International Journal of Research in Orthopaedics
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Use of palmaris longus graft in chronic distal radio-ulnar joint instability in complex tear of triangular fibro-cartilage complex
Get PDFChronic distal radio-ulnar instability often results from complex tear of triangular fibro-cartilage complex (TFCC), which serve as a critical stabilizer for wrist. This injury frequently arises due to repetitive trauma or acute injury, leading to significant pain, functional impairment, and diereses grip strength. Chronic dislocation of the distal radio ulnar joint has traditionally been managed through intricate osteotomies and reconstructive procedures, often resulting in stubborn stiffness and diminished functionality. It is advantageous to employ a fixation method that not only restores wrist biomechanics but is also aesthetically pleasing for the affected individual. Here, we introduce a new technique for use of palmaris longus graft with fixation button stabilizing chronic distal radio-ulnar joint instability. The advantage of this surgery is decries the duration of the surgery, and start early range of movements of wrist with significant improvement in pain using the vas score. None of the patients had complications. The use of palmaris longus graft is believed to an innovative, safe, reliable and efficient method for of distal radio-ulnar joint (DRUJ) instability
Expert perspectives on polmacoxib monotherapy in the management of osteoarthritis in Indian settings
Get PDFBackground: Although there were several clinical studies available, there was a dearth of studies among clinicians in actual practice. So, the present survey-based study aimed to gather expert perspectives on the clinical use of polmacoxib monotherapy for the management of osteoarthritis (OA) in routine Indian settings.
Methods: This cross-sectional study employed a 19-item questionnaire to gather expert opinions on managing OA and covered topics such as prescription practices, clinical observations, preferences and experiences with polmacoxib for routine OA management. Descriptive statistics were used to analyze the gathered data.
Results: The study involved 239 participants, with 45% of respondents noting that 31-40% of OA patients are women. According to 65% of the participants, etoricoxib emerged as the most preferred nonsteroidal anti-inflammatory drug (NSAID) in clinical practice. Moreover, 87% of experts recognized the dual cyclooxygenase-2 (COX-2) and carbonic anhydrase (CA) binding properties of polmacoxib as potentially offering superior safety profiles in cardiovascular (CV), renal aspects and Gastrointestinal (GI) tolerability. Around 35% of respondents observed improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain reduction, stiffness alleviation and enhanced physical function with polmacoxib.
Conclusions: The study highlighted a significant preference among Indian clinicians for polmacoxib in managing OA, primarily due to its dual COX-2 and CA binding properties that potentially offer better safety profiles in terms of cardiovascular, renal and GI tolerability. Additionally, the observed improvements in pain, stiffness and physical function with polmacoxib underscore its effectiveness as a monotherapy in routine OA management
The dark side of cartilage: ochronosis unmasked during femoral neck fracture surgery
Get PDFAlkaptonuria is a rare autosomal recessive disorder caused by a deficiency in homogentisic acid oxidase, leading to the accumulation of homogentisic acid in connective tissues. It is characterized by bluish-black pigmentation of cartilage and other connective tissues, with progressive joint degeneration and early-onset osteoarthritis. Ochronosis typically becomes symptomatic after the age of 30, affecting larger joints and the spine. A 75-year-old female presented with a transcervical femoral neck fracture and a right distal end radius fracture following a fall. During hip surgery, intraoperative findings included blackish discoloration of the femoral head and acetabulum. The patient had a history of stooped posture and calcified intervertebral discs. Further examination revealed ochronotic pigmentation of the sclera and ear cartilage, and a urine test confirmed the diagnosis of ochronosis. Postoperative recovery was uneventful. Ochronosis should be considered in the differential diagnosis of patients with calcified intervertebral discs and early-onset joint degeneration. The condition is typically asymptomatic until joint involvement occurs. Current treatment options are limited, though nitisinone and dietary modifications show some promise. This case highlights the importance of recognizing ochronosis in patients with joint degeneration, particularly when intraoperative findings reveal characteristic pigmentation
Functional outcomes of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur
Get PDFBackground: Early diagnosis and management of avascular necrosis (AVN) is of paramount importance in order to preserve the femoral head. Early intervention, if implemented at the pre-collapse stage, has favourable impact on the prognosis of disease. This study was conducted to compare the functional outcome of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur and to evaluate the complications associated with the procedure.
Methods: It was a comparative, and prospective study. After obtaining ethics committee approval, total 30 hips (19 patients) divided randomly into two groups for treatment, as per inclusion and exclusion criteria. Group A (core decompression with autologous cancellous bone grafting with PRP), and group B (core decompression with autologous cancellous bone grafting without PRP). Assessment of the results, was based on the Harris hip score (HHS) and visual analogue scale (VAS) at preoperative, 2 weeks, 4 weeks, 6 weeks and 3, 6, and 9 months post-operatively.
Results: There was no statistical difference seen between two groups in terms of distribution of cases based on age, gender, side, duration of symptoms, etiology, Ficat-Arlet grade, and surgical time. Mean HHS and mean VAS was found to be comparable in two groups postoperatively at all follow ups. Excellent to good results were obtained on functional assessment by HHS grading at final follow up of 9 months in patient treated under group A while patients treated under group B showed good to fair results. Both groups showed statistically significant improvement in HHS grade at 9 months as compared to preoperative HHS. In both groups, there was a statistically significant improvement in mean VAS at 9 months as compared to preoperative VAS.
Conclusions: When combined with core decompression and bone grafting, PRP produces better HHS/functional outcomes as compared to core decompression and bone grafting alone for the treatment of early avascular necrosis of head of femur
The influence of retropatellar fat preservation on the positioning of the tibial component of total knee arthroplasty
Get PDFBackground: The good clinical-functional outcomes of total knee arthroplasty (TKA) depend on several factors, such as the surgical time and the adequate positioning of the prosthesis components. The present study aims to evaluate whether the preservation of retropatellar fat pad during the surgical act influences the rotational alignment of the tibial component and the surgical time of the procedure.
Methods: The study was carried out with 50 patients operated on by the main author, who were randomly divided into two groups, experimental and control. For the evaluation of the positioning of the tibial component, the patients underwent computed tomography (CT) four weeks after the surgery, on average. Casuistry was determined by pilot study with the first five patients of each group. For the sample calculation, the t-student test was used for two independent samples.
Results: All patients presented internal rotation of the tibial component, with no statistical difference in mean rotation between the experimental and control groups. When there was complete detachment of the fat in the experimental group, the tibial component showed greater external rotation, with a statistical difference. Surgical time was shorter in the experimental group, varying in this group according to the degree of osteoarthrosis.
Conclusions: Maintenance of retropatellar fat pad did not influence the rotational alignment of the tibial component; however, in patients with advanced osteoarthrosis, such maintenance increases the surgical time
Closed atraumatic flexor hallucis longus tendon rupture following hallux valgus correction repaired using a turn down flap
Get PDFA case report of closed atraumatic rupture of flexor hallucis longus (FHL) tendon few months after hallux valgus correction in a high functioning individual is presented. There have been only two cases of FHL tendon rupture reported following hallux valgus correction in literature till now. Our patient underwent Hallux valgus corrective osteotomy, 4 months after which he presented with rupture of the FHL tendon, he subsequently underwent successful surgical turn down flap repair with good clinical outcome. Closed atraumatic rupture of FHL tendon as an isolated injury is a rare event evidenced by systematic review reporting only 10 cases in literature till now. Low clinical suspicion of FHL rupture in closed foot injuries could be one factor resulting in fewer cases being reported in literature. Acute rupture of FHL tendon following open foot injuries and partial closed rupture due to tendinitis in dancers have been reported frequently in literature. In conclusion, we emphasize careful handling of FHL tendon while performing corrective osteotomy of the hallux in any patient. Although, turn down flap is a well-documented technique to bridge gaps and repair chronic tendo-achilles rupture, we were able to replicate the same technique in our patient and produce good functional result using this effective tendon repair technique to bridge segmental gap as evidence by return of almost normal power of great toe plantar flexion
Case series of results of intertrochanteric femur fracture treated with hemiarthroplasty
Get PDFIntertrochanteric femoral fractures are one of those mysteries which become more and more mysterious with advancing knowledge and better imaging modalities. 20 patient of intertrochanteric fracture treated with hemiarthroplasty prospective study done at GCS Medical College and Hospital. Good result obtain in term of early mobilization. The conclusion is that in comminuted fractures. 31A2.2, 31A2.3 by hemiarthroplasty give good result.
Assessment patient satisfaction after total knee replacement in Indian population
Get PDFBackground: We aim to assess the satisfaction of patients after total Knee replacement in Indian population. Tоtаl knee Аrthrорlаsty is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. Knee reрlасement surgeries helрs tо restоre nоrmаl meсhаniсs during level wаlking аs well аs mоre demanding аnd соmрlex асtivities suсh аs stаir negоtiаtiоn. Раtient sаtisfасtiоn rаtes fоr the рrосedure hаve been reроrted between 81-97%. However, this leаves а signifiсаnt роrtiоn оf the TKR рорulаtiоn аs dissаtisfied with the оutсоmes оf the reрlасed knee.
Methods: Patients were assessed at opd visit or with telephonic conversation and scores are calculated and mentioned in excel sheet. Post surgery satisfaction (PSS) score is the score created to measure the satisfaction after total hip replacement. This score contains different questionnaires. These questions include inquiry about relief of pain, ability to do daily routine activities, requirement of walking aids etc. Score contains total 7 questions.
Results: Out of 55 patients we found through this study that about 92.7% were classified as satisfied while 7.3% patients were dissatisfied. Satisfaction rate is more as compared to dissatisfaction rate.
Conclusions: In present study we have tried to eliminate other factors responsible for dissatisfaction such as hospital ward cleanliness, hospital administration, patient and hospital staff communication. we recommend total knee replacement surgery for end stage arthritis and it is more beneficial to the patients in terms of improvement in post-operative pain and function
Malignant transformation of a recurrent giant cell tumor of bone with lung metastasis: a case report
Get PDFGiant cell tumors (GCT) are benign tumors with potential for aggressive behaviour and capacity to metastasize. It is a locally destructive tumor that occurs predominantly in long bones of adolescents and young adults in the epiphysis. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi-nucleated giant cells with homogenous distribution. There are varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favour an intralesional approach that preserves anatomy of bone. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Malignant transformation without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Here we reported a case of recurrent GCT of tibia that at the time of final recurrence was found to have undergone malignant transformation over a period of 6 years following several limb salvaging procedures. Concurrent metastases were found in the lung, but these were non-transformed GCT following which the patient has undergone above knee amputation
Tuberculosis of bilateral sacroiliac joints with bilateral psoas abscess: an unusual presentation
Get PDFInfectious diseases usually affect the sacroiliac joint unilaterally. Out of all tuberculosis cases, bone tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of bilateral tuberculous sacroiliitis with psoas abscess, as this clinical picture is very rare. Tuberculosis of the sacroiliac joint is often missed due to vague symptoms. More often, patients are examined in the supine position, thereby overlooking the sacroiliac joint. Involvement of the sacroiliac joint is rare, but exact numbers are not available. Our case report shows a complication of skeletal Tb that a psoas abscess may develop, causing nonspecific symptoms.