International Journal of Research in Orthopaedics
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Comparison of Lapidus procedure fixation methods for hallux valgus: a 10-year retrospective analysis
Get PDFBackground: The purpose of this study was to identify the type of Lapidus fixation method used in Leeds Teaching Trust Hospital that produces the best post-operative radiographical measurements.
Methods: Thirty-five patients who underwent the Lapidus procedure were reviewed. Pre-operative and post-operative X-rays were measured to obtain angles; hallux valgus angle (HVA), first intermetatarsal angle (IMA), distal metatarsal articulate angle (DMA), meary angle (MA), and metatarsal declination angle (MDA). The fixation groups compared were dorso-medial plate vs dorsal plate vs medial plate and plate-single screw versus plate-crossed screw. The change in angle (Δ-angles) between pre-operative and post-operative were measured and the groups were compared. The fixation method that resulted in the largest Δ-angles and is statistically significant will be regarded as a superior fixation type within that group.
Results: Groups with plate-single screw fixation showed a statistically significant (p<0.05) larger change in distal metatarsal articulate angle compared to plate-crossed screw fixation. Dorso-medial plate showed largest Δ-angles in the plate group although none were statistically significant.
Conclusions: Fixation systems with single-screw result in better radiographical measurements compared to crossed-screws, significantly with the distal metatarsal articular angle. Dorso-medial plates result in better radiographical measurements followed by dorsal plate and then medial plate. However, these findings need validation with a randomized controlled trial before being generalized
A rare case of extra-synovial and intracapsular ganglion cyst of the knee joint
Get PDFA 23 year old female presented with knee swelling which was found to be ganglion cyst of the knee with extra synovial and intracapsular origin form the lateral meniscus which was causing pain in extreme extension. The cyst was excised and confirmation was done on histopathology. Ganglion cysts may have following differential diagnoses of ganglion cysts may include synovial chondromatosis, pigmented villonodular synovitis, meniscal or parameniscal cysts, and synovial hemangioma. Which needs good histopathological and radiological correlation. Most common sites of Intra-articular ganglion cysts are in the dorsal wrist, palm, and shoulder but rarely found in the knee joint
Prospective study comparing between plate osteosynthesis and antegrade interlocking nailing its functional and radiological outcome in treating humeral shaft fractures
Get PDFHumeral shaft fractures are common injuries making upto 1-3% of all fractures. They are widely treated by conservative methods leading to higher rates of non-union. Henceforth surgeons tend to perform operative procedures to treat them. To statistically analyse and compare the functional and radiological outcome of two treatment modalities of humeral shaft fractures, they are plate osteosyntheis and antegrade intramedullary nailing. A total of 22 patients of humeral shaft fractures were operated by either of two methods 12 in plating (P) group ,10 in nailing (N) group and their radiological outcome was assessed by rate of union, time taken for callus formation etc and their Functional outcome was analysed based on Rodriguez Merchan criteria. The commonest age group of patients operated is 21-40 years (70%) majority being males (70%) and road traffic accident being commonest mode of injury. The plate osteosynthesis group stands superior than nailing group in terms of duration of union (20 weeks), rate, percentage of union (100%), least risk of non-union (0). Statistically significant (p<0.05) improvement in shoulder joint function with minimal complications. The plate osteosynthesis method is the most promising surgical procedure for treating humeral shaft fracture due to negligible rates of non-union and early recovery of motion. Though nailing group has minimal need of soft tissue dissection, preserves fracture biology, decreased operative time and early rehabilitation period it still stands inferior when it comes to complications like rotator cuff injury, shoulder impingement pain and restriction of shoulder movements. Ultimately the post operative quality of life is equally good in both techniques
Tibia fractures managed with minimally invasive internal fixation: a case series of 20 cases
Get PDFDistal tibia fractures are frequently associated with an extensive soft tissue injury, leading to a higher risk of complications such as skin complications, infection, non-union, and eventually poor overall outcome. This study aims to measure the outcome of open/closed distal tibia fractures treated with minimally invasive internal fixation. We aim to propose an algorithm for the management of distal tibia fractures by evaluating the treatment options, outcomes, and risk factors present. This study is a case series study of all distal tibia fractures treated surgically in Kamineni Academy of Medical Sciences, LB Nagar from 2018 to 2022. Patient records were reviewed to analyze the outcomes of surgical treatment and the risk factors associated with it
Prospective evaluation of the role of limb reconstruction system in fracture non-union of femur: a case series
Get PDFTraditionally the Ilizarov’s ring fixator was used in the management of non-union of long bones, especially in the cases with infection. But limb reconstruction system (LRS) is a viable lightweight, technically easier alternative for the same. The aim of this study was to assess the functional outcome, the radiological outcome and the complications associated with the management of fracture non-union femur treated with LRS. A prospective case series was undertaken comprising of 10 patients. Both infected and non-infected shaft of femur fractures were enrolled. Patients underwent debridement, implant removal and definitive fixation with LRS. Post-operative radiological outcome and functional outcome using the ASAMI (Association for the Study and Application of the Method of Ilizarov group) score. In 70% cases the mechanism of injury was road traffic accident. Mean period of non-union before admission was 11.9 months, mean time for union was 10.10 months, with 90.0% cases successfully uniting. 70% cases underwent lengthening following Ilizarov’s principles. ASAMI radiological outcome was excellent in 70%, good in 10%, fair in 10% and poor in 10% cases. ASAMI functional outcome was excellent in 60%, good in 10%, fair in 10% and poor in 20% cases. Pin tract infection was the most common problem at 70.0% while knee stiffness at 40% was the most common true complication. Thus by this study it can be expressed that LRS is a feasible alternative to ring fixators for the management of fracture non-union shaft of femur
A comparative study of the outcome of displaced fractures neck of femur treated with unipolar prosthesis and fenestrated bipolar prosthesis in active elderly patients
Get PDFBackground: Fractures of the neck or femur are among the most serious surgical problems affecting older groups. These fractures constitute a large burden on families and society due to the inability to stand and walk. Objectives were to compare the functional outcomes of unipolar (Austin-Moore) versus uncemented bipolar hemiarthroplasty in displaced fractures neck femur among these active elderly patients.
Methods: This prospective interventional study was carried out at NITOR, Dhaka, Bangladesh in total 60 patients. Among them, 30 patients were treated with unipolar and 30 patients were treated with fenestrated bipolar prosthesis through a lateral approach.
Results: There was no significant age difference between the two groups. Regarding the functional outcome, 6 (20%) patients in the unipolar group and 11 (36.67%) patients in the bipolar group had excellent outcomes. About the same number of patients had good outcomes 36.67% in the unipolar and 43.33% in the bipolar group; the fair and poor outcome was more in the unipolar group than the bipolar group. So, the final outcome after 6 months of operation, 57.57% of patients had satisfactory results in the unipolar group whereas 80% of patients had satisfactory results in the bipolar group. The average Harris hip score was 77.14±14.58 in the unipolar group and 84.63±10.15 in the bipolar group and the p=0.01 which is below 0.05. So, the result is statistically significant.
Conclusions: Uncemented bipolar hemiarthroplasty with a fenestrated stem can give better functional outcomes for displaced intracapsular femoral neck fractures in active elderly patients compared to Austin-Moore prostheses
Case of left hip acute pediatric septic arthritis - polymicrobial etiology
Get PDFSeptic arthritis is a true orthopedic emergency, involving a severe bacterial, viral, or fungal joint infection that triggers inflammation and the degeneration of joint tissues. It typically affects joints such as the knee, hip, shoulder, or wrist. Early diagnosis and treatment are crucial to avoid long-term complications. Herein, we describe the case of an 8-year-old male patient who presented with complaints of spontaneous onset of hip pain and an abnormal gait. The patient was diagnosed with left hip septic arthritis and underwent a left hip arthrotomy under general anesthesia (GA). The patient was administered intravenous antibiotics for 21 days while being kept on non-weight-bearing mobilization. After 3 weeks, the patient's intravenous antibiotics were switched to oral antibiotics for the next 3 weeks. On the second follow-up visit, the patient showed significant improvement, with laboratory findings within normal limits
Comparative analysis of the clinical, functional and radiological outcomes of proximal femoral nail alone verses proximal femoral nail along with lateral wall plating in management of unstable intertrochanteric femur fracture, AO/OTA, type 31A2 fractures with deficient lateral wall
Get PDFBackground: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating.
Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared.
Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B.
Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better
Efficacy of postural awareness by booklet on back pain among the sweet makers
Get PDFBackground: The purpose of the study was to identify the efficacy of postural awareness by a booklet on back pain among sweet makers. Objective was to explore socio-demographic (age, gender, educational status, occupation) characteristics of sweet-makers with back pain. To compare the rating of pain intensity before and after postural awareness by a booklet with the back pain of sweet-makers.
Methods: This study was conducted by pre-test post-test experimental study in which a total of 25 sweet-makers were selected with back pain from January 2021 to December 2022. Data were collected by using the functional rating index questionnaire to evaluate the activity of daily living and pain measured by the visual analogue scale questionnaire. Statistical package for the social sciences (SPSS) was used for data analysis.
Results: In this study, the results showed significant improvement in the reduction of back pain and increase functional activities of daily living by postural awareness with an educational booklet among sweet-makers. The NPRS score in pair sample t-test before and after 15 days of postural awareness by booklet was the level of significant 0.000123, the mean of 0.640±0.700. The pattern of pain before and after 15 days of postural awareness by booklet was the level significant 0.042896 when the mean difference was -0.160±0.374. The referred pain before and after 15 days of postural awareness by booklet was 0.000032 level significant where the mean difference was -0.520±0.510.
Conclusions: The result of this study suggests that postural awareness through a booklet on back pain was effective and it also improves activities of daily living among sweet-makers.
A rare presentation site for osteochondroma scapula and pelvis, intramembranous ossifying bones of axial skeleton: case series
Get PDFOsteochondroma is the most common primary bone tumour comprising over 33% of benign bone tumours. The formation of osteochondroma occurs because of exophytic protuberance on the surface of growing bones. The most common sites for osteochondroma are the distal femur, proximal tibia, and proximal humerus. We are presenting a case series of three patients with rare presentation sites of osteochondroma, scapula and pelvis. Osteochondroma is primarily disease of appendicular skeleton but we are reporting it in axial skeleton. Radiographic findings include fluffy cartilaginous outgrowth arising from the external surface of a long tubular bone that may be pedunculated or sessile. Osteochondromas usually develop in bones that develop by enchondral ossification and rarely develop in bones developing by intramembranous ossification like pelvis. These tumours are usually asymptomatic but can cause pubic visceral compression or neurovascular compromise by compressing external and internal iliac vessels and lumbosacral pluxes. Scapular osteochondroma can cause compression or neurovascular compromise in thoracic cavity and axillary vessels and brachial pluxes. Treatment with surgical excision gives consistent results and relief of pain