International Journal of Research in Orthopaedics <p>International Journal of Research in Orthopaedics is an open access, international, peer-reviewed journal that publishes original research work across all disciplines of orthopaedics and allied sciences. The journal's full text is available online at The journal allows free access to its contents. The journal aims to provide a platform for the exchange of information about all areas of orthopaedics and to promote the discipline of orthopaedics throughout the world. International Journal of Research in Orthopaedics is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new techniques. It is published every two months and available in print and online version. International Journal of Research in Orthopaedics complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></strong></p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix: 10.18203</strong></p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Research in Orthopaedics accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>About the Journal &gt; <a title="Online Submissions" href="" target="_blank" rel="noopener">Online Submissions</a></p> <p>Registration and login are required to submit items online and to check the status of current submissions.</p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p> </p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Res Orthop.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The journal is indexed with </p> <p><a title="PubMed and PubMed Central (PMC)" href="" target="_blank" rel="noopener">PubMed and PubMed Central (PMC)</a> (NLM ID: 101775784, Selected citations only), </p> <p><a title="Scilit (MDPI)" href="" target="_blank" rel="noopener">Scilit (MDPI)</a>, </p> <p><a href=";journalId=44185" target="_blank" rel="noopener">Index Copernicus</a>, </p> <p><a title=";referer=brief_results" href=";referer=brief_results" target="_blank" rel="noopener">OCLC (WorldCat)</a>,</p> <p><a href="" target="_blank" rel="noopener">CrossRef</a>, </p> <p><a title="LOCKSS" href="http://localhost/index.php/ijoro/gateway/lockss" target="_blank" rel="noopener">LOCKSS</a>, </p> <p><a href="" target="_blank" rel="noopener">Google Scholar</a>,</p> <p><a href="" target="_blank" rel="noopener">ICMJE</a>, </p> <p><a href="" target="_blank" rel="noopener">J-Gate</a>, </p> <p><a title=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" href=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" target="_blank" rel="noopener">JournalTOCs</a>,</p> <p><a href="" target="_blank" rel="noopener">ResearchBib</a>.</p> en-US (Editor) (Editor) Wed, 28 Dec 2022 06:49:48 +0000 OJS 60 Clinico-radiological correlation of reverse shoulder arthroplasty outcomes <p>Positioning of prosthetic components is essential for the success and longevity of the prosthesis. Judging prosthetic implantation radiologically is always beneficial; plain radiographs and computed tomography can provide information regards inclination and version of glenoid component, besides, lateralization of prosthetic components.<strong> </strong>This study aims at postoperative radiological evaluation of component positioning of reverse shoulder prosthesis and correlating measured radiological parameters with clinical outcome.<strong> </strong>Radiological assessment was carried on by radiographs taking advantage of true anteroposterior projection, and midaxial two-dimensional computed tomography cut. Radiographs evaluated glenoid inclination in coronal plane (superior-inferior tilt) via global inclination angle, and critical shoulder angle. Center of rotation was evaluated by calculating acromion index. Additionally, acromiohumeral interval, and deltoid lever arm distance were documented. Midaxial CT cuts evaluated glenoid version. Each parameter was correlated to postoperative clinical outcome represented in range of motion and total functional scores.<strong> </strong>the mean acromion index revealed significant change to 63.82±9.06%, total medialization surged significantly with average 1.51 cm with a mean postoperative calibrated center of rotation-distance of 3.72±0.78 cm. The mean increase in acro-mio-humeral interval was 1.57 cm with a new postoperative value of 2.49±0.9 cm. The mean glenoid version declined to 5.7º±5º, however, this change was not significant.<strong> </strong>In conclusion, accurate positioning of shoulder prosthesis components with proper tensioning of soft tissue envelope within acceptable measurement parameters is considered crucial for stability and longevity of implant with the best clinical outcomes.<strong></strong></p> Amr Elshahhat, Naser Selim, Yehia Basyoni, Khaled Nour Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 A case series of percutaneous tension band wiring technique for fixation of fractures of olecranon and patella <p class="abstract">There are several advantages in the treatment of fractures by means of closed reduction. Percutaneous fixation is a type of biological fixation. The aim and objectives of this study are to demonstrate the technique of percutaneous tension band wiring in cases of transverse, non- comminuted olecranon and patella fractures and to decrease the soft tissue dissection, blood loss, chances of infection and to ensure speedy mobilization using the innovative percutaneous fixation technique.<strong> </strong>This retrospective study includes ten patients of olecranon and ten patients of patella operated by the same surgeon. All patients were operated with percutaneous tension band wiring for olecranon and patella. There were six males and four females with olecranon fractures. There were seven males and three females who suffered patella fractures. The average duration of surgery was 55 minutes and average follow up was 24±6 weeks. The suture removal was done at 2 weeks. All patients had full range of movements at six weeks with significantly improved DASH score and Oxford knee score. None of the patients had any complications. Percutaneous fixation decreases the chances of bleeding secondary to unnecessary soft tissue dissection, thereby decreasing the post-operative morbidity. It also, convincingly, decreases the chances of post-operative infection and promotes early mobilization. Closed reduction with percutaneous fixation is believed to be an innovative, safe, reliable and efficient method of managing these difficult fractures.</p> R. C. S. Khandelwal, Swapneel Shah, Umang Sanghvi, Aditya K. Agrawal Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Is novel “PGI technique” worth considering for closed reduction of posterior hip dislocations? <p>There are numerous approaches for closed reduction of posterior hip dislocations, but the most call for strong and prolonged traction, help stabilizing the pelvis, and difficult placement of the doctor and/or patient. A novel closed reduction procedure that only requires one surgeon to complete safely and effectively the hip reduction and does not require traction-counter traction or unique posture of patient. The 11 patients, with a mean age of 34.1 years, underwent reduction. Five type I, five type II, and one type III dislocations consisted our study. Closed reduction was accomplished in 11 hips (100%), with all requiring just one try. This innovative method is an easy, secure, and efficient replacement of other techniques for closed reduction of posterior hip dislocations. It can be performed by a single surgeon, requires no traction, and can be very helpful for patients with polytrauma as well as those patients who have pelvic fractures and ipsilateral lower limb injuries.</p> Marouf Aslam, Asif Sultan, Mohammad Ashraf Khan, Mudasir Nazir Bhat, G. Nabi Dar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Neurological deterioration after spinal anaesthesia: a rare mode of presentation of spinal tumours <p class="abstract">Spinal anaesthesia is a safe and widely performed mode of anaesthesia with low complication rate. It may however be complicated infrequently with neurological deterioration as a result of injury to nerve root and spinal cord or epidural haematoma. Rarely neurological deterioration may occur following spinal anaesthesia in the presence of spinal tumours. We presented a case of neurological deterioration following spinal anaesthesia for caesarean section in a patient with previously undiagnosed thoracic spinal tumour.</p> Toyin A. Oyemolade, Augustine A. Adeolu, Olugbenga D. Akinwonmi, Inwonoabasi N. Ekanem Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Traumatic ulnar nerve dislocation: an unusual entity <p class="abstract">Ulnar nerve dislocation is defined as abnormal movement of the ulnar nerve at the elbow joint. This dislocation has been reported in 16% of asymptomatic arms. However, posttraumatic ulnar nerve subluxation remains a rare clinical entity. We present a unique case of posttraumatic ulnar nerve dislocation and describe clinical characteristics and etiology of this injury and how it was managed.</p> Abdellatif Benabbouha, Faycal Rifki, Hicham Sallahi, Omar Mergad Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 A rare case of ulnar nerve calcification in a patient without Hansen’s disease <p>Ulnar nerve calcification is rarely seen without association with Hansen’s disease. Ulnar nerve arises from brachial plexus within the axilla and is a major peripheral nerve of the upper limb. Its root value is C8-T1. It is one of the superficial nerves and is the most commonly affected nerve in leprosy. Our patient 52 years old female, came to Dr. D. Y. Patil hospital, Nerul casualty with a history of fall in bathroom and complaining of pain in right elbow with no neurological deficit. The radiological investigations confirmed a severely comminuted intra-articular humeral condylar fracture of the right side with a linear calcification seen in soft tissues near the ulnar nerve. It is an idiopathic ulnar nerve calcification of the right side. Hence, ulnar nerve calcification can also be seen in patients without Hansen’s disease.</p> Joydeep Kumar Dey, Sanjay B. Dhar, Sunil H. Shetty, Aditya Gunjotikar, Sarang Agrawal, Abhilash Srivastava, Shikhar Singh Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Management of aseptic non-union of shaft femur using intramedullary nailing combined with bone grafting: a case report <p>Despite the advances in trauma care, improved surgical techniques, latest implants and therefore the evolution of new adjuvants to healing, biologic agents, non-union still persists thanks to high energy trauma as initial event. Non-union of femur shaft represents a significant socioeconomic problem to the patient, related to prolonged patient morbidity, inability to return to figure, gait abnormality, re-operations and psycho-emotional impairment. Here we discuss the case of such non-union of fracture shaft femur presented to us with shortening of 3.5 cm managed with bone graft and intramedullary nailing. 22-year-old male patient had a history of trauma due to fall from bike due to dash from behind by tractor (high velocity road traffic accident) sustaining injury over right thigh leading to closed fracture mid-shaft femur of the same side treated immediately by femur nailing. After 6 months post-surgery, he noticed swelling over operated thigh which was increasing and causing difficulty in walking. X-rays revealed broken nail, re-operated at the same centre with dynamic compression plating (DCP) probably after freshening the fracture edges using 12-hole DCP, implant failure with whole plate and screw construct extrusion and re-fracture at the same site. This time patient presented to our institute. We planned of implant removal and intramedullary nailing with bone grafting. Management of aseptic femoral non-union with fracture gap of 2.5-4 cm range with intramedullary nailing combined with autologous fibular cortical and cancellous grafts showed good functional results at the end of 1 year post operative interval after prior repetitive failure of implants due to non-union. </p> Saikrishna B. Rengerla, Akhil H. Lohkare, Nikhil R. Warade, Supratim Roy, Aniket K. Wankhede Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Brodie’s abscess of proximal shaft radius in 17-year-old male: a case report <p class="abstract">Brodies abscess is an uncommon form of osteomyelitis. It is typically found in metaphyseal region of long bones particularly of lower limb. We herein report rare case of Brodies abscess of proximal shaft radius in 17-year-old male presented with pain over proximal aspect of left forearm for 2 months. A plain radiograph showed a translucent lesion of approximately 1.9×1.1 cm. Magnetic resonance imaging (MRI) showed Penumbra sign on T1 and T2 weighted images. Laboratory results showed no inflammatory response. Treatment was done by curettage. Culture report showed Staphylococcus aureus growth. Postoperatively administration of antibiotics was done. Follow up was uneventful. We diagnosed and surgically treated a rare case of Brodies abscess of proximal shaft radius in 17-year-old male. As the upper extremities are areas of unloaded bone, we successfully treated this patient by curettage and antibiotics without bone grafting.</p><p> </p> Nikhil R. Warade, Saikrishna B. Rengerla, Aniket K. Wankhede, Vyankatesh Deshpande Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Management of proximal femur varum deformity in skeletal dysplasia: an illustrative case report <p>Metaphyseal chondrodysplasia is skeletal dysplasia involving long tubular bones at metaphyseal regions, sparing the epiphysis, predominantly involving lower limbs, hence hindering normal mobilization activity of the individual. Individuals present with pain and deformity due to pathological fracture at the deformity site which necessitates deformity correction and surgical fixation. This is a case of skeletal metaphyseal dysplasia in 47-year female, short statured with bilateral proximal femoral Vara with pathological fracture, treated with deformity correction, surgical fixation. Patient initially presented at 36 years of age with sudden onset left hip pain. She was diagnosed with left femoral neck fracture and coxa Vara deformity. The femoral neck had spontaneously fractured due to increased bending forces acting on the femoral neck due to the coxa Vara deformity. She underwent valgus osteotomy with dynamic hip screw fixation. Further advised for prophylactic corrective osteotomy of contralateral proximal femur however patient was lost to follow-up. At 47 years she presented with pain in the right thigh. She was diagnosed to have right proximal femur pathological fracture due to progressive femur varus deformity for which she underwent right proximal femur valgus closing wedge subtrochanteric osteotomy and fixation using dynamic condylar screw. In our case left proximal femur which was operated did not have any complications. However, right proximal femur which was operated, at four months follow-up revealed no complications except for the foot drop which she developed post-surgery. Hence main aim of the study is to prove that the early prophylactic surgical management of the Vara help to provide successful outcomes.</p> Vignesh Gadupudi, Viraj Nalam, Giriraj Harshavardhan Jairaj Kadaikaran Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Six month old neglected metacarpophalangeal joint volar complex dislocation: a case study <p class="abstract">Metacarpophalanegal dislocations are rare, accounting for 3-5% of all dislocations with thumb being the most common finger affected. these dislocations can be decided into volar and dorsal and further into simple and complex, depending upon direction of dislocation and reducibility respectively. Although there is no approach superior over another, we selected volar approach for better visualization and direct reduction of dislocation and found reduction was unstable. hence a temporary fixation was attempted with K-wire which was removed 7th day postoperative and started with physiotherapy. Postoperatively patient was having near total range of motion (25-90 degree) and patient was able to do all the routine daily activities with his affected hand post operative 2 month. Complex metacarpophangeal joint dislocations needs intervention and should be combined with vigorous postoperative physiotherapy to achieve good clinical outcomes.</p> Rajesh K. Ambulgekar, Niranjan S. Ghag Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Sessile solitary osteochondroma at dorsal scapula: a case report <p>Osteochondroma is the most common benign tumor of the bone that occurs predominantly in metaphyseal regions of the long bones but rarely involves flat bones like scapula. However, this is often the most common primary benign bone tumor affecting scapula. These tumors usually occur in the growing age and cease to extend in size after skeletal maturity. Any increase in swelling of an asymptomatic swelling turning symptomatic should raise the suspicion of a malignancy. Here, we presented a case of swelling over the left scapula of a fourteen-year-old boy by his parents since the past three years, which showed no progress since last 1 year but however they presented to the hospital for cosmetic reasons. We performed an open extra periosteal resection of the osteochondroma using modified Judet’s approach after diagnostic workup and ruling out malignancy and confirmation by post operative histopathological study of resected lesion. Patient was able to perform full range of motion at his left shoulder after 1 month. With no evidence of recurrence even after six months of follow-up post operatively.<strong></strong></p> Saikrishna B. Rengerla, Nikhil R. Warade, Sonali Tiwari Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Stiff hip managed with capsular incision in adolescent girl: a case report <p>Idiopathic chondrolysis is an uncommon condition defined by the complete loss of femoroacetabular articular cartilage in a child with no previous trauma, slipped capital femoral epiphysis, infection, or extended immobilisation. Because of the gradual onset of symptoms, escalating radiographic abnormalities, and the lack of a diagnostic laboratory test, diagnosis is sometimes delayed. Localized osteoporosis, subchondral erosions, femoral head alterations, and a reduction in joint space are all common radiographic findings. We report a case of Idiopathic chondrolysis of the hip in a 14‑year‑old Indian girl who presented with pain and stiffness in her right hip with an MRI differential diagnosis of avascular necrosis/ tuberculosis of right hip joint.</p> Shreekantha K. S. Rao, Jasmal A. S. Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Single-stage contralateral total hip and knee arthroplasty: a report of two cases with literature review <p>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been performed for end stage degenerative arthritis of hip and knee respectively, with reliable functional outcomes. A single joint arthroplasty has wide acceptance, and presents less complications than a staged or simultaneous bilateral joint arthroplasty. Any contralateral or ipsilateral staged or simultaneous two joint arthroplasty have been infrequently performed and occasionally described. We present two cases where contralateral hip and knee arthroplasty were performed in single-stage simultaneously for an end-stage degenerative arthritis. Hip was operated first than knee in both the cases. The clinical, radiological, and functional recovery was graded good in both. There were no complications, or an extended stay in hospital, and blood transfusion requirements were insignificant. The contralateral two joint arthroplasty needs meticulous preoperative work-up, dedicated high volume joint arthroplasty unit, and use of meticulous standard surgical techniques to achieve the desired functional outcomes. </p> Lavindra Tomar, Gaurav Govil, Pawan Dhawan Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 The black bone disease: a case report of ochronotic hip arthropathy <p class="abstract">Ochronotic arthropathy is a rare complication in patients with alkaptonuria (AKU) that arises as a result of accumulation of ochronotic pigment in the joints. This case report presented a 70-year-old female patient with chronic pain in B/L knee and right hip with decreased e range of motion. The physical and radiographic findings were agreeable with end-stage hip osteoarthritis and knee osteoarthritis. The diagnosis was done by finding of a dark capsule and femoral head during the total hip replacement. The surgical treatments significantly minimized and enhanced the range of motion (ROM). AKU normally emerges after age 40 and is normally asymptomatic till the involvement of the spine, hip, knee and shoulder joints. Therefore, orthopedic surgeons must be observant of clinical manifestations of this rare condition, before and during the surgery. Arthroplasty is an appropriate therapeutic recourse for patients suffering from ochronotic arthropathy.</p> Rahul Rathi, Shivam Garg, Vishwas ., B. L. Kumar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Osteosarcoma of jaw, common entity at an uncommon site: a rare case report <p class="abstract">Osteosarcoma is the most common primary malignant bone tumor. Jaw is an uncommon site. The etiopathogenesis is still unknown. We present a case of 47-year-old female who underwent left partial maxillectomy as the lesion increased in size over one month after removal of a tooth. Prior to the surgery, computed tomography (CT) scan was suggestive of left maxillary sinus carcinoma and biopsy report was suggestive of spindle cell lesion. Partial maxillectomy specimen received in which size of the tumor was 5.5×5.5×4 cm with a pearly-white, solid, homogenous cut surface with gritty sensation on cutting. On histopathology it turned out to be osteosarcoma of the jaw. Mouse double minute 2 homolog (MDM2) and special AT-rich sequence-binding protein 2 (SATB2) was done to confirm the diagnosis of osteosarcoma. The patient was given chemotherapy after the confirmation and at present the patient is doing well.</p> Atithi A. Bansal, Surekha H. Bhalekar, Surekha H. Bhalekar, Divya Shetty Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 An interesting case of external type of coxa saltans treated by z plasty of iliotibial band-a case report <p>Coxa saltans commonly known as snapping hip is a nagging illness which can physically and mentally hinder patients life.<strong> </strong>A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical release since most cases respond well to conservative management. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. We present a case report of 47-year-old lady who was diagnosed to have snapping hip of external type who was treated with Brignall and stainsby technique of Z plasty. The surgical results of Z-plasty are excellent and predictable. Careful examination is necessary to rule out other causes. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip.</p> Mohamed Sameer M., Sibi Sanjay Baskaran Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Case of giant cell tumour of proximal tibia treated with intra-lesion curettage with adjuvant therapy and reconstruction with the sandwich technique fixation <p>Giant cell tumour (GCT) of bone is a benign but locally aggressive tumour with the potential of malignant transformation that mostly involves the meta-epiphyseal region of long bones. A 34-year-old female was presented to our institute with progressive pain and swelling in her right knee and was radiologically and histologically found to have a GCT of proximal tibia. She was treated with extended curettage with power burr, intra-lesion phenol application and internal fixation using the sandwich technique. No recurrence was found and the procedure led to a good functional outcome. A GCT of proximal tibia treated with joint preserving surgery with extended curettage and the sandwich technique fixation gives optimal results leading to a good functional outcome.</p> Aliasger H. Moaiyadi, Aniket K. Wankhede, Chandrashekar M. Badole, Kisan R. Patond Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 A rare case of ribbing disease of the proximal tibia <p>Ribbing disease is a rare disease that causes bony growths to develop in long bones mostly the lower limbs. It often develops after puberty. The disease also goes by other names like multiple diaphyseal sclerosis. The disorder is caused by discrepancy in the osteoclast regulation process. Here in we report a 28 years old male presenting with a case of ribbing disease of right proximal tibia. A 28 years old male gives history of fall when he was 6 years old i. e., 22 years back. Now patient complaints of pain in right proximal tibia since last 6 months. Pain is of mild nature. It is most likely a case of ribbing disease based on the clinical, radiological findings. Ribbing disease is a disease of exclusion, needs high degree of suspicion for its diagnosis. However, patient should be advised for regular follow ups.</p> Joydeep Kumar Dey, Shobhan Mandal, Varmit Shah, Shashwat Anand, Sarang Agrawal, Abhilash Srivastava, Sunil H. Shetty Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 The impact of intraoperative adverse events on orthopaedic surgery residents <p class="abstract"><strong>Background:</strong> The goal of this study was to quantify the impact of intraoperative adverse events on orthopaedics residents to better understand how these occurrences affect resident training. Additionally, the study identified the emotional toll of adverse events on trainees and barriers to reporting.</p><p class="abstract"><strong>Methods:</strong> An anonymous 26 question web-based survey was adapted from the Boston intraoperative adverse events surgeons’ attitude study (BISA) survey to be applicable to orthopaedic residents. The survey was sent to orthopaedic residency program coordinators listed in the Council of Orthopaedic Residency Directors (CORD) database. The coordinators then distributed the survey to each program’s residents and fellows.<strong></strong></p><p class="abstract"><strong>Results:</strong> 77 orthopaedic residents and fellows completed the survey. Almost all (84.4%) reported having been involved in an IAE during their training, and the majority (80.6%) experienced emotional distress as a result. 50.7% of respondents have never been involved in discussions with patients or their family regarding a complication during their training.</p><p class="abstract"><strong>Conclusions:</strong> The majority of residents have experienced emotional distress following an intraoperative adverse event, but residents are not routinely involved in subsequent discussions with patients and families following complications. This represents a significant area for improvement in both supporting and training surgical residents.</p> Madeline M. Lyons, Haley E. Smith, Kamran S. Hamid, Adam P. Schiff Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Evaluation of open reduction and internal fixation with closed reduction and external fixation in distal radial fracture <p><strong>Background:</strong> Radial fracture frequently occurs in osteoporotic disorders, or in low-energy injuries. It is most frequent fracture of the upper extremity. Open reduction or closed reduction is done but there is debate between the two about its efficacies. Aims and objectives were to find out the efficacy and safety of open reduction and internal fixation (ORIF) with that of closed reduction and external fixation (CREF) among patients with distal radial fracture of all ages.</p><p><strong>Methods:</strong> This prospective study was conducted with patients of distal radial fracture. They underwent interventions, namely, ORIF (Open reduction group) or CREF (Closed reduction group). DASH score was measured before the intervention and during several follow ups at 4<sup>th</sup> week to 15<sup>th</sup> week. DASH score was statistically analyzed between the two groups. Additionally, the complications of the patients in each group were evaluated and sick leaves of the patients was recorded to assess their quality of life.</p><p><strong>Results:</strong> The study has found that the number of days taking patients took sick leave from field work is significantly more in "closed reduction" group as compared to "open reduction" group (p&lt;0.05). The number of days patients took sick leave is significantly higher in “closed reduction” group as compared to “open reduction” group (p&lt;0.05).</p><p><strong>Conclusions:</strong> The study has concluded that the disability of the patients who received ORIF decreased significantly as compared to those who received external fixation and the patients who received open reduction significantly improved from the fracture.</p> Rupesh Jung Belbase, Kumud Limbu, Anil Kumar Basnet, Pratik Chaudhary Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Clinical outcomes of the intramedullary femoral nailing system in the treatment of femoral fractures <p><strong>Background:</strong> Femoral fractures are a common type of fracture brought on by large force impaction. This study's objective was to clinically assess the results of using an intramedullary femoral nailing system to treat femoral fractures.</p><p><strong>Methods:</strong> 32 patients with femoral fractures are included in this retrospective clinical trial. They are all treated with an intramedullary femoral nailing system made by Kaulmed private limited in Sonipat, Haryana, India. This system includes KN-1 advance nails (PFNA), KN-6 femur nails (retrograde Nails), KN-3 nails type II (gamma nails), KN-2F femur nails (expert femoral nails), and KN-5F universal intramedullary cannulated femoral nails. There were 32 patients, with 15 from one hospital and 17 from the other. The first hospital group consisted of 8 men and 7 women, with an average age of 32 years and the second hospital group consisted of 9 male and 8 female with mean age of 40.5 years. The fractures were categorized based on AO classification and pre-operative fitness was assessed using American society of anaesthesiologist (ASA Grade). The clinical effectiveness was evaluated using the VAS score and anatomical results.</p><p><strong>Results:</strong> Surgery was performed on 32 patients with at-least three post-operative follow-up visits in 180 days. No patient in any group complained after the final follow up about complications or hardware problems, and every patient's bone union was achieved successfully. Radiological outcomes also showed proper union at 6 months. </p><p><strong>Conclusions:</strong> In femoral fractures, the intramedullary femoral nail provides better results with a high rate of union and postoperative composure.</p> Akash Sharma, Arpit Jain, Gaurav Luthra Copyright (c) 2022 International Journal of Research in Orthopaedics Thu, 29 Dec 2022 00:00:00 +0000 Clinical efficacy of the radius bone plates for the fixation of radius bone fractures <p><strong>Background:</strong> The purpose of this study was to evaluate the clinical efficacy of the radius bone plates fixation for treating radius bone fracture.</p><p><strong>Methods:</strong> Forty-Five patients with fracture of the radius involving the distal part were treated with fixed angle plate fixation approach. This was a retrospective study in which 45 patients (39M, 6F) were treated at different hospitals and countries between August 2020 to October 2021 with a mean follow up of year (1month, 3months, 6months and 12months). All patients were followed using radiographs, physical examination, ASA and VAS score.</p><p><strong>Results:</strong> All patients with radius fracture treated with specific fixation of plate system were enrolled and received continuous physiotherapy by physiotherapists, which helped in early healing. The clinical treatment results showed decline in the VAS score percentage after 1 year follow up. About 91.1% patients were satisfied with no pain and 8.8% patients were unsatisfied due to mild pain. A successful surgical outcome was reported without any complications related to implant breakage, loosening, corrosion or other factors.</p><p><strong>Conclusions: </strong>The radius plate system results in more efficient, stable fixation and better subjective results early in the postoperative period. It has minimal complications requiring reoperation and risks.</p> Tarun Kumar, Mridul Beriwal, Bhawana Chawale, Mohit Kumar, Gaurav Luthra Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Post-operative management of inflammation after orthopaedic surgeries using trypsin, bromelain and rutoside combination: a single-centre prospective observational study <p><strong>Background:</strong> Post-operative management of inflammation plays an important role in orthopaedic surgeries, as delay in wound healing may lead to extended hospital stay. Proteases like trypsin and bromelain combined with the bioflavonoid rutoside are often used to reduce post-operative pain and swelling. The present study aimed to evaluate the efficacy and safety of oral administration of a fixed dose combination of trypsin-bromelain-rutoside in the post-operative management after orthopaedic surgeries.</p><p><strong>Methods:</strong> The study was a prospective, observational data collection exercise. Hundred subjects undergoing orthopaedic surgeries, who were administered trypsin-bromelain-rutoside combination, were observed over a period of 8 days post-surgery. Verbal rating scales were used for grading the pain intensity and extent of swelling, while a 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling. Scores at day 3 and day 8 were analysed using paired t test.</p><p><strong>Results:</strong> At day 3 and day 8, the mean scores of pain and swelling were significantly reduced from baseline (all p&lt;0.0001). By day 8, 74% of the patients achieved complete resolution of pain, while 50% reported complete resolution of swelling. By day 8, 54% patients reported excellent/ very good global improvement in pain and swelling, while the investigator reported excellent/ very good global improvement in 81% of the patients. No adverse event was reported in any of the patients.</p><p><strong>Conclusions:</strong> The combination of trypsin-bromelain-rutoside was safe and effective in reducing the post-operative pain and swelling after orthopaedic surgeries. An 8-day treatment led to complete resolution of pain in three-fourths of the patients and complete resolution of swelling in half the patients. The use of this combination has the potential to reduce hospital stay and pill burden.</p> Yogesh Sisodia, Ramprasad Dharangutti, Bhushan M. Khemnar, James John, Deepakkumar T. Vishwakarma Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Clinical outcome of early-stage knee osteoarthritis after intra-articular platelet rich plasma injection <p><strong>Background:</strong> Osteoarthritis (OA) is a degenerative joint disease due to degradation of articular cartilage, proliferative reformation of subchondral bone and low degree of synovitis resulting in reduced quality of life (QOL), being the major cause of pain and disability in the elderly population. Platelet-rich plasma (PRP) is an autologous mixture of concentrated platelets and growth factors produced by centrifugation of whole blood, used to treat bone, tendon and ligament injuries. The growth factors released by PRP have been shown to promote cell recruitment, proliferation and angiogenesis resulting in a decrease in the expression of inflammatory enzymes. The aim was to study the effectiveness of intra-articular PRP injections in early-stage OA knee patients and to evaluate the clinical outcome and QOL at 6 months.</p><p><strong>Methods:</strong> We conducted an observational study of 100 patients with early OA knee changes with age group &gt;50 years and injected their knees with PRP injections and serial follow up assessment was done.</p><p><strong>Results:</strong> We saw significant improvement in quality of lives evaluated as per world health organization quality of life (WHOQOL) questionnaire after PRP injections on their follow-up. Significant reduction in pain, reduction in joint stiffness and improvement in physical activities shown by significant reduction in Western Ontario and McMaster universities osteoarthritis index (WOMAC) scores.</p><p><strong>Conclusions: </strong>OA of knee is one of the commonest rheumatological problems after 50 years of age. It was commonly observed in females more than 60 years age with sedentary lifestyle. PRP therapy has given excellent results in pain relief, reduction of joint stiffness and improvement in physical activities and improvement in QOL.</p> Chaitanya D. Khanolkar, Prafulla G. Herode, Vinoth Kumar L., Franklin Francis Chazhoor Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Comparing the findings of clinical examination versus magnetic resonance imaging for the diagnosis of ligamentous injuries of knee in rural area <p class="abstract"><strong>Background:</strong> The knee is a complex synovial joint allowing flexion, extension, anteroposterior gliding and internal-external rotation. The major articular surfaces are the medial and lateral condyles of the femur and patellar surface. The aim of the study was to compare the findings of clinical examination versus magnetic resonance imaging (MRI) for the diagnosis of ligamentous injuries of knee in rural area.</p><p class="abstract"><strong>Methods:</strong> Present study was an observational study carried out at rural medical college under orthopaedic department. All patients coming with ligamentous injury to orthopaedic department were studied. Thus such 50 cases were studied. All cases were referred to radiology department for MRI of knee. MRI reports and clinical reports were compared and analysis was done. Cases contraindicated for MRI examination were excluded from study. General demoghraphic history, clinical presentation and MRI reports were recorded. All data was compiled in Microsoft excel and analysed using OpenEPi 2.3.1.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age was 46.4±11.2 years. Majority were males 70% and 30% were females. Swelling 62% was most commonly seen followed by knee pain. Majority 58% cases had grade 3 tear on MRI, followed by 36% had grade II and only 6% had grade I. </p><p class="abstract"><strong>Conclusions:</strong> MRI is an excellent, non-invasive, radiation free imaging modality with multilane capabilities and excellent soft tissue delineation. It can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis thereby guiding further management of the patient.</p> Pratik A. Vishavadia, Prafulla G. Herode, Ashish M. Somani, Ashok V. Reddy Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Study of the immediate short term clinical and radiological outcome of intertrochanteric neck of femur fractures treated with primary bipolar hemiarthroplasty in geriatric population in a tertiary care centre <p class="abstract"><strong>Background:</strong> Intertrochanteric fracture in elderly patient is a frequent problem and is becoming more common as the proportion of elderly people in the population increases. Unstable intertrochanteric fracture in the elderly patient is associated with a high rate of mortality as much as 20 percent during the first postoperative year. The treatment of such unstable intertrochanteric fracture is still controversial. So as to allow for earlier postoperative weight-bearing, primary hemiarthroplasty was proposed by some authors. The purpose of this study is to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patient.</p><p class="abstract"><strong>Methods:</strong> It was an observational retrospective plus prospective study design over a period of 18 months in a tertiary care setting with a sample size of 41. Patients fulfilling the inclusion criteria were assessed clinically using Harris hip score and radiologically were operated for bipolar hemiarthroplasty. They were assessed intraoperatively, immediate postoperatively and after 4 weeks for functional outcome using Harris hip score and assessed radiologically. Patients were also be evaluated for intraoperative and postoperative complications if any. The outcome was analysed statistically to comment on functional outcome of bipolar hemiarthroplasty.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study majority of the patients 70% (29) had excellent and good outcomes at the end of 1 month. Out of the rest 22% more had fair outcome at the end of month. Thus 93% patients had favorable outcomes at the end of 1 month while 7% (3 cases) had poor outcome when measured using Harris hip score.</p><p class="abstract"><strong>Conclusions:</strong> Primary cemented bipolar hemiarthroplasty is a viable option that leads to good functional outcomes and allows early mobilization and weight bearing.</p> Shubham N. Katti, Ajay S. Chandanwale, Sushant S. Ghumare, Prithviraj A. Paigude, Sushilkumar R. Mane, Vijay P. Yadav Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Comparative study of range of motion and anterior knee pain in parapatellar versus trans patellar approach in tibia nailing <p><strong>Background:</strong> Tibial shaft fractures are common traumatic fractures especially in road traffic accidents. Intramedullary interlocking nailing is considered treatment of choice tibial diaphyseal fractures, minimizing soft tissue injury and permitting early weight bearing and fracture healing. Anterior knee pain and reduced range of motion are some common complications that patients have to face in post-operative period.</p><p><strong>Methods: </strong>The<strong> </strong>60 patients of both sex with traumatic diaphyseal tibial shaft fractures were included in this study out of which 30 were operated with interlocking tibia nailing with trans patellar (tendon splitting) approach while 30 were operated with medial parapatellar approach for tibia nail insertion. Range of motion at knee joint (in degrees) and anterior knee pain (on visual analogue scale) was evaluated on post-operative day 1, 2 weeks, 1 month, 3-month post operatively and compared for both groups.</p><p><strong>Results: </strong>Mean anterior knee pain was significantly lower in parapatellar approach group at 2 weeks, 1 month and 3 months while there was no significant difference on post-operative day 1. Mean range of motion at knee joint was more in parapatellar approach group on post-operative day 1 and 2 weeks while there was no significant difference in range of motion after 2 weeks.</p><p><strong>Conclusions: </strong>In our study medial parapatellar approach is superior than tendon splitting approach with comparatively greater range of motion and lesser anterior knee pain. Thus, medial parapatellar approach should be encouraged for interlocking tibia nailing.</p> Nikhil Pralhad Deokar, Kiran L. Gaonkar, Siddharth Daruwala, Anshuraj Jagdale Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Treatment of proximal tibia fractures with locking compression plate: a prospective study <p><strong>Background</strong>: With the rise in the incidence of proximal tibia fractures in India due to road traffic accidents, this prospective study was intended to assess the operative procedure in the management of such fractures using the locking compression plate (LCP).</p><p><strong>Methods:</strong> 30 subjects attending the study site scheduled to undergo the defined surgery were enrolled as per the study selection criteria.</p><p><strong>Results:</strong> A total of 30 patients with proximal tibia fractures were enrolled. Majority of cases were due to RTAs, with a higher incidence of types IV, V and VI. Average time for union of fracture ranged from around 16-24 weeks. 23 patients were treated with ORIF and 7 patients were treated with MIPO technique. Three different principles of fixation were done using the LCP, viz. compression, bridging and combined. Functional outcome was evaluated, which revealed excellent results in 53.33% patients, good results in 30% patients, fair results in 13.33% results, while 3.33% had poor outcomes.</p><p><strong>Conclusions:</strong> Based on the findings of the present study we can conclude that overall Locking Compression plate (LCP) for fractures of the proximal tibia is a useful adjunct in the management of trauma patients. The locking compression plate system with its various type of fixation act as a good biological fixation including difficult fracture situations.</p> Devendra V. Kommuru, Shikhar Singh, Sunil Shetty, Sachin Kale, Abhilash Srivastava Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Management of distal unstable radius fractures with locking distal radius plates: a retrospective study <p class="abstract"><strong>Background:</strong> Distal radius fractures that are unstable are challenging to treat. The locking distal radius plate screws is a superior alternative to the other forms of treatment (external fixator and K pin). The purpose of this study was to provide the radiographic and functional clinical outcomes of patients who had locking distal radius plate screws treatment. This study's objective was to clinically assess the results of using a locking distal radius plate system to treat radius fractures.</p><p class="abstract"><strong>Methods:</strong> 31 patients with radius fractures are included in this retrospective clinical trial. They are all treated with a locking distal radius system made by Kaulmed Private Limited in Sonipat, Haryana, India. The patients were treated with variable angle locking distal radius plates that includes 2.4 mm KL-8 variable angle two column volar distal radius plates and 2.4 mm KL-8 variable angle volar rim distal radius plates. There were 31 patients consisting of 24 male and 07 female, with an average age of 44 years. The fractures were categorized based on AO classification and pre-operative fitness was assessed using American society of anaesthesiologist (ASA grade). The patients were assessed clinically, radiologically and functionally using visual analogue scale (VAS), post-operative radiographs and measuring grip strength and weight bearing respectively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Surgery was performed on 31 patients with at-least three post-operative follow-up visits in 180 days. No patient in any group complained after the final follow up about any major complications or hardware problems, and every patient's bone union was achieved successfully. Radiological outcomes also showed proper union in 6-7 weeks.</p><p class="abstract"><strong>Conclusions:</strong> Distal radius volar locking plates provide effective results in correcting distal radius anatomy.</p> Akash Sharma, Arpit Jain, Gaurav Luthra Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Real world evidence of effectiveness and safety of an oral formulation containing un-denatured type-II collagen 40 mg and aflapin 100 mg (HAPID®) in the management of osteoarthritis of knee: findings of a prospective, multi-center, observational study <p><strong>Background: </strong>Osteoarthritis (OA) of knee is a common progressive multifactorial joint disorder affecting the quality of life, and surgical repair is the final option which has substantial impact on healthcare costs. This real-world study evaluates the efficacy and safety of an oral formulation containing UC-II and aflapin (Boswellia serrata extract enriched in 3-O-acetyl-11-keto-beta-boswellic acid) for treatment of OA of knee.</p><p><strong>Methods: </strong>Data of 505 ambulatory adult patients (study duration-Jul-21 to Jul-22) of either gender (227 M, 278 F) having OA of knee, and who received study treatment (capsule HAPID®, Wockhardt, India) once daily for a period of up to 90 days were included for the study after obtaining informed written consent. Primary outcomes were mean change in Western Ontario and McMaster universities OA index (WOMAC) scores from baseline through day 90 (total and sub-scales for joint pain, joint stiffness, and physical function), and change in 0-10 visual analogue scale (VAS) score for pain.</p><p><strong>Results: </strong>About 285 (56.4%) patients were newly diagnosed, majority (63.4%) were having grade 2 severity of OA (Kellgren and Lawrence grade). The mean (SD) baseline total WOMAC scores improved from 60.94 (23.60) at baseline to 26.42 (22.19) on day 90. Significant improvements were seen starting from day 5 (p=0.023) and progressively up to day 90 (p&lt;0.0001).</p><p><strong>Conclusions: </strong>The excellent safety and efficacy profile of combination therapy with aflapin and UC-II makes it a desirable pharmacological treatment modality for management of patients of knee OA.<strong></strong></p> A. K. Pal, Sanjoy Sen, Sanatan Behera, Rajeev Anand, Chandradhur Bhattachayya, K. Kalidoss, Arumugam S., Shivarajaiah ., P. C. Jagadeesh, Sagar Karvir, J. C. Patil, Rajeev Anand, Jawahar Jethwah, Ashok Suryavanshi, H. J. Sangtani, Sameer Jadhwar, Khokan Debnath, Atul Panghate, Pradeep Moonot Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Prospective study comparing early functional outcome and gait analysis in femoral neck fracture treated by cemented hemiarthroplasty using modified Hardinge approach and conventional posterior approach <p><strong>Background: </strong>A prospective study was done to compare the outcomes of management of fracture neck of femur by cemented hemiarthroplasty using modified Hardinge approach and conventional posterior approach<strong></strong></p><p><strong>Methods:</strong> The 2019 to 2022 50 patients underwent bipolar hemiarthroplasty for femoral neck fracture. Group A (Femoral neck fracture treated using conventional posterior approach) and group B (Femoral neck fracture treated using modified Hardinge approach) with 25 patients in each group. Outcomes were evaluated based on mean surgical time and Harris hip score and SF-36.</p><p><strong>Results:</strong> Mean duration of surgery in minutes was more for modified Hardinge approach. Harris hip score with standard deviation for modified Hardinge Approach for follow-ups was better and statistically significant than posterior approach. Similarly, quality of life after surgery, in terms of mean SF-36 score with standard deviation for modified Hardinge approach was better and statistically significant than posterior approach. Modified Hardinge approach has fewer complications in comparison to the posterior approach. With the advantages comes a longer learning curve to operate without complications. Hence, with proper surgical technique, and proper tight closure, we prefer the modified Hardinge approach over other approaches as it had nil dislocations and abductor lurch.</p><p><strong>Conclusions:</strong> Modified Hardinge approach for hip arthroplasty in elderly people with femoral neck fracture provide significant benefit in the early post operative period when compared to conventional posterior approach in terms of post operative pain, time of recovery, dislocation rate and quality of life.</p> Shivsagar V. Jadhav, Kishor G. Murkute, Amit P. Swamy, Omprakash Badgujar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Prospective study of management of unstable intertrochantric femur fractures in elderly: hemiarthroplasty vs. osteosynthesis by proximal femoral nail <p><strong>Background: </strong>A prospective study was done to compare the outcomes of management of unstable intertrochantric femur fractures in elderly by hemiarthroplasty and osteosynthesis by proximal femoral nail.<strong></strong></p><p><strong>Methods: </strong>This was an interventional prospective study.<strong> </strong>The study was carried out over 3 years from 2019 to 2022 at PCMC’s PGI YCMH, Pimpri, Pune, Maharashtra, India<strong>. </strong>The study was carried out over 3 years from 2019 to 2022;50 Patients were randomly divided into two groups; Group A (unstable intertrochanteric femur fracture patients treated by bipolar hemi-arthroplasty) and Group B (unstable intertrochanteric femur fracture patients treated by proximal femoral nailing) with 25 patients in each group. Outcomes were evaluated based on functional outcomes, mean surgical time, mean blood loss during surgery, post-operative length of stay, post-operative complications. Harris hip Score was used to assess clinical functional outcomes.<strong></strong></p><p><strong>Results: </strong>The PFN group showed a better Harris Hip score at 1, 3, and 6 months follow ups.<strong> </strong>Mean surgical time was more in bipolar hemiarthroplasty group. Mean blood loss during surgery was more in bipolar hemiarthroplasty group. Post-operative length of stay was more in bipolar hemiarthroplasty group. Post-operative complications like infections, limb length discrepencies were more in bipolar hemiarthroplasty group, whereas 2 implant failures occurred in PFN group compared to a single one in bipolar hemiarthroplasty group.<strong></strong></p><p><strong>Conclusions: </strong>Both PFN and bipolar-hemiarthroplasty appear to produce satisfactory outcomes in surgically treated unstable IT fractures, bipolar-hemiarthroplasty has the advantages of early mobilization and early weight bearing, no risk of non-union but PFN group is superior when it comes to functional outcomes, mean surgical time, Mean blood loss during surgery, post-operative length of stay, post-operative complications.<strong></strong></p> Kishor G. Murkute, Shivsagar V. Jadhav, Jeevan Tonde, Omprakash Kumar Badgujar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Double-plating approach in the management of isolated distal femoral fractures <p><strong>Background</strong>: Fractures above 9 cm of the articular surface of distal femur are defined as distal femoral fractures which accounts for an estimated 4%-6% of all femur fractures. Stable fixation can be achieved by dual plating of distal femoral fracture. The indications of a dual- lateral and medial plate medial are comminuted distal femur fractures (AO type C3), medial supra-condylar void and bone loss of more than 3 cm, medial Hoffa fracture, inter-condylar comminuted bicondylar fractures, non-union after failed fixation with single lateral plate, poor bone quality.</p><p><strong>Methods</strong>: The retrospective research study of 35 cases of distal femoral fractures which were treated with lateral and medial plates in post graduate institute Swasthiyog Pratishthan, Miraj (G. S. Kulkarni Hospital, Miraj). The study period was from September 2020 to May 2022. The average follow-up was 8 months.</p><p><strong>Results</strong>: 1 year after operation, knee function was evaluated by Oxford knee score along with Mean EQ-5D-5 L score. Functionally the mean oxford knee score was 41.53±1.69, with a maximum Oxford Knee Score of 48. Mean EQ-5D-5 L score was 83.8 (72-82). Average time to union was 9 months (6-12 months). Four (17.4%) cases needed autologous bone graft. <strong></strong></p><p><strong>Conclusions</strong>: Double incision dual-plating approach for distal femoral fractures is effective and provides stable construct without reduction loss allowing early rehabilitation. Single lateral plating of distal femur fractures was associated with relatively higher failure rate. Addition of medial plate along with lateral plate reduces chances of fixation failure.</p> Sunil Kulkarni, Saurabh R. Supare, Anjan Nadange, Rohith Garimella, Pranit Pawaskar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Comparison between clinical examination and magnetic resonance imaging in accurately diagnosing meniscal tears <p><strong>Background: </strong>The primary goal of this study was to examine the correlation between clinical results, MRI scans, and Arthroscopic findings in the case of meniscal injury. We compared various parameters between clinical findings and MRI findings in case of suspected meniscus injury cases keeping Arthroscopy findings as the gold standard.</p><p><strong>Methods: </strong>Patients coming to our OPD with complaints of knee pain were examined by an experienced orthopaedic surgeon. The sample size of our study was 60 cases. All suspected meniscal tear cases underwent clinical examination, MRI scanning and Arthroscopic examination to assess the relationship between clinical findings and MRI findings, keeping Arthroscopy findings as a gold standard.</p><p><strong>Results: </strong>For the diagnosis of medial and lateral meniscus tears, a clinical evaluation carried out by an experienced orthopaedic surgeon exhibited greater sensitivity, specificity, precision, and negative and positive predictive values than MRI.</p><p><strong>Conclusions: </strong>A clinical evaluation by an experienced orthopaedic surgeon yielded superior outcomes than an MRI for diagnosing meniscal injuries. MRI is indicated in case of complex knee injuries.</p> Siva K. Mamillapalli, Jagan B. Chowdam Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Clinical outcome of proximal tibia plates in extra-articular proximal tibia fractures: a retrospective study <p><strong>Background:</strong> Tibial fractures, which account for 2.2% of all intra-articular fractures, are frequent. These fractures are prevalent in two age groups: younger patients experience higher-energy fractures, whereas elderly patients experience lower-energy fractures as a result of osteopenia. These injuries are linked to a higher frequency of complications such as non-union, infection, mobility limitation, and post-traumatic arthritis in the younger population. The study's primary objective was to assess the results of proximal tibial fracture treated with a locking plate.</p><p><strong>Methods:</strong> Thirty patients with proximal tibia fractures are included in this retrospective clinical study. They are all treated with a tibia plate system made by Kaulmed private limited in Sonipat, Haryana, India. Thirty patients consisting of 18 males and 12 females, with average age of 42 years. Fractures categorized based on AO classification and type of soft tissue injury. Patients assessed clinically, radiologically, functionally using VAS, post-op radiographs and ROM.</p><p><strong>Results:</strong> All 30 cases that were chosen were monitored for 6 months. The average time for fracture union was 21 weeks, with a range of 18 to 24 weeks. No delayed union and non-union was observed. Infection, valgus, Knee stiffness were the complication that was observed. Two patients complained about the mild pain on the post-operative visit. Acceptable knee ROM of angle &gt;120° was achieved and all patients were satisfied at their last visit based on parameters of pain, ADLs, aesthetics and full weight bearing.</p><p><strong>Conclusions:</strong> Excellent results were achieved in the surgical treatment of proximal tibia fractures by MIPO (minimal invasive plate osteosynthesis) and ORIF (Open reduction and internal fixation) using proximal tibia plate technique. Optimum knee function is achieved with reduction, rigid fixation to restore articular fragments, and early mobility. preventing osteoarthritis following trauma.</p> Akash Sharma, Arpit Jain, Gaurav Luthra Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Incidence and location of deep vein thrombosis of lower extremity following surgery of tibial plateau fracture <div class="Section1"><p><strong>Background:</strong><strong> </strong>Tibial plateau fractures are commonly seen fractures of lower limb. They are challenging to manage since they are mostly associated with soft tissue injuries. Deep vein thrombosis (DVT) is a significant cause of morbidity and pulmonary embolism can even cause mortality in all hospitalized patients, especially after trauma and lower extremity fracture, which further carries risk of significant morbidity and mortality. We aim to evaluate the epidemiological characteristics of postoperative DVT in tibial plateau fractures.</p><p><strong>Method: </strong>A prospective observational randomized study was performed. A total of 79 patient were included in this study who had proximal tibia fractures. Pre-op ultrasonography was done and post operative ultrasonography was done following proximal tibia plating surgery on day 2. Successive evaluation with USG was done at week 2, week 3 and week 4 for DVT. If DVT is diagnosed it will be managed medically.</p><p><strong>Result: </strong>A total of 79 patients were included in the study, 28 were females and 51 males. 4 out of 79 patients were diagnosed with DVT following surgery of tibial plateau fracture. Predominantly DVT was seen in male patient of elderly age group who had high energy trauma operated by open reduction with duration of surgery of more than 1 hour. 3 out of 4 patients had distal DVT and 1 had proximal DVT.</p><p><strong>Conclusions</strong>: Six risk factors were found to be strongly associated with DVT i.e., old age, male gender, high energy trauma, increased preoperative interval, open reduction and prolonged duration of surgery. These epidemiologic data will be helpful in individual assessment, risk categorisation and development of targeted prevention programs.</p></div> Rajeev Kelkar, Pranav Mahajan, Subhash Mishra Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Treatment of intertrochanteric femur fracture in elderly patients with the proximal femoral nail antirotation: evaluation in terms of union and functional outcome <p><strong>Background: </strong>Trochanteric fractures almost invariably occur as a result of a trivial fall involving both direct and indirect forces. Fixation in the geriatric population generally consists of weakened, osteoporotic bone; intramedullary devices (PFNA) carry an advantage over other load sharing devices by not having to depend on plate fixation with bone screws purchasing a compromised lateral cortex. The purpose of the present study is to verify the theoretical advantages of the proximal femoral nail in elderly osteoporotic patients and eventually functional outcome of the patient.</p><p><strong>Method: </strong>A total of 30 patients with age &gt;60 years with intertrochanteric femur fractures managed with proximal femoral nail anti-rotation for prospective study. Harris hip score had been used in our study for regular follow up and evaluation at each and every follow up visit.</p><p><strong>Results: </strong>Average Harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 73% patients showing excellent or good outcome. And 100% fractures got united with a good component position and average time to bone healing was 14 weeks.</p><p><strong>Conclusions: </strong>PFNA are now favored in western countries and there are multiple studies coming from that region to support this. Due to advantages of high union rate, early postoperative mobilization, and short operation time, PFNA osteosynthesis is the method of choice for surgical treatment of stable and unstable osteoporotic intertrochanteric femoral fractures.</p> Ashutosh Verma, Atul K. Saroj, Sushil K. Saini, Ravindra K. Gupta, Punit Agarwal Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Evaluation of functional outcome by modified mayo wrist score in intra- articular distal end radius fracture managed by plate osteosynthesis <p class="abstract"><strong>Background:</strong> Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability.</p><p class="abstract"><strong>Methods:</strong> A prospective study of forty patients with intra-articular distal end radial fractures treated under the department of orthopaedics, PIMS, Udaipur, were included in this study. All patients managed by plate osteosynthesis were followed up to 9 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> When outcome according to modified Mayo wrist scoring system was assessed, only one patient (2.50%) scored with poor grade. 11 (27.50%) were graded as excellent, 19 (22.50%) as grade good, 9 (22.50%) as grade fair. 32 (80%) patients had union within 2-3 months and 06 (15%) patients had union in 3-4 months. There were 2 (5%) case of delayed union.</p><p class="abstract"><strong>Conclusions:</strong> Assessment of functional outcome by modified mayo wrist score in intra-articular distal end radius fracture managed by plate osteosynthesis gives an excellent scoring system to assess outcome of communited intrarticular distal radius fractures with reference to function of the hand and wrist of the individual. Also, it will help to predict the likely functional outcome in relation to fracture pattern of distal radius.</p><p> </p> Ashish Verma, Laxmi Narayan Meena, B. L. Kumar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Prospective study of functional outcome of distal femur fracture managed by distal femur nailing <p class="abstract"><strong>Background:</strong> The purpose of the present study was to assess the functional outcome of distal third femur fracture managed by retrograde intramedullary nailing.</p><p class="abstract"><strong>Methods:</strong> 25 patients with closed distal third femur fracture were enrolled in the study satisfying the inclusion criteria and underwent surgical management with distal femur nailing. Follow up of all the patients was done at 1, 3, 6 and 12 months. The functional outcome of all the operated patients was evaluated by using Lysholm knee scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> In present study 25 cases underwent surgical management with distal femur nailing. After the clinical sign and radiological sign of union, cases were trained with active and passive joint mobilization exercises and functional outcome was evaluated by Lysholm knee scoring system (component-limp, support, pain, instability, locking, swelling, stair climbing, and squatting). The scores were further graded as excellent (&gt;90), good (84-90), fair (65-83) and poor (&lt;65). Out of 25 patient, functional outcome was excellent in 13 (52%), good in 4(13%), fair in 6 (24%) and poor in 2 (8%).</p><p class="abstract"><strong>Conclusions:</strong> The retrograde intramedullary nailing can be considered as a successful, safe reliable, effective and useful technique which should find a place in the armamentarium of every orthop<strong>a</strong>edic surgeon who deals with distal third femoral fractures.</p> Sameer R. Tayade, Shashikant B. Kukal, Shreenivas M. Nalhe Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Safety and efficacy of topical tranexamic acid over intravenous tranexamic acid in reducing blood loss and transfusion rates in hip and knee arthroplasty <p><strong>Background:</strong> Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss. Hence the present study was undertaken to compare the efficacy of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rate in primary total hip and total knee arthroplasty.</p><p><strong>Methods:</strong> Total of 31 cases undergoing either primary THA (23 cases) or TKA (8 cases) during a study period from June were enrolled. Outcome measures were drained output, transfusion rate, drop in haemoglobin (Hb) and blood loss measured by Nadler et al formula.</p><p><strong>Results:</strong> In THR group, 12 (52.17%) cases and in TKA group, 3 (37.5%) cases were managed using IV TXA whereas 11 (47.82%) and 5 (62.5%) cases were managed using topical TXA in THR and TKR group respectively. The mean drain output was greater among IV TKR group (261.66±129.60 ml) as compared to topical TKR group (210±129.49 ml). In THR drain output in IV group was 216±104.08 ml. In both the groups, mean blood loss was lower in cases where IV TXA was administered as compared to topical TXA, (p&gt;0.05). The mean drop in Hb was greater after topical administration of TXA in both the groups as compared to IV administered TXA. In THR group, 9 (39.13%) patients required blood transfusion. In sickle cell disease patients, we found more blood loss and drain output as compared to non-sickle cell disease (SCD) patients.</p><p><strong>Conclusions:</strong> Both IV and topical TXA are clinically effective and safe in decreasing calculated blood loss, Hb drop after THA and TKA.</p><p> </p> Rohit K. Bhurre, Pravin J. Gore, Sajal R. Mitra, Ashish A. Kukreja, Nilesh S. Sakharkar Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Clinical outcomes of fibula bone fracture treated with fibula plate and screws: a retrospective study <p><strong>Background:</strong> The aim of this study was to examine the performance of the plate system with screws while treating Fibula bone fracture.</p><p><strong>Methods:</strong> This was a retrospective study in which 36 patients (27M and 9F) were treated for fibula bone fracture in M.O.H. Jeetoo hospital between September 2020 to December 2021 with a mean follow up of 1 year (1month, 3 months, 6months and 12months). Radiological results at every follow up showed bone union and related complications. Physical fitness of the patients was examined by the American society of anesthesiologists grade and the pain intensity was analyzed by VAS scoring table.</p><p><strong>Results:</strong> The gradually dropping in VAS score indicates positive results to pain management. Consistently, all patients received physiotherapy under physiotherapists. No patient complained of problems or hardware-related issues at the time of the last follow-up, and every patient had proper bone union. At a six-month follow-up, radiological results also indicated proper union.</p><p><strong>Conclusions: </strong>Complications risks are minimal with plate fixation for fibula bone fractures. Better outcomes and accuracy depend upon the surgical skills that can lead to reduced complications.</p> Tarun Kumar, Shashank Mishra, Bhawana Chawale, Mohit Kumar, Gaurav Luthra Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 A comparative study between dynamic hip screw and proximal femoral locking plate in the management of unstable pertrochanteric fracture femur <p><strong>Background:</strong> Pertrochanteric fracture represent perhaps the most important public health problem facing the orthopedic surgeon today. The purpose of the present study is to compare dynamic hip screw with proximal femoral locking plate (PFLP) in pertrochanteric fracture femur.<strong> </strong></p><p><strong>Method: </strong>During the period from December 2019 to August 2021, 50 patients with pertrochanteric fracture femur who were admitted in the orthopaedics department were selected. The 25 patients treated with PFLP and 25 patients treated with dynamic hip screw according to the standardized protocol. Patients were followed up for the 1 year. </p><p><strong>Results</strong>: The mean operative time and average intraoperative blood loss was more in PFLP group when compared with DHS group it was statically significant. PFLP group has marginally better functional than DHS group. There was no difference in the radiological outcome between two group.</p><p><strong>Conclusions:</strong> PFLP can be feasible alternative to treatment of complex comminuted pertrochanteric fractures. It can be use in old age patients with osteoporotic bone which provide stable fixation.</p> Atul N. Parshuramkar, Pramod A. Jain, Kisan R. Patond, Aditya S. Jagdale Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Fracture supracondylar femur treated with various modalities of treatment-an exploratory study <p><strong>Background: </strong>Present study looked at functional outcomes and rate of complications in cases of adult supracondylar-intercondylar femur fractures treated with different treatment modalities at a tertiary care government hospital.</p><p><strong>Methods:</strong> The study was conducted over 2 years wherein 23 patients with fracture in intercondylar-supracondylar region were included. The different implants and surgical techniques used in the study were: Condylar blade plate, dynamic condylar screw (DCS) with side plate, buttress plate single, supracondylar nail technique and TARPO technique. Neer’s criteria was used to compare functional outcome with different modalities of treatment.</p><p><strong>Results: </strong>Eight out of 11 patients treated using DCS with side plate-showed excellent results as per Neer’s criteria. Excellent results were observed in 3 out of 4 fractures fixed with GSH supra-condylar nail, 3 out of 3 in those fixed with TARPO technique, 0 out of 3 in patients managed using buttress plate and 1 out of 2 patients treated with blade plate.</p><p><strong>Conclusions:</strong> Closed method of reduction followed by internal fixation (TARPO technique and GSH nail) is better than open reduction (Buttress plate, DCS with side plate and condylar blade plate) for the management of fracture supracondylar femur. DCS with side plate by open method is at par with GSH nail and TARPO technique for knee ROM and rate of complications. It is recommended that, the Neer’s criteria should not be utilised in isolation for the purpose of comparing outcomes in cases of fracture supracondylar femur.</p><p> </p> Mukesh Sancheti Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Functional assessment after anterior cruciate ligament reconstruction using quadrupled semitendinosus graft <p><strong>Background:</strong> Anterior cruciate ligament is the primary stabilizer of the knee and prevents translation and rotatory forces and it is one of the most prevalent ligament injuries in the knee. Arthroscopic ACL reconstruction is recommended for which different graft options can be Quadrupled Semitendinosus and Gracilis, doubled Peroneus, Quadriceps Tendon, and Bone patellar tendon-bone. As all grafts have their advantages and disadvantages in terms of donor site morbidity, fixation, and failure rate; the ideal ACL reconstruction graft remains a point of contention. So, we did a functional assessment after ACL reconstruction using Quadrupled Semitendinosus graft.</p><p><strong>Methods:</strong> The prospective cohort study included 30 patients under the age of 55 years admitted with ACL deficiency from August 2019 to August 2020 in the orthopedic department of a Sapthagiri hospital, Bangalore who underwent arthroscopic ACL reconstruction. This study aims to evaluate the functional result of arthroscopic anterior cruciate ligament reconstruction with only quadrupled semitendinosus tendon graft using the Tegner, Lysholm, and IKDC knee grading systems.</p><p><strong>Results:</strong> Patients were followed up for a minimum period of one year. On evaluation, the maximum Lysholm, IKDC score achieved was 97 and 79 respectively while the minimum score was 86 and 69 respectively. Comparisons of pre-and postoperative improvement scores were statistically significant.</p><p><strong>Conclusions:</strong> Arthroscopic ACL reconstruction with quadrupled semitendinosus graft yields good functional results with minimal postoperative morbidity irrespective of graft diameter.</p> Shreekantha Rao, Prabhat Mittal, Bhoomika Saxena Copyright (c) 2022 International Journal of Research in Orthopaedics Wed, 28 Dec 2022 00:00:00 +0000 Clinical outcomes of the intramedullary humerus nailing system in the treatment of humerus fractures <p><strong>Background</strong>: After femoral and tibia bone fractures, the humerus fracture is the third long bone fracture. The purpose of this study was to clinically evaluate the outcomes of treating humerus fractures with an KN-5H humerus nailing system. The fixation of humerus fracture especially shaft fractures from intramedullay humeral nail the clinical outcomes obtained from the retrospective study of humerus nailing system on humeral fracture is controversial feature in surgical technical research, follow-up factors, and implants.</p><p><strong>Methods: </strong>In this retrospective study of KN-5H humerus nailing system (KN-5H intramedullary cannulated humerus nail, KN-5H reconstruction nail, cannulated and KN-5H reconstruction cannulated intramedullary humerus nail) manufactured by the Kaulmed Pvt. Ltd. is used. The total 26 patients from which 11 males and 15 females between the age group of 18-70 years with humerus fracture were taken. Patients didn't received conservative management. The fractures were categorized based on AO classification and Neer type. Th post-operative clinical effectiveness was evaluated using the Radiological evaluation, VAS score and Functional ROM results.</p><p><strong>Results: </strong>The mean follow-up period was 15 months (range 13 to 24 months). The mean time of union was 14 weeks (range 10 to 18 weeks) in 26 patients. No non-union occurred in any patients. Functional end results of shoulder and elbow were excellent in 92.3% patients, moderate 5.75% patients and poor in 1.95% patients. Postoperative complications included one superficial infection, 3 patients had nail impingement complain, one patient has shoulder stiffness and had pain in adduction. No implant related complication was reported.</p><p><strong>Conclusions: </strong>The treatment of proximal and diaphysis humerus fracture is highly recommended using intramedullary humeral nailing due to lower post-operative complication with high union rate. <strong></strong></p> Akash Sharma, Arpit Jain, Gaurav Luthra, Roshani Kamlesh Upadhyay, Rahul Badyal Copyright (c) 2022 International Journal of Research in Orthopaedics Thu, 29 Dec 2022 00:00:00 +0000