International Journal of Research in Orthopaedics

Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

Kęstutis Bliznikas, Gintarė Lukoševičiūtė, Barbora Dauderytė — Mon, 26 Feb 2024 00:00:00 +0530

Meniscal repair procedures are on the rise due to an enhanced understanding of the adverse long-term effects associated with the loss of meniscal tissue. Although meniscal repair has a higher reoperation rates compared to meniscectomy, recent systematic reviews indicate improved long-term outcomes with meniscal repair. Even though there are a lot of studies that compare the results of all-inside and inside-out techniques there are only few that evaluate all-inside and outside-in approaches. This study aims to review the relevant literature on the epidemiology, mechanism of injury, clinical presentation and imaging of meniscus and to compare the failure rates and time to failure of AI and OI meniscal repairs. PubMed and Scopus were searched for studies published between January 2014 and January 2024 reporting on meniscus repair outcomes using “outside-in” or “all-inside” techniques with a minimal duration of 6 months for follow-up. Failure was characterized as the recurrence of clinical symptoms or the need for a meniscal reintervention. Over 50 English-language articles were analyzed between 2000 and 2022. After conducting a review and data analysis, it is observed that the “all-inside” technique is more frequently chosen as a treatment method, possibly due to its simpler execution. Both total and percentage rates of failures are higher using this technique, amounting to 79 cases and reaching 16%, compared to “outside-in” approach, which is less commonly chosen, but has lower frequency of failures totaling 6 cases and 5%.

Skeletal involvement in Burkitt's lymphoma: a comprehensive review

Navin Tripathi, Anil Regmi — Tue, 06 Feb 2024 00:00:00 +0530

Burkitt's lymphoma, a highly aggressive form of non-Hodgkin lymphoma, exhibits a distinctive predilection for rapid growth and systemic dissemination. While its primary manifestation is often observed in the lymphatic system, orthopaedic involvement has been increasingly recognized. This review synthesizes current literature to comprehensively explore the orthopaedic implications of Burkitt's lymphoma, encompassing clinical presentation, diagnostic challenges, treatment modalities, and associated outcomes.

Allograft sterilization and processing: impact on biomechanical strength

Mahantesh Magadum, Manjunath K. L., Deeppak D Chitragar — Mon, 26 Feb 2024 00:00:00 +0530

The allograft used for anterior cruciate ligament reconstruction (ACLR) must posses good biomechanical properties and it should have similar properties to the original tendon. During reconstruction the allograft must undergo proper sterilization and several sterilization methods have been used in the clinical practice. There are varations in the sterilization process and it has significant impact on the allograft tissue performance during ACL reconstruction. It is advisable to refrain from utilising grafts that have been exposed to radiation doses exceeding 15 kGy, as well as grafts that have undergone more than eight freeze-thaw cycles. Gamma radiation has disadvantages when compared to electron beam radiation in term of loss of mechanical strength.

Essential amino acids in total knee and hip joint replacement: a narrative review

Mon, 26 Feb 2024 00:00:00 +0530

The increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA.

Measuring the outcomes of medial meniscectomies with a femoral end medial collateral ligament release and reattachment in patients with a tight knee: a case series

Kanwar Parhar, David Frolov, Ryan Tapio, Katherine Slack, Miguel A. Schmitz — Mon, 26 Feb 2024 00:00:00 +0530

Partial meniscectomies are the most commonly performed arthroscopic knee procedures, however, are complicated by the presence of a tear in the posterior medial compartment (PMC) in tandem with a “tight knee”. This inhibits adequate spacing for instrumentation access, increasing the chances of causing iatrogenic cartilage damage which can progress to early onset osteoarthritis. We present a unique method for increasing the joint space, in such cases, and avoiding cartilage damage, by performing a femoral end medial collateral ligament release and reattachment (MCLR). Patient outcomes were evaluated in two parts. The first part compared the fourteen patients who underwent a MCLR pre- and post-operatively via the Lysholm and Tegner score, VAS pain scale and knee flexion angle. Finally, the MCLR patients were compared via 1:1 propensity score-matching to patients who underwent a valgus maneuver only for a PMC tear. The patients receiving an MCLR showed a statistically significant improvement (p<0.001) within each of the pre- and post-operative measured variables. When compared with 1:1 propensity score matched and unmatched patients, no statistically significant difference was seen between the Lysholm, Tegner and Flexion angle while VAS pain scale did show a difference. For patients requiring a PMM with a “tight knee”, performing an MCLR provides a clinical and functional improvement in symptoms and showed no statistically significant difference when compared with valgus maneuver only patients. Therefore, it is an effective procedure for increasing the joint space in a patient with a tight knee that requires a partial medial meniscectomy (PMM).

Pixee knee+ augmented reality assisted navigation for total knee arthroplasty in an ambulatory surgical center

Jacob Waitzman, Safa Kassab — Mon, 26 Feb 2024 00:00:00 +0530

Total knee arthroplasty (TKA) requires precise alignment for optimal post-operative outcomes and prosthesis longevity. Recently, augmented reality (AR) has emerged as a promising technology in surgical procedures, including TKA. This case series evaluates the feasibility and accuracy of the knee+ augmented reality-assisted navigation (ARAN) system by Pixee Medical in an ambulatory surgical center (ASC) setting. Our study involved 17 consecutive TKA patients performed with the knee+ ARAN system at an ASC from August 2022 to October 2022. Demographic data, including sex, age, ASA score, height, weight, and BMI, were recorded. Postoperative measurements of the mechanical distal femoral angle (MDFA), mechanical distal tibial angle (MDTA), posterior tibial slope (PTS), femoral-tibial angle (FTA), and posterior femoral flexion (PFF) were compared to the ideal intraoperative angles. Outliers were defined as deviations greater than 3° from the planned angles. In this study, 15 out of 17 TKAs utilizing the Pixee knee+ ARAN system were analyzed. All mean post-operative radiographic measurements were within clinically acceptable ranges. The study also found that surgeries using the knee+ system had a slightly longer incision-to-closing time relative to the control group of patients undergoing normal TKA. Our results indicate clinically acceptable accuracy and precision in alignment with the knee+ ARAN system, albeit with a slight increase in surgery duration. This is the first study evaluating the knee+ ARAN system in an ASC setting indicates its suitability for outpatient centers, highlighting its precision, portability, and cost-effectiveness. Larger studies utilizing outcome measures can further assess the system’s advantages and disadvantages.

Functional outcome of operative management of Haglund deformity in non-athletic individuals-a case series

Mon, 26 Feb 2024 00:00:00 +0530

Haglund’s deformity is a symptomatic osseous outgrowth or prominence of the posterolateral corner of calcaneus usually in young individuals which presents in the form of posterior heel pain, sometimes intractable in chronic cases, which aggravates on walking or on dorsiflexion of the foot and is relieved with rest and anti-inflammatory medications in the initial phases. Management involves an initial conservative trial involving lifestyle changes and medical management, failure of which warrants surgical management for symptomatic relief along with ability to return to perform activities of daily living. We have a series of 4 patients with a Haglund’s deformity who presented to us with chronic posterior heel pain of varying duration with episodic exacerbations who were initially managed with a conservative trial with medications, physiotherapy, lifestyle modifications, usage of soft silicon sole for the footwear; the failure of which prompted us to go ahead with surgical management of these patients-all 4 patients were managed with a lateral wedge removal of the calcaneus with excision of the retrocalcaneal bursa. All 4 patients reported significant improvement in the symptoms with adequate postoperative care and rehabilitation. As we have seen in this case series of 4 patients presented here, Haglund’s deformity which is a part of a larger Haglund’s syndrome, has a chronic progression over a period of time with episodic exacerbations and remissions, which could be managed conservatively for a significant period initially but, if need be, surgical management should not be deferred not only to provide symptomatic relief as a major goal, but also to avoid permanent degenerative damages to the concerned soft tissues.

Tumors around the ankle: a reconstructive challenge

Subbiah Shanmugam, G. Vijayalakshmi — Mon, 26 Feb 2024 00:00:00 +0530

Tumors around the ankle can be either bone or soft tissue sarcomas. The aggressive nature of these tumors and the complex anatomy of the ankle mortice make for a challenging reconstructive ladder. We have explored four different histological tumors which required tailor made resection and reconstruction. All our patients had reasonably good functional outcomes.

Immediate versus early soft tissue coverage for severe open grade III B tibia fractures: a comparative clinical study

Karun Jain — Mon, 26 Feb 2024 00:00:00 +0530

Controversy remains regarding timing in the management of grade III-B open tibia fractures. Many authors recommend an immediate definitive soft tissue coverage within a critical period of 12 hours, yet in many patients, this may be impossible due to concomitant injuries or delayed referral. The present case series aims to compare the role of immediate versus early soft tissue coverage for severe open grade III-B tibial fractures. 20 cases of tibial fractures of were divided into two groups; 10 cases each. Immediate group (within 12 hours) and early group (3-7 days), according to the soft tissue coverage time. Strict criteria for inclusion in the first group included debridement within 12 hours of injury, no sewage or organic contamination, the presence of bleeding skin margins, and the absence of systemic illness. All 20 cases had been treated by a debridement and soft-tissue cover with a muscle pedicle or fasio-cutanous flap. Functional outcome measures included deep infection rate, stable soft tissue coverage, number of inpatient’s stays, number of surgical procedures, and union time. The mean follow-up period was 24 months. Mean inpatient time was 30 and 41 days respectively. Mean surgical procedures were 2.2 and 3.4 respectively and union time was 26 versus 34 weeks. Mean inpatient time, mean surgical procedures per time and union time were pointedly less in the immediate flap coverage group which significantly improves results concerning early union, healing time, and cost of hospitalization and rehabilitation.

Arthrodesis following persistent periprosthetic knee infection using femoral condyle allograft: a case report and review of literature

Tue, 02 Jan 2024 00:00:00 +0530

Periprosthetic joint infections (PJI) of the knee are difficult to treat and can require costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures. Knee arthrodesis is considered a last resort for persistent knee joint infections and provides stability and pain relief by fusing the knee joint. The authors describe a case of a persistent and difficult to treat periprosthetic total knee arthroplasty (TKA) infection, subjected to multiple surgeries and revisions, where an arthrodesis was performed as a last resort. The arthrodesis was performed using a femoral-tibial endomedullary nail with interposed femoral condyle allograft. Complete graft integration and consolidation was achieved without complications. The patient performed well post-operatively and is currently ambulatory with walking aids and has no knee pain. The removal of well-fixed metaphyseal sleeves in TKA can be challenging and associated with complications such as damage to the surrounding bone and soft tissue during the removal process. Taking special care and not rushing this step can present an extremely meaningful difference in the final outcome. In cases with large bone defects, especially after sleeve removal, allograft usage can be extremely useful for managing dead space and limb-length discrepancies while promoting faster bone healing. When successful, as was the case described, arthrodesis using allografts can have beneficial outcomes with high patient satisfaction and deliver function to previously very unhealthy joints and limbs.

Proximal humerus fracture in a newborn-like a thief in the night

Sofia Madeira, Carolina Escalda — Mon, 26 Feb 2024 00:00:00 +0530

Epiphysiolysis of the shoulder is rare in newborns. The radiographic evaluation may be limited due to the non-ossification of the epiphyses, and it can be misdiagnosed as a dislocation. Ultrasonography and MRI provide a better answer in the diagnosis of these lesions. We describe a clinical case of an epiphysiolysis of the shoulder in a newborn baby after caesarean section. A premature born with 26 weeks and 660 g shows oedema and ecchymosis of the right shoulder. Radiographies and ultrasound show a fracture-epiphysiolysis of the proximal humerus. She was treated in a conservatory way. At 8 months old, she has no complaints and has a normal range of motion of the shoulder.

Medial dorsal cutaneous nerve entrapment following inversion ankle sprain

Marcelo P. T. Alves, João P. G. Nóbrega, Paulo F. F. M. Dourado — Mon, 26 Feb 2024 00:00:00 +0530

The medial dorsal cutaneous nerve is one of the terminal branches of the superficial peroneal nerve that provides sensory innervation to the dorsum of the foot. It may be prone to injury by direct blow, iatrogenic surgical lesion or in rare situations secondary to ankle sprains. The authors report a case of persistent ankle pain in a female patient caused by a post- traumatic compressive neuropathy of the medial dorsal cutaneous nerve secondary to an ankle sprain which was successfully surgically treated with complete resolution of the symptoms.

Escherichia coli mono articular septic arthritis of shoulder joint in an elderly female

Shubhank Narula, Atul Kakar, Atul Gogia, Tanvi Batra — Mon, 26 Feb 2024 00:00:00 +0530

Septic arthritis of the shoulder joint is a very rare entity to encounter in clinical practice. Escherichia coli (E. coli) pathogen isolation is only seen to occur in individuals with multiple comorbidities. We report a similar case of gram-negative E. coli urosepsis in a veteran female that transmitted hematogenously to the shoulder joint and how a prompt diagnosis and treatment prevented extension and damage of the joint space.

Tubercular arthritis of the elbow mimicking as a neoplasm: a case report and literature review

Ankitha K. S., Ramesh L. J., Vadhiraj Krishna J. B., Karthik D. — Mon, 26 Feb 2024 00:00:00 +0530

Tuberculous arthritis of the elbow joint is rare. A 38-year-old male patient presented with swelling, pain, and deformity of the elbow. The symptoms first appeared one year ago; he was clinic-radiologically evaluated and diagnosed with neoplasm. The patient underwent biopsy to confirm the diagnosis and was found to have tuberculous arthritis and was started on anti-tubercular treatment and underwent surgical debridement. Tuberculous arthritis usually presents with chronic arthritis. However, it can also present in patients with septic arthritis. If untreated, it can cause joint destruction. Hence, early diagnosis and treatment is important.

Pelvic insufficiency fracture in an osteoporotic 47-year-old female: a case report

Chandan Mehta, Devansh Lalwani, Ashraf Fazal Shaikh, Mohan Madhav Desai — Mon, 26 Feb 2024 00:00:00 +0530

Insufficiency fractures (IFs) represent a form of stress fractures frequently linked to osteoporosis and a lack of vitamin D. These fractures, which are not caused by trauma, typically manifest in the pelvis and spine, although occurrences in atypical locations are also relatively frequent. The primary methods for diagnosing IF involve using plain radiographs and magnetic resonance imaging scans, which are commonly employed imaging techniques. The management involves both medical and surgical methods, tailored as per the needs of the patient. 47-year-old female patient presented to the outpatient department with complaints of low back ache with waddling gait, with pain not responding to analgesics. Laboratory and radiological assessment revealed osteoporotic Insufficiency fracture in the pelvis which was managed with both surgical and medical methods, with surgical management involving percutaneous screw fixation of the fractures. Diagnosis of the osteoporotic insufficiency fractures at atypical locations can be extremely challenging because of the inconclusive radiographs and the lack of a perceptible trauma history and hence, can be missed at the initial presentation. The management includes both operative and non-operative modalities, best tailored as per the patient needs and expectations.

Management of infected gap non-union of the tibia with bone transport over plate

Gopal Pundkare, Pratik Mankar — Mon, 26 Feb 2024 00:00:00 +0530

Compound tibia fracture with bone loss is common presentation in Orthopaedics, treatment for which is well described in the literature. Ilizarov technique is commonly used to fill the bone defect with its different modifications which include additional stabilization with IMIL or Plate. We report a case of infected gap nonunion of proximal tibia shaft which was managed with Ilizarov technique along with a stabilizing plate. The purpose of this report is to provide an alternative mode of management for infected of tibia shaft fracture with bone defect.

Pacinian neurofibroma of index finger in young adult: a rare case report

Gopal Tukaram Pundkare, Amey Ramakant Gursale — Mon, 26 Feb 2024 00:00:00 +0530

Pacinian neurofibroma (PN) of index finger (hand) is a rare entity with only few cases reported till now. Although it’s a neurofibroma but the association between PN and neurofibromatosis has not been established. We present a rare case of young adult coming with painful swelling on palmer aspect of base of index finger. Patient didn’t respond to the conservative line of management so on excision biopsy it revealed out to be PN.

A rare case of solitary exostosis of capitate

Siddhartha Singh, Amarendra Bahadur Singh, Manjunath Nishani, Mohit Kumar Verma — Mon, 26 Feb 2024 00:00:00 +0530

Exostosis arising from carpal bones is rare and only a few cases have been reported till date. A 29 years old female came to the outpatient department with a localized swelling present on the dorsum of her right wrist since the past three years. On examining the patient clinically, a well-defined protuberance was observed over the dorsal aspect of the right wrist. CT report showed bony outgrowth over the dorsum of the capitate extending beyond the carpometacarpal joint. In surgical intervention, the mass was removed from the base, which grossly had an appearance of chondral origin. The biopsy report confirmed the diagnosis of exostosis (osteochondroma). Hence, excising the exostosis surgically led to achievement of adequate motion of the patient's wrist along with the additional cosmetic correction benefit.

Lupus with myositis in an adult Indian male

Shubhank Narula, Atul Kakar, Tanvi Batra — Mon, 26 Feb 2024 00:00:00 +0530

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves various organs and has a vast spectrum of multi system involvement. SLE is an autoimmune illness which is rarely found in males but when present holds a poor prognosis with a predisposition to develop various manifestations. This case involves a 50-year-old male who developed myositis as a complication of lupus despite adequate immunosuppressive therapy.

Trauma outcomes at higher-level trauma centres compared with lower-level trauma centres: a systematic review and meta-analysis

Nithish Jayakumar, Islam Sarhan, Ian M. Lahart, Sajjad Athar, Neil Ashwood — Mon, 26 Feb 2024 00:00:00 +0530

The introduction of trauma systems has helped reduce mortality in severely injured patients. This fall in mortality, however, appears to be concentrated in higher-level trauma centres (TCs) in comparison to lower-level TCs, but the evidence is inconsistent. Therefore, we undertook a systematic review with the aim of comparing outcomes in lower-level TCs (i.e. level III and IV trauma centres) with higher-level TCs (i.e. level I and II centres). This systematic review was performed in accordance with the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). The review was registered on PROSPERO (CRD42019111933). Mortality data were combined using the Mantel-Haenszel random-effects method for meta-analysis, using Review Manager (RevMan v5.3.5). We found 28 eligible articles from an initial total of 10,816 identified abstracts. Our meta-analysis revealed no evidence of a difference in mortality risk in severely injured patients between lower-level and higher-level TCs (RR 1.55; 95% CI 0.97 to 2.50; p=0.07), but there was considerable heterogeneity (I2=92%) in the dataset. The risk of death in lower-level TCs in patients with neurological trauma, however, was statistically lower than in higher-level TCs (RR 0.80; 95% CI 0.73 to 0.86; I2=78%; p<00001). There was a higher risk of death in patients with neurological trauma managed at higher-level TCs and this is likely to be due to the higher severity of injury (intracranial and extracranial) sustained by patients at higher-level TCs. However, the high level of heterogeneity in the risk estimates of evaluated studies reduces the certainty of our interpretations.

Is there a role for ischaemic pre-conditioning in orthopaedic and trauma surgery? A systematic review and meta-analysis of randomised controlled trials

Sean D. X. Duffy, Andrew D. Beswick, Ashley Blom — Mon, 26 Feb 2024 00:00:00 +0530

Surgical procedures using a tourniquet submit tissues to ischaemia and reperfusion on restoring blood flow. Ischaemia-reperfusion may lead to local or remote tissue damage resulting in pain and complications. We aimed to evaluate the effectiveness of ischaemic preconditioning with a tourniquet in preventing pain, disability, adverse events, inflammation and facilitating recovery and discharge in patients receiving orthopaedic and trauma surgery. We conducted a systematic review of randomised controlled trials investigating ischaemic preconditioning in patients undergoing trauma and orthopaedic surgery. We searched The Cochrane Library, Medline and Embase until January 2021. Where possible continuous data were pooled and meta-analysis performed. Ten RCTs met inclusion criteria, eight of which underwent meta-analysis. Three studies reported lower acute post-operative pain or morphine consumption in patients randomised to IPC. We found weak evidence for shorter length of stay in the intervention group (MD-0.54 days; 95%CI-1.11, 0.03; p=0.0615). Malondialdehyde levels were lower in patients randomised to IPC at two hours following tourniquet deflation (MD -1.39 nmol/ml; 95%CI-2.23, -0.55; p=0.0012). We found no between group differences in Tumour Necrosis Factor-α, Lactate or Interleukin-6. The mechanism behind IPC may be related to reduced lipid peroxidation rather than reduced inflammation. There is evidence IPC reduces post-operative pain following knee surgery that merits further study.

Application of machine learning constructs to predict post-operative complications and adverse events following shoulder hemiarthroplasty

Mon, 26 Feb 2024 00:00:00 +0530

Background: Artificial intelligence (AI) constructs and machine learning (ML) algorithms have demonstrated utility in predicting various clinical, surgical, and financial outcomes. In this study, we applied AI to shoulder hemiarthroplasty (HA) to predict various post-operative complications.

Methods: The sample was queried from the American college of surgeons-national surgical quality improvement program (ACS-NSQIP) database for all shoulder HA cases from 2008-2018. Six ML algorithms-random forest classifier, gradient boosting classifier, decision tree classifier, SVM classifier-tuned model, Gaussian Naïve Bayes classifier, multi-layer perception-analyzed the sample dataset. Postoperative complications included extended length of stay, non-home discharge destination, transfusion, and any adverse event. Each ML model was compared to logistic regression (LR), and model strength was evaluated.

Results: We identified a total of 1585 shoulder HA cases. Mean age, BMI, operative time, and length of stay were 66±12 years, 31±8 kg/m², 114±61 minutes, and 2.93±6.61 days. Preop hematocrit, longer operative time, and older age were most predictive of extended length of stay. Preop hematocrit, operative time, and ASA class had the highest importance in any adverse events (AAE) prediction. ML models outperformed traditional comorbidity indices, LR, for predicting extended length of stay (79% vs. 66%), non-home discharge destination (79% vs. 65%), any adverse event (78% vs. 66%), and transfusion requirement (82% vs. 63%).

Conclusions: ML algorithms predicted post-surgical outcomes of interest following shoulder HA at a higher rate to conventional LR and can assist orthopedic surgeons in decision making.

Evaluating the effectiveness of Baker's procedure in restoring functionality in neglected Achilles tendon injuries

Thu, 25 Jan 2024 00:00:00 +0530

Background: Neglected Achilles tendon injuries present a significant challenge in orthopedic practice, often requiring complex surgical interventions for effective treatment. This study aims to evaluate the functional outcomes of patients with neglected Achilles tendon injuries treated using Baker's procedure, a surgical technique designed for complex cases.

Methods: This prospective interventional study was conducted at multiple medical centers in Dhaka, Bangladesh, from January 1, 2012, to May 31, 2013. It included 42 patients aged 18 to 60 years with signs of old Tendo-Achilles rupture. Participants were selected based on specific inclusion and exclusion criteria and underwent Baker's Procedure. Postoperative assessments included pain levels, ankle stiffness, calf-muscle weakness, footwear restrictions, range of motion, and patient satisfaction, evaluated using the Juhana Leppilahti modified score.

Result: The majority of patients (85.71%) reported no pain post-treatment, while 14.29% experienced mild pain. Ankle stiffness was absent in 71.43% of the patients and mild in 28.57%. Calf-muscle weakness varied, with 64.29% showing no weakness, 28.57% mild weakness, and 7.14% moderate weakness. Footwear restrictions were minimal, with 92.86% reporting no restrictions. Active range of motion was normal (≤5°) in 64.29% of patients and mildly limited (6-10°) in 35.71%. Patient satisfaction was high, with 71.43% being 'Very satisfied' with their treatment outcomes.

Conclusions: The study demonstrates that Baker's Procedure is an effective surgical intervention for neglected Achilles tendon injuries, leading to significant pain relief, restored functional mobility, and high patient satisfaction. These findings suggest that with appropriate surgical and rehabilitative care, patients with complex Achilles tendon injuries can achieve favorable outcomes, emphasizing the importance of tailored surgical approaches in orthopedic practice.

Assessment of clinical, functional and radiological outcomes in young patients with grade 3 and 4 osteoarthritis of the knee joint undergoing knee joint distraction with and without arthroscopic debridement and chondroplasty-a prospective, comparative and randomized controlled study

Dinesh Gupta, Rohit N. Garg, Amey Ashok Adate — Mon, 26 Feb 2024 00:00:00 +0530

Background: Treatment of severe osteoarthritis (OA) in relatively young patients is challenging. Although successful, Total knee arthroplasty (TKA) has a limited lifespan, with the risk of revision surgery, especially in active young patients. Our study aims to assess the comparative clinical, functional and radiological outcomes of knee joint distraction (KJD) with and without arthroscopic debridement and chondroplasty in OA of knee in the young, in a randomized controlled trial.

Methods: Our study was a prospective randomized trial with equal allocation. A total of 160 patients needing intervention for knee arthritis, in the age group of <55 years were included as per the inclusion criteria, and were randomized into 2 groups. Group A included 80 patients who underwent KJD alone. Group B included 80 patients who underwent KJD with arthroscopic debridement and chondroplasty. All patients were followed up to 24 months post intervention. Clinical (Visual analogue scale-VAS), functional (Western Ontario and McMaster universities OA index-WOMAC) and radiological (Joint space width-JSW) outcomes were then compared and assessed.

Results: Both the groups showed statistically significant improvement of clinical, functional and radiological outcome scores compared to baseline levels. The mean improvement in KJD+SCOPY group was statistically superior to that of KJD group with regard to clinical and functional outcome scores; however, the radiological improvement though being statistically significant in both groups compared to baseline levels, but one group was not superior to that of other.

Conclusions: KJD in patients with OA of knee (Kellegren Lawrence grade 3-4) aged <55 years results in improvement of clinical, functional and radiological parameters at 2 year follow up. Addition of arthroscopic debridement and chondroplasty to KJD makes it superior to KJD alone in terms of improvement in clinical, functional and radiological outcomes. We recommend arthroscopic debridement and chondroplasty coupled with KJD for compliant patients of less than 55 years with grade 3-4 OA of the knee.

Detecting suspected scaphoid fractures? the role of different imaging modalities within a district general hospital during the pandemic

Tihami Mansoor, Hamzah Khan, Gur Sidhu, Neil Ashwood, Christos Kitsis — Mon, 26 Feb 2024 00:00:00 +0530

Background: This study evaluates the effectiveness of magnetic resonance imaging (MRI) versus computerised tomography (CT) scans for persistent wrist pain at the thumb base following injury in adults and children during covid. This was part of a pathway introduced as access to MRI scan was limited.

Methods: Patients were identified as having possible scaphoid fractures within the emergency department but had no fracture identified on initial imaging over a 3-month period. These were triaged to a scaphoid pathway during the covid pandemic from a virtual clinic. Patients were reviewed clinically and radiographically within the hand clinic using further imaging with CT or MRI scan.

Results: During the study time 45 patients with scaphoid fractures were detected on initial radiography in ED and 187 with suspected scaphoid fractures were selected for further review. Ninety (48%) were referred to the hand clinic where 2 (1%) scaphoid fractures were diagnosed on a second radiograph and ninety-seven (52%) were to be seen in an upper limb clinic where 2 (1%) further fractures were detected. 92% of scaphoid fractures were identified on radiography either in ED or orthopaedic clinic. Of the remaining 178 with two negative radiographs further imaging was requested in 45 cases (25%). Pathology was found in 17 (58%) MRI scans and in 7 (39%) CT scans.

Conclusions: Imaging needs to be timely to enable effective treatment. Obtaining MRI scans while diagnostically superior is not always achievable especially in times of resource depletion. Back up pathways using alternative imaging can be effective.

Outcome of dynamic locked plate in treatment of intracapsular femur neck fracture

Mabrouk S. Bohalfaya, Salem M. Elmabsout, Hassan M. Nouh — Mon, 26 Feb 2024 00:00:00 +0530

Background: The ideal surgical treatment of femoral neck fractures is still debatable. When internal fixation is used, many implants are available. This study aimed to evaluate the outcome following fixation of intracapsular femur neck fractures using the Targon-FN system (B. Braun, AG. Melsungen, Germany) comparing the results with a similar study done by the manufacturer and to assess risk factors associated with complications.

Methods: A prospective interventional case series involved 30 consecutive patients aged from 23 to 82 (Mean 49 years) treated at Al-Jalaa trauma hospital in Benghazi- Libya in period from January 2016 to July 2017, for an intracapsular femur neck fracture with Targon-FN system. According to Garden classification 9 fractures (30%) undisplaced and 21 (70%) were displaced fractures, with 2 patients (6.7%) had type I, 7 patients (23.3%) had type II, 7 patients (23.3%) had type III and 14 patients (46.7%) had type IV fracture. Epidemiological data were collected. Patients were followed-up for 2 years (average 16 months). Joint function was assessed clinically by using Harris hip score (HHS) and fracture healing by radiological assessment at sex weeks, 3 months, 6 months, 1 year and finally at 2 years. Complications were recorded. Statistical analysis done to predict risk factors associated with reoperation and complications.

Results: Sixteen patients (53.3%) developed one or more complications. Complications were higher than those of manufacturer’s study and included avascular necrosis (53.3%, n=16), nonunion (30%, n=9), blown out implant (16.66%, n=5), loosening screw (3.3%, n=1), and deep infection (3.3%, n=1). In total, 5 patients required total hip replacements. At end of 2 years 19 patients (63%) had poor result, one patient (3.3%) had fair result, 1 patient (3.3%) had good result and 9 patients (30%) had excellent result according to HHS. Delayed surgery, fracture displacement, surgeon’s experience, age ≥40 years and time to postop weight bearing recognized as risk factors for complications.

Conclusions: A minimally-invasive surgery of Targon FN justifies use of this system for the preservation of the patient’s hip joint, early rehabilitation and mobilization. Complications and re-operation could be minimized by performing surgery within 24-48 hours, provision of skillful surgeons, and proper timing of postoperative weight bearing. The main limitation is the small number of cases and short follow-up averaged at 16 months.

Short-term functional outcomes in patients undergoing primary total knee arthroplasty according to their body mass index

Mon, 26 Feb 2024 00:00:00 +0530

Background: The impact of an increased body mass index (BMI) in patients with ostheoarthritis who undergo total knee arthroplasty (TKA) remains a controversial variable in terms of risks and benefits. This study aimed to evaluate the influence of BMI in the functional outcomes of patients with ostheoarthritis who underwent TKA.

Methods: We followed a cohort of patients who underwent total knee arthroplasty with a primary diagnosis of osteoarthritis. Patients were stratified into 3 groups according to the World Health Organization classification of BMI. We assessed the association between BMI group and functional scores using the Western Ontario and McMaster osteoarthritis index (WOMAC) over the time intervals of pre– and postoperatively at 1 month, 3 months and 1 year.

Results: The difference in means between pre-surgical WOMAC and WOMAC at first follow-up according to each BMI group was divided as follows: normal 10.9 (p=0.195), overweight 15.7 (p≤0.001) and obese 20.6 (p≤0.001). Study participants with a higher BMI had worse preoperative WOMAC scores and had greater improvement from baseline to 1 month. After one year of follow-up, participants in all BMI groups had similar WOMAC scores.

Conclusions: Patients with obesity who underwent TKA showed greater functional improvement one month after surgery compared to the other BMI groups. Subsequently, it was observed at the end of the 12-month follow-up that all patients, regardless of BMI, had improved functional outcomes, and the magnitude of improvement was similar in all BMI groups.

Role of ortho-pantho-graphic X-ray in the diagnosis of osteoporosis

Hassan M. Nouh, Amina R. Alomami — Mon, 26 Feb 2024 00:00:00 +0530

Background: Osteoporosis affects people, especially old age, as postmenopausal women and remains unnoticeable until the patient presents with a fracture. Osteoporosis in human begins started with the loss of bone mass that increases with age, this is related to the decrease in bone density and an increase in porosity that will cause fractures in this osteoporotic bone. Objective was to assess the usefulness of orthopanthographic (OPG) in the early detection of osteoporosis.

Methods: This is an analytic across-sectional test validation study, was done in Hawari Hospital-Benghazi, Libya which considered a referral General Hospital affiliated with University of Benghazi. This study was done during a period from March 2022 to July 2023. Sixty women were selected, divided into osteoporotic and non osteoporotic groups depending on the clinical and laboratory investigations under the supervision of an orthopedic consultant in the outpatient clinic. Panoramic radiographic X-rays were taken for evaluation and estimation of the mandibular cortex on the basis of (Mental index, Klemetti index, and Panoramic mandibular index) as a diagnostic tool to differentiate normal from osteoporotic patient, all three indices correlated significantly with bone mineral density and used as useful indicators for detected the osteopenia and osteoporosis.

Results: We calculated values of the three indices (Mental index, Klemetti index, and Panoramic mandibular index) values were low especially in the osteoporotic group, as well the values of mental index and panoramic mandibular index were low compared with low bone mineral density of the patient and klemetti index with: C2, C3 categories (moderate and severe erosion) most common observed in the osteoporotic patient.

Conclusions: Orthopanthographic X-rays provide a valuable tool for early detection and assessment of osteoporosis (preclinical stage) especially when characterized by a decrease in bone mineral density.

Assessment of clinical, functional and radiological outcomes in patients with fracture of distal end radius managed with close reduction and internal fixation with multiple percutaneous K wires: a prospective, single centre study

Ameya Dhuldeo Thaware, Rohit Nirbhay Garg, Shailendra Patil, James Kuris — Mon, 26 Feb 2024 00:00:00 +0530

Background: Distal end radius fractures are one of the commonest fractures, occurring in all the age groups. Different treatment modalities have been described in the literature ranging from conservative to operative including close/open reduction to external fixation. Our prospective study aimed at evaluating the outcomes and complications in these fractures managed by close means with multiple percutaneous K wires.

Methods: All the patients with distal end radius fracture were treated with close reduction and internal fixation with multiple percutaneous K wires. They were then evaluated clinically with visual analogue scale (VAS) score, functionally with Mayo wrist score and radiologically with Sarmiento’s modification of Lindstrom’s criteria on the follow ups.

Results: The study included a total of 152 patients (88 females and 64 males) with mean age being 49.5±10.4 years, with fall on outstretched hand being the most common mode of injury, and dorsal displacement (73.7%) being the most common X-ray finding. Maximum patients in the study had A2.2 fracture (80 patients) followed by C1.2 fracture type (36 patients). There was clinically and statistically significant improvement in the mean VAS scores on follow ups. Excellent functional and radiological outcomes were seen in 124 patients and 108 patients respectively.

Conclusions: Close reduction and internal fixation with multiple percutaneous K wires is a cost effective and easy method to treat all distal end radius fractures, provided good anatomical reduction is achieved before the wires are put.

Percutaneous release of trigger finger and its functional outcome

Sulabh Maheshwari, Aditya K. Mishra, Raunaq Saxena, Bilal Kaleem, Navneet Badoni — Mon, 19 Feb 2024 00:00:00 +0530

Background: An overview of percutaneous release for trigger finger and its functional outcomes.

Methods: The present prospective controlled analytical study was conducted after taking approval from center human ethical committee. A written and informed consent was obtained. There were 50 patients who reported to outpatient department (OPD) with symptoms suggestive of trigger thumb/ finger, were subjected to the study.

Results: Most of the patients belonged to the age group of 41-50 years. Majority of patients were females (56%) and males were (44%). Most of the patients had the right 1^st digit involved (32%), followed by left 1^st and right 3^rd digit (18% each). Before the release of affected digit, 56% were grade 3, 26% were grade 4 and only 18% were grade 1. Complete resolution immediately after the procedure was seen in 82% cases. Pre procedure, mean VAS of 8.4 reduced to mean VAS of 6.2 immediate post procedure. At 48 hours post procedure, mean VAS of 3.06 and mean VAS of 1.12 was seen at 1-month post procedure period. At 3 months post procedure, mean VAS of 0.42. 94% cases had no complications.

Conclusions: Percutaneous release of trigger finger is a safe and effective procedure associated with favorable functional outcomes. It provides an alternative treatment option for patients who have failed conservative management or prefer a minimally invasive approach.

Role of magnetic resonance imaging in differentiating tuberculous spondylitis from pyogenic spondylitis in a TB endemic area

Sachin Sharma, M. Shamim Ahmad, Shreya Bhat, Asif Khursheed — Tue, 13 Feb 2024 00:00:00 +0530

Background: Infectious spondylitis is an infection by a specific organism of one or more components of spine, namely the vertebra, intervertebral discs, paraspinal soft tissues, and epidural space. Magnetic resonance imaging (MRI) of the spine is gold standard in imaging to assess anatomical abnormalities of the spine and surrounding structures.

Methods: This cross-sectional observational study was conducted in the Department of Radiology Narayan Medical College and Hospital Sasaram, Bihar (India), where tuberculosis is endemic from July 2022 to September 2023. It included 40 patients, purposively sampled, adhering to strict inclusion and exclusion criteria. Sensitivity, specificity and accuracy of MRI in discriminating tuberculous spondylitis from pyogenic spondylitis were compared against histopathological diagnosis and differences in MRI findings between these conditions were obtained.

Results: In this study, 93% patients with tuberculous spondylitis had an enhanced signal with well-defined margins. Meanwhile, pyogenic spondylitis provided an ill-defined margins in 72.7% patients. Most of the patients 82.7% with tuberculous spondylitis showed thin and smooth wall paravertebral abscesses, while pyogenic spondylitis showed an irregular and thick wall paravertebral abscesses in 45% patients. A total of 72.4% patients with tuberculous spondylitis indicated involvement of ≥3 vertebral bodies. 100% patients with pyogenic spondylitis showed an abnormal contrast enhancement of the intervertebral discs. It was identified that tuberculous spondylitis had sensitivity, specificity, and accuracy values of 100%, 84.6%, and 95.2% respectively. For pyogenic spondylitis, the corresponding values were 84.6%, 96.6%, and 93%.

Conclusions: MRI was accurate for differentiation of tuberculous spondylitis from pyogenic spondylitis. A well-defined paraspinal abnormal signal, a thin and smooth abscess wall, subligamentous spread to three or more vertebral levels, and less likely involvement of intervertebral discs were more suggestive of tuberculous spondylitis than pyogenic spondylitis.

Intra-articular autologous conditioned plasma reduces pain in early osteoarthritis and improves stiffness in advanced osteoarthritis knee: a prospective observation

Navin Tripathi, Anil Regmi, Bhola Shrestha, Krishna Sapkota, Dipesh Kayastha — Mon, 26 Feb 2024 00:00:00 +0530

Background: In this study, we aimed to investigate the effects of single-dose intra-articular autologous conditioned plasma injection as the treatment for early and advanced osteoarthritis knee.

Methods: A single centre-based prospective observational analysis was conducted among patients who opt for conservative management by intra-articular autologous conditioned plasma Injection between July 2022 to June 2023. Total 46 patients were included and analysed in study on 1, 3, and 6 months’ follow-up after ACP injection. The WOMAC score and its sub scores were analysed and compared pre-procedure and on subsequent follow ups.

Results: A total of 46 patients were analysed in the study, with male predominance of 56.5% with mean BMI of 27.37±5.35. On KL grading, 34.8% patients had KL grade II Osteoarthritis, 52.2% had grade III and 13.0% had grade IV. On comparison of WOMAC score and its sub-scales, all the values were found to be statically significant while comparing before injection (p value <0.0001) and one month follow up and before injection and six months’ follow-up (p value <0.0001).

Conclusions: Six months following intra-articular autologous conditioned plasma injection, there was a noteworthy decrease in pain in early stages of osteoarthritis and improvement in knee stiffness in advanced stages of osteoarthritis as compared to the pre-treatment state.

Supervised machine learning algorithms used to predict post-surgical outcomes following anterior surgical fixation of odontoid fractures

Mon, 26 Feb 2024 00:00:00 +0530

Background: Odontoid fractures have a high mortality rate, and numerous classification systems have previously predicted surgical outcomes with mixed consensus. We generated a machine learning (ML) construct to predict post-operative adverse events following anterior (ORIF) of odontoid fractures.

Methods: 266 patients from the American college of surgeons-national surgical quality improvement program (ACS-NSQIP) with anterior ORIF (CPT 22318) of odontoid fractures from 2008-2018 were analyzed using ML algorithms random forest classifier (RF), gradient boosting classifier (GB), support vector machine classifier (SVM), Gaussian Naive Bayes classifier (GNB), and multi-layer perceptron classifier (MLP), and were compared to logistic regression classifier (LR). Algorithms predicted increased length of stay (LOS), need for transfusion (Transf), non-home discharge (NHD), and any adverse event (AAE). Permutation feature importance (PFI) identified risk factors.

Results: ML algorithms outperformed LR. The average AUC for predicting Transf was 0.635 (accuracy=77.4%), extended LOS=0.652 (accuracy 59.6%), NHD 0.788 (accuracy=71.9%) and AAE 0.649 (accuracy 68.1%). GB performed highest for Transf (AUC=0.861), identifying operative time (PFI 0.253, p=0.016). GB and RF performed equally for NHD (AUC=0.819), highlighting preoperative hematocrit (PFI=0.157, p<0.001). GB predicted AAE (AUC=0.720) also identifying preoperative hematocrit (PFI=0.112, p<0.001). RF predicted extended LOS (AUC=0.669) highlighting preoperative hematocrit (PFI=0.049, p<0.001).

Conclusions: ML outperformed LR, successfully predicting Transf, extended LOS, NHD, and AAE for anterior ORIF of odontoid fractures. Our construct may complement conventional risk stratification to reduce adverse outcomes and excess cost.

Improving cosmetic and functional outcome in case of post burn contracture of hand and fingers by using de-epithelized plantar skin graft

Satyabrata Mohanty, Jitendra Kumar Gupta — Mon, 26 Feb 2024 00:00:00 +0530

Background: Burn scar contractures in the fingers and hand often lead to debilitating functional and cosmetic issues. Various surgical approaches exist, but achieving optimal outcomes remains a challenge. While grafting glabrous split-thickness skin from the foot's plantar aspect is a well-established method, it remains underutilized, with conventional grafts leading to complications, especially in darker-skinned individuals.

Method: This study involved 35 patients with McCauley grade II and III hand burn contractures, spanning various age groups and genders. Surgical procedures encompassed scar removal, contracture release, and plantar skin graft application. Post-operatively, patients received dressing, splinting, and physiotherapy. Donor site healing was evaluated at the 3-week mark.

Results: Remarkably, all patients exhibited successful donor site healing within 3 weeks. The surgical technique effectively addressed contractures, enhancing range of motion and function. Post-operative care, featuring physiotherapy, coconut oil massages, and pressure garment use for at least 6 months, significantly contributed to post-burn hand and finger contracture management.

Conclusions: De-epithelized plantar skin grafts offer a promising avenue for enhancing both aesthetics and function in individuals with post-burn hand and finger contractures. This technique minimizes complications common with traditional grafts while promoting successful donor site healing and improved range of motion. The study underscores the significance of using like-for-like reconstruction to achieve the best possible results in managing post-burn contractures.

Evaluating the functional outcomes of tibia and ipsilateral femur fracture, which are floating knee injuries, in adults

Mon, 26 Feb 2024 00:00:00 +0530

Background: High velocity trauma leads to ipsilateral femur and tibia fractures. Despite being very uncommon, they have a significant morbidity rate. Combinations of diaphyseal, metaphyseal, and complicated intra-articular fractures may be present in this kind of injury. Objectives were to assess the functional success of adult patients with ipsilateral femur and tibia fractures treated with various methods.

Methods: The 30 adult patients with floating knee injuries underwent surgical treatment as part of the prospective research at the department of orthopedics, govt. medical college, and affiliated group of institutions in Kota. A combination of implants, such as an intra-medullary nail, locking plates, screws, or external fixators, were used to treat both femur and tibia fractures.

Results: Karlstrom-Olerud criteria were used for the final evaluation. In our study, five patients (16.6%) had excellent outcomes, ten (33.3%) had good results, seven (23.3%), had acceptable results, and eight (26.6%) had poor results.

Conclusions: When the fracture is diaphysis and it is treated with intra-medullary nails for both the femur and the tibia, the results are excellent. In this way, the age of the patient, the kind of fracture, the methods of fracture fixation, and the functional result were all taken into account.

Gender difference in foot progression angle in patients with osteoarthritis knee: an observational cross-sectional study

Aavrati Rastogi, Roop B. Kalia — Mon, 26 Feb 2024 00:00:00 +0530

Background: An essential clinical parameter related to gait is foot progression angle (FPA). The objective of this study was to evaluate foot progression angle difference between Kl grade 2 and 3 in osteoarthritis knee patients and understanding biomechanical factors associated knee OA.

Methods: Study was conducted on 108 patients diagnose with osteoarthritis knee according to EULAR classification knee OA. Age, gender and BMI were recorded, gait analysis was done to evaluate difference in FPA between OA knee patients with KL grade 2 and 3.

Results: The 108 patient, 68 female and 40 males with osteoarthritis knee were included in study. Mean age of patients was 55.92±0.8 year, mean BMI was 27.24±0.4 kg/m². Mean and SD of FPA in male 7.31±3.60 and in female 8.31± 4.18 in patients with Kl grade 2 and 3 mean difference between male and female FPA is -0.99 with 95% CI, p=0.43 and t=0.78. In KL grade 3, FPA mean and SD of male 6.79±2.80 and female 7.62±9.10, t=0.9, mean difference -0.83 with 95% CI and p=0.6925.

Conclusions: This study suggests, females in comparison to males have less FPA and therefore, females are more prone in progression of knee OA. Potential confounders including age, gender, BMI disease severity did not alter magnitude, although 95% CI.

Epidemiology of humerus shaft fractures in children-observational study of 50 patients

Rajesh K. Ambulgekar, M. Zafar Iqbal, Raman Toshniwal — Mon, 26 Feb 2024 00:00:00 +0530

Background: Objective was to study the epidemiology of humerus shaft fracture in children.

Methods: This was an observational study of 50 cases of humeral diaphyseal fractures in children aged between 5 to 15 years reporting to tertiary care center over a period of 18 months. Each patient was categorized with respect to age, sex, mode of trauma, side injured, type of fracture, associated injuries, modality of treatment given.

Results: Most patients belonged to upper lower class (66 %), and 80% patient belonged to rural population. Boys (60%) were more prone to have humerus shaft fracture than girls. Mean age of the patient were 10.12 years (±2.6 SD). Most common mode of trauma was accidental fall on arm (68%). Traumatic fracture was noted in 94% of cases while 6 % cases were having pathological fracture. Most patients were having middle third shaft fracture (40%), followed by distal third (30%) and lastly proximal third (22%), and left side involvement (58%) was more. Out of the 50 patients, poly trauma was observed in 4 cases, multiple bone fracture was noted in 2 cases, while 2 patients were having fibrous dysplasia and 1 with bony cyst as an associated cause of pathological fracture and 1 patient had radial nerve injury pre-operatively.

Conclusions: The findings of this study provide valuable insights into the epidemiology of humerus shaft fractures in children in respect to age, sex, socio-economic status, mode of trauma. These data can help understand the risk factors and help in preventing the incidence. Most of these fracture can be managed successfully with retrograde titanium elastic nailing system (TENS) nailing with minimal complications.

Comparison of open reduction and internal fixation by lateral extensile approach versus minimal invasive percutaneous fixation (Essex Lopresti) for the management of Sanders type 2 and 3 calcaneum fractures: a prospective, two-arm, parallel group study

Rohit N. Garg, Pankaj Tathe, Soutrik Kundu, Dinesh Gupta, Rakesh Dubey — Mon, 26 Feb 2024 00:00:00 +0530

Background: Calcaneum is one of the most common tarsal bone to get fractured accounting for around 50-60% of all tarsal fractures. Due to lack of Indian studies comparing the outcomes of fracture calcaneus managed by operative methods of open reduction internal fixation (ORIF) versus the percutaneous minimal invasive approach (Essex Lopresti); we decided to conduct one such study.

Methods: Adult patients with intra-articular Sander type 2 and 3 calcaneum fractures, managed by ORIF or Essex Lopresti were enrolled. The clinical outcomes (VAS score for pain, range of motion), radiological outcomes (Bohler’s and Crucial angle of Gissane) and functional outcomes (American orthopedic foot and ankle society (AOFAS) and Maryland foot score) were assessed at 6th month and 1-year post intervention and compared.

Results: 117 patients managed with percutaneous fixation (n=63) or ORIF (n=54) were enrolled. Mean age of patients was 42.63±7.93 years. Mean VAS score was statistically comparable in both operative groups at 6^th month and 1 year (p>0.05). Mean dorsiflexion and eversion angles were significantly higher in plating group at 6th month (p<0.05) while other movements were comparable in both the groups. Mean Bohler’s angle, Gissane’s angle, AOFAS and Maryland scores were found to be comparable in both groups (p>0.05) on follow-up. Both groups showed similar complications trend.

Conclusions: Percutaneous fixation and plating methods were found to be comparable for calcaneus fracture management based on clinical, functional and radiological outcomes with similar complication rates.

Validation of a patient-reported knee-specific outcome questionnaire specifically intended to assess pain, stiffness, and functional activities in Indians with osteoarthritis knees: an observational cross-sectional study

Aavrati Rastogi, Roop B. Kalia — Mon, 26 Feb 2024 00:00:00 +0530

Background: Patient-reported outcome measurement assessments that are frequently used for knee joint disorders have ceiling effect. This restriction is allegedly not there in New Hindi score. Purpose of this study is to validate New Hindi Score in patients with osteoarthritis knee.

Methods: Level II Prospective cohort study was conducted. In pilot study, 20 patients had their comprehension of New Hindi Score assessed. A prospective cohort study involving 200 individuals with osteoarthritis knee Kl grade 2 and 3 was conducted in AIIMS, Rishikesh, Uttarakhand. Patients' overall age 57.76±8.63 years, both mean and SD. There were 125 females & 75 males. Men's mean & SD were 59.52±9.39 while women's 56.70±8.00. All patients were requested to complete WOMAC, KOOS, OKS & New Hindi Score questionnaires. Validity, reliability, repeatability of New Hindi Score for knee function in KOA patients were evaluated. There's no floor ceiling effect. New Hindi Score's validity, responsiveness, and floor ceiling effect were assessed. Validity was measured using the Pearson correlation coefficient.

Results: In pilot study participants answered all question accurately. New Hindi Score shows moderate correlation with WOMAC & weak correlation with OKS and KOOS (Pearson coefficients of 0.45, 0.21, and 0.28, respectively) with 95% confidence interval, indicating strong construct validity in primary study. There was no floor or ceiling effect seen.

Conclusions: For KOA patients, New Hindi Score exhibits strong levels of validity, reliability, and reliability. As result, it can be effectively applied to research knee function in Indian population.

Importance of clinical and radiological assessment of patient of osteoarthritis knee foroptimum outcome in total knee replacement

Soutrik Kundu, Kosturi Dakshit, Rohit Nirbhay Garg, Kumarswami Ramulu Dussa — Mon, 26 Feb 2024 00:00:00 +0530

Background: Total knee replacement (TKR) provides symptomatic relief in patients with severe arthritis by removing pathologic joint tissue and restoration of the joint anatomy and function by the replacing with metal or plastic components leading to more stable biomechanics. Inspite of all advances in the surgical techniques 1 out of 5 people who undergo TKA remain unsatisfied. Clinical and radiological grading of osteoarthritis of knee may be an important prognostic marker to assess the outcome following TKR.

Methods: Study conducted was retrospective study. Pre-op routine and clinical assessment data noted from departmental records. Correlation between ‘initial knee society score’ (KSSi) and ‘radiological severity’ in terms of (Kellgren-Lawrence) grade and varus angle with ‘change in knee society score’ (ΔKSS) assessed to reach at conclusion.

Results: Lower KSS values, higher KL grading, higher femorotibial angle and were associated significantly with higher change in KSS values, i.e. better outcome.

Conclusions: Severe OA knee with high FTA and higher KL grade has shown better outcome following TKA. In early stages it is better to manage the patient conservatively with medications and physiotherapy.

Cost benefit analysis of intralesional injections in keloids using Luer lock and non-locking syringes

Mon, 26 Feb 2024 00:00:00 +0530

Background: For keloid scarring, intralesional corticosteroid injections continue to be the most often utilised first therapeutic option. This is a common procedure done on an outpatient basis by surgeons and orthopaedists. Luer lock syringes which lock the needle with syringe prevent any leakage or spillage of drug while pushing it near the keloid compared to normal syringes.

Methods: We intend to do a cost benefit analysis based on the retrospective data of intralesional steroid injections done by the authors (AP and SK) in their private practice.

Results: The time between 2021 to 2022, 200 injection data was retrieved, 100 each using non locking syringes and Luer lock syringes. The spillage rate with non-Luer lock syringes was 14%.

Conclusions: We found that luer lock syringes prove to be cost effective after giving more than 200 injections in keloids than non-locking syringes.

Assessment of the safety and efficacy of intravenous versus topical tranexamic acid in patients undergoing primary total hip and knee arthroplasty surgeries with respect to decreasing peri-operative blood loss and blood transfusion rates: a prospective and comparative study

Rohit N. Garg, Rakesh Dubey, Soutrik Kundu, Dinesh Gupta, Shweta Sonu Vaje — Mon, 26 Feb 2024 00:00:00 +0530

Background: Synthetic antifibrinolytic agent like tranexamic acid has been increasingly used in Arthroplasty surgeries to decrease the peri-operative blood loss. The current study was undertaken to compare the efficacy between the intravenous and Topical route of TXA in deceasing the blood loss and transfusion rate in patients undergoing primary total hip and knee arthroplasty (THR and TKR) surgeries.

Methods: A total of 120 patients were enrolled in the study with 60 each undergoing THR and TKR surgeries with 30 each given TXA in IV and Topical routes. Outcomes were assessed in terms of mean 24 hours drain output, mean blood loss, mean drop in hemoglobin blood transfusion rate.

Results: The mean drain output was more in the IV group in both THR and TKR patients (p>0.05). The mean blood loss was more in the Topical group in both THR and TKR patients (p>0.05). The mean drop in hemoglobin was more in the Topical group, with the difference being significant in the THR patients (p<0.05) and being insignificant in TKR patients (p>0.05). In IV group 9 patients (15%) and in Topical group 25 patients (41.67%) needed blood transfusions, the difference being statistically significant.

Conclusions: Both IV and Topical routes of TXA are equally effective in decreasing the peri-operative blood loss and transfusion rates in patients undergoing primary arthroplasty surgeries, with IV route having slightly upper hand as compared to the Topical route.

Limb salvage surgery for primary bone tumors: retrospective study in a tertiary care centre

Gopu Govindha Swamy, Senthil Kumar Krishnan — Mon, 26 Feb 2024 00:00:00 +0530

Background: Limb salvage surgery is the standard of care for patients with primary bone tumors. The study retrospectively analyses a single center experience of use of endo-prosthesis for limb conservation in cases of primary bone tumors over a five-year period (2015-2020).

Methods: Total of 34 histologically proven primary bone tumor were retrospectively studied which included 25 males and 9 females who received limb salvage surgery for bone tumors at department of surgical oncology, Rajiv Gandhi Government general hospital, Madras medical college, Chennai.

Results: Median age at diagnosis was 23 years. Tumor localized to lower limb in 23 patients, and upper limb in 9 patients, pelvic bones in 3 cases. Tumors were malignant in 24 patients (70.4%) and benign in 10 patients (29.4%). The most common diagnosis was osteosarcoma17 patients (50%). The median resection length was 10 cm. High grade tumors (grade 2a and 2b and grade 3) was found in 14 cases (41.1%). 6 patients had prosthesis related complications. The mean follow-up was 5 years (range: 3-7). 27 (79.4%) patients of 34 were alive with the endo-prosthesis at the last follow-up.

Conclusions: The custom mega prosthesis favored by us in most of the cases in limb sparing surgery for bone tumors results in satisfactory results in terms of local tumor control and limb function.

Expert opinion on the clinical use of calcium and vitamin D supplements in osteoporosis in Indian settings

Manjula S., Krishna Kumar M. — Mon, 26 Feb 2024 00:00:00 +0530

Background: Several clinical studies demonstrated that calcium intake decreases the risk of osteoporosis and osteoporotic fractures. However, understanding the prescription practice of calcium supplements employed in Indian contexts may help in improving patient management and developing evidence-based recommendations for optimizing the treatment. So, this study aimed to gather clinicians’ perspective regarding the use of calcium and vitamin D supplements for the management of osteoporosis in Indian settings.

Methods: The current survey involved 17 questions pertaining to current feedback, clinical observations, and clinical experience of specialists on osteoporosis management and the use of calcium and vitamin D supplements.

Results: According to 30%, 26%, 25%, and 19% of the experts, higher dietary sodium (salt) intake was generally associated with negative calcium balance and bone mineral loss, increased risk of fracture, decreased calcium excretion in the urine and decreased dietary calcium absorption. Calcium and vitamin D were recommended by 78% of the respondents for the management of osteoporosis. Approximately 72% of the respondents stated calcium aspartate anhydrous as the preferred calcium supplement to manage osteoporosis. Around 49% of the respondents reported a reduced risk of bone fractures among those who consume more calcium than the average amount. Further 48%, 30%, and 25% of the respondents indicated that calcium aspartate anhydrous have better absorption, better bioavailability, and better gastrointestinal tolerability.

Conclusions: According to the expert’s opinion, both calcium and vitamin D administration in conjunction with maintaining a balanced sodium intake were recommended for managing osteoporosis.

A study on functional outcome of distal end femur fracture in adults managed with locking compression plate

Mon, 26 Feb 2024 00:00:00 +0530

Background: We have evaluated the clinical outcome of surgery using locking compression plate in patients with fracture of distal end of femur in terms of union time, weight bearing and complications.

Methods: The present study was conducted in the department of orthopaedics, Bombay hospital, Indore (M. P.). With a prevalence of 3% of adult distal femoral fracture, the sample obtained was 30 with distal end femur fractures in the study. Protocol of surgery was followed in each patient. Postoperative rehabilitation was also adhered to in all patients.

Results: The mean age of 37.87±11.76 years with a male (25) predominance and more right-side involvement. RTA constituted 90% of the patients. According to AO/ASIF classification, type C1 (23.3%) and type A2 (20%) were the common fracture types seen. The radiological union was achieved in majority by 19-20 weeks. Full weight bearing was started by 15-16 weeks with mean of 18.93±2.02 weeks. In 43.3% patients knee flexion of more than 110 degree was achieved. Infection was seen in 10% patients and limb shortening (<10 mm) was seen in 6.7% patients. According to Neer’s scoring system, 56.7% patients had excellent, 33.3% patients had good, 3.3% patients had fair and 6.7% patients had poor functional outcome.

Conclusions: The treatment of fracture distal end of femur using locking compression plate was found to provide good to excellent functional outcome in majority of the patients, with low prevalence of complications.

Role of ultrasound guided suprascapular nerve block aided mobilization physiotherapy in frozen shoulder recovery: a prospective study

Mufassir Musthafa, Deepanshu Bandil, Shilpi Singh, Aman Verma — Mon, 26 Feb 2024 00:00:00 +0530

Background: Frozen shoulder is debilitating condition marked by progressive shoulder pain and restricted mobility, affecting sleep and activities of daily living of a person. The objective of this study was to evaluate the efficacy of USG guided suprascapular nerve block aided mobilization physiotherapy for management of frozen shoulder so as to improve the quality of living of patients.

Methods: This prospective interventional study was conducted at the Department of Orthopaedics of a teaching institute of Central India from January 2021 to April 2023 after obtaining ethical clearance. Patients diagnosed with frozen shoulder and giving written consent were included in this study after considering the inclusion and exclusion criteria. Baseline demographics, symptom duration, degree of active and passive shoulder range of movement, Shoulder pain and disability index (SPADI) score were documented on day of presentation (preintervention) after which USG guided suprascapular nerve block was given. Post SSNB, 10 sessions of supervised mobilization physiotherapy was given. SPADI scores and degree of active and passive range of movement were noted at 3rd, 6th and 12th week and compared using statistical tests namely repeated measure ANOVA and chi square test of independence.

Results: A total of 54 patients enrolled in the study after meeting inclusion criteria, only 46 completed the follow up and their mean SPADI pain score and mean SPADI disability score at presentation significantly reduced at 12 weeks post intervention. Range of flexion, abduction and external rotation of shoulder also showed significant increase (p value<0.05). Number of participants with severe restriction of shoulder internal rotation also decreased after SSNB aided physiotherapy.

Conclusions: USG guided suprascapular nerve block aided physiotherapy exercise schedule is a safe and effective outpatient treatment for frozen shoulder providing early pain relief and improving shoulder mobility.

Evaluation of the safety, efficacy and technical advantages of spinal anesthesia in patients undergoing single lower lumbar level minimally invasive transforaminal lumbar interbody fusion, as an alternative to general anesthesia: a prospective study

Rohit N. Garg, Shweta Sonu Vaje, Soutrik Kundu, Dinesh Gupta — Mon, 26 Feb 2024 00:00:00 +0530

Background: In spinal anesthesia, patients experience shorter OT, quicker recovery and ambulation, better post-operative analgesia and fewer complications than general anesthesia. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) shows fewer complications and early ambulation than open TLIF. Our study aims to assess spinal anesthesia’s safety, efficacy and technical benefits in MIS-TLIF.

Methods: Patients unresponsive to conservative treatment for 6-8 weeks underwent MIS TLIF for lower lumbar degenerative pathologies. The demographic data, OT entry to incision time, blood loss, bandaging to exit from OT time, post anesthesia care unit (PACU) time, post-op complications, requirement of analgesia, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, hospital stay, fusion rates and satisfaction scores were noted and assessed.

Results: The study included a total of 200 patients undergoing MIS-TLIF with mean age being 54.32±10.36 years; mean surgery time being 165.23±21.41 minutes; and mean blood loss being 123.56±65.14 ml. The mean OT entry to incision time was 28.91±9.63 minutes, while the mean bandaging to exit time was 7.43±4.12 minutes. The mean PACU stay was 41.35±5.78 minutes. The mean hospital stay was 3.28±1.23 days, with 97% patients showing solid radiographic fusion while 92.5% patients were fully satisfied with the surgery. VAS and ODI scores were significantly improved as compared to the pre operative status.

Conclusions: Spinal anesthesia for lower lumbar MIS-TLIF is cost effective and safe alternative to general anesthesia with lesser post operative pain and other side effects; taking into consideration proper patient selection for the same.