International Journal of Research in Orthopaedics
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Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods
Get PDFMeniscal repair procedures are on the rise due to an enhanced understanding of the adverse long-term effects associated with the loss of meniscal tissue. Although meniscal repair has a higher reoperation rates compared to meniscectomy, recent systematic reviews indicate improved long-term outcomes with meniscal repair. Even though there are a lot of studies that compare the results of all-inside and inside-out techniques there are only few that evaluate all-inside and outside-in approaches. This study aims to review the relevant literature on the epidemiology, mechanism of injury, clinical presentation and imaging of meniscus and to compare the failure rates and time to failure of AI and OI meniscal repairs. PubMed and Scopus were searched for studies published between January 2014 and January 2024 reporting on meniscus repair outcomes using “outside-in” or “all-inside” techniques with a minimal duration of 6 months for follow-up. Failure was characterized as the recurrence of clinical symptoms or the need for a meniscal reintervention. Over 50 English-language articles were analyzed between 2000 and 2022. After conducting a review and data analysis, it is observed that the “all-inside” technique is more frequently chosen as a treatment method, possibly due to its simpler execution. Both total and percentage rates of failures are higher using this technique, amounting to 79 cases and reaching 16%, compared to “outside-in” approach, which is less commonly chosen, but has lower frequency of failures totaling 6 cases and 5%.
Pacinian neurofibroma of index finger in young adult: a rare case report
Get PDFPacinian neurofibroma (PN) of index finger (hand) is a rare entity with only few cases reported till now. Although it’s a neurofibroma but the association between PN and neurofibromatosis has not been established. We present a rare case of young adult coming with painful swelling on palmer aspect of base of index finger. Patient didn’t respond to the conservative line of management so on excision biopsy it revealed out to be PN.
Comparison of open reduction and internal fixation by lateral extensile approach versus minimal invasive percutaneous fixation (Essex Lopresti) for the management of Sanders type 2 and 3 calcaneum fractures: a prospective, two-arm, parallel group study
Get PDFBackground: Calcaneum is one of the most common tarsal bone to get fractured accounting for around 50-60% of all tarsal fractures. Due to lack of Indian studies comparing the outcomes of fracture calcaneus managed by operative methods of open reduction internal fixation (ORIF) versus the percutaneous minimal invasive approach (Essex Lopresti); we decided to conduct one such study.
Methods: Adult patients with intra-articular Sander type 2 and 3 calcaneum fractures, managed by ORIF or Essex Lopresti were enrolled. The clinical outcomes (VAS score for pain, range of motion), radiological outcomes (Bohler’s and Crucial angle of Gissane) and functional outcomes (American orthopedic foot and ankle society (AOFAS) and Maryland foot score) were assessed at 6th month and 1-year post intervention and compared.
Results: 117 patients managed with percutaneous fixation (n=63) or ORIF (n=54) were enrolled. Mean age of patients was 42.63±7.93 years. Mean VAS score was statistically comparable in both operative groups at 6th month and 1 year (p>0.05). Mean dorsiflexion and eversion angles were significantly higher in plating group at 6th month (p<0.05) while other movements were comparable in both the groups. Mean Bohler’s angle, Gissane’s angle, AOFAS and Maryland scores were found to be comparable in both groups (p>0.05) on follow-up. Both groups showed similar complications trend.
Conclusions: Percutaneous fixation and plating methods were found to be comparable for calcaneus fracture management based on clinical, functional and radiological outcomes with similar complication rates
Physical examination, magnetic resonance imaging and the arthroscopy of the shoulder: a correlation of diagnostic tests
Get PDFBackground: Shoulder pathology is the third cause of consultation for musculoskeletal disorders; it is a cause of disability and economic losses. The gold standard for its diagnosis and treatment is arthroscopy. However, arthroscopy is an invasive diagnostic technique. Therefore, clinical and imaging methods may be useful as diagnostic techniques before considering arthroscopy. Nevertheless, these non-surgical diagnostic methods may present a poor correlation in diagnostic accuracy when compared to the arthroscopic diagnostic method in the context of shoulder pathology.
Methods: A retrospective study including 123 patients who presented shoulder complains, underwent physical examination and a shoulder magnetic resonance imaging (MRI) study prior to a shoulder arthroscopy. A clinical correlation was made using the kappa index, sensitivity and specificity of the clinical and imaging tests were also calculated.
Results: The correlation between arthroscopy and the clinical assessment showed a kappa index of 0.25 for rotator cuff injuries, 0.41 biceps pathology, 0.51 sub acromial impingement, 0.51 acromioclavicular arthrosis, 0.28 for SLAP injury. MRI diagnostic method showed a kappa correlation of 0.24 for rotator cuff injuries, 0.59 biceps pathology, 0.39 sub acromial impingement, 0.46 acromioclavicular arthrosis and 0.34 for superior labral anterior posterior (SLAP) injury.
Conclusions: After comparing arthroscopy with clinical assessment and the MRI diagnostic method we found that clinical assessment is useful to diagnose biceps pathologies, subacromial impingement, and acromioclavicular arthrosis. On the other hand, MRI studies and diagnosis made by a radiologist showed to be a valuable tool for the diagnosis of biceps pathology and acromioclavicular arthrosis
Comparative study of compound both bone leg fractures managed with versatile antibiotic intramedullary inter locking nailing with external fixator
Get PDFBackground: Background Compound fractures of the tibia are more likely to result in non-union and the development of infection because of inadequate blood supply and the absence of soft tissues in the antero-medial side of the tibia. Whether to undertake a primary fixation or a staged fixation is still a difficult decision to make in situations like these. Hence, we performed this study to compare the clinical, functional and radiological outcome of compound both bone leg fractures managed with Versatile Antibiotic Intramedullary Interlocking Nailing system and external fixator.
Methods: This is a Prospective comparative study performed on all patients admitted with compound fractures (Grade 1,2,3A,3B) of both bone leg fractures in the Department of Orthopaedics at a tertiary care center. Thorough wound debridement was done layer by layer after adequate extension of the wound. Fracture ends were debrided, thorough wound wash given with Reamer Irrigation Aspiration system (RIA).
Results: In our study, there is a significant association between the time delay of surgery and post operative infection (p value 0.008). In our study, average time from admission to surgery was 20.9 hours in group A vs group B (21.81 hours).
Conclusions: The final outcome in our study mainly depended on wound debridement and thorough pulsatile lavage and early intervention (VAIL Nailing), earlier the surgery better the outcome
Long term outcomes of neonate septic arthritis of the shoulder
Get PDFUpper limb palsy in the newborn may be caused by a large number of pathologies, such as fracture, brachial plexus palsy or infection. The diagnosis of neonatal osteoarticular infection is extremely challenging, especially in the shoulder joint. The lack of obvious clinical signs can frequently result in a delay in the diagnosis, which can lead to important sequelae. A retrospective study of nine patients with a history of neonatal septic arthritis of the shoulder was performed. All patients were treated at the same institution
Impact of innovations in surgical techniques and advanced imaging on postoperative recovery and reduction of complications in patients with long bone fractures: a systematic review
Get PDFLong bones fracture is one of the most complicated surgeries in orthopedics and the progress in the techniques as well as technologies used has recorded a steady progression in the last few years. Minimally invasive surgery (MIS), computer-assisted surgery and improved imaging techniques can all be cited as impacting on emerging practices. Conversely, the success of such techniques and their influences on the performance results should continue to be assessed in order to adjust the treatment approaches and patients’ conditions. This paper aimed at reviewing and researching current journals and literature on the topic of managing long bone fractures with specific emphasis on the new developments in surgery, imaging, and after care. Included articles were randomized control trials, cohort studies, meta-analysis, from reputable orthopedic journals and evaluated both effectiveness, and adverse outcomes of these advancements. In light of the study, it emerges that less invasive procedures in thoracic surgery lead to fewer postoperative complications and quicker convalescence time among the patients; and magnetic resonance imaging (MRI) and intraoperative fluoroscopy improves diagnostic accuracy and also surgical localization. Computer assisted surgery and augmented reality have been recognized as useful adjuncts in both the preoperative planning and intra operative navigation through the surgical field but they are still not widely used due to the costs associated with the purchase of equipment and initial technical difficulties. In particular, the use of these technologies successfully advanced the clinical efficiency in the treatment of long bone fractures
From incision to outcomes: a comparative dive into the functional outcomes of arthroscopic all-inside and outside in meniscal repair techniques
Get PDFBackground: Meniscal repair has been associated with superior outcomes, including enhanced knee function, increased activity levels, reduced osteoarthritis progression, cost savings, and improved long-term functional outcome scores compared to partial meniscectomy. This study aimed to evaluate and compare the functional outcomes of meniscal repairs performed using the outside-in and all-inside techniques, utilizing the International Knee Documentation Committee (IKDC), Tegner Lysholm (TL) scores and comparing our results with previous studies.
Methods: This prospective study included 53 patients with traumatic meniscal tears and associated ligamentous injuries that underwent arthroscopic meniscal repair. Details of investigations were recorded, and knee functional assessment was performed using the 2000 IKDC score and TL scores.
Results: The mean age of the patients was 28±8.41 years, with 41 (77.36%) males and 12 (22.64%) females. At the final follow-up of 1 year, the IKDC scores in the all-inside group and outside in group were 93.26±4.45 and 94.31±2.63. The TL scores in the all-inside and outside in groups were 95.33±2.45 and 96±1.00. No statistically significant difference was noted between the two groups (p value >0.005).
Conclusions: Meniscal repairs in the two groups in our series demonstrated favourable clinical outcomes, as evidenced by significant improvements in IKDC score with averages increasing from 25.31 to 93.26 and from 25.91 to 94.31 in all-inside and outside-in groups respectively. The TL sores showed an improvement from 21.07 to 95.33 and from22.43 to 96.00 in all-inside and outside-in groups respectively. In conclusion, short-term results of traumatic meniscal tears with repair are promising, leading to significant improvements in knee function irrespective of concomitant injuries and the type of repair
A rare case of a floating knee concomitant with an ipsilateral floating hip and a bimalleolar fracture
Get PDFAn ipsilateral floating knee and hip is an extremely rare condition that is associated with a life threatening condition. So its correct management, is essential to mantain a stable hemodynamic condition. We reported our management for this fracture in order to underline the rareness, the severity of this entity and highlight the importance of damage control to respond to this. A 71-year-old female referred to our hospital after motor vehicle accident. At arrival, the patient was hemodynamically unstable and went directly to the emergency room, which was reverted. In physical examination there was a swollen thigh, without neurovascular deficits. X-rays reveal a LC type 1 fracture with sacrum, superior and inferior pubic ramus compression fracture, a wedge extra-articular distal femur fracture, a transverse tibial shaft fracture and a bimalleolar fracture. Then in the operation room the patient become unstable hemodynamically, and it was decided to do a reduction and fixation with an external fixator in the femur shaft and in the tibiotarsi joint, which enable the patient recovery. After 7 days, the patient still stable hemodynamically and a retrograde femoral nailing and an anterograde tibial nailing was made. Due to lack of skin conditions, the bimalleolar fixation was postponed to thirteen days after when its osteosynthesis was performed. The LC type 1 fracture underwent osteosynthesis with two percutaneous partially-threaded screws. Then the patient underwent to a rehabilitation protocol. Follow-up appointments showed good radiologic and clinically evolution. At 6 months revealed a complete return to normal daily life, without limitation or pain. In our work, we highlight the rareness and the severity of this injuries and the need of the damage control approach due to the hemodynamic unstableness of this kind of patients
Inferior humeral head subluxation after acute humeral shaft fractures
Get PDFBackground: Inferior humeral head subluxation (IHHS) is an abnormal inferior translation of the humeral head with respect to the glenoid. While well described for proximal humerus fractures there is little literature regarding IHHS in humeral shaft fractures and the impact of IHHS on fracture healing during non-operative treatment. This study characterized the prevalence and impact of IHHS among patients with acute humeral shaft fractures at a large urban trauma center.
Methods: This retrospective analysis included 62 patients treated conservatively for acute humeral shaft fractures at a single level I trauma center from 2018-2021. Occurrence of IHHS in millimeters was measured radiographically as the distance between the inferior glenoid edge and humeral anatomic neck, a distance greater than 10 mm was considered positive. Demographic data, injury mechanism, AO/OTA fracture classification, risk factors (history of stroke, smoking, diabetes mellitus, radial nerve palsy on presentation, any neurovascular disorder), and failure of conservative management (surgical fixation after a 90-day trial) was recorded. Statistical analyses were performed to evaluate association between risk factors, treatment outcome, and IHHS resolution.
Results: At an average follow-up of 18 weeks, IHHS was noted at any time point in 32.3% patients. All cases of IHHS resolved without formal treatment. No factors were significantly associated with the occurrence of IHHS. 17.7% patients failed conservative treatment, only three had IHHS.
Conclusions: Although IHHS occurred in one third of the study population, it was not significantly correlated with failed conservative management or the need for surgical intervention. This study expands the scope of this phenomenon to include humeral shaft fractures