International Journal of Research in Orthopaedics
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Management of cubitus varus deformity by three-dimensional osteotomy: analysis of outcome
Get PDFBackground: Cubitus varus deformity, commonly resulting from malunited supracondylar fractures of the humerus, is prevalent in pediatric and adolescent populations. Traditional treatment methods often fall short in addressing the complex three-dimensional nature of this deformity. This study aims to evaluate the efficacy and outcomes of three-dimensional osteotomy in correcting cubitus varus deformity.
Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery, BSMMU, Shahbag, Dhaka, from March 2016 to September 2018. A total of 40 patients aged 8 to 20 years with cubitus varus deformity were enrolled. Participants underwent three-dimensional osteotomy, and outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and functional recovery parameters.
Results: The majority of patients (75%) achieved bone union within 8-10 weeks post-osteotomy. The MEPS results were promising, with 40% of patients scoring 'Excellent' and 45% scoring 'Good'. Functional outcomes were predominantly positive, with 95% of patients reporting satisfactory results. The complication rate was low, with 80% of patients experiencing no postoperative complications.
Conclusions: Three-dimensional osteotomy is an effective and reliable surgical intervention for treating cubitus varus deformity, offering high rates of patient satisfaction, minimal complications, and improved functional outcomes. This technique presents a promising option for orthopedic surgeons in managing this complex deformity
War-related orthopedic injuries: a comprehensive analysis from Benghazi medical center 2013-2016
Get PDFBackground: The majority of war-related injuries involve the extremities and typically necessitate surgical intervention. These injuries are notably severe due to the impact of high-velocity rockets, including gunshot wounds and blast injuries. However, epidemiology of the war-related injuries of the last decade Libyan conflict remains under investigated. The study aimed to illustrate the characteristics of the cases volume, mechanism of injury, and the emergency department management protocol.
Methods: A retrospective observational study included all patients admitted to the orthopedic department with war-related injuries between December 2013 and December 2016. Relevant data collected included patient demographics, injury patterns, and treatment modalities. The data was organized and analyzed using SPSS statistical software.
Results: The 563 patients with war-related orthopedic injuries were treated during the study period. The highest percentage of patients were seen in 2015 (45%) and 2014 (44.2%), with a peak in July/summer months. Most patients were male (86.3%) with a mean age of 30.5 years. The most common causes of injury were gunshot wounds (36.1%) and explosions (28.2%), primarily affecting the upper (35%) and lower (29.3%) extremities. The 75.7% of injuries resulted in fractures, with 16.2% having associated injuries like bowel, nerve, and amputation. The most common emergency interventions were damage control surgery, debridement, and fixation.
Conclusions: This data provides valuable insights into the complex nature of war-related orthopedic injuries and the challenges healthcare teams face in conflict-affected regions. The findings underscore the critical need to strengthen the resilience and capacity of medical systems to effectively address the specific needs of war trauma
Bilateral symptomatic ring-shaped meniscus: a case report
Get PDFDiscoid meniscus is the most common meniscal anatomical variant, affecting almost exclusively the lateral meniscus. Ring-shaped meniscus is an extremely rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns, forming a complete ring. Ring-shaped meniscus is generally asymptomatic and found incidentally. We present the case of a 16-year-old male who presented with bilateral mechanic knee pain associated with positive meniscal tests. Arthroscopic surgery was performed and ring-shaped lateral meniscus with complex tears were identified in both knees. Partial lateral meniscectomies were performed on both knees and hay-bale mattress sutures were used to preserve the remnant lateral meniscus of the left knee. After surgery, the patient obtained good outcomes with regards to pain and mechanical symptom relief. To our knowledge this is the first reported case of bilateral symptomatic ring-shaped meniscus. The reported case demonstrates that complex ring-shaped lateral meniscus tears can be successfully addressed with arthroscopic surgery
Functional and radiological outcome of intramedullary nailing in proximal tibial fractures through supra patellar approach
Get PDFBackground: Proximal third tibial fractures pose complex challenges in orthopaedic trauma care. The choice of surgical approach plays a pivotal role in achieving successful outcomes. This study was conducted to address the significant gap in research regarding the functional and radiological outcomes of the supra patellar approach in intramedullary nailing for proximal tibial fractures.
Methods: This prospective cohort study was conducted on a total of 100 patients presenting with proximal tibial fractures. All patients underwent intramedullary nailing using the supra patellar approach. Functional Outcome was assessed using the lower extremity functional scale (LEFS) at 3 weeks, 3 months, and 6 months and 1-year post-surgery. Union status, alignment, and hardware-related complications were assessed through X-rays at each follow-up point to study the radiological outcome.
Results: At the end of 1-year follow-up, 88% of patients had an excellent LEFS score,10% had a good LEFS score, and 2% had a fair LEFS score. All patients had a radiological union at 1 year follow up with an average radiological union time being 5.6 (±1.8) months.
Conclusions: We advocate for the utilization of suprapatellar nailing as the preferred approach for managing proximal third tibial fractures. This method consistently yields excellent clinical and radiological outcomes while maintaining a minimal complication rate in comparison to other management modalities
Effect of magnesium supplementation on diaphyseal tibia fractures: a pilot study
Get PDFBackground: This study aimed to assess and compare the efficacy of magnesium supplementation in patients with long diaphyseal tibia fractures who have undergone surgical management with intramedullary interlocking nailing.
Methods: In a prospective, randomized trial, thirty patients were included, with half receiving magnesium (420 mg/day) along with calcium (500 mg/day) supplementation for 3 months alongside surgical treatment. Radiological outcomes were evaluated through postoperative X-rays using the radiographic union scale for tibia fractures (RUST) scoring system at 6 and 12 weeks.
Results: A significant difference was observed between the two groups. Patients receiving magnesium supplementation exhibited a notable improvement in RUST score, indicating an accelerated bone healing process.
Conclusions: This study demonstrates the efficacy of magnesium supplementation in achieving superior radiologic outcomes compared to patients who did not receive such supplementation. The findings suggest that adjuvant magnesium supplementation could be a viable therapeutic option to enhance bone healing outcomes in individuals with tibia diaphyseal fractures
Metachronous osteoid osteoma in adjacent proximal phalanges: a case report and literature review
Get PDFOsteoid osteoma (OO) is a benign bone tumor commonly affecting long bones, and in rare cases, involves small bones such as hand phalanges. The presenting symptom is usually nocturnal inflammatory pain. OO is in the majority of cases a solitary lesion, with very rare reported cases of metachronous lesions in different locations. We present a case of a 31-year-old female patient who presented for severe pain and swelling over her fourth finger proximal interphalangeal joint (PIPJ) of the right hand. After thorough radiological investigations, a presumptive diagnosis of OO was made and the patient underwent surgical excision and curettage with resolution of her symptoms post-operatively. Six years after remission, the patient presented again to our clinics with the same clinical picture in the third finger PIPJ of the right hand. Clinical and radiological investigations revealed a metachronous OO in the adjacent phalanx of the previous surgical site. Similar management consisting of excision and curettage was performed, resulting in a symptom-free follow up. To our knowledge, this is the first case of metachronous OO in adjacent proximal phalanges of the hand. This case highlights the importance of considering metachronous OO in the differential diagnosis of patients previously diagnosed and treated for OO and presenting with a similar clinical and radiological picture
The cost-effectiveness of an additional surgical scrub in reducing prosthetic joint infections in total hip and knee arthroplasty
Get PDFBackground: Surgical skin preparation prior to total knee and hip arthroplasty is an important step in infection prevention. Compared to a single application, repeat skin preparation after draping demonstrates greater efficacy in reducing the overall occurrence of surgical site infections in total joint arthroplasty. We sought to find if the addition of an extra surgical scrub after draping is a cost-effective means of decreasing prosthetic joint infection (PJI), and if so, under what conditions it would be most cost-effective.
Methods: We employed a model to assess the cost-effectiveness of repeat skin preparation in total knee and hip arthroplasty. This model determines a threshold at which the expenses associated with a new intervention is offset by its ability to reduce overall costs. Literature review and records from our institution were used to draw average expenses for treatment of PJI, as well as surgical prep scrubs, to evaluate at their cost-effectiveness. We also compared against hypothetical higher and lower costs and infection rates to gain further information on the additional surgical prep’s cost-effectiveness.
Results: Each of the surgical scrubs is cost-effective at our institution's cost when an absolute risk reduction (ARR) of 0.01% is achieved. The cost-effectiveness was also noted with hypothetically higher infection rates and scrub cost prices. Lower potential two-stage revision costs make the additional surgical scrub less cost-effective.
Conclusions: Our findings demonstrate that an extra surgical scrub can be cost-effective way of decreasing PJI across a variety of different surgical scrub prices, arthroplasty revision costs, and PJI rates
Use of Hartshill rectangle with sublaminar wiring for posterior stabilization of D7-D9 tubercular spondylodiscitis with paraplegia: a cost effective treatment
Get PDFTuberculosis presents a significant health challenge, with extrapulmonary cases comprising 15-20%. Spinal tuberculosis often leads to neurological deficits, requiring surgical intervention such as Hartshill system fixation. Various posterior instrumentation methods are employed, with sublaminar wiring pioneered by Luque and enhanced by Dove's Hartshill system for superior biomechanical performance. This case underscores Hartshill system's efficacy in stabilizing the spine post-tubercular destruction, offering a cost-effective alternative to pedicle screws. An 18-year-old presented with 6-month upper back pain, progressing weakness in lower limbs, weight loss, and fever. Radiographs revealed D7-D9 vertebral destruction, leading to kyphosis. MRI showed paradiscal bony destruction and abscess, suggestive of tubercular spondylodiscitis. Surgery with Hartshill rectangle and sublaminar wiring provided kyphosis correction. Post-operative Gene-Xpert confirmed tuberculosis. Mobilization and chemotherapy led to limb power restoration within 3 months, with ongoing rehabilitation and consolidation of affected segments with complete recovery by eight months. Instrumented stabilization in spinal TB prevents kyphosis and graft complications; Hartshill loop rectangle and sublaminar wire fixation, cost-effective and suitable for resource-poor settings, offer comparable outcomes to pedicle screws, enabling hybrid fixation, especially in low-income countries
Functional evaluation of unstable intertrochanteric fractures treated with proximal femoral nailing
Get PDFIn this study the functional outcome of proximal femoral nailing (PFN) in patients with unstable intertrochanteric fractures is studied and outcome is assessed with Modified Harris Hip Score. A post-operative analysis of unstable intertrochanteric fractures treated with PFN is done for its functional assessment. Various national & international studies are taken into consideration and our institutional study is compared with them. Between September 2020 to March 2022, 20 patients with unstable intertrochanteric fractures of the hip joint who were operated with PFN were functionally and clinically evaluated as per the Modified Harris Hip Score. Patients who satisfied the inclusion criteria were included in the study and follow-up was done up to 9 months. Fracture pattern, operative details and post-operative complications were documented. This study of 20 patients of unstable intertrochanteric fractures fixed with PFN showed excellent results in 9 patients (45 %), good functional outcome in 6 patients (30 %) and fair functional outcome in 3 patients (15 %). 2 patients showed a poor outcome accounting for 10%. The study showed that PFN is a reliable and effective device for the treatment of unstable intertrochanteric fractures. It provides a satisfactory fixation, but success is dependent mainly on fracture type, bony architecture, operative technique, postoperative care and rehabilitation. In view of the fewer post-operative complications, early union of fracture, early weight bearing and early return to work, we concluded the PFN to be a versatile, stable and acceptable implant in fixation of unstable intertrochanteric fractures which leads to a better functional outcome
Management and evaluation of osteoarthritis knee, stage III and IV by total knee arthroplasty in an institution at rural set-up: a cases series
Get PDFThe management of advanced knee osteoarthritis remains a subject of discussion. The use of total knee prosthesis is a solution to improve the quality of life’s patients. The end of this work was to describe the epidemiology and estimate the results of a series of 60 cases advanced knee osteoarthritis, treated with total knee prostheses in the department. This was a retrospective study conducted from August 2023 to June 2024 at Dr. PMR Institute of medical Sciences and Teaching Hospital, Chevella, Telangana. The study concerned the analysis of the patients operated on for advanced stage III and IV knee osteoarthritis by total knee prostheses. We collected 15 patients which includes 9-female and 6 male. The average age of the patients was 55 years. All patients were operated on under indigenous anesthesia in the supine position with a pneumatic tourniquet. The surgical site was approached antero-medially. The functional results evaluated according to the International Knee Society (IKS) score were favorable in 96.7%. In conclusion, knee osteoarthritis is a condition of elderly females. Its treatment, using total knee arthroplasty, evaluated according to the IKS score, gave satisfactory results