International Journal of Research in Orthopaedics
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Effect of zoledronic acid on functional outcome in cases of pertrochanteric femoral fractures in elderly patients operated with proximal femoral nailing
Get PDFBackground: Osteoporosis is a very common problem in geriatric population and postmenopausal women. Zoledronic acid injection is a very convenient and effective treatment option available for osteoporosis. Our study aimed to study the effect of zoledronic acid on functional outcome and fracture related complications in elderly patients with low energy pertrochanteric femoral fractures who were operated with proximal femoral nail.
Methods: This was a case control study. Elderly patients who underwent surgery in the form of proximal femoral nailing for low energy pertrochanteric femoral fractures were included. Injection zoledronic acid was given to every alternate patient who underwent surgery. Radiological healing was evaluated at six weekly intervals for six months and then 12 weekly intervals for one year. The Harris hip score was used to measure the functional outcome of the patient.
Results: Effective study population consisted of total 49 patients (25 cases and 24 controls). The mean union time in the cases and the control was 8.76±9.12 weeks and 7.04±1.57 weeks respectively. The mean Harris hip score was 86.742±7.55 in the cases and 84.339±11.20 in the control group. The p value was 0.3815. This study concluded that the two groups had no statistically significant difference between functional outcome and fracture related complications.
Conclusions: Zoledronic acid in patients admitted for surgery with osteoporotic fracture does not improve the functional outcome of the patients. It does not affect the mortality of the patients
Management of adhesive capsulitis of shoulder joint with arthroscopic release vs. manipulation under anaesthesia: a comparative study
Get PDFBackground: Shoulder stiffness is a manifestation of various pathologies or clinical scenarios variously described as scapula humeral periarthritis, frozen shoulder and adhesive capsulitis. Frozen shoulder is characterized by significant restriction of active and passive motion of the shoulder that occurs due to unknown factors. Adhesive capsulitis causes contracted, thickened joint capsule that seemed to be drawn tightly around the humeral head with a relative absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule. In this study we did a comparison of 30 patients treated with arthroscopic release and manipulation under anesthesia.
Methods: There were 30 patients in this study with 15 patients in each group of different age groups. All the patients were studied for a period of one year between July 2021 to July 2022. The functional outcomes were assessed using dash scoring system.
Results: in this study of 30 patients with different age groups followed for 12 months and assessed by DASH scoring system. We had excellent results in arthroscopic group with postop dash score standard deviation is 5.87.
Conclusions: The arthroscopic capsular release of shoulder joint in adhesive capsulitis was found to have a better functional outcome as compared to the manipulation of shoulder joint under anaesthesia. Currently no treatment protocols are universally effective which needs more and more research and developments for proper treatment strategies. Morbidity with this condition has caused significant loss both economically and psychologically
Functional evaluation of various modalities of management in floating knee injuries at a tertiary care centre in central India
Get PDFBackground: The injuries involving femur and tibia fractures due to high velocity are known as floating knee injuries. These fractures may involve the shaft, metaphysis or the articular surface. There are many complications associated with these injuries. This study evaluates the functional, clinical and radiological outcomes of floating knee injuries.
Methods: A Prospective and interventional study was performed at MGMMC and MYH Hospital, Indore. We included 30 patients in our study. Femur fractures are managed by intramedullary nailing or distal femur plating. Tibia fractures are managed by Intramedullary nailing or tibia plating. Patient were called for regular follow up for a minimum of 6 months. Functional and clinical evaluation done by Karlstorm and olerud scoring system and radiological outcome by union on x rays were done.
Results: Out of 30 patients 28 (93.33%) male and 2 (6.66%) female. According to Fraser classification, 17 (56.66%) type 1, 4 (13.33%) type 2A, 4 (13.33%) type2B, 5 (16.66%) type 2C injuries. A majority of the injuries occurred due to road traffic accidents involving right limb 21 (70%) more then left 9 (30%). Knee stiffness occurred in 8, infection in femur 3, infection in tibia 2, malunion of femur 2, limb length discrepancy in 2 patients. Outcome was excellent in 5 (16.66%), Good in 10 (33.33%), Acceptable in 9 (30%) and poor in 6 (20%).
Conclusions: Fraser type 1 fracture has excellent results and Fraser type 2C has poor results. Closed fracture has better outcome compared to compound Fractures. A better functional outcome can be determined on the basis of implant choice based on Fraser Classification, level of injury, open or closed injury, simple or compound type of fracture
Double trouble-unveiling the hidden pain: bilateral paediatric parsonage-turner syndrome: an unprecedented encounter
Get PDFParsonage-turner syndrome (PTS), also known as idiopathic brachial neuritis, is a rare disorder characterized by sudden-onset severe shoulder pain followed by weakness and atrophy of the shoulder and arm muscles. This case report presents the clinical scenario of an 11-year-old girl diagnosed with PTS, highlighting the unique challenges and considerations in the paediatric population. In our case, a 11-year-old girl presented with sudden-onset severe bilateral shoulder pain, followed by weakness and atrophy of the shoulder and upper arm muscles. The clinical examination revealed muscle wasting and limited range of motion. The diagnosis of PTS was confirmed through MRI and electromyography (EMG) showing denervation in the affected shoulder muscles. Patient was managed with symptomatic supportive treatment in the form of analgesics and physical therapy. Patient is on the road to recovery and on regular follow up. We concluded that prompt recognition and appropriate management of PTS are crucial to optimize outcomes and prevent long-term disability, particularly in the paediatric population
Comparative efficacy of intra-articular hyaluronic acid and corticosteroid injections in the management of knee osteoarthritis
Get PDFBackground: Osteoarthritis management includes a myriad of treatment modalities. This study compared the effects of corticosteroid and Hylan G-F 20 injections on knee osteoarthritis outcomes.
Methods: Patients were randomized to receive either corticosteroid or Hylan G-F 20 injections. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, knee society rating system scores, and visual analog scale scores, collected at baseline, 3 months, and 6 months.
Results: Baseline demographic and clinical parameters were comparable between both groups. The corticosteroid group demonstrated a significant decrease in the WOMAC score over time (p<0.001). Hylan G-F 20 group showed significant improvements in both the WOMAC scores and Visual Analog Scale scores over time (p<0.01). Gender-based sub-analysis suggested both treatments were effective in men, while in women, significant benefits were seen only with Hylan G-F 20.
Conclusions: Both corticosteroid and Hylan G-F 20 demonstrated efficacy in managing knee osteoarthritis, albeit in different domains. The results suggest the need for individualized treatment plans and further research into potential gender-based variations in treatment response
Anatomical pre-contoured plates in management of distal tibia fracture: a prospective study
Get PDFBackground: Distal tibial fractures are complex injuries with high complication rate. Management of such fractures are often complicated by soft tissue injuries. Precarious vascularity around distal tibia also results in high non-union rates. This study aims to study and analyse the outcome of distal tibia fracture managed by anatomical contoured plate.
Methods: In this prospective observational study, we attempted to assess the functional and radiological outcome of distal tibia fracture managed by with distal tibia fracture with average follow up of 24 weeks. ORIF/MIPO with plating was done for fracture distal tibia with anatomical precontoured plates.
Results: Patients were evaluated using AOFAS and measure of ankle range of motion. Average functional score was 88 with complications in 3 patients.
Conclusions: We believe precontoured plates provide for better biological fixation than conventional plates
The association of late carpal tunnel syndrome with carpal misalignment following distal radius fracture in old Jordanian women
Get PDFBackground: Late carpal tunnel syndrome following distal radius fracture is a frequent hazard especially after conservative management. Objective was to assess the association of radiological carpal alignment with the intensity of late carpal tunnel syndrome in old Jordanian women during 1 year of distal radius fracture.
Methods: Our retrospective investigation recruited 100 women, aged more than 50 years with unilateral distal radius fracture managed conservatively during one year of the fracture at Royal Jordanian Rehabilitation center, Jordan, between January 2021 to April 2023. Participants were split into 2 groups. Group I comprised of 50 patients with clinical features of late carpal tunnel syndrome (nocturnal or diurnal) and group II comprised of 50 women without clinical features. CTS-6 assessment tool score (1-6) was recorded to evaluate the intensity of the condition. Electrophysiological and radiological evaluation were performed to record carpal alignment. Student t-test was used to assess the variables.
Results: There was a remarkable discrepancy between groups in terms of the radiological variables of carpal alignment (The average of radio-capitate distance, volar tilt and volar prominence height were: -10.69 mm, -19.89 D angle and 1.45 mm, respectively in group I). There was a positive association between reduction in the variables of carpal alignment and the intensity of late CTS. Volar tilt was positively engaged in the late CTS. The threshold of the volar tilt was -19.41 D angle (p<0.005).
Conclusions: Modification of the carpal tunnel following distal radius fracture with carpal dorsal misalignment leads to late CTS. Reducing volar tilt and volar prominence height and radio-capitate distance are the main remarkable independent anticipators of late CTS in non-surgically treated distal radius fracture
A comparative study of Ilizarov ring fixators and limb reconstruction system fixators in the treatment of compound tibial shaft fractures
Get PDFBackground: Tibia is the most commonly fractured long bone, and the prevalence of compound fractures has risen due to an increase in high-energy traumatic incidents. In addressing challenging tibial fractures with significant soft tissue damage, infected tibial nonunion, and compound tibial fractures, medical professionals have turned to specialized treatments, such as Ilizarov ring fixators and limb reconstruction system fixators. These fractures typically cannot be managed effectively with traditional internal fixation methods. To facilitate early weight-bearing, limb lengthening, and efficient wound care, two minimally invasive fixation systems have been developed: the Limb Reconstruction System and the ring fixator.
Methods: The study was conducted on 40 patients with compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators with the aim to evaluate the functional outcome, union rate and amount of limb lengthening using Ring and ILRS fixators in compound tibial fixators.
Results: In our study, a significant portion of the participants fell within the age range of 28 to 37 years, comprising 45% of the total sample. Furthermore, the majority of the study subjects were male, constituting 65% of the participant pool. The primary mode of injury reported in our study was road traffic accidents, accounting for 77.5%.
Conclusions: The study concluded that LRS fixators show good and promising results like easy to apply, carry, compress, distract and clean while Ilizaro ring fixator is technically demanding, difficult to carry and cumbersome to the patient
Unveiling the silent nemesis: periprosthetic joint infection-the burden and road to recovery
Get PDFPeriprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery that poses significant challenges for patients and healthcare systems. It is associated with increased morbidity, financial burdens, and emotional distress for patients. Understanding the risk factors for PJI and implementing preventive strategies are crucial to reducing its incidence and mitigating its impact on both individuals and healthcare institutions
Unforeseen consequence: heterotopic ossification following traumatic brain injury and acetabulum fracture-a case report
Get PDFHeterotopic ossification (HO) is a rare pathological condition characterized by the formation of bone in soft tissues outside the normal skeletal system. HO can result in restricted joint mobility, nerve compression, and pain. We present a case report of a 34-year-old male who developed HO. There is a history of neurological injury and fracture acetabulum (left). Imaging studies revealed extensive HO with complete bony bridging of the hip joint, leading to severe functional impairment and chronic pain. The patient had previously undergone multiple medical treatments with non-steroidal anti-inflammatory drugs, and physiotherapy with limited success. Ultimately, he underwent a complex surgical intervention involving resection of HO, release of joint contractures, resulting in significant improvement in joint mobility and pain control. Here we discuss a rare and debilitating presentation of HO and the treatment options available for such patients. Clinicians should be aware of this challenging condition and manage patients through a multidisciplinary approach