International Journal of Research in Orthopaedics
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Long term outcome of tibial adamantinoma: a case report and literature review
Get PDFAdamantinoma is a rare malignant bone tumor that typically occurs in the tibia but can also occur in the jaw, forearm, hands, or feet. It commonly affects young adults between 20 and 40 years. It accounts for less than 1% of primary bone tumors. It is a slow growing tumor and often indolent but generally symptoms are persistent pain in the affected area, localized swelling, tibial bowing deformity and pathological fracture which occurs acutely. the diagnosis is based on imaging and a necessary biopsy to confirm the diagnosis, showing nests of epithelial-like cells in a fibrous stroma. The treatment consists of surgical resection and recurrence can be problematic and may occur even decades after initial treatment. Here, we report one case of tibial adamantinoma with atypical treatment and long-term evolution greater than 24 years and with no recurrence
Transthoracic discectomy for a rare presentation of calcified dorsal disc herniation
Get PDFThoracic disc herniation is rare entity, with incidence of 0.5%-4% of all disc herniation. Mostly are asymptomatic and does not need treatment if symptomatic cause intractable pain, intercostal neuralgia, persistent axial back pain and myelopathic symptom need surgical excision. We present a case of 74-year female with central calcified dorsal disc herniation at T11-12 level. surgical excision done by transthoracic discectomy
Low back pain: shifting the paradigm from non-specific to specific
Get PDFLow back pain is a leading cause of disability worldwide and it imposes huge economic burden on affected individuals and the government. It can be broadly classified into specific and non-specific low back pain. Non-specific low back pain constitutes about 90% of all low back pain, and it is now a leading cause of years lived with disability. The present review aims to describe the evolution of the term non-specific low back pain, to show that the term may no longer be appropriate and to propose hypothesis that can explain low back pain in general. A review of the literature shows that several terms have been used to describe non-specific low back pain. Examples of such terms are mechanical low back pain, and idiopathic low back pain with few inconsistencies in the usage of the term. The term, non-specific low back pain, became widely accepted after introduction of the concept “diagnostic triage” by Waddell in 1994. The concept classified low back pain into specific, radicular syndrome and non-specific. As explained by Waddell, only radicular syndrome and specific types of low back pain require further diagnostic evaluation. This has been the practice ever since. Recent evidence from MRI findings of symptomatic and asymptomatic individuals however, suggest that diagnostic evaluation, coupled with specific provocation tests can lead to specific diagnosis of low back pain in majority of the cases. Based on these recent evidences and others, it can be hypothesized that low back pain is a spectrum of disease with a specific cause.
A case report of rare incidence of benign vascular lesion of hand masquerading magnetic resonance imaging findings
Get PDFVascular anomalies of hand can present as soft tissue swelling and can be one of differential along with the common ones’ ganglion cyst, giant cell tumor (GCT), and epidermoid cyst. It can be hemangioma or vascular malformation, they differ based on histological, clinical and biological characteristics. A 65-year-old male presented with swelling in right little finger dorsal part since one month. It was insidious in onset and not associated with pain or trauma. Vascular lesions of hand should be kept in mind as one of differential while examining swellings of hand. Initial investigation like ultrasonography (USG), X ray, magnetic resonance imaging (MRI) and fine needle aspiration cytology (FNAC) should always be followed by excisional histopathology for confirmation and labelling the diagnosis.
Efficacy of the anterograde calcaneo-stop method in the management of flexible flatfoot in children
Get PDFBackground: Flexible flatfoot is one of frequent foot deformity among pediatric population. The calcaneo-stop procedure has been reported to be effective in short-term studies when conservative treatment is not successful. The aim of this study to evaluate the efficacy after removal of screws following the anterograde calcaneo-stop procedure in the treatment of flexible flatfoot in children.
Methods: This retrospective study consists of 260 calcaneo-stop procedures performed from the period of January 2016 to December 2024 in 65 patients (130 anterograde calcaneo-stop surgeries and 130 removals of calcaneo-stop implant surgeries), which were evaluated clinically, and instrumental diagnostic techniques such as radiography, photoplantography and pedobarography were implemented. The inclusion criteria of this study consist of patients with symptomatic flexible flatfoot, patients with ages from 6 to 14 years, patients with informed consent, patients with negative Wynne-Davies joint hypermobility test and the exclusion criteria of this study includes the following; patients with ages below 6 years and above 14 years, the time elapsed of 3 years after screw implantation, patients with other skeletal deformities, patients without informed consent.
Results: Out of the 130 surgical interventions performed on bilateral flexible flatfoot, which were evaluated in 65 patients after removal the screws following the anterograde calcaneo-stop procedure, revealed no signs of loss correction; which were further evaluated by radiography, photoplantography and pedobarography.
Conclusions: The calcaneo-stop procedure is the least invasive and simplest surgical treatment for symptomatic flexible flatfoot in children. The collected data indicated a sufficiently high efficiency of anterograde calcaneo-stop method in the treatment of flexible flatfoot in children
Functional outcome in adults treated for both bone forearm fractures with intramedullary square nails
Get PDFBackground: The forearm fractures are considered intraarticular due to functional characteristics and spatial orientation. These fractures require anatomic reduction to maintain axial and rotational stability and preserve bone length with absolute stability for adequate healing to restore function. Open reduction and internal fixation is accepted as the treatment of choice for both bone forearm fractures according to many studies. However, it can result in complications like extensive soft tissue damage, evacuation of fracture hematoma, periosteal damage, radioulnar synostosis, neurovascular injury, compartment syndrome, delayed union, non-union, infection, refracture after implant removal. Intramedullary nailing is an alternative technique to avoid the above problems, with the advantages of minimal incision, no periosteal stripping, faster healing and biologic fixation. This study evaluates the functional outcome in adults treated for both bone forearm fractures with intramedullary square nail fixation at our institute.
Methods: 113 patients with closed both bone forearm fractures were treated with Intramedullary square nail fixation between January 2014 to December 2023. There were 54 (22A) type fractures, 44 (22B) type fractures, 15 (22C) type fractures. Functional outcome was assessed based on Anderson’s criteria.
Results: 105 patients had excellent to satisfactory results while fixation in 8 patients resulted in failures based on Anderson’s criteria.
Conclusions: Intramedullary nailing is a simple, safe and effective method of alternative fixation of both bone forearm fractures that is associated with closed reduction, early union, biologic fixation, low infection rate, small cosmetic scars, less blood loss, shorter operating time, and less risk of compartment syndrome
Short term outcomes following biplane double supported screw fixation of femoral neck fractures in adults: a prospective observational study
Get PDFFemoral neck fractures are common among the elderly population. Non-union is a common complication of these fractures, despite various fixation options. Nonunion results in considerable morbidity and impaired function. Biplane double-supported screw fixation (BDSF) is a newer technique for femoral neck fractures, demonstrating superior fixation strength in biomechanical studies. We conducted this prospective observational study to evaluate the fixation strength of BDSF in adult femoral neck fractures, focusing on fracture union, loss of reduction over one year, and functional outcomes at the end of one year. Loss of fracture reduction was assessed using radiological parameters, while functional outcomes were measured with the modified Harris hip score (MHHS) and Parker mobility score (PMS). We recruited 19 patients aged 18-65 years who were treated using the BDSF technique and followed them for a year. The radiological and functional parameters were measured at regular intervals. Only 17 patients reported for final follow-up at one year. The mean neck shaft angle reduced by 6.35 degrees and the mean neck length decreased by 1.02 cm over 12 months. Two patients had expired during the follow up period and 17 patients were available for the final follow up at 1 year. Fracture union was achieved in 16 patients. No patient had fixation failure. Both the MHHS and PMS showed significant improvement at 1 year and 6 months respectively. BDSF provides strong fixation and good union rates. Although there was a reduction in neck-shaft angle and neck length, our study showed excellent functional outcomes
Current practices and perceptions among clinicians in osteoarthritis and osteoporosis management 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 study aimed to assess clinician perspectives on the prevalence, risk factors, diagnosis and management practices of osteoarthritis (OA) and osteoporosis (OP) in routine clinical settings, to identify gaps in awareness, treatment approaches and patient compliance.
Methods: The cross-sectional study utilized a 23-item questionnaire to gather expert insights on the management of OA and OP in Indian settings. It explored various aspects, including epidemiology, risk factors, diagnostic practices, treatment preferences and challenges in current management. The collected data were analysed using descriptive statistics.
Results: The study included 119 experts and nearly 75% of them identified knee OA as the most prevalent form of the condition. For the early management of OA, around 88% of respondents preferred a combination of nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, dietary modifications and exercise. Nearly 83% recognized family history, smoking, poor diet, advancing age and post-menopausal status as common risk factors for OP. Regarding screening practices, 55% of participants reported that blood tests, bone turnover markers and bone mineral density (BMD) assessments via ultrasound are the most commonly used methods. Around 77% believed that calcitriol supports fracture management, offers the benefit of weekly dosing for better compliance and is effective in treating OP. A majority (84.87%) of participants agreed that calcium aspartate is a well-tolerated and effective calcium supplement suitable for individuals across all age groups.
Conclusions: This study indicates that knee OA is the most commonly observed form, with early management favouring NSAIDs, physiotherapy, dietary modifications and exercise. In OP, lack of awareness remains a key treatment gap, while calcium aspartate and calcitriol are widely regarded as effective and well-tolerated options
Posterolateral corner of the knee “the mysterious corner”: a review of anatomy, biomechanics and current treatment paradigms
Get PDFThe posterolateral corner (PLC) of the knee remains one of the most complex and often underdiagnosed stabilizing units of the knee joint. Injuries to the PLC are frequently overlooked, contributing to chronic instability, early onset osteoarthritis and increased likelihood of total knee arthroplasty. Recent anatomical and biomechanical studies have highlighted the critical role of the PLC in maintaining knee stability, particularly in resisting varus stress, external tibial rotation and posterior translation. This review aims to consolidate current knowledge on the anatomy and biomechanics of the PLC, epidemiological trends and evolving management strategies, including anatomical reconstruction techniques and arthroscopic advancements. It emphasizes the necessity for heightened clinical suspicion, accurate diagnosis and appropriate treatment to prevent long-term disability
Periprosthetic fractures after total knee arthroplasty: an extensive review of its patterns, risk factors, treatment options, outcomes and correlation of its severity with the bone mineral density
Get PDFBackground: Periprosthetic fracture (PPF) around knee is a rare but debilitating complication after total knee arthroplasties.
Methods: Retrospective analysis of 12,133 knee replacements done at a single centre from 2011-2024 was done to analyse incidence, risk factors, pattern, treatment and outcomes of PPF and correlation of its severity with the Bone mineral Density.
Results: The incidence of PPF was 0.42% (femur=0.34%, tibia=0.07% and patella=0.01%). 51.6% were female patients. Mean age, BMI, CCI and follow up was 63.32 (22-89 years; SD=13.51), 30.6 (20.2-43.8; SD=3.9), 2.2 (1-4; SD=0.77) and 5.1 years (1-14 years; SD=4.29). Mean BMD was -1.78 (1 to -3; SD=0.69). Primary osteoarthritis was the diagnosis in 93.91% and PFC Sigma (Depuy, Johnson and Johnson) posterior stabilised prosthesis was used in 88% of the patients. The mean grade of anterior cortex notching (Tayside classification) was 0.39 (0-3, SD=0.12). Only female gender was a significant risk factor for PPF (OR=3.1; 2.31-3.97 at 95%CI; p value=0.01). There was no significant correlation between the BMD and the grade of fracture as per Lewis and Rorabeck, Su and Felix classifications (p values=0.77, 0.80 and 0.74 respectively). 33 PPFs (64.7%) were fixed with locking plates and 5 (9.8%) were revised to hinged prosthesis. 98% fractures united at mean 17.8 weeks and Mean KSS at 1 year was 144.77+/-2.08. 1 year mortality rate post PPF was 2%.
Conclusions: While female gender is a significant risk factor for PPF, BMD does not correlate with its severity. Appropriate treatment option selected based on the general health of the patient, fracture pattern and implant stability results in good outcomes and less mortality