International Journal of Research in Orthopaedics
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Evaluating functional recovery post-total knee replacement, a WOMAC based comparison of synovectomy versus non-synovectomy approaches in a tertiary care hospital in South India
Get PDFBackground: Synovectomy is commonly performed during total knee arthroplasty (TKA) for patients with osteoarthritis (OA) and inflammatory arthritis to address synovial inflammation. However, its impact on long-term functional outcomes remains unclear. Objective of this study was to evaluate the effect of synovectomy during TKA on postoperative pain, stiffness, and functional outcomes in patients with OA and inflammatory arthritis.
Methods: A hospital-based retrospective cohort study was conducted with 86 patients who underwent TKA one year prior (43 with synovectomy, 43 without). The Western Ontario and McMaster osteoarthritis index (WOMAC) was used to assess pain, stiffness, and physical function at follow-up.
Results: The mean age of patients was 65.4 years. No significant differences were found in pain (p=0.638) and stiffness (p=0.647) between the two groups. However, physical function was significantly better in the group without synovectomy (p=0.004), with significantly fewer difficulties in activities such as standing, bending, and getting in/out of bed (p<0.05). The mean total WOMAC score was significantly lower in the group without synovectomy (p=0.045).
Conclusions: Synovectomy during TKA had no impact on postoperative pain or stiffness and was associated with poorer functional outcomes compared to TKA without synovectomy. These findings suggest that synovectomy may not offer additional benefits for patients with OA and inflammatory arthritis. Further research with larger samples is recommended to better understand its role in TKA
Assessing the efficacy of doppler ultrasound in determining the level of amputation amongst diabetic foot patients: a 2-year retrospective study
Get PDFBackground: Diabetic foot complications leading to amputation represent a significant healthcare burden, particularly in elderly populations. Understanding the patterns, procedures, and outcomes of these amputations is crucial for improving patient care.
Methods: A retrospective observational study of 33 patients who underwent diabetic foot amputation was conducted. Data collected included demographic characteristics, clinical parameters, surgical procedures, and outcomes. Doppler ultrasound was requested for all the patients to confirm the level of amputation that had been determined clinically.
Results: The mean age was 68.8±8.9 years, with a slight male predominance (51.5%). Most patients (78.8%) belonged to the low socioeconomic class, and 63.6% had only primary education. Below knee amputation was the most common procedure (81.9%), and 66.7% of patients presented with grade 4 diabetic foot. Doppler ultrasound was requested for all patients, but only 18.2% underwent the investigation. Comorbidities were present in 69.7% of cases, with hypertension being the most prevalent (45.5%). The mean HbA1c was 9.742±4.9267. A significant improvement in PCV was observed post-operatively (31.6±4.9% versus 26.3±6.7%, p=0.001).
Conclusions: The correlation between Doppler USS and intra-op findings is statistically significant. Doppler USS remains important investigation in determining level of amputation following clinical assessment of diabetic foot patients
Multilevel spinal tuberculosis: a case report emphasizing the critical role of early diagnosis in mitigating neurological complications
Get PDFTuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%–60% of cases 1. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult, and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity 2. We report a case of tuberculosis of the spine in a 23-year-old female patient who presented with complaints of lower back pain for 2 months and difficulty in standing and walking for 1 month. Pain had an insidious onset and gradually progressed over a period of 2 months. The patient gave a history of weakness of both lower limbs for 1 month. Plain X-ray The dorso-lumbar spine showed vertebral segmental bone destruction at the D11 vertebra. MRI of the dorsal spine showed wedging and collapse noted at the D11 vertebral body, forming a gibbus deformity causing thecal and cord compression. So, surgery was performed with debridement of debris and posterior stabilization and fixation at the D8, D9, and L1-L2 vertebrae, and also psoas abscess drainage was done on a later date. The patient was started on anti-tubercular therapy after confirming the diagnosis, and the patient recovered well and is currently under follow-up. For patients with spinal TB, debridement and autograft bone fusion with posterior fixation appear to be effective in arresting disease, correcting kyphotic deformity, and maintaining correction until solid spinal fusion
Effective outcomes of home-based unsupervised rehabilitation protocol after rotator cuff repair: a prospective study
Get PDFBackground: Rotator cuff tears, common in both elderly and athletic populations, require effective rehabilitation following surgical repair for optimal recovery. The study evaluates the outcomes of a patient-led home-based rehabilitation program after rotator cuff repair.
Methods: This prospective study was conducted at SCB Medical College and Hospital, Cuttack, with 46 patients who underwent rotator cuff repair via mini-open incision. A structured home-based rehabilitation program was followed, with outcomes assessed at one year using visual analogue scale (VAS), disabilities of the arm, shoulder, and hand (DASH) score, range of motion, and cuff strength.
Results: Postoperative VAS score improved from 7.3 to 1.5, and the DASH score decreased from 35.0 to 5.2. Range of motion significantly improved in active abduction, forward flexion, and external rotation. Ninety-one percent of patients returned to work within three months, though five failures were noted, including one with stiffness and four with retear.
Conclusions: The home-based rehabilitation program resulted in significant pain relief and functional recovery, with a high return-to-work rate. The study suggests that home-based rehabilitation is a viable alternative to supervised physiotherapy
A study to evaluate the functional outcome of supracondylar intercondylar fracture femur fixed by open reduction internal fixation using distal femoral locking plates in a tertiary care centre
Get PDFBackground: Supracondylar Intercondylar fractures frequently exhibit greater complexity than supracondylar fractures and may result in considerable complications if not appropriately managed. The present study assessed the benefit of open reduction internal fixation (ORIF) of supracondylar-inter-condylar fracture femur using distal femoral locking plates in terms of functional outcome of the patient.
Methods: The present descriptive study conducted in a tertiary healthcare centre located in Kollam, Kerala. The study included patients suffering from supracondylar intercondylar fracture femur fixed by ORIF using distal femoral locking plates. The patients were treated and assessed using range of motion, Knee society score and time taken for weight bearing. These findings were then compared for association with demographic and clinical variables. The data was analysed using chi-square test and p<0.05 was considered as statistically significant.
Results: The study involved a total of 63 patients with supra-condylar intercondylar femur fractures, with most being females over 70 years old. Postoperatively, most patients showed a range of motion of 91-120 degrees, and the time for radiological union was less than 6 months. The mean KSS score improved significantly at 12 months, with the majority having excellent scores. The study also found significant differences in mean range of motion based on age, type of fracture, and open/closed fractures. The time taken for full weight bearing was also associated with the type of AO fractures.
Conclusions: The study reveals significant differences in weight-bearing outcomes after ORIF of supracondylar intercondylar femur fractures. C1 fractures showed positive recovery, while C2 and C3 required extended rehabilitation. The study emphasizes fracture classification and personalized treatment for improved patient outcomes.
Magnetic resonance imaging knee joint measurements for the prediction of the population at risk of anterior cruciate ligament tear injuries
Get PDFBackground: This study aims to investigate whether patient-related anterior cruciate ligament (ACL) damage is associated with measures of various knee joint components.
Methods: Patients who had magnetic resonance imaging (MRI) and suffered from ACL injuries were included in this retrospective case-control study. There was also a control group of individuals who had normal MRI results for knee diseases. The following 14 knee variables were gathered: lateral and medial (MFC) femoral condyle sphere diameter; lateral and medial tibial plateau length; patella tendon horizontal and vertical diameter; lateral meniscus (LM) posterior horn height, length, depth, and volume; and medial meniscus (MM) posterior horn height, length, depth, and volume. The two groups were compared using a multivariate logistic regression that took into account the patella tendon horizontal diameter, MFC sphere diameter, MM posterior horn length, MM volume, LM posterior horn depth, and receiver operating characteristic curve.
Results: We enrolled 98 patients in total; 48 had ACL injuries, and 50 had normal knee MRIs as a comparison group. The results of the logistic regression analysis showed that the following factors independently predicted the risk of ACL rupture: decreased MM posterior horn length (OR=0.45; 95% CI=0.33-0.630; p<0.001), increased LM posterior horn depth (OR=1.78; 95% CI=1.37- 2.03; p<0.001), and MFC sphere diameter (OR=1.27; 95% CI=1.01-1.60; p=0.0354).
Conclusions: Individuals with an ACL injury had shorter MM posterior horns, deeper LM posterior horns, larger MFC sphere diameters
A comparative study of plating versus interlocking nail in fracture shaft humerus
Get PDFThis study is to compare the outcomes of each method of fixation i.e. plating and interlocking nailing for the patients with fracture shaft of humerus and to analysis statistically significant difference in the results of these two methods conducted during October 2020 to September 2022 among 20 patients who satisfied the inclusion criteria and exclusion criteria, follow up was done up to 9 months. The study of 20 patients of humerus shaft fracture fixed either with plate or interlocking nail showed postoperatively in the plating group there were 2 complications and in the interlocking group there were 6 cases with complications, healing rate is found to be good in the plating maximum time taken is ≤17 weeks and while interlocking more than half cases took ≥17 weeks, the average disabilities of the arm, shoulder and hand (DASH) score in the plating group was 19.8 and in the interlocking group it was 44.6, among the 20 patients 5 had excellent results, 8 had good results, 5 had fair results, 2 had poor results. We conclude that both the modalities of treatment i.e., plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the functional outcome and rate of complications, we are of the opinion that plating offers better result than interlocking nailing with respect to pain and function of the shoulder joint
Effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic low back pain in adults
Get PDFBackground: Chronic low back pain (LBP) causes lot of pain and suffering thus contributing to frequent and increased cost and burden on health-care-facilities. In United Kingdom, it has been estimated that economic cost of LBP pain is around £12.3B per annum. It is also associated with increased incidence of depression, anxiety. These morbidities also lead to increased costs for patient. To study effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic LBP in adults.
Methods: Hospital-based randomized comparative study was carried out among 100 adult cases of chronic LBP. They were randomly assigned as 50 cases treated with bupivacaine without steroids and 50 cases treated with bupivacaine with steroids. Modified oswestry disability index was used to assess functional improvement and visual analogue scale to assess pain score. Patient data was used to assess cost-utility.
Results: Patients in group-II were significantly older, had more pain duration than group-I. Incidence of repeat procedure required was more in group-I compared to group-II (p<0.05). The functional level in both groups was comparable (p>0.05) at baseline. At one, three, six and twelve months, it improved more significantly in group-II compared to group-I (p<0.05). At baseline, pain score was significantly more in group-II compared to group-I (p<0.05). But, at one, three, six and twelve months, it was significantly lesser in group-II compared to group-I (p<0.05). Patients in both groups were comparable for physician cost and facility cost. But total number of procedures and average number of treatments per patient were lesser in group-II compared to group-I.
Conclusions: Thus, we conclude that bupivacaine with steroids is not only effective in relief of pain and returning normal functionality, but also cost-effective compared to bupivacaine without steroid in adult patients with chronic LBP
A prospective study of the surgical management of malleolar fractures around the ankle
Get PDFBackground: Ankle fractures are commonly occurring fractures, especially in the aging population, where they often present as fragility fractures.
Methods: Malleolar (mono, bi and tri malleolar) fracture patients treated at a tertiary healthcare centre located in South Kerala, India were included in this prospective study. The present study comprised of 27 patients over 20 years of age with closed, unstable or displaced ankle malleolar fractures treated surgically attending the study centre over a period of 6 months. After a clinical evaluation, a full survey was done to rule out major damage. After surgical intervention, follow-up occurred every 6 weeks for at least 8 months. The study used Baird and Jackson's subjective, objective and radiographic ankle scoring method to assess functional outcome.
Results: The findings indicated that the predominant injury types according to the lauge hansen classification were supination-external rotation (40.7%) and pronation-external rotation (40.7%). The results indicated that the majority of participants achieved excellent scores (59.25%), followed by good scores (18.5%), fair scores (14.8%) and poor scores (7.4%).
Conclusions: The study of surgical interventions for malleolar fractures at the ankle demonstrates that open reduction and internal fixation (ORIF) is an effective treatment method, leading to improved functional outcomes. The findings underscore the importance of precise anatomical alignment and stable fixation in mitigating issues such as malunion and non-union
Pure talonavicular subluxation
Get PDFTalon-navicular dislocation of the tarsus is a rare injury that can be easily overlooked in emergency settings. This report details the case of a 26-year-old man who experienced a right foot injury due to a fall resulting in plantar hyperflexion. Initially misdiagnosed as an ankle sprain, further evaluation revealed a plantar sub-dislocation of the navicular bone, confirmed by radiological imaging.