International Journal of Research in Orthopaedics
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Evaluating the functional outcomes of tibia and ipsilateral femur fracture, which are floating knee injuries, in adults
Get PDFBackground: High velocity trauma leads to ipsilateral femur and tibia fractures. Despite being very uncommon, they have a significant morbidity rate. Combinations of diaphyseal, metaphyseal, and complicated intra-articular fractures may be present in this kind of injury. Objectives were to assess the functional success of adult patients with ipsilateral femur and tibia fractures treated with various methods.
Methods: The 30 adult patients with floating knee injuries underwent surgical treatment as part of the prospective research at the department of orthopedics, govt. medical college, and affiliated group of institutions in Kota. A combination of implants, such as an intra-medullary nail, locking plates, screws, or external fixators, were used to treat both femur and tibia fractures.
Results: Karlstrom-Olerud criteria were used for the final evaluation. In our study, five patients (16.6%) had excellent outcomes, ten (33.3%) had good results, seven (23.3%), had acceptable results, and eight (26.6%) had poor results.
Conclusions: When the fracture is diaphysis and it is treated with intra-medullary nails for both the femur and the tibia, the results are excellent. In this way, the age of the patient, the kind of fracture, the methods of fracture fixation, and the functional result were all taken into account
Short-term functional outcomes in patients undergoing primary total knee arthroplasty according to their body mass index
Get PDFBackground: The impact of an increased body mass index (BMI) in patients with ostheoarthritis who undergo total knee arthroplasty (TKA) remains a controversial variable in terms of risks and benefits. This study aimed to evaluate the influence of BMI in the functional outcomes of patients with ostheoarthritis who underwent TKA.
Methods: We followed a cohort of patients who underwent total knee arthroplasty with a primary diagnosis of osteoarthritis. Patients were stratified into 3 groups according to the World Health Organization classification of BMI. We assessed the association between BMI group and functional scores using the Western Ontario and McMaster osteoarthritis index (WOMAC) over the time intervals of pre– and postoperatively at 1 month, 3 months and 1 year.
Results: The difference in means between pre-surgical WOMAC and WOMAC at first follow-up according to each BMI group was divided as follows: normal 10.9 (p=0.195), overweight 15.7 (p≤0.001) and obese 20.6 (p≤0.001). Study participants with a higher BMI had worse preoperative WOMAC scores and had greater improvement from baseline to 1 month. After one year of follow-up, participants in all BMI groups had similar WOMAC scores.
Conclusions: Patients with obesity who underwent TKA showed greater functional improvement one month after surgery compared to the other BMI groups. Subsequently, it was observed at the end of the 12-month follow-up that all patients, regardless of BMI, had improved functional outcomes, and the magnitude of improvement was similar in all BMI groups.
Validation of a patient-reported knee-specific outcome questionnaire specifically intended to assess pain, stiffness, and functional activities in Indians with osteoarthritis knees: an observational cross-sectional study
Get PDFBackground: Patient-reported outcome measurement assessments that are frequently used for knee joint disorders have ceiling effect. This restriction is allegedly not there in New Hindi score. Purpose of this study is to validate New Hindi Score in patients with osteoarthritis knee.
Methods: Level II Prospective cohort study was conducted. In pilot study, 20 patients had their comprehension of New Hindi Score assessed. A prospective cohort study involving 200 individuals with osteoarthritis knee Kl grade 2 and 3 was conducted in AIIMS, Rishikesh, Uttarakhand. Patients' overall age 57.76±8.63 years, both mean and SD. There were 125 females & 75 males. Men's mean & SD were 59.52±9.39 while women's 56.70±8.00. All patients were requested to complete WOMAC, KOOS, OKS & New Hindi Score questionnaires. Validity, reliability, repeatability of New Hindi Score for knee function in KOA patients were evaluated. There's no floor ceiling effect. New Hindi Score's validity, responsiveness, and floor ceiling effect were assessed. Validity was measured using the Pearson correlation coefficient.
Results: In pilot study participants answered all question accurately. New Hindi Score shows moderate correlation with WOMAC & weak correlation with OKS and KOOS (Pearson coefficients of 0.45, 0.21, and 0.28, respectively) with 95% confidence interval, indicating strong construct validity in primary study. There was no floor or ceiling effect seen.
Conclusions: For KOA patients, New Hindi Score exhibits strong levels of validity, reliability, and reliability. As result, it can be effectively applied to research knee function in Indian population.
Pelvic insufficiency fracture in an osteoporotic 47-year-old female: a case report
Get PDFInsufficiency fractures (IFs) represent a form of stress fractures frequently linked to osteoporosis and a lack of vitamin D. These fractures, which are not caused by trauma, typically manifest in the pelvis and spine, although occurrences in atypical locations are also relatively frequent. The primary methods for diagnosing IF involve using plain radiographs and magnetic resonance imaging scans, which are commonly employed imaging techniques. The management involves both medical and surgical methods, tailored as per the needs of the patient. 47-year-old female patient presented to the outpatient department with complaints of low back ache with waddling gait, with pain not responding to analgesics. Laboratory and radiological assessment revealed osteoporotic Insufficiency fracture in the pelvis which was managed with both surgical and medical methods, with surgical management involving percutaneous screw fixation of the fractures. Diagnosis of the osteoporotic insufficiency fractures at atypical locations can be extremely challenging because of the inconclusive radiographs and the lack of a perceptible trauma history and hence, can be missed at the initial presentation. The management includes both operative and non-operative modalities, best tailored as per the patient needs and expectations.
Management of infected gap non-union of the tibia with bone transport over plate
Get PDFCompound tibia fracture with bone loss is common presentation in Orthopaedics, treatment for which is well described in the literature. Ilizarov technique is commonly used to fill the bone defect with its different modifications which include additional stabilization with IMIL or Plate. We report a case of infected gap nonunion of proximal tibia shaft which was managed with Ilizarov technique along with a stabilizing plate. The purpose of this report is to provide an alternative mode of management for infected of tibia shaft fracture with bone defect
Role of ultrasound guided suprascapular nerve block aided mobilization physiotherapy in frozen shoulder recovery: a prospective study
Get PDFBackground: Frozen shoulder is debilitating condition marked by progressive shoulder pain and restricted mobility, affecting sleep and activities of daily living of a person. The objective of this study was to evaluate the efficacy of USG guided suprascapular nerve block aided mobilization physiotherapy for management of frozen shoulder so as to improve the quality of living of patients.
Methods: This prospective interventional study was conducted at the Department of Orthopaedics of a teaching institute of Central India from January 2021 to April 2023 after obtaining ethical clearance. Patients diagnosed with frozen shoulder and giving written consent were included in this study after considering the inclusion and exclusion criteria. Baseline demographics, symptom duration, degree of active and passive shoulder range of movement, Shoulder pain and disability index (SPADI) score were documented on day of presentation (preintervention) after which USG guided suprascapular nerve block was given. Post SSNB, 10 sessions of supervised mobilization physiotherapy was given. SPADI scores and degree of active and passive range of movement were noted at 3rd, 6th and 12th week and compared using statistical tests namely repeated measure ANOVA and chi square test of independence.
Results: A total of 54 patients enrolled in the study after meeting inclusion criteria, only 46 completed the follow up and their mean SPADI pain score and mean SPADI disability score at presentation significantly reduced at 12 weeks post intervention. Range of flexion, abduction and external rotation of shoulder also showed significant increase (p value<0.05). Number of participants with severe restriction of shoulder internal rotation also decreased after SSNB aided physiotherapy.
Conclusions: USG guided suprascapular nerve block aided physiotherapy exercise schedule is a safe and effective outpatient treatment for frozen shoulder providing early pain relief and improving shoulder mobility
Role of magnetic resonance imaging in differentiating tuberculous spondylitis from pyogenic spondylitis in a TB endemic area
Get PDFBackground: Infectious spondylitis is an infection by a specific organism of one or more components of spine, namely the vertebra, intervertebral discs, paraspinal soft tissues, and epidural space. Magnetic resonance imaging (MRI) of the spine is gold standard in imaging to assess anatomical abnormalities of the spine and surrounding structures.
Methods: This cross-sectional observational study was conducted in the Department of Radiology Narayan Medical College and Hospital Sasaram, Bihar (India), where tuberculosis is endemic from July 2022 to September 2023. It included 40 patients, purposively sampled, adhering to strict inclusion and exclusion criteria. Sensitivity, specificity and accuracy of MRI in discriminating tuberculous spondylitis from pyogenic spondylitis were compared against histopathological diagnosis and differences in MRI findings between these conditions were obtained.
Results: In this study, 93% patients with tuberculous spondylitis had an enhanced signal with well-defined margins. Meanwhile, pyogenic spondylitis provided an ill-defined margins in 72.7% patients. Most of the patients 82.7% with tuberculous spondylitis showed thin and smooth wall paravertebral abscesses, while pyogenic spondylitis showed an irregular and thick wall paravertebral abscesses in 45% patients. A total of 72.4% patients with tuberculous spondylitis indicated involvement of ≥3 vertebral bodies. 100% patients with pyogenic spondylitis showed an abnormal contrast enhancement of the intervertebral discs. It was identified that tuberculous spondylitis had sensitivity, specificity, and accuracy values of 100%, 84.6%, and 95.2% respectively. For pyogenic spondylitis, the corresponding values were 84.6%, 96.6%, and 93%.
Conclusions: MRI was accurate for differentiation of tuberculous spondylitis from pyogenic spondylitis. A well-defined paraspinal abnormal signal, a thin and smooth abscess wall, subligamentous spread to three or more vertebral levels, and less likely involvement of intervertebral discs were more suggestive of tuberculous spondylitis than pyogenic spondylitis
Functional outcome of mini external fixator in hand injuries: an observational study in a tertiary care hospital
Get PDFBackground: Metacarpal and phalangeal fractures are one of the common fractures of the upper extremity that account for about 10% of total body fractures. The distal parts of the hand are the most common parts to be injured. Outcome is also influenced by other factors such as patient’s age, occupation, socio economic status, systemic illness, surgeon’s skill and the patient’s compliance.
Methods: We are doing an observational study with 40 patients included according to the inclusion and exclusion criteria for a period of six months with age group between 20 and 60 years. We use mini external fixators with JESS clamps, 1.8 mm threaded pins and k wires. Patients were followed up periodically with required radiograph for the union of the fracture.
Results: Out 40 patients, most of the patients were between the age of 21 to 40 years with male preponderance, open fractures were more when compared with closed fractures. Functional outcome was excellent and good on the higher side which was analysed with Strickland score. Radiological union were also in greater side with 17.5% of them with delayed union.
Conclusions: Simple surgical technique will minimize complications and an aggressive rehabilitation will ensure best result. In general, mini external fixator is a good treatment for management of fractures with best functional outcome.
Functional outcome of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital
Get PDFIsolated medial condyle fractures of the femur with an intact lateral condyle are a rare entity. These fractures require prompt diagnosis and anatomical restoration of joint surface to prevent post traumatic arthritis. Till date no suitable implant is available for fixation of these fractures. In this study we have used 4.5 recon plates and CC screws to fix these fractures. We aim to study the functional outcome of these fractures in a group of patients fixed with the above implants. The study was conducted in a group of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital. An ORIF was done and fractures were fixed with recon plates and lag screws and various parameters were evaluated such as range of motion of knee, average time to weight bearing, Lysholm knee scores, pain perception etc 20 patients were evaluated in the age group of 20-70 in a 5 year period. Majority of the patients had a very good functional range of motion of the knee and nearly 75% achieved union by 12-16 weeks. 70% of the patients had a low VAS score. Overall early diagnosis and prompt anatomical restoration of joint surface in isolated medial condyle fractures of femur led to favourable range of motion of knee, early radiological healing and low VAS score
Tibial pilon fractures: management and evaluation of the outcome in mean and long term about 51 cases
Get PDFBackground: the management of tibial pilon fractures is a real challenge in our regions.
Methods: This was a mixed study: dynamic from January 1 to December 31, 2013 involving 19 patients; retrospective from January 1, 2014 to December 31, 2018, covering 32 patients, received, treated and followed up for tibial pilon fracture in the Orthopedics-Traumatology department of the Donka university hospital center, Conakry Republic of Guinea. The clinical diagnosis was guided by the pain, functional impotence, a context of high trauma energy and confirmed by the X-ray of the ankle in antero-posterior and lateral views. The AO (association for Osteosynthesis) classification was used in our department.
Results: The average age was 36.21 years old with male predominance, the sex ratio was 5.4. The road accidents were the mostly found (86.27%). The motorbicycles were the mostly involved; the osseous lesions the mostly found were the type C according to AO classification (56.86%), followed by type B (33.33%). The orthopaedical treatment (27.45%), and surgical (72.55%). The ankle arthrosis was the most complication found (27.45%).
Conclusions: Tibial pilon fractures are rare but serious however the treatment depends on the anatomopathological type. The prognosis of these lesions remains always reverved in our context of lack of equipment in our hospitals