnexal hidradenoma should also be taken into account as a differential diagnosis. This aids in the planning of the patient's future course of treatment. This instance emphasizes the significance of tracing reports prior to repeat surgery and submitting biopsies of all hand lesions for histological testing
A retrospective study to assess the complications associated with surgical management of distal radius fracture by ligamentotaxis
Get PDFBackground: Fractures of the distal radius are the most common upper limb fractures encountered by orthopedic surgeons. It constitutes about 75% of all the forearm fractures. There is steady increase in this type of fracture in all age groups but is the highest in children and elderly. There are multiple modalities of treatment available for distal end radius fractures, among which ligamentotaxis is one of the modalities, where the ligaments, retinaculum, tendons and periosteum that envelope the fracture serves as barrier during open reduction, helps achieve the reduction of the fracture. The objective is to study the most common complication associated with distal radius fractures treated by ligamentotaxis in this institution.
Methods: This hospital based retrospective study was conducted at MVJMC and RH after receiving ethical clearance from the institutional ethical committee. The study population contained 50 patients that met the inclusion criteria over a period of 4 years from March 2019 to March 2024.The administrative health data was collected from OPD and OT registers, and the collected data was entered in Microsoft excel and results were calculated and tabulated at the end of the period. All the patients with distal end radius fractures treated by ligamentotaxis over a period of 4 years were included
Results: According to the study distal end radius fracture was more prevalent among males than females and the highest percentage with 30% was seen among the age group of 31-40 years. The most common complication encountered was neuropathy and residual wrist pain which accounted for 14%.
Conclusions: The study concludes that most of the fractures and its complications are note among the active age group. The study helps understand the complications and find strategies to reduce the complication percentage
Short-term post-operative evaluation of young to middle age population following primary uncemented total hip arthroplasty
Get PDFBackground: Total hip arthroplasty (THA) is the most commonly performed adult reconstructive procedure. The most common indication is severe osteoarthritis of the hip. THA remains the treatment of choice for restoring in end stage hip arthritis. It aims for immediate and long-lasting effects on pain and function in osteoarthritic hip.
Methods: The study is a prospective observational study conducted on 30 patients enlisted in the inpatient department of orthopaedics at a rural tertiary health care centre (JIIU’S Indian Institute of Medical Sciences and Research, Warudi, Jalna). Only those patients satisfying the inclusion and exclusion criteria were included in the study. All the patients were explained about the surgical procedure, the purpose of the study and informed consent was taken. The patients were followed up at 1, 3 and 6-months post-operatively and the functional outcome was evaluated using Harris hip score and visual analogue scale (VAS).
Results: Among the 30 cases included in the study, subjects were between 22 to 60 years of age. The cases were of either gender, with predominance of male cases. The mean Harris hip score and the mean pain score (VAS) at post-operative 1-month, 3-month and 6-month follow-ups improved significantly compared to their respective values at the pre-operative stage (p value <0.05 for all).
Conclusions: The uncemented total hip replacement in young to middle-aged patients is an effective surgery which provides dramatic pain relief and excellent functional outcomes in majority of the subjects
Comparison of outcomes of dual-mobility cemented total hip arthroplasty versus bipolar cemented hemiarthroplasty in patients with femoral neck fractures
Get PDFBackground: Elderly people with femoral neck fractures are more likely to experience complications after hip replacement. Compared with total tripolar hip arthroplasty (THA), bipolar hemiarthroplasty (HA), more effective alternative treatments that improve overall safety. We aimed to review the benefits of dual mobility tripolar arthroplasty and compare it to bipolar hemiarthroplasty in treatment of the femoral neck in the elderly.
Methods: This study was conducted as a comparative randomized controlled prospective study. Patients were divided randomly to two equal groups 19 patients each one group underwent cemented bipolar hip hemi arthroplasty and the other group underwent cemented tripolar total hip arthroplasty, surgical approach for the two study groups was modified lateral Hardinge approach. The patients were followed up after one month, three months 6 months and one year. The follow up period was one year, and modified Harris hip score was reported, and radiograph scan of fracture site was done before and after surgery. Complications were reported whether intraoperative or in the follow up period.
Results: The result of the study showed that the operative time was much longer in tripolar group as compared to bipolar group, there was more blood loss in tripolar group more than bipolar group. The functional outcome assessed using Harris hip score showed better outcome in tripolar group as compared to bipolar group. As regard complication, there was one case of periprosthetic fracture intraoperative in bipolar group and one case of cement extrusion in tripolar group. There was no dislocation in both groups.
Conclusions: Tripolar total hip arthroplasty had better functional outcome than bipolar hip hemiarthroplasty and we recommend more studies for a longer period of follow up to assess rate of complications and functional outcome on the long run
Comparative study of crossed pinning v/s lateral pinning in paediatric supracondylar humerus fractures
Get PDFBackground: Closed reduction and percutaneous pinning are the preferred management of supracondylar humerus fractures in children, but the preference of pinning pattern needs more research. A prospective comparative interventional study was undertaken to compare the stability of fixation, functional outcome and neurovascular complications between crossed pinning and lateral pinning in Gartland type 2 and type 3 fractures.
Methods: 60 patients of age group 2 to 12 years with Gartland’s type 2 and 3 fracture were randomized into 2 groups- lateral pinning (n=30) and crossed pin fixation (n=30). Intraoperative parameters were compared, post operative ulnar nerve palsy and serial range of motion were assessed. At 3 month follow up, outcome was assessed using Flynn criteria. The results were compared and analysed.
Results: There were 2 cases (3.3%) of iatrogenic ulnar nerve injury in crossed pinning group and none in lateral pinning group. Lateral group had more cases with excellent Flynn rating. The mean loss of range of motion and the mean loss of carrying angle was significantly lower for lateral method.
Conclusions: Lateral pinning provides, better functional outcome along with comparable stability without the risk of iatrogenic ulnar nerve injury.
Rare case of medial Hoffa fracture with ipsilateral femur shaft fracture with unusual mechanism of injury
Get PDFHoffa’s fracture is a rare fracture which involves coronal fracture of the distal femur involving one or both the condyles. We report a rare combination of Hoffa fracture with ipsilateral femur shaft fracture with an unusual mechanism of injury. This case report will help increase awareness about such combined fracture pattern and eventually avoid missing these important intra-articular injuries- Hoffa’s fracture. In a patient with ipsilateral femur shaft fracture and in polytrauma patients, diagnosis of Hoffa’s fracture is very challenging because of presence of other long bone fracture and injuries. Missed Hoffa’s fracture in a patient with ipsilateral femur shaft fracture may restrict post-operative knee range of motion, knee pain, increased risk of early arthritis and joint deformity and stiffness
Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis
Get PDFIntroduction: Malnutrition has been shown to cause perioperative complications, which can be particularly detrimental following total knee arthroplasty (TKA). These complications can lead to increased morbidity, extended hospital stays, and significant financial burdens on both patients and healthcare systems. To evaluate the nutritional status and body mass index (BMI) of patients undergoing TKA and monitor them for complications immediately postoperatively, at one week, and three months after surgery.
Methods: This prospective study included 88 patients who underwent TKA at government medical college Kozhikode, Kerala, India. Nutritional status was assessed using serum albumin, ferritin, haemoglobin, and BMI (body mass index) levels. Patients were followed up for three months postoperatively to identify any complications. Data analysis was conducted to determine the relationship between malnutrition and postoperative complications.
Results: Of the 88 patients, 5 developed major wound complications, with 4 of these patients exhibiting hypoalbuminemia. Hypoalbuminemia was found to have a statistically significant association with major wound complications (p<0.001). Malnutrition was associated with higher rates of major wound complications, increased need for postoperative blood transfusions, and longer hospital stays.
Conclusion: Identifying modifiable risk factors such as malnutrition in patients undergoing TKA is crucial for reducing the risk of postoperative complications, which can otherwise lead to disastrous outcomes. Preoperative optimization of nutritional status can significantly improve surgical outcomes and reduce complications
Sequential manual manipulation technique of closed reduction to retrieve a bent femoral intramedullary nail: a case report
Get PDFA bent intramedullary nail in femur can be extremely difficult to extract when a patient presents after a secondary episode of trauma following the original episode for which nailing was done. These bent nails require utmost precision while extracting them, to prevent injury to the surrounding soft tissues and neurovascular bundle of the limb. We encountered a particularly rare case of a bent Kuntscher nail who presented to us nearly 20 years (post his primary surgery in 2001) after sustaining a secondary trauma. There was a 29-degree bend in the antero-posterior view and a 106-degree procurvatum bend in the k nail on the lateral view. We followed a technique of sequential manual manipulation under radiographic guidance to correct the acute bend of the nail, taking care not to create any additional fractures. Following nail extraction, the fracture was fixed with an interlocking nail and went on to unite uneventfully. At 3-year follow up, patient was walking pain free and exhibited a good knee range of motion
Comparative analysis of treatment outcomes in osteoarthritis knee: integrating physiotherapy and medication versus mono-therapies
Get PDFBackground: Osteoarthritis (OA) of the knee is a prevalent degenerative joint disorder that significantly impacts patients' mobility and quality of life. Effective management of knee OA is crucial to alleviate symptoms and improve daily functioning. This study aims to conduct a comparative analysis of treatment outcomes for knee OA by evaluating three distinct therapeutic approaches: a combination of physiotherapy and medication, physiotherapy alone and medication alone, all supplemented with routine daily activities.
Methods: The research involves a cohort of patients diagnosed with knee OA, divided into three groups, each receiving one of the specified treatments. Outcome measures include pain reduction, assessed through the Visual Analog Scale (VAS); functional mobility, evaluated using the Timed Up and Go (TUG) test; and overall quality of life, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS).
Results: Preliminary findings suggest that patients receiving the integrated treatment of physiotherapy and medication show significantly greater improvements in pain relief and functional mobility compared to those undergoing mono-therapies. The combination approach appears to leverage the synergistic effects of both modalities, offering a more comprehensive management strategy. Physiotherapy alone also demonstrates notable benefits in enhancing mobility and reducing pain, while medication primarily provides symptomatic relief.
Conclusions: This study underscores the importance of a multidisciplinary approach in treating knee OA, highlighting that integrated treatment plans may offer superior outcomes. These findings aim to inform clinical practice, suggesting that combining physiotherapy with medication can optimize therapeutic efficacy, improve patient quality of life and potentially alter the standard care protocols for knee OA. Further research is warranted to substantiate these results and explore long-term benefits
Arthrodesis following persistent periprosthetic knee infection using femoral condyle allograft: a case report and review of literature
Get PDFPeriprosthetic joint infections (PJI) of the knee are difficult to treat and can require costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures. Knee arthrodesis is considered a last resort for persistent knee joint infections and provides stability and pain relief by fusing the knee joint. The authors describe a case of a persistent and difficult to treat periprosthetic total knee arthroplasty (TKA) infection, subjected to multiple surgeries and revisions, where an arthrodesis was performed as a last resort. The arthrodesis was performed using a femoral-tibial endomedullary nail with interposed femoral condyle allograft. Complete graft integration and consolidation was achieved without complications. The patient performed well post-operatively and is currently ambulatory with walking aids and has no knee pain. The removal of well-fixed metaphyseal sleeves in TKA can be challenging and associated with complications such as damage to the surrounding bone and soft tissue during the removal process. Taking special care and not rushing this step can present an extremely meaningful difference in the final outcome. In cases with large bone defects, especially after sleeve removal, allograft usage can be extremely useful for managing dead space and limb-length discrepancies while promoting faster bone healing. When successful, as was the case described, arthrodesis using allografts can have beneficial outcomes with high patient satisfaction and deliver function to previously very unhealthy joints and limbs