The Internet Journal of Orthopedic Surgery最新文献

{"title":"Neglected Isolated Fracture Of The Trochlea- A Case Report.","authors":"Sheikh Irfan Bashir, A. Manan, M. Beigh, A. Hanan, R. Sharma","doi":"10.5580/20b2","DOIUrl":"https://doi.org/10.5580/20b2","url":null,"abstract":"Isolated shear fractures of the trochlea are also called Laugier’s fractures. Only a few cases have been reported so far. There is difference of opinion regarding mechanism of injury as well as in the treatment options. We report a case of a neglected fracture of the trochlea; we could not find a similar case reported so far in the literature. An Indian female belonging to the lower socioeconomic group presented 3 months after injury to her elbow with complaints of restricted painful movements of the elbow. Fracture of the trochlea was diagnosed on the radiograph. The patient was thoroughly counselled and surgery was done with excision of the trochlea as the cartilagionous portion was showing degeneration. The post-operative status was improved with increased range of motion and a stable painless elbow. We consider the excision of the degenerated fragment to be a better option for such neglected cases where socioeconomic restraints limit any reconstructive surgery.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125789863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous Nucleus Pulposus Attracts Monocytes In Vivo In A Pig Model. Implications For The Pathophysiology Of Sciatica.","authors":"M. Neumann, K. Olmarker","doi":"10.5580/1aa4","DOIUrl":"https://doi.org/10.5580/1aa4","url":null,"abstract":"Previous experimental studies have indicated that that an autoimmune reaction towards herniated nucleus pulposus may constitute a pathogenetic component in the pathophysiology of sciatica. If an autoimmune reaction would be present, one would expect that exposure of nucleus pulposus to the host would induce an up regulation of antigen-presenting cells, such as monocytes. Autologous nucleus pulposus was placed in perforated titanium chambers, which were placed subcutaneously in pigs, together with an equal amount of empty chambers for control. After 7 days, the chambers were harvested and the number of monocytes in the chambers was determined using flow cytometry. The proportion of monocytes was significantly higher in the nucleus pulposus filled chambers than in the empty chambers. In conclusion, nucleus pulposus was shown to attract monocytes, which may suggest that monocytes might play a role in the pathophysiology of sciatica.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"76 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132878127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Of Open Type IIIA And Type IIIB Fractures Tibia With LRS External Fixator","authors":"C. Vijay, L. MahendraKumarK, N. ManjappaC","doi":"10.5580/23a","DOIUrl":"https://doi.org/10.5580/23a","url":null,"abstract":"Back ground: The specific method of skeletal fixation and soft tissue management in open fracture of tibia, one of the common fracture continues to be a topic of debate in orthopedic traumatology. The current study was done with an objective to assess the role of LRS external fixator in the management of open type IIIA and type IIIB fractures of the tibia.Materials and method: Out of the total 157 cases of open fractures of tibia encountered during the study period, 45 cases belonged to type IIIA and IIIB were treated by primary wound debridement and fracture stabilization with LRS external fixator. The surgery was aimed at achieving anatomical reduction, stable fixation and early soft tissue coverage to allow early mobilization. Average duration of the use of external fixator was 24 weeks. Using the principle of compression distraction osteogenesis, fracture union was enhanced by doing compression and distraction at the rate of 1 mm for every 10 days alternatively. Regular follow up done and the cases were assessed as per modified Andersons and Hutchins criteria. Additional procedures like bone grafting fibular osteotomy were performed for few patients.Results: Overall 90% of the fractures united well. While good to excellent results were seen in 28 cases amounting to 72%, moderate and poor results were observed in 18% and 10% of the cases respectively.Conclusion: The method of management using the LRS external fixator was found to be simple and effective for fracture stabilization in terms of easy access to soft tissue care, enable fracture union, early return to function and can be considered as an alternative choice fixation for type IIIA and type IIIB fracture both bone of leg with bone loss which lessens the economical burden and those patient not willing to undergo multiple procedures.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121321674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Current Review Of Outcome Studies On The Dynesys® System For Dynamic Stabilization Of The Lumbar Spine","authors":"D. Berman","doi":"10.5580/ab3","DOIUrl":"https://doi.org/10.5580/ab3","url":null,"abstract":"The current article reviews the literature on the effectiveness of the Dynesys® system of dynamic lumbar spine stabilization from 2008-2010, updating the review conducted by the UK National Institute for Clinical Excellence in 2009. A systematic search was conducted using PubMed, MEDLINE, and The Cochrane Library for studies including pain and/or disability as outcome measures, yielding 13 studies. While the results of earlier studies question the advantage of the Dynesys® system, the most studies, with follow-ups as long as 52 months, reported significant, positive changes in pain and disability. These results are limited by the predominant use of case studies. The Dynesys® system is designed for the dynamic stabilization of the lumbar spine to improve stability of the spine while lessening pain and disability without the rigid fixation found in more traditional systems. While the Dynesys® system uses a traditional pedicle-based system of screws, what makes it different is that it maintains anatomical features of the lumbar spine and uses flexible materials between the pedicles. Designed and developed in France, the Dynesys® system was first implanted in 1994. 1 Some facilities, like the Orthopaedic Clinic of the S. Chiara Hospital in Pisa, Italy, have been using this system since 1999. 2 The Dynesys® system has been used worldwide in more than 40,000 surgeries. 3 A recent overview of this system is provided by Schwarzenbach and Berlemann. 4 A comprehensive review of the literature on the Dynesys® system was conducted by the National Institute for Clinical Excellence (NICE) of the National Health Service (NHS) in the United Kingdom. 5 They were unable to find any previously published reviews of the literature. This 2009 report by the NICE Interventional Procedures Program reviewed the literature on the effectiveness and safety of the Dynesys® interventional procedure of non-rigid stabilization techniques for the treatment of low back pain. This document reviewed outcome studies that included a total of 743 patients from 4 non-randomized comparative studies and 3 case series. The publication dates for these studies were, with one exception, from 2001 – 2007. The exception was one study published in 2009. Outcome measures for the reviewed studies included range of motion (ROM) and further disc deterioration, with follow-up data as long as 75 months. They also looked at patient reported outcomes such as pain, quality of life, disability, and satisfaction. Safety of the Dynesys® system was also reviewed. The review conducted by the NICE Interventional Procedures Program formed the basis for the NHS 2010 Interventional Procedure Consultation Document 6 recommendations which concluded that Dynesys®, as a dymanic stabilization technique for some patients with intractable lumbar pain is both safe and efficacious. This cleared the way for spinal surgeons in the UK to offer Dynesys® as one of a range of treatment options. The purpose of the current articl","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116365893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Foreign Body (Bone) In An Open Fracture Of The Femur- A Rare Case Report","authors":"N. S. Gudi, V. Chaudhary","doi":"10.5580/1b68","DOIUrl":"https://doi.org/10.5580/1b68","url":null,"abstract":"Loss of bone following open fractures is common. Most often bone is lost on the road side and become unusable. The gap so formed also becomes a problem during management.We present a case report of a patient who had an open femur fracture with bony fragments embedded in the soft tissue of thigh and another patient with type III C fracture of the distal 1/3 of the right femur with bone loss and vascular injury. Both patients had history of RTA between collision of two 2wheelers resulting in these two victims with open injuries","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123866839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role Of Histopathology In Lytic Lesions Of Bone – A Study Of Seventy Cases Of Lytic LesionOf Bone.","authors":"V. Popat, Vijay R. Sata, Deval N Vora, V. Bhanvadia, M. H. Shah, L. N. Kanara","doi":"10.5580/beb","DOIUrl":"https://doi.org/10.5580/beb","url":null,"abstract":"Aims: Histopathogical study of lytic lesions of bone with evaluation of types and occurrence ofdifferent lesions with correlation in different age and sex. Material & method: A study of 70 cases of lytic lesion of bone was carried out during two years duration (January 2008 to December 2009).Result: In our study, out of 70 cases of lytic lesion of bone, 24 cases were of inflammatorylesions, 30 cases were of benign tumors, 6 cases of Primary malignant bone tumours and 10cases of metastatic lytic lesions were found. Most of the patients belonged to the middle agegroup with the age incidence varying with the type of lesion. Out of these 70 cases, 46 weremales and 24 were females. The lytic lesions occur more commonly in the males within the agegroup of 11-20 years. Conclusion: Benign tumors are more common amongst all lytic lesions with giant cell tumour ranking first in benign tumors. Tuberculous osteomyelitis is more common than pyogenic osteomyelitis. Secondaries in the bone are a more frequent finding than primary malignant tumors. The present study was carried out in the Dept. Of Histopathology & Radiology, M. P. Shah medical college, Jamnagar, Gujarat state of India and cases were referred from Dept. of Orthopaedics. Of G. G. Hospital, M. P. Shah Medical College, Jamnagar.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122569437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Biomechanical Study of the Stability of Titanium Elastic Nails in the Treatment of Oblique Segmental Fracture of the Femur in Children","authors":"A. Abosala, D. Westacott, J. Cunningham","doi":"10.5580/2169","DOIUrl":"https://doi.org/10.5580/2169","url":null,"abstract":"Purpose Titanium elastic nails are widely used in the treatment of femoral shaft fractures in children. The standard technique employs the retrograde insertion of two curved nails, with the apex of the curve at the fracture site. This study examines the biomechanical stability of this configuration of titanium elastic nails in segmental femoral fractures, an injury which is often highenergy and therefore inherently unstable. The stability of a new nailing technique is also tested, using an additional third nail inserted antegrade. Methods A model of a segmental femoral fracture was created in four synthetic femora. Two were fixed with the standard two retrograde nails and two with the third antegrade nail. A fifth was used as a control. Each was tested with axial, torsional and bending loads and the deflection measured. Result Minimal deviation of the models occurred under physiological loads in all forms of loading. There was statistically significant increased torsional and bending stiffness using the three-nail technique compared with the standard two-nail technique. Conclusion Titanium elastic nails in the standard two-nail retrograde system can provide a stable mechanical construct for the fixation of segmental femoral fracture. The use of a third nail inserted antegrade increased the stability in bending and torsion, however theoretically it carries a potential risk of splitting the femoral canal and creating subtrochantric fracture especially if the canal fill exceeds 80%. Accordingly we do not recommend the use of the three-nail system described in this study as a routine choice.Clinically Titanium elastic nail provide sufficient stability to avoid prolonged period in traction. Post-operative bed rest might be recommended to allow the development of early callus formation that further increase the stability of the fracture and allow weight bearing.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122634972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixation Of Compound Fractures Of Distal Tibia Using A Delta External Fixator As A Definite Modality Of Treatment With Or Without Fibular Plating/ Limited Internal Fixation With K- Wires.","authors":"A. Shikari, A. Wani, Kanav Padha, M. Bhatti, H. Dang","doi":"10.5580/e43","DOIUrl":"https://doi.org/10.5580/e43","url":null,"abstract":"Introduction : The goal was to evaluate the results of fixation of compound fractures of distal tibia using a delta external fixator and to analyse the results vis-à-vis functional outcome, soft tissue healing and fracture union. Compound fractures of distal tibia produce a challenge to manage, especially when associated with significant soft-tissue injury. Although a variety of options are available to treat these fractures, timing of definitive surgery is crucial with respect to the condition of the soft tissues. Despite the advances that have been made in managing these fractures, new developments in the field continue to lead to better outcomes. Ankle spanning external fixation has become the initial treatment of choice for complex tibial pilon fractures [1].Material: Between 2006 and 2010, 25 patients, three lost in follow up, net 22 (17 men and five women) with compound tibial fractures were treated with delta external fixator using a two staged protocol at the Department of Orthopaedics and Traumatology ,government medical college jammu. The average age of the patients was 35.5 years. The fractures, evaluated by the AO classification, included 14 AO43A2, 5 AO43C1, 1 AO43B3, 1 AO43C2,1 AO43C3.There were 5 type I, 9 type II, 6 type IIIa, 2 type IIIb open fractures according to the Gustilo-Anderson Classification [2]. In 13 patients the fracture was associated with multiple traumas and in 12 it was a single injury. The injury was due to a high-velocity motor vehicle accident in 18 and a fall in three patients. Method: All the patients were treated by debridement followed by Ankle spanning Delta external fixator, with or without fibular plating/ Kwire fixation of articular elements.All the patients were assessed clinically and radiographically for an average follow-up of 7.5 months using American Orthopaedic Foot and Ankle Society score (AOFAS). RESULTS: The evaluation, based on clinical and radiographic findings and subjective complaints of the patients, was made with the use of the American Orthopaedic Foot and Ankle Society score (AOFAS). 22 patients were followed up, three failed to turn up. AOFAS scoring: excellent in 81% (18/22).Average hospital stay: 28.6 days .Non union: one case, delayed union: two case.Mean time to union 5.5 months (3-16 months). Conclusion: Delta type of external fixator is a safe and useful modality in compound tibial fractures as definitive modality, however caution is advocated as cohort is short.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114338767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixation Of Compound Fractures Of Tibia By Intermedullary Nail After The Golden Period","authors":"Kanav Padha, Vikramadittya Singh, M. Bhatti, S. Bhat, Sudesh Sharma","doi":"10.5580/154c","DOIUrl":"https://doi.org/10.5580/154c","url":null,"abstract":"Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in compound fractures of the tibia becomes a formidable challenge in patients reaching the hospital late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.Thirty patients, having 30 compound fractures (10 Type II, 15 type III A and 5 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged six to eighteen months.Result: Overall infection rate noted was (n = 4) 13.3% (0% in II, 6.66%in IIIA and 6.66% in IIIB). Nonunion was seen in two fractures. Functional evaluation using Katenjian's criteria, showed 73% (22 fractures of 30) good to excellent results.Conclusion: Satisfactory results may be obtained in compound fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129075907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transdural Discectomy Lumbar Region: A retrospective series of 10 cases","authors":"Manjeet Singh, Nipun Kalsotra, Siddhartha Sharma, Dara Singh","doi":"10.5580/15a6","DOIUrl":"https://doi.org/10.5580/15a6","url":null,"abstract":"Over the past Ten years more than 500 Lumbar discectomies have been performed by the senior author through all standard methods, but only ten patients underwent Transdural disc excision. Seven males and three females in age group of 18 58 yrs were treated by this method. Six patients had PIVD at L4-L5 level, 3 at L5-S1 and one patient had PIVD at two levels L2-L3 and L3-L4.Results were evaluated by postoperative Frankel’s grading, relief from pain, sensory improvement, return of bowel and bladder functions and complications. We achieved excellent results as for as relief of sciatica was concerned. Full recovery in motor and sensory symptoms was observed in 80% (n = 8) cases. One patient of cauda-equina syndrome did not recover and one patient developed headache due to CSF leak.","PeriodicalId":322846,"journal":{"name":"The Internet Journal of Orthopedic Surgery","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115638191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}