International Journal of Research in Orthopaedics
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Acetabular fractures in the elderly population: internal fixation combined with acute total hip arthroplasty
Get PDFThe incidence of acetabular fractures in the elderly population is increasing, primarily due to pre-existing osteoporosis and low-energy trauma. Nevertheless, the optimal treatment algorithm remains a subject of debate. This case report details the treatment of a 77-year-old male patient with an acetabular fracture involving both columns and dome, treated with open reduction and internal fixation plus concomitant total hip arthroplasty
Complications and outcomes of curettage, chemical cauterization and bone graft in giant cell tumor of bone
Get PDFBackground: Giant cell tumor of bone (GCTB) is a locally aggressive benign bone neoplasm with a high potential for recurrence. While intralesional curettage remains the standard treatment, combining chemical cauterization and bone grafting may enhance therapeutic outcomes. This study aimed to evaluate the complications and outcomes of this combined approach in managing GCTB.
Methods: A prospective observational study was conducted at the national institute of traumatology and orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. A total of 32 patients diagnosed with GCTB were treated using curettage, chemical cauterization and bone grafting. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, while complications and recurrence rates were recorded. Statistical analysis was performed using Student’s t-test and Chi-square test, with significance set at p<0.05.
Results: The mean MSTS score significantly improved from 58.8%±15.4% preoperatively to 85.2%±15.9% at the last follow-up (p<0.01). A low recurrence rate of 6.25% was observed. Pain levels, assessed by the visual analogue scale (VAS), significantly decreased from 4.3±1.2 to 2.1±1.5 (p=0.00002). Complications included joint stiffness (25%), superficial infections (9.38%) and early osteoarthritis (6.25%).
Conclusions: The combination of curettage, chemical cauterization and bone grafting proved to be an effective treatment strategy for GCTB, resulting in low recurrence, significant pain reduction and favorable functional outcomes. This approach should be considered a reliable management option, particularly in resource-limited settings
Comparative study of functional outcome of inter-trochanteric fractures in adult population treated with modified first generation proximal femoral nail versus second generation proximal femoral nail- PFN-A2
Get PDFBackground: Intertrochanteric fractures are fairly prevalent in elderly, owing to osteoporosis. High velocity trauma is a common cause in younger age groups. Surgical fixation is the choice of treatment. Closed reduction being minimally invasive has lower infection rates and higher union rate. Providing early mobility lowers morbidity. Over time, there have been multiple changes in the implant design. Two screws in femoral head are used in the first generation PFN, compared to a single helical bolt in the subsequent modification i.e. PFNA2.
Methods: Prospective and comparative study was undertaken, from January 2023 to June 2024, including 52 adults (17 males and 35 females) of either sex, with intertrochanteric fracture femur. 26 patients underwent first generation PFN (group A) and 26 underwent PFNA2 (group B). Clinico-radiological evaluation was done at 6 weeks, 3-, 6- and 12-months following surgery. Functional evaluation was based on the mean Harris hip score (HHS). Post-operative pain based on VAS, early mobilization and complications were taken into consideration. Statistics was analysed with Statistical Package for The Social Sciences (IBM SPSS version 22).
Results: There was 100% union rate. The average date of mobilization in group A patient was 1.9±0.8 days and in group B was 2.2±0.7 days. Group A has a statistically significant higher VAS score than group B at 24 hours post-surgery. Weight bearing as tolerated was started on day 1 post surgery in all patients. The mean HHS was significantly higher in group B (71.5±3.8) at 6 weeks follow-up, which on subsequent follow-ups was statistically insignificantly between the two groups. None of the patients had implant failure of any form.
Conclusions: The final outcome was statistically insignificant. There was negligible difference between the first generation PFN and PFNA2 in terms of post-operative stability and fracture union. Hence, both PFN and PFNA2 are equally suitable devices for fixation of inter-trochanteric fracture
An uncommon presentation of aneurysmal bone cyst in spine of scapula: a rare case report
Get PDFAneurysmal bone cyst is locally aggressive benign osteolytic lesion of the bone. It is more common in second decade of life with slight inclination to female gender. Metaphysis of long are most commonly affected. Incidence in flat-bones is <2% especially in scapula. We present a rare case of aneurysmal bone cyst of scapula with atypical radiological finding that was confirmed with pathological correlation. A 45 years old female, right hand dominant, presented with 3 months old swelling over left shoulder. There was painful restriction of terminal shoulder range of movements. On examination the swelling was 8×7 cm cystic, non-trans illuminant, fixed to scapula, no neurovascular deficit. X-ray shown eccentric lytic lesion over the supraspinous fossa with relatively more prominent soft tissue shadow. MRI image shown well defined cystic swelling with fluid filled level, lacking septations. Excision and extended curettage of lesion revealed hematogenous fluid as content. Histopathology confirmed aneurysmal bone cyst. Our case presented with all atypical features of ABC with regards to age, location and imaging. High degree of clinical suspicion and ruling out other closest possibilities like telanectatic osteosarcoma is necessary when cystic swelling around the scapula is encountered. Excision and extended curettage of the lesion is satisfactory. Periodic follow up with MRI and long-term clinical assessment for recurrence is needed.
A rapidly advancing intraosseous angiosarcoma masquerading as an infected pathological periprosthetic fracture: a case report
Get PDFWe present a case of a rapidly progressive angiosarcoma that presented initially as a pathological fracture in our institution after a fall. Mdm A, a 74-year-old Chinese lady initially presented with non-specific thigh pain prior to an unwitnessed fall, following a recent bipolar hemiarthroplasty 3 months before current presentation. Blood markers were grossly within acceptable limits and computed tomography (CT) scan revealed displaced greater and lesser trochanteric periprosthetic fractures with subsidence of femoral stem, and findings suggestive of intramuscular haematomas. She subsequently turned septic on day of planned surgery for a revision arthroplasty with markedly raised inflammatory markers. Revision surgery was postponed, with repeat imaging noting evolving fluid collections suspicious of an infected prosthetic joint infection (PJI). Joint washout for presumptive PJI performed 1-week later yielded negative histopathology and cultures. She developed respiratory compromise a few days later. CT-thorax revealed bilateral pleural effusions with small spontaneous haemo-pneumothoraces which again yielded negative cultures and cytology. Eventually a repeat CT-hip 1-month post admission showed new soft tissue lesions in the superficial muscle layers. Biopsies performed returned as intermediate grade angiosarcoma with positive CD31 and ERG stainings. This is the first case study to describe an aggressive metastatic angiosarcoma mimicking a PJI on initial presentation. Angiosarcomas are very rare and presentations may also be highly varied. Diagnosis of angiosarcoma may be made difficult by the absence of clear lesions to biopsy, as in this particular case. A high clinical suspicion of a pathological periprosthetic fracture is needed when diagnosing patients who present atypically for PJIs
Holistic approach to managing acute soft tissue injury: PEACE and LOVE protocol-observational research
Get PDFBackground: Soft tissue injuries such as sprains, strains and contusions are common in football and the initial response to these injuries plays a crucial role in recovery. Traditional methods like R.I.C.E. (rest, ice, compression, elevation) have been widely used since their introduction in 1978. However, recent evidence suggests that these methods may not support optimal tissue healing, leading to the development of the P.E.A.C.E. (protection, elevation, avoid anti-inflammatories, compression, education) & L.O.V.E. (load, optimism, vascularization, exercise) protocol, which emphasizes natural healing processes without the use of anti-inflammatory treatments. This study aims to analyze the recurrence of injuries and the remedial management strategies used by footballers, promoting awareness of the P.E.A.C.E. & L.O.V.E. principle for better injury outcomes.
Methods: This was a survey-based observational study involving 200 footballers aged 18 to 35, playing at different levels in Lucknow football academies and clubs. Data were collected using a self-made questionnaire comprising questions about football-related injuries and their management. Statistical analysis was performed using MS Excel (v2019) and SPSS (v26.0).
Results: Injury recurrence: 76.5% experienced more than one recurrence, while 24.5% had a single recurrence. Immediate treatment strategies: 59.5% followed R.I.C.E., 30.5% used P.R.I.C.E. and 9.5% followed P.O.L.I.C.E. Awareness of P.E.A.C.E. & L.O.V.E.: 88% were unaware, while only 12% were aware of the principle. Perceived study impact: 96.5% of participants found this study informative.
Conclusions: The study revealed that 88% of footballers lacked awareness of the P.E.A.C.E. & L.O.V.E. principle, which highlights the need for educating athletes about its benefits for optimal recovery and injury prevention. Incorporating these updated guidelines can reduce the recurrence of injuries and enhance long-term outcomes
Large osteochondroma excision from distal radius
Get PDFOsteochondroma is a common benign bone tumor, originating within the periosteum as a small cartilaginous nodule. The distal femur, the proximal tibia, and the proximal humerus are the most common locations and the majority of these lesions cause no symptoms and are discovered incidentally. We present a rare solitary large (approx. 11 cm long) osteochondroma originating from the ventral aspect of the distal end of the radius with mechanical restriction of movement of the wrist joint in an 8-year-old female patient. The biopsy is suggestive of benign chondro-osseous neoplasm favoring the diagnosis of osteochondroma. Surgical intervention with the excision of the osteochondroma of the distal radius was performed and thereby the symptoms showed a complete resolution.
A study on functional outcomes of ‘Joshi’s external stabilization system distractor’ in the correction of deformities in neglected, resistant or relapsed cases of congenital talipes equinovarus
Get PDFEarly intervention by an optimal treatment modality in the management of congenital talipes equinovarus (CTEV) or club foot is of paramount importance in order to preserve the functional efficacy of foot. Neglected, resistant, or relapsed cases of clubfeet are even more challenging to treat, as with time the deformities become fixed and the feet develops secondary adaptive bony changes. Joshi’s external stabilization system (JESS) distractor is an effective treatment modality for such kind of deformities with a precise viability and efficacy. This case series study was conducted to evaluate the functional outcomes of JESS distractor in the correction of the deformities in neglected, resistant or relapsed cases of CTEV and to assess the complications associated with the procedure. Total 22 club feet (15 patients) included in this case series considering inclusion and exclusion criteria. JESS distractor was applied and distraction done as per distraction schedule, followed by its removal and corrective cast application. Functional outcome was based on the Pirani score with one year follow-up. The statistically significant (p value <0.05) improvement was found in all clinical and radiological parameters after the procedure in all the post-operative patients. Pirani score improved to good score (0-2) in comparison to its pre-operative poor score (5-6) without any significant complication. Considering the parents compliance, JESS distractor is a good alternative for neglected, resistant or relapse cases of club feet, as it avoids soft tissue as well as bony procedures to correct the deformity of CTEV while preserving the normal foot anatomy
Functional and radiological outcomes of Essex-Lopresti procedure in intra-articular calcaneal fractures: a prospective study
Get PDFBackground: Calcaneal fractures are among the most common tarsal bone injuries, often leading to significant morbidity. The Essex-Lopresti procedure is a minimally invasive surgical technique used to treat intra-articular fractures of the calcaneum. Objective of the study was to evaluate the functional and radiological outcomes of the Essex-Lopresti procedure in patients with intra-articular calcaneal fractures and assess post-operative pain relief and complication rates.
Methods: A hospital-based prospective study was conducted at tertiary care centre, Jaipur, on 85 patients. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, while radiological outcomes were evaluated using Bohler’s angle.
Results: The mean preoperative Bohler’s angle (15.19°) improved to 29.55° postoperatively and stabilized at 27.38° at the 6-month follow-up. The AOFAS score improved significantly from 47.56 preoperatively to 87.38 at 6 months. The mean Visual Analog Scale (VAS) score decreased from 7.53 preoperatively to 0.54 postoperatively, indicating significant pain relief.
Conclusions: The Essex-Lopresti procedure is an effective treatment for intra-articular calcaneal fractures, achieving favorable functional and radiological outcomes with minimal complications
Paralytic sciatica revealing a thigh hematoma: a case report
Get PDFAuthors report the case of a 27-year-old man, on fondaparinux for prophylaxis, who presented to the emergency department with acute, paralyzing, painful sciatica of the left lower limb, following minor trauma. Clinical examination, combined with angio-computed tomography (angio-CT), revealed a voluminous compressive hematoma in the posterior compartment of the thigh, probably of muscular origin. The patient underwent emergency surgical evacuation, during which approximately one liter of hematoma was removed. The postoperative course was favorable, and appropriate rehabilitation led to full neurological recovery within 12 months. This case highlights the importance of considering a compressive hematoma in the differential diagnosis of sciatic paralysis following trauma, however minimal, particularly in patients on anticoagulants. It also highlights the crucial role of early diagnosis and multidisciplinary management