International Journal of Research in Orthopaedics
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Percutaneous release of trigger finger and its functional outcome
Get PDFBackground: An overview of percutaneous release for trigger finger and its functional outcomes.
Methods: The present prospective controlled analytical study was conducted after taking approval from center human ethical committee. A written and informed consent was obtained. There were 50 patients who reported to outpatient department (OPD) with symptoms suggestive of trigger thumb/ finger, were subjected to the study.
Results: Most of the patients belonged to the age group of 41-50 years. Majority of patients were females (56%) and males were (44%). Most of the patients had the right 1st digit involved (32%), followed by left 1st and right 3rd digit (18% each). Before the release of affected digit, 56% were grade 3, 26% were grade 4 and only 18% were grade 1. Complete resolution immediately after the procedure was seen in 82% cases. Pre procedure, mean VAS of 8.4 reduced to mean VAS of 6.2 immediate post procedure. At 48 hours post procedure, mean VAS of 3.06 and mean VAS of 1.12 was seen at 1-month post procedure period. At 3 months post procedure, mean VAS of 0.42. 94% cases had no complications.
Conclusions: Percutaneous release of trigger finger is a safe and effective procedure associated with favorable functional outcomes. It provides an alternative treatment option for patients who have failed conservative management or prefer a minimally invasive approach
Cost benefit analysis of intralesional injections in keloids using Luer lock and non-locking syringes
Get PDFBackground: For keloid scarring, intralesional corticosteroid injections continue to be the most often utilised first therapeutic option. This is a common procedure done on an outpatient basis by surgeons and orthopaedists. Luer lock syringes which lock the needle with syringe prevent any leakage or spillage of drug while pushing it near the keloid compared to normal syringes.
Methods: We intend to do a cost benefit analysis based on the retrospective data of intralesional steroid injections done by the authors (AP and SK) in their private practice.
Results: The time between 2021 to 2022, 200 injection data was retrieved, 100 each using non locking syringes and Luer lock syringes. The spillage rate with non-Luer lock syringes was 14%.
Conclusions: We found that luer lock syringes prove to be cost effective after giving more than 200 injections in keloids than non-locking syringes.
The study of outcome in fractures of proximal third of tibia in adults treated by expert tibia nail
Get PDFThis study aims to evaluate the clinical, functional outcome and complications of fracture proximal third of tibia treated with expert tibia nail in terms of radiological union, functional outcomes by short form -36 (SF-36) score, Johner and Wruhs criteria, visual analogue score and patient satisfaction score. Twenty-five patients with fracture proximal third of tibia treated with expert tibia nail in SNMC and HSK hospital and research centre, Bagalkot were enrolled in this study. The radiological union was assessed by plain radiograph and functional outcome by SF-36 score, Johner and Wruhs criteria, visual analogue score and patient satisfaction score. The radiological union was achieved in all the patients between 14 to 26 weeks duration (mean of 19.6±2.82 weeks). The mean SF-36 score was 84.9±4.06 and the mean visual analogue score was 2±1.78 at the 22nd week of follow-up. Results based on Johner and Wruhs criteria, 17 patients had excellent, 6 had good, 1 had fair and 1 had poor results. The average patient satisfaction score was 8.88 out of 10. There were 8 cases of post-operative knee pain, 5 cases of infection, 2 cases of malunion, 1 case of shortening and 1 case of the delayed union in our study. Intramedullary fixation with expert tibia nail for fracture proximal third tibia is a safe and less invasive technique. The radiological union was achieved in all the cases. This technique ensures excellent functional outcomes and a low incidence of complications
Chondral lesion of the patella in a junior football player: chondral-only fragment fixation
Get PDFChondral lesions of the patella are a relatively common pathology that can cause pain and impairment in active young individuals. These lesions can have lifelong consequences, with increased risk of osteoarthritis in some cases. Surgical excision of medium to large fragments is associated with poor long-term outcomes. There is a general belief that fixation of purely chondral lesions in the absences of subchondral bone is associated with low integration rates, however recent case reports and basic science studies have been challenging this belief. In this case report, we describe a young patient with a chondral lesion of the patella and a fragment without subchondral bone, who underwent open fragment reduction and fixation using bioabsorbable pins. The patient had a successful outcome with significant fast improvement in pain and function and full return to practice. This case highlights the potential benefits of conservative surgical management with preservation of the native cartilage, even in the absence of subchondral bone, especially in the young active patient.
Comparison of Singh’s index in view of osteoporosis in patient with in tertrochanteric fracture and intracapsular fracture
Get PDFBackground: Osteoporosis is a progressive, systemic, skeletal disease with low bone mass. Diagnosing osteoporosis in practice is a major challenge, where resources are limited and costly. Measurement of osteoporosis through Singh’s index in proximal femur fracture patients is consistent with Bone Mineral Density estimation like DEXA scan. Singh’s index is a reliable, reproducible and easily available investigation for osteoporosis. The aim of this study is to evaluate the Singh’s index of the patients with inter-trochanteric and intra-capsular fracture.
Methods: A retrospective observational study of 20 IT and IC fracture each. Singh’s index evaluated from the X-rays at time of fracture presentation. Other required information collected at presentation.
Results: Out of 40 Patients, 6 had Singh's Index Grade 1 (15%), 11 had Grade 2 (27.5%), 10 had Grade 3 (25%), 7 had Grade 4 (17.5%), 6 had Grade 5 (15%), 0 Patients had Singh’s index Grade 6. There was no noticeable significant variation in relation of gender with the type of fracture. Patients with higher age tend to have a lower grade of Singh’s index.
Conclusions: Singh’s Index indeed represents bone quality and a fall in the grades predisposes to fractures. Inter trochanteric fractures are common in the older age group with poor Singh’s index (<3) compared to the relatively younger age group with Singh’s index around 3. Gender, exercise, history of hypertension and diabetes, sunlight exposure, etc. has no significant impact on Singh's Index. Age is deciding factor for Singh’s Index
Functional outcome of diaphyseal fractures of forearm in children treated with titanium elastic nailing system
Get PDFBackground: Forearm fractures are common injuries in children, with diaphyseal fractures of the forearm being among the most frequent injuries treated in the pediatric population. This study aimed to assess the functional outcome of diaphyseal fractures of the forearm in children treated with the titanium elastic nailing system.
Methods: This prospective observational study was conducted at the Department of Orthopaedics, Mainamoti Medical College, Cumilla, Bangladesh from January 2020 to December 2022. The study included 67 patients aged 6-15 with diaphyseal forearm fractures treated with the titanium elastic nailing system, selected through purposive sampling. MS Office tools were used for data analysis.
Results: According to the functional outcome criteria described by Price et al., it was observed that in the highest number of patients (86.56%), the functional outcome was excellent, followed by good, fair, and poor outcomes found in 8.96%, 2.99%, and 1.49% of the cases, respectively. As the postoperative complications, the delayed union was found among 4%, and skin infection was found among 3% of cases.
Conclusions: Considering the excellent outcomes and lower complication rate, the titanium elastic nailing system may be considered a very effective and safe treatment method for the management of diaphyseal fractures of the forearm in children
Functional outcome of transforaminal epidural steroid injection in lumber disc herniation with radiculopathy
Get PDFBackground: Transforaminal epidural steroid injection (TFESI) is a useful therapeutic tool for lumber disc herniation with radiculopathy. TFESI reduce inflammation and edema around herniated disc and nerve root, thus alleviating pain and accelerating the natural history of the herniated disc by shrinkage. This study aims to determine the effectiveness of TFESI in lumber disc herniation with radiculopathy.
Methods: In this prospective observational study, 273 patients were included considering inclusion & exclusion criteria. All subjects received TFESI for lumber disc herniation with radiculopathy. The primary outcome was assessed with a Bengali version of Oswestry disability index (ODI) score and Roland-Morris disability questionnaire (RMDQ) scores at 2 weeks, 1 month, 3 months and 1 year.
Results: From baseline (18.6±3.6), mean RMDQ score was significantly reduced at 2 weeks (14.4±3.7), at 1 month (13.8±3.8), at 3 months (11.6±3.6) and at 1 year (7.8±3.7) respectively. 69.2% patients had severe disability at baseline according to disability rank of ODI score; after procedure during follow up severe disability was found in 21.6% cases at 2 weeks, 9.1% at 1 month, 5.0% at 3 months and 1.2% at 1 year. The reduction of severe disability from baseline in subsequent follow up was significant. From baseline (45.7±10.0), mean ODI score was significantly reduced at 2 weeks (36.4±9.0), at 1 month (28.2±8.9), at 3 months (24.3±8.9) and at 1 year (18.9±10.5) respectively.
Conclusions: Transforaminal epidural steroid injection significantly reduced disability and provide improved functional outcome in patients with lumber disc herniation with radiculopathy
Lupus with myositis in an adult Indian male
Get PDFSystemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves various organs and has a vast spectrum of multi system involvement. SLE is an autoimmune illness which is rarely found in males but when present holds a poor prognosis with a predisposition to develop various manifestations. This case involves a 50-year-old male who developed myositis as a complication of lupus despite adequate immunosuppressive therapy.
Functional outcome of operative management of Haglund deformity in non-athletic individuals-a case series
Get PDFHaglund’s deformity is a symptomatic osseous outgrowth or prominence of the posterolateral corner of calcaneus usually in young individuals which presents in the form of posterior heel pain, sometimes intractable in chronic cases, which aggravates on walking or on dorsiflexion of the foot and is relieved with rest and anti-inflammatory medications in the initial phases. Management involves an initial conservative trial involving lifestyle changes and medical management, failure of which warrants surgical management for symptomatic relief along with ability to return to perform activities of daily living. We have a series of 4 patients with a Haglund’s deformity who presented to us with chronic posterior heel pain of varying duration with episodic exacerbations who were initially managed with a conservative trial with medications, physiotherapy, lifestyle modifications, usage of soft silicon sole for the footwear; the failure of which prompted us to go ahead with surgical management of these patients-all 4 patients were managed with a lateral wedge removal of the calcaneus with excision of the retrocalcaneal bursa. All 4 patients reported significant improvement in the symptoms with adequate postoperative care and rehabilitation. As we have seen in this case series of 4 patients presented here, Haglund’s deformity which is a part of a larger Haglund’s syndrome, has a chronic progression over a period of time with episodic exacerbations and remissions, which could be managed conservatively for a significant period initially but, if need be, surgical management should not be deferred not only to provide symptomatic relief as a major goal, but also to avoid permanent degenerative damages to the concerned soft tissues
Evaluation of the safety, efficacy and technical advantages of spinal anesthesia in patients undergoing single lower lumbar level minimally invasive transforaminal lumbar interbody fusion, as an alternative to general anesthesia: a prospective study
Get PDFBackground: In spinal anesthesia, patients experience shorter OT, quicker recovery and ambulation, better post-operative analgesia and fewer complications than general anesthesia. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) shows fewer complications and early ambulation than open TLIF. Our study aims to assess spinal anesthesia’s safety, efficacy and technical benefits in MIS-TLIF.
Methods: Patients unresponsive to conservative treatment for 6-8 weeks underwent MIS TLIF for lower lumbar degenerative pathologies. The demographic data, OT entry to incision time, blood loss, bandaging to exit from OT time, post anesthesia care unit (PACU) time, post-op complications, requirement of analgesia, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, hospital stay, fusion rates and satisfaction scores were noted and assessed.
Results: The study included a total of 200 patients undergoing MIS-TLIF with mean age being 54.32±10.36 years; mean surgery time being 165.23±21.41 minutes; and mean blood loss being 123.56±65.14 ml. The mean OT entry to incision time was 28.91±9.63 minutes, while the mean bandaging to exit time was 7.43±4.12 minutes. The mean PACU stay was 41.35±5.78 minutes. The mean hospital stay was 3.28±1.23 days, with 97% patients showing solid radiographic fusion while 92.5% patients were fully satisfied with the surgery. VAS and ODI scores were significantly improved as compared to the pre operative status.
Conclusions: Spinal anesthesia for lower lumbar MIS-TLIF is cost effective and safe alternative to general anesthesia with lesser post operative pain and other side effects; taking into consideration proper patient selection for the same