Indian Journal of Orthopaedics最新文献

{"title":"Nonunion of Fractures: A Review of Epidemiology, Diagnosis, and Clinical Features in Recent Literature","authors":"Eman Gharu, Bobby John","doi":"10.1007/s43465-024-01249-6","DOIUrl":"https://doi.org/10.1007/s43465-024-01249-6","url":null,"abstract":"<p>Understanding the etiology of nonunion is crucial to its effective management. Nonunion arises from a complex interplay of biological and mechanical factors. High-velocity injuries, which are becoming more prevalent, often involve extensive soft-tissue damage and stripping compromises the vascularity of bone fragments. The lack of adequate blood supply hampers the healing process and contributes to persistence of nonunion. Such injuries often result in high levels of contamination and persistent infections, making fractures particularly difficult to manage and leading to nonunion. Despite recent advances in medical techniques and interventions, managing the problem of nonunion still remains a formidable challenge. Much effort has gone into the understanding of the problem. With this review, we have made an attempt to correlate some of the known factors and looked at the future including the possible role of genetics in predicting the problem and modifying the outcome of nonunion.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location of the Anatomic Footprint Centers of the Anterior Cruciate Ligament Determined by Quadrant Method on Three-Dimensional Magnetic Resonance Imaging","authors":"Vũ Tú Nam, Võ Sỹ Quyền Năng, Phạm Trung Hiếu, Hồ Ngọc Minh, Phan Bá Quỳnh, Trần Trung Dũng, Dương Đình Toàn","doi":"10.1007/s43465-024-01234-z","DOIUrl":"https://doi.org/10.1007/s43465-024-01234-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The quadrant method is widely used to determine the femoral footprint center (FFC) on radiographs or computed tomography (CT) and can also describe the tibial footprint center (TFC). However, its application on three-dimensional (3D) magnetic resonance imaging (MRI) has been limited. This study aims to describe the ACL footprint center position on 3D MRI of healthy knees using the quadrant method.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Proton density (PD) sequence 3D MRI was conducted on 45 intact knees, aged 18 to 45 years. The centers of the ACL footprints were determined, and 2D simulated radiographic images were generated from the 3D MRI data. The quadrant method was then applied to calculate the positions of the footprint centers.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The FFC was located at 31.6% in the deep–shallow (DS) direction and 31.3% in the high–low (HL) direction. The TFC was positioned at 45.1% in the mediolateral (ML) direction and 39.9% in the anteroposterior (AP) direction.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The ACL footprint centers identified in this study were positioned similarly to previous studies, with the exception of the TFC in the ML direction, which was found to be more medial. This approach has the potential to enhance preoperative planning and intra-operative navigation in ACL reconstruction surgeries.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a Surgical Vulnerability Score Predict Outcomes of Hip Reconstruction in Children with Severe Neuromuscular Disability?","authors":"Alistair Bevan, Stephanie Buchan, Alexander Aarvold, Simon Bennet, Darius Rad, Nick Le Prevost, Caroline Edwards","doi":"10.1007/s43465-024-01257-6","DOIUrl":"https://doi.org/10.1007/s43465-024-01257-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Hip surgery is often necessary for children with severe neuromuscular disabilities to avoid chronic pain resulting from hip migration. This study correlated the Surgical Vulnerability Score (SVS), a novel measure of physiological reserve, with reconstructive hip surgery outcomes to improve shared surgical decision-making.</p><h3 data-test=\"abstract-sub-heading\">Materials and methods</h3><p>Sixty-eight cases performed by a single surgeon were retrospectively evaluated. Cases were graded according to physiological vulnerability using the SVS, which was then correlated with two outcomes: length of hospital stay (LOS) and severity of postoperative complications. The Gross Motor Function Classification System (GMFCS) level was used as a baseline comparison. Sub-analysis compared results for patients who underwent only a femoral varus derotation osteotomy (VDRO) (<i>n</i> = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) (<i>n</i> = 20).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Results showed that a higher SVS was associated with increased LOS (<i>p </i>= 0.001) and severity of postoperative complications (<i>p</i> = 0.0008). A greater GMFCS level was not associated with either LOS (<i>p</i> = 0.246) or the severity of postoperative complications (<i>p</i> = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS (<i>p</i> = 0.483) or severity of complications (<i>p</i> = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS (<i>p</i> = 0.0002) and severity of complications (<i>p</i> = 0.0001).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The SVS can aid surgical decision-making and prepare the child’s family for surgery. Early intervention and fixation using only a VDRO may lead to better outcomes, underscoring the importance of hip surveillance programs in the early identification of migrating hips.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modern-Day Algorithm for the Treatment of Multi-Ligament Knee Injuries","authors":"Fidelius von Rehlingen-Prinz, Sebastian Rilk, Victor Beckers, Robert O’Brien, Gregory S. DiFelice","doi":"10.1007/s43465-024-01252-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01252-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Multiligament knee injuries (MLKI) are rare and complex, significantly impacting long-term outcomes, with risks of osteoarthritis, joint stiffness, and reduced activity levels.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To explore the evolution of MLKI treatment protocols, comparing historical and modern approaches, and to present a patient-tailored, preservation-first algorithm.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This article reviews the literature on MLKI management, focusing on surgical timing, techniques, and rehabilitation protocols. The proposed algorithm categorizes MLKIs based on tear location and tissue quality, incorporating options, such as primary ligament repair, augmentation, and reconstruction.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The modern preservation-first algorithm provides a tailored approach to MLKI treatment, addressing the complexity and heterogeneity of these injuries, and aims to mitigate risks like postoperative arthrofibrosis.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>MLKI management remains complex and controversial. The presented algorithm offers a structured, individualized treatment strategy that integrates modern surgical and rehabilitation advancements.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mini-LET: A Technique Note","authors":"Manit Arora, Tapish Shukla, Jay Shah","doi":"10.1007/s43465-024-01269-2","DOIUrl":"https://doi.org/10.1007/s43465-024-01269-2","url":null,"abstract":"<p>Lateral extra-articular tenodesis (LET) has shown an upswing in popularity since the role of antero-lateral rotatory instability (ALRI) in ACL tears has become better understood. Its primary aim is to restore antero-lateral rotatory stability and hence reduce stresses placed on the ACL graft in high-risk individuals which should reduce graft failure rates. Many techniques have been described for LET using a variety of fixation methods (screws, anchors, etc.). Most of these techniques rely on a large incision laterally. We describe a novel technique (‘mini-LET’) which uses a 3–4 cm incision, to improve cosmesis.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Nitinol Continuous Compression Implants in Orthopaedic Trauma","authors":"Dylan Mistry, Usama Rahman, Chetan Khatri, William Carlos, Alastair Stephens, Bryan Riemer, Jayne Ward","doi":"10.1007/s43465-024-01253-w","DOIUrl":"https://doi.org/10.1007/s43465-024-01253-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Continuous compression implants (CCIs) can provide continuous compression across a fracture site. They are mainly used in foot/ankle surgery, with very limited descriptions in the literature of their potential for trauma. The aim of this study was to describe the use and associated outcomes of CCIs in modern day trauma practice.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This was a single-centred case series with a retrospective analysis of a prospectively maintained database of any patients who were treated with a CCI across 4 years. The primary outcome was to determine the mode of the CCIs and secondary outcomes were unplanned returns to theatre.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>60 patients were eligible with a mean age of 44.2 and 122 CCIs were used. 51 patients were treated for acute fractures, 9 were treated for non-unions, and 27 patients had open injuries. 42 of the 122 CCIs were used as definitive fixation (midfoot dislocations, an iliac wing fixation and isolated medial malleolus fixation), and the rest as adjuncts for fixation; of this remainder, 39 were used in reduction mode, 38 for fixation of key fragments, and 3 for compression. Ten patients returned to theatre, two for metalwork failure, two for infection and 6 for non-unions—three were acute fractures and three originally non-unions.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This paper demonstrates a novel technique for the use of CCIs in UK trauma practice as either definitive fixations or in three different modes as adjuncts to fixation. They do not replace tradition implants but do have equivalent rates of complications. They may be a useful tool in the arsenal for trauma surgeons.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined AMRI and ALRI of the Knee in Elite Kabaddi Players: A Prospective Cohort Study of 26 Players","authors":"Manit Arora, Ananya Sharma, Tapish Shukla, Jay Shah","doi":"10.1007/s43465-024-01268-3","DOIUrl":"https://doi.org/10.1007/s43465-024-01268-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>ACL tears are the most common injuries in kabaddi, an inherently violent high pivoting and high-velocity direct contact sport. Combined ACL and MCL injuries and combined ACL and ALL injuries have been better understood but there is a lacuna of literature on these combined injuries in kabaddi players and no literature on combined AMRI and ALRI injuries. The present prospective cohort study aims to assess knee outcomes and return to sport for these injuries in elite kabaddi players.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A prospective cohort of 26 elite kabaddi players with clinical and MRI findings of ACL and MCL high-grade partial or complete tears were recruited. After ACL reconstruction and MCL repair, the resultant pivot shift was assessed against the now intact medial pillar and those with high-grade or explosive pivot were addressed using a modified deep Lemaire lateral extra-articular tenodesis. Pain scores (VAS) and knee outcomes (IKDC and Lysholm scores) were assessed pre-operatively and at regular intervals until 1-year follow-up. Return to sport and complications were also assessed.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>There was significant improvement in pain and knee scores throughout the study period, with most patients achieving full scores by six months duration. Return to sport was 96% and return to sport at pre-injury level was 77%. Complication rate of the combined triple procedure was low (&lt; 5%), with most complications being minor.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The triple procedure of ACL reconstruction, MCL repair and Lateral extraarticular tenodesis successfully addressed the combined AMRI and ALRI in elite kabaddi players with a high rate of return to sport, excellent knee outcomes and low complication rate.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Limb Length and Body Weight are Surrogate Predictors of Peroneus Longus Autograft Diameter","authors":"Manit Arora, Sachin Tapasvi, Tapish Shukla, Chiranjeev Jani","doi":"10.1007/s43465-024-01266-5","DOIUrl":"https://doi.org/10.1007/s43465-024-01266-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Graft diameters are essential in any ACL surgery, with diameters less than 8mm associated with higher revision rates. Peroneus longus (PL) grafts have garnered much attention recently due to ease of harvest and more reliable graft diameters. The present study aimed to study various anthropometric parameters associated with PL-graft diameters.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We performed a prospective cohort study of 50 patients undergoing PL harvest for ACL surgery at a tertiary referral hospital. Age, gender, height, weight, length of the lower leg (lateral tibial plateau to the tip of the fibula), circumference at the head of the fibula and girth at the lateral malleolus were measured pre-operatively. The length of the graft doubled and tripled graft diameters were assessed intra-operatively. Pearson correlation coefficient was used to study the association between the pre-operative anthropometric variables and the intra-operative graft diameters and length of graft harvested.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The mean doubled and tripled PL-graft diameter in our study population was 7.7 ± 0.9 mm and 8.7 ± 0.8 mm, respectively. The mean length of the graft was 25.9 ± 3.5 cm. We found no significant correlation between graft diameters and age, gender or height of the patient. We found that the patient's weight significantly correlated (<i>p</i> &lt; 0.001) with graft diameter. We also found that the length of the lower leg (<i>p</i> &lt; 0.0001), circumference at the head of the fibula (<i>p</i> = 0.001) and girth at the lateral malleolus (<i>p</i> = 0.029) showed significant correlation with tripled PL-graft diameter.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>We found that weight, length of the lower leg and girth at the head of the fibula showed a strong correlation with tripled PL-graft diameter.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Hydatid Cyst of Entire Right Femur with Pathological Fracture: Total Femur Replacement Case Report","authors":"Hemant Sharma, Lokesh Garg, Rajesh Kumar Verma, Asgar Ali, Lovesh Agarwal, Guruditta Khurana, Lalit Kumar, Sourabh Chachan, Jasmine Kokiloo, Nikita Jajodia","doi":"10.1007/s43465-024-01226-z","DOIUrl":"https://doi.org/10.1007/s43465-024-01226-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Hydatid disease is uncommon in Humans. It rarely affects the bones and joints (0.5–4%). Frequent sites of bony involvement are vertebrae, pelvic bones, upper end of long bones e.g. humerus, femur and tibia.</p><h3 data-test=\"abstract-sub-heading\">Material and methods</h3><p>We report a case of 41-year old female with primary Hydatid cyst of the entire right femur. Patient complaint of severe pain and was non ambulatory since the last 2 months.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Here, single staged Total Right Femur Replacement was done under General Anaesthesia. Patient was discharged after 6 days of hospital stay in a stable condition where physical rehabilitation was initiated after day one of the surgery, progressing to aided walking, standing and active lower limb exercises.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Involvement of the entire femur was a challenging case. There is no consensus/gold standard treatment of severe cases. Given the involvement of the entire Right Femur along with spillage in the neighbouring muscles, patient underwent Total Femur Replacement with Hip and Knee Replacement.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Morbidity due to Sterile Zone Fire Outbreak during an Orthopaedic Trauma Surgery: A Case Report","authors":"Nishit Palo, Mahima Lakhanpal, Madhan Jeyaraman, Abhishek Shukla","doi":"10.1007/s43465-024-01264-7","DOIUrl":"https://doi.org/10.1007/s43465-024-01264-7","url":null,"abstract":"<p>Operating room fires are considered ‘never events’; they are uncommon but can prove to be potentially damaging to the humans involved and the expensive operating room instrumentation. Research indicates that significant knowledge gaps exist in orthopaedic community relating to fire prevention, fire safety and fire management. A 24-year-old male patient with clavicle fracture was planned for surgical fixation. A nerve block procedure was performed. Skin preparation was done with 10% betadine scrub and surgical spirit. The surgical team performed skin incision, and superficial dissection was carried out using electrocautery. A fire broke out, and on noticing the fumes, saline was poured, drapes were removed and the authors observed charring of deeper linen and skin damage. A superficial thermal burn, greenish blue in colour (7 x 1.5 cms) located 1–1.5 cms above the surgical incision was evident (see Fig. 4). The event was later explained to the patient. The surgical scar was healthy, and burn margins became defined and darkish green blue. Dressing was done with megaheal ointment. The burn healed in 4 weeks. As these events are rare, a specific action protocol has not been orchestrated. With newer reports coming in, orthopaedic associations should work out a sustainable plan of action to minimize the occurrence of these events and the damage incurred. Training of orthopaedic and anaesthesia team and operating room personnel remains the most important step in countering a fire event, as more the helping hands, the better is the outcome. Maintaining a high vigil ensures timely action response to maintain patient safety and counter adverse events effectively.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}