Indian Journal of Orthopaedics Surgery最新文献

{"title":"Role of Bipolar hemiarthroplasty in geriatric patients with hip implant in failure","authors":"Sharath Nandi Kotresh, M. Katkar, S. Kumarjuvekar, Vishal Anand Mangwalkar, Mohit Arun Kakad","doi":"10.18231/j.ijos.2024.028","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.028","url":null,"abstract":": The incidence of different hip implants failing in situ, irrespective of the cause, is on the rise. On the other side, its management remains widely understudied. Bipolar hemi-arthroplasty contributes to the salvage of failed trochanteric fracture fixation. Managing such cases necessitates skills related to complex trauma and advanced arthroplasty. It is crucial for the surgeon to comprehend and individualize surgical modalities based on the patient, fracture, and implant.This case series presents three different cases involving three distinct implants undergoing failure and their management through Bipolar Hemi-arthroplasty.: Three previously operated hip fracture cases with three different implants in the elderly population presented with implant in situ failure. They were surgically managed with a cemented modular bipolar prosthesis. Following this, a postoperative protocol was maintained, and the postoperative outcome was graded using the Hip scoring system. Bipolar arthroplasty enhances the long-term outcome of hemiarthroplasty due to reduced wear of the metal–cartilage interface. It stands as a viable, valid, and sound surgical modality compared to other surgical and non-surgical options.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"9 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336009","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":"Can we treat idiopathic CTEV without tenotomy? A prospective study","authors":"Pandiyarajan E, Alok Chandra Agrawal, D. Garg, Santosh Kumar Yadav","doi":"10.18231/j.ijos.2024.018","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.018","url":null,"abstract":"Tendoachillis tenotomy is the procedure of choice to correct equinus deformity in Ponseti technique. Though Tenotomy is the most frequently done procedure, is associated with complications in 11% to 50% of cases. So, we were in search of an alternative which would have less complication and will give similar results to a standard tenotomy. One such method is Botulinum toxin type A injection into the gastronemius-soleus muscle which causes reversible paralysis of the muscle leading to lengthening of muscle unit, easy manipulation and casting. In our study, we compared the outcomes of Botulinum toxin with tenotomy in the correction of hindfoot equinus in children (<2>0.05) between the two groups in the post-intervention Pirani score and ankle dorsiflexion was seen at 3&6 weeks and 3,6,12 month post intervention. Average dorsiflexion was around 11±1º in both groups upto 1 year post intervention.Early results shows that Botulinum toxin type A is a good alternative to a routine tendoachillis tenotomy to correct hindfoot equinus in the management of clubfoot by the Ponseti method.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336270","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 study of risk factors for Pott’s disease","authors":"M. Katkar, Ajay Chandanwale, Shreyas Zad, Sandeep Deshpande, Vishal Anand Mangwalkar","doi":"10.18231/j.ijos.2024.020","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.020","url":null,"abstract":"Pott’s spine is caused by Mycobacterium tuberculosis, a slow growing gram-positive, acid-fast bacillus which becomes lodged in the bone via Batson’s venous plexus and lymphatic from primarily infected lung, lymph nodes, mediastinum and viscera, forming granulomatous inflammation and caseation necrosis. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Predisposing factors for tuberculosis include poverty, overcrowding, illiteracy, malnutrition, alcoholism, drug abuse, diabetes mellitus, immunosuppressive treatment, and HIV infection. These are also predisposing factors for spinal tuberculosis. Older age, female gender, chronic peritoneal dialysis, household crowding and previous tuberculous infection were identified as risk factors for Pott’s spine. (10G) Additionally, vitamin D deficiency has been linked to an increased risk of spinal bone loss and an increased risk of spinal fractures in individuals with Pott’s spine. : To identify and evaluate the risk factors for Pott’s spine. : Present study was prospective in nature conducted among 441 patients of Pott’s spine. All patients fulfilling inclusion criteria and exclusion criteria were taken up for the study. Study was carried out over a period of 3 years. Serum Vitamin D was assessed.: Majority of the patients was in the age group of 41-50 years and most of them were male. In this study, we found that age, socioeconomic status, employment, presence of comorbidities and BMI(<18) were associated with increased risk of pott’s spine.: This cross-sectional study investigates 441 cases of intervertebral disc degeneration leading to disc bulge/protrusion/extrusion, focusing on demographic, socioeconomic, and health-related factors. The majority of cases (31.82%) occurred in individuals aged 41-50 years, with females accounting for a larger proportion (54.55%) than males. Religious demographics revealed a prevalence of Muslims (45.57%) and Hindus (42.17%), with bilateral involvement common. A substantial portion of patients resided in slum areas (60.09%), reflecting socioeconomic disparities, with the majority (60.31%) belonging to the lower socioeconomic status. Most patients reported symptoms lasting less than 6 months (61.36%) and came from families with 5 or more members (85.48%). Addiction history (78.45%) and pre-existing co-morbidities (65.75%) were prevalent. Notably, no significant associations were found between serum Vitamin D levels and demographic factors. Among the employed, a significant proportion were unemployed (31.97%), underscoring socioeconomic challenges. These findings provide comprehensive insights into the multifaceted nature of intervertebral disc degeneration, crucial for informing targeted interventions and management strategies.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337354","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":"Extra-articular distal end radius fractures in elderly treated conservatively- functional outcome","authors":"Rohit Ranjolkar, Rajesh Sajjanshetty","doi":"10.18231/j.ijos.2024.022","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.022","url":null,"abstract":"An ageing population is associated with an increase in the frequency of distal radius fractures, an orthopaedic problem that affects many people. Orthopaedic surgeons have special concerns while treating some types of fractures, including those involving the distal end of the radius that occur outside of the joint. For this reason, we set out to compare the efficacy of conventional cast methods with that of percutaneous pinning in a sample of older adults. From June 1, 2021 to June 1, 2022, researchers from Bidar Institute of Medical Sciences, Bidar, conducted a prospective, randomised trial. Thirty patients underwent cast immobilisation and closure reduction. thirty-one patients underwent closed reduction with percutaneous K wires. The patients underwent a clinical examination and X-rays at each subsequent follow-up. The results showed that the group that had closed reduction K-wire fixation had greater range of motion, VAS scores, and loss of radial length compared to the other group. When looking at the Saito chart and Lindstrom's criterion findings for both groups, it was also evident of this. In 13% of patients, a pin tract infection developed following K-wire fixation but went away after the wires were removed. This was the sole serious side effect of the procedure. When treating displaced, distal end radius fractures, the best, safest, and most complication-free method is closed reduction with percutaneous K-wire fixation.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"6 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337222","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":"Clinical, radiological and functional outcome following surgical fixation of acetabular fractures","authors":"Senthil Narayanan Vanamail, Perumal Vanamail","doi":"10.18231/j.ijos.2024.021","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.021","url":null,"abstract":": Acetabular fractures are commonly caused by high-velocity injuries that can result from falls from heights or motor vehicle accidents. Surgical fixation has been found to result in improved clinical outcomes such as reduced pain, improved range of motion, and improved alignment and stability of the joint. Patients with pelvic injuries often have associated multiple systemic injuries, adding to the overall morbidity and mortality. Treating fractures in the pelvic area involving the acetabulum can be complicated, significantly when displaced. Proper exposure of the acetabulum and rigid internal fixation is necessary to achieve the main goals of treatment, which are to reconstruct the articular surface and promote early mobilization. Closed methods make it nearly impossible to restore the articular surfaces completely and obtain enough stability for early hip motion.: This study assesses the functional outcome of open surgical fixation of acetabulum fractures involving single or both columns. : Our study looked at patients over 18 years old with displaced fractures, and we treated them using only two approaches: the Kocher Langenbeck approach and the Modified Stoppa approach. Radiological and functional examinations were performed monthly for the first six months. Postoperative radiological assessments were graded using Matta's criteria, and functional outcomes were assessed using modified Merle d' Aubigné and Postel Hip Score.: We treated displaced acetabular fractures using only two non-extensile approaches: the Kocher Langenbeck approach and the Modified Stoppa approach. In most cases (67%), we used only one method, except in 7 patients. Our treatment achieved an impressive 85% rate of good to excellent outcomes (18 out of 21). Our study found that the delay in surgery time significantly impacted Merle d' Aubigne scores (P<0.05), leading to complications and lower functional outcomes in complicated cases. The functional and radiological outcomes were also significantly affected by the mechanism of injury, time between injury and surgery, initial degree of displacement, and quality of reduction. Surgical fixation of displaced acetabular fractures can yield better results with good imaging facilities, experienced surgeons, better instrumentation, and good perioperative care. However, further studies with an adequate sample size are needed to validate our findings. A study on the outcome of acetabular fractures treated surgically found that early surgical intervention and good perioperative care can lead to satisfactory functional outcomes. The study used only two non-extensile approaches and achieved an 85% rate of suitable to excellent outcomes. The study also observed that the mechanism of injury, time between injury and surgery, initial degree of displacement, and reduction quality significantly affected functional and radiological outcomes. However, further studies are needed to validate the findings.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"18 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336721","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":"MRI vs arthroscopy in the diagnosis of meniscal tears: A comparative study","authors":"Rajesh Sajjanshetty, Rohit Ranjolkar","doi":"10.18231/j.ijos.2024.023","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.023","url":null,"abstract":"The diagnostic accuracy of magnetic resonance imaging (MRI) for meniscal tears has not been adequately investigated, although it has been utilized extensively. By contrasting MRI results with arthroscopy findings, we hoped to gauge MRI's diagnostic precision.   Investigating the incidence of ACL and meniscal tears; establishing a correlation between arthroscopy and MRI findings by calculating the specificity, sensitivity, positive and negative predictive values (with arthroscopy highly esteemed); grading the degree of subluxation; and ascertaining the minimal quantity of fluid that ought to be present in the knee. The MRI of forty patients in the age range of twenty to forty years old and twelve arthroscopic correlations was evaluated in the year 2021-2022. In percentage form, the sensitivity, specificity, PPV, and NPV were calculated. For MM, the ACL results were 87.87, 81.57, 80.55, and 88.57, whereas for LM, they were 77.77, 81.81, 72.41, and 85.71. One patient had anterior tibial subluxation, which accounted for 35.6% of all cases. Joint fluid was seen in 201 cases when the suprapatellar pouch appeared laterally with internal disruption. Patients with ACL injuries should be carefully evaluated during arthroscopy since preoperative MRI has a limited diagnostic accuracy.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"1 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336267","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":"Outcome study of operative treatment of displaced intra-articular calcaneal fractures by sinus tarsi approach & extensile lateral approach","authors":"Raveendra Kumar, Z. Islam, Suresh Bora","doi":"10.18231/j.ijos.2024.024","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.024","url":null,"abstract":"Traditionally used extensile lateral approach for treatment of displaced intra- articular calcaneal fractures has reported high rate of soft tissue complications (30%). In attempt to lower the complication rates, various minimal invasive techniques were introduced likes Sinus tarsi approach etc. To study the clinical & functional outcome of operative treatment of displaced intra- articular calcaneal fractures by STA & ELA.This prospective study was conducted in a tertiary care teaching center for 1 year from July 2019 to June 2020 following clearance from institutional ethics committee (Human). Sander’s type 2 & 3 closed fracture included and open fractures, sander’s type 1 & 4, extra-articular fracture, severe osteoporotic bone and conditions affect the gait were excluded. 15 patients underwent STA and 15 patients underwent ELA. Clinico-radiological follow-up was done at 2, 6, 12 weeks and 6th month to assessed union, radiological outcome, functional outcome and complications. VAS for pain relief, AOFAS score for functional outcome.Most were working middle age male mainly due to fall from height and road traffic accidents. Sander’s type 2 and 3 were more common. STA had shorter operative time (54.20 ±4.48mins), less intra-operative blood loss (51.00 ±5.73ml) and less soft tissue complications (13.33%) compared to ELA (operative time = 70.80± 9.05mins, blood loss= 98.00 ±9.2ml, complications = 46.67%). Both groups had 100% union. STA had early pain relieved (at 6th weeks) but VAS score was similar in both groups at final outcome. No difference was observed in radiological parameters and AOFAS score at final follow-up.STA gives better result than ELA in operative treatment of sander’s type 2 and 3 calcaneal fractures.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"86 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337960","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 a Giant Cell tumors with megaprosthesis in a resource-limited setting","authors":"M. Augustus, Allan Ali, Allan Beharry, David Armorer, Derrick Lousaing","doi":"10.18231/j.ijos.2024.031","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.031","url":null,"abstract":"Giant Cell Tumors (GCTs) of bone are primary bone tumors that are benign. They are biologically aggressive and have metastatic potential after malignant transformation. There have been several cases of GCTs described in the medical literature. The management of juxta-articular GCTs in the young population is one of the greatest challenges in orthopaedic oncology. Amputations were once the standard treatment for malignant bone tumours. Advances in orthopaedic surgical techniques and bioengineering have made limb-sparing surgery a viable treatment option. Limb- salvage surgery is considered safe and is routinely undertaken for 90% of cases of bone tumors. The advances in orthopaedic surgical techniques and bioengineering of prosthesis have made this a viable option for these complex cases.Staging is performed using the Campanacci Radiographic Classification System and this is based on the radiological findings of the GCT. This staging system is used to guide the planning of the initial surgical management. Campanacci Stage III GCTs are aggressive lesions thus En bloc resection and reconstruction have been proposed as the choice of treatment. This is done with the goal of joint preservation as well as reducing the risk of recurrence. This case report highlights the challenges in the management of a Campanacci Grade III GCT of the distal femur. A mega prosthesis or endoprosthesis is a viable first-line treatment for oncological patients with significant bone and soft tissue loss. Oncological clearance was achieved then by the customized megaprosthesis was assembled and set in place. Procurement of this custom-made megaprosthesis during the COVID-19 pandemic was particularly challenging.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"85 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337963","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 rare presentation of mid shaft humerus fracture with axillary artery & brachial artery traumatic thrombus with brachial plexus palsy","authors":"Prabhakar Ganeshraj, Nalini Rajapandian","doi":"10.18231/j.ijos.2024.030","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.030","url":null,"abstract":"Humerus fractures account for 3% of all orthopaedic injuries and are common among adult population following trauma. With high velocity trauma we witness associated injury to nearby vessels, nerves or both. We present a rare case of mid shaft humerus fracture associated with brachial artery, axillary artery and brachial plexus injury, sustained at work place while operating the heavy hydraulic door of a lorry. Emergency CT-angio was done and site of vascular injury was identified, following which patient was taken up for surgery. Fracture was first fixed by open reduction and internal fixation (ORIF) through anterolateral approach with locking plate and it was followed by vascular reverse saphenous vein bypass graft from axillary artery to distal brachial artery through a median approach.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"4 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141336031","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":"The Kapandji pinning: Technique of closed reduction for distal end radius fracture in adults","authors":"Nibin Sanil, Alvin Sajan","doi":"10.18231/j.ijos.2024.025","DOIUrl":"https://doi.org/10.18231/j.ijos.2024.025","url":null,"abstract":": Fractures of the distal end of radius are characterized by varying degrees of comminution with volar or dorsal displacement, articular depression and angulation of major fragments with or without involvement of joints. The technique that has been discussed most frequently is the intrafocal (Kapandji) technique. Initially the technique was described using two pins for unstable extra-articular fractures in younger adults. The indications have since been expanded to include fractures with minimally displaced intra-articular fragments and use of third pin dorsoulnarly.: 40 adults with distal radius fracture admitted to Sanjay Gandhi institute of trauma and orthopaedics. All patients will be evaluated at 4, 6 weeks intervals and once at 3 months post operatively and final outcome assessments at 3 months. For functional evaluation, the modified Gartland and Werley demerit point system. The results were evaluated as per Sarmiento’s Modification of Lindstrom criteria. Restoration of anatomy was excellent in 71.8% (28.75) and 23.75% (9.5) had good anatomical outcome while 3.75% (1.5) had fair results. 40(n=sample size) were included in the study to analyse the articular angles. The mean value of radial inclination was 20.471 standard deviation 1.26, palmar tilt with mean value of 8.725 with standard deviation of 0.678 and radial length with mean of 10.625 with standard deviation of 1.169. The complication observed was 3 pintract infection. All patients achieved full wrist flexion and extension and forearm rotation. Mean time to achieve full wrist. ROM after immobilization was 2 weeks.","PeriodicalId":407871,"journal":{"name":"Indian Journal of Orthopaedics Surgery","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141337856","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}