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   Table of Contents - Current issue
January-April 2023
Volume 6 | Issue 1
Page Nos. 1-120

Online since Tuesday, December 27, 2022

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“Osteomicrobiology,” “Osteoimmunology,” and “Immunoporosis”- promising frontiers to study bone health and homeostasis p. 1
Ganesh Singh Dharmshaktu
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Results of intra-articular distal humerus fracture treated with open reduction and internal fixation Highly accessed article p. 3
Ishani Patel, Tarkik K Amin, Vipul R Makwana, Mrudul M Prajapati, Amit Virabhai Patel, Dhaval R Modi, Shivam K Kavi
Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2% of all adult fractures. The complex shape of the elbow joint, the adjacent neurovascular structures, and the soft-tissue envelope combine to make these fractures difficult to treat. The treatment usually consists of determining the injury mechanism and developing a treatment algorithm to regain full mobility of the joint. Materials and Methods: This is a prospective study of 20 cases of distal humerus intra-articular fracture treated by open reduction and internal fixation at our institute during 2017–2019. All the patients in this study were above 18 years of age. These patients were treated with open reduction and internal fixation either by paratricipital approach for fractures with minimal intra-articular comminution or by olecranon osteotomy approach for fractures with more intra-articular comminution. Results: In this study of 20 patients with distal humerus fracture treated with open reduction and internal fixation with ages ranging from 18–65 years, 13 (65%) were male patients and 7 (35%) were female patients. 12 (60%) patients had fracture on the left side, and 8 (40%) patients had fracture on the right side. 11 (55%) patients sustained fractures following the fall from height, and 9 (45%) patients had fracture due to a road traffic accident. Postoperatively, 2 (10%) patients had superficial infection; both patients recovered with antibiotics. In our study, 17 (85%) patients had excellent results, and 3 (15%) patients had a good result according to the Mayo Elbow Performance Score. Conclusion: Distal humerus intra-articular fractures require anatomical reduction of intra-articular components. Vigorous, active physiotherapy is a must for good results. Rigid internal fixation is best accomplished by low-profile anatomical plate fixation, which provides an optimal biomechanical stability; hence, early mobilization can be started, and a good functional outcome can be achieved with a low complication rate.
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Relevance of sonological evaluation in medial knee injuries and its comparison with magnetic resonance imaging findings – A prospective study p. 7
Gayathri Mohanan, Kumar Chandan, J Unnikrishnan, Suma Job
Background: Ultrasonography offers several unique strengths over magnetic resonance imaging (MRI) that makes it a promising technique for the evaluation of certain disorders of the knee. Ultrasonography has higher spatial resolution than MRI, which may be helpful in evaluating the superficial structures and popliteal fossa of the knee in detail. Visualizing the medial collateral ligament (MCL) under ultrasound is relatively easy due to its superficial location, spanning from the medial femoral condyle to the medial tibial metaphysis. Meanwhile, MRI is expensive, not advisable to all due to its claustrophobia and ferromagnetic property. Ultrasound, on the other hand, is an inexpensive, widely available, and non-invasive technique which also allows dynamic imaging. Our objective is to assess the validity of ultrasound in the diagnosis of medial knee injuries in comparison with MRI findings. Materials and Methods: Patients attending the Department of Orthopaedics are referred to the Department of Radiodiagnosis of Government (TD) Medical College, Alappuzha, who were clinically suspected to have medial knee injury, during the study. This study was a prospective study. Prospective patients with clinically suspected medial knee injuries scheduled for MRI of the knee were evaluated by ultrasound examination before the MRI. Sonographic findings were then compared to MRI results. Results and Discussion: Sixty patients were enrolled in the study. 73.3% of the study population were male and most of them belonged in their 2nd and 3rd decades. Most of the injuries were left-sided (60%) and majority (65%) presented for radiological evaluation within 1 week–1 month of history of injury. The accuracy of ultrasound in the diagnosis of MCL and medial meniscus injuries were 86.7% and 85%, respectively. Ultrasonography demonstrated 89.6% sensitivity and 75% specificity for MCL injuries and 85.3% sensitivity and 84.6% specificity for medial meniscus tears. The most frequent knee finding in this study was joint effusion which was seen in 50 (83.3%) of patients. Conclusion: Ultrasonography gives high accuracy and specificity in the detection of MCL and medial meniscal injuries. Ultrasound may have a role as the initial rapid imaging modality in patients with suspected MCL or medial meniscus injuries, and it may serve as an effective low-cost screening tool for patients with medial meniscal or MCL injuries and avoid performing the high-cost MRI.
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Orthogonal dual plating: A reliable choice for complex distal humerus fractures p. 13
Anil Kumar Nathi, Gopal M Shinde, Baladitya Sarma Sista, Sivananda Pathri, Varun Kumar Paka, Jameer Shaik, Pramoda Nakka, Chandana Pathri
Background: Distal humerus fractures are difficult to manage and perfect intra-articular reduction is a prerequisite for a successful outcome. Dual plating is the norm, and this may be in the form of orthogonal or parallel plating. Controversy regarding the choice between these modes of plating is a topic of debate. Aims and Objectives: To show that perpendicular or orthogonal plating is an adequate mode of treatment option to handle all patterns of distal humerus fractures compared to later-introduced parallel plating. Patients and Methods: We, here, report a case series of 30 cases of AO type C distal humerus fractures, in patients aged between 20 and 60 years, managed by orthogonal plating. All patients were operated between 2015 and 2019 by a single surgeon at our institute. Results: A total of 22 (73.33%) patients showed good or excellent results. Six (20%) patients had fair results. Two (6.66%) patients had poor results. About 86% of the total patients were satisfied with their outcomes. Conclusion: Orthogonal plating offers a satisfactory outcome in AO type C distal humerus fracture with reasonable functional output through early mobilization due to the inherent stability offered by the construct.
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Management of pediatric unstable diaphyseal both-bone forearm fractures (AO 22-D4 and AO 22-D5), A comparison between the results of intramedullary nailing using titanium elastic nail systems versus K-wires in the rural Indian children: A prospective study p. 20
Santosh Kumar Singh, Prashant Pratap Singh, Jitesh Arora, S PS Gill, Laxminath Mishra, Pulkesh Singh
Background: Forearm fractures constitute the largest group of injuries in the pediatric age group. When treating these injuries, we seek to achieve a complete union while also restoring the appropriate axis and arm length, which determine the upper limb's normal function. Intramedullary fixation (IM fixation) is becoming an increasingly common choice for fracture fixation. Aim: The aim of this study was to compare the functional and radiological results of IM nailing by Titanium Elastic Nail Systems (TENS) versus K-wire in the pediatric displaced diaphyseal both-bone forearm fracture. Settings and Design: This prospective comparative study was conducted in the department of orthopedics at a rural tertiary care center in North India from April 2016 to November 2019. Materials and Methods: In total, 44 children between the age of 8 and 12 years with displaced diaphyseal fracture of both-bone forearm either closed or open were available for follow-up and included in the study. They were divided into two groups randomly. Reduction was done under general anesthesia and fluoroscopic images. First, a close reduction was tried, and if it failed, open reduction was tried. IM fixation was done subsequently either by TENS (Group-A, n = 23) or K-wire (Group-B, n = 21). Patients were followed up for 12 months. Functional and radiological outcomes and complications were compared between both groups. Conclusions: IM nailing is a safe, effective, and valid technique in treating displaced both-bone forearm fractures in the pediatric age group. Both TENS and K-wire are equivalent in terms of clinical results, fracture union time, surgical time, or complication rates.
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Effect of surgical approach on functional outcome and component positioning in total hip arthroplasty p. 27
Sreekanth Kashayi-Chowdojirao, Asif Hussain Khazi Syed, Sandeep Boddeda, Chandrasekhar Patnala
Context: Total hip arthroplasty (THA) is commonly performed through a posterior or a direct lateral (Hardinge) approach, and each one has merits and demerits. Aims: The purpose of this study was to examine the difference between the lateral and posterior approaches with respect to functional outcome, component positioning, intraoperative blood loss, and patient satisfaction. Settings and Design: This is a prospective comparative study of short- to mid-term outcome of cementless THA using two approaches. Subjects and Methods: Seventy hips satisfying our inclusion criteria were selected, of which 21 hips operated by lateral approach in supine position were included in lateral approach group (LAG), and 49 hips operated by posterior approach in lateral position were included in posterior approach group (PAG). Functional assessment was performed 1 day before surgery, 1 year after surgery, and at the latest follow-up using Harris Hip score (HHS). Component positioning of acetabular cup and femoral stem was assessed in plain radiographs at the latest follow-up. Generic satisfaction questionnaire was used to measure satisfaction after THA at the latest follow-up. Radiographic measurements (cup inclination, cup version, and femoral stem tip position) were performed postoperatively using low-centered pelvic anteroposterior and cross-table lateral hip radiographs. Results: At an average of 3 years and 6 months of follow-up, the mean HHSs were 88.05 and 90.32, respectively, in LAG and PAG; the difference was not significant (P = 0.178). The average inclination of the cup in LAG was 37.9° and in PAG was 45.02° with a significant difference (P = 0.00027), both of which are in the normal range. The cups were significantly (P ≤ 0.0001) more anteverted in the PAG (average angle of 27.69° vs. 16.14°). The mean blood loss was significantly more in PAG (510 ml vs. 436.67 ml; P = 0.04). Majority of femoral stems in lateral approach had their tips directed posterior. Nineteen out of 21 LAG patients and 45 out of 49 PAG were very satisfied/satisfied with their outcomes after THA. Statistical Analysis Used: Data were collected using prestructured data forms and analyzed with unpaired Student's t-test with 95% confidence interval. Conclusions: There was no significant difference in functional outcome and patient satisfaction at short- to mid-term follow-up between both approaches. The cup anteversion was significantly more in PAG. For better conclusions, other factors (i.e. immediate postoperative pain, and long-term survival), combined anteversion and spinopelvic parameters, have to be included in the study with a larger sample size.
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Influence of risk factors for hip injuries and effect of co-morbidities on postoperative complications and outcome after hip fracture surgery in the elderly p. 32
Khazi Syed Asif Hussain, Aluka Sundeep Kund Reddy, Mayani Raju, Chandrashekhar Patnala
Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study aims to analyze the risk factors that contribute to falls in elders and analyze the effect of comorbidities on the outcome and the treatment decision-making in elderly patients with hip fractures. Materials and Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 cases of geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) of each geriatric hip fracture patient were calculated based on data retrieved from the medical records. Clinical assessment was assessed using a modified Harris hip score during each visit. Results: The mean age of patients was 72.21 ± 12.2 years. The mean CCI was 1.02 ± 0.3, and ASA was 2.0 ± 0.53, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). Greater the CCI and ASA, more chances of developing postoperative complications (χ2 = 15.724, P = 0.001). Delirium is the most common postoperative complication 15.7%, and pulmonary infection 11.4% is the most lethal complication. Conclusions: Patients with high CCI, ASA grading, and revision surgery are at high risk of developing postoperative complications, morbidity, and mortality. With efficient medical co-management of these patients, orthogeriatric care offers the best chance for a successful outcome.
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Joshi's external stabilization system and K-wire fixation in the management of hand fractures – A prospective comparative study p. 41
Vivek Singh, Sabeel Ahmad, Gobinder Singh, Sukhmin Singh, Kshitij Gupta, RB Kalia
Background: Hand fractures can be treated conservatively or surgically, depending on the severity, location, and type of fracture, as in conservative management chance of nonunion, malunion, and stiffness is more if it is displaced or angulated fracture. Various modes of treatment have been used which include K-wire fixation, mini plates, and external fixator application. A modified form of mini-external fixator devised in India is Joshi's External Stabilization System (JESS). Aim: This prospective study was conducted to compare the functional and radiological outcomes following metacarpal/phalangeal fracture fixed with either K-wire or JESS. Materials and Methods: Forty patients with hand fractures (58 fractures – 18 metacarpal and 40 phalanges) were prospectively studied. Twenty patients underwent K-wire fixation and 20 were fixed with JESS, functional and radiological outcomes were assessed, grip strength using dynamometer, visual analog scale (VAS) score, disabilities of the arm, shoulder, and hand (DASH) score, range of motion (ROM) using the American Society for Surgery of the hand scale, tip pinch strength. Student's t-test, Wilcoxon test, Fisher's exact test, and Chi-squared test were used. Results: At 6 months' follow-up, patients fixed with either of the fixation modality showed statistically significant improvement in different outcome variables such as ROM (P < 0.001), quick DASH score (P < 0.001), VAS score (P < 0.001), tip pinch strength (P < 0.001), and hand grip (P < 0.001). All the fractures united at an average 6 weeks. Functional outcomes were excellent in closed fracture fixed with either JESS or K-wire and good to moderate in open injuries. However, overall comparison between K-wire and JESS, no significant difference in these outcome measures was found. Conclusions: K-wires as well as JESS both provide adequate stability and satisfactory results in fractures of the metacarpal and phalanges. This study could not find the superiority of JESS over traditional K-wire fixation.
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Evaluation of the effect of platelet-rich plasma in early osteoarthritis knee using the oxford knee score: A short-term outcome p. 48
K Nitish, Sandeep Kubsad, JS Sharath, Bharath Shekharappa Gadagoli, S Manjunath, B Suresha, Harish S Pai
Introduction: Osteoarthritis (OA) is classically described as a noninflammatory, degenerative joint disease most commonly occurring in the elderly population. It is characterized by the deterioration of articular cartilage and by the formation of new bone at joint surfaces and margins. Our study aims at evaluating the efficacy of intra-articular platelet-rich plasma (PRP) injections in Grade I and II OA knees. Materials and Methods: A total of 46 patients with Grade I and II (Kellgren and Lawrence grading) primary OA knee were enrolled for a prospective study. Prior consent was taken for intra-articular injection of PRP from all patients. The study group was evaluated using the Oxford Knee Score (OKS) at 3 months and 6 months. Results: In our study, we found decreasing pain and improvement in activities of daily living with an increase in OKS at 3 and 6 months, follow-up indicating long-term pain relief, improvement in function, and decreased stiffness. Conclusion: Our study shows that intra-articular injection of PRP is safe and effective in treating Grade I and Grade II OA knee. We also observed improvement in daily living activities and a reduction in pain in patients with OA of the knee treated with two doses of PRP. PRP therapy is an easy, affordable, and minimally invasive treatment, which is practical to administer for treating degenerative OA of the knee with minimal associated adverse events.
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Antibiotic-impregnated cement-coated intramedullary nail in primary fixation of compound fractures of tibial shaft – A comparative study with external fixator in terms of infection control p. 53
Rahul Verma, Saurabh Sharma, Chetan Solanki, Ankit Prasad, Mundalapati Gopala Rao, Suneet Tandon
Introduction: Compound tibial shaft fractures are conventionally managed by debridement and primary stabilization by external fixators, followed by definitive fixation after the wound healing; however, many problems such as infection, difficult soft tissue reconstruction, and psychosocial effects encountered. Hence, a technique of antibiotic-impregnated cement-coated intramedullary nailing has been advocated. Aims: The aim of the study is to compare functional and biological outcomes of antibiotic-impregnated cement-coated nail with external fixators. Settings and Design: This was a prospective interventional study. Subjects and Methods: A total of 20 patients with Compound Grade 3A and 3B (Gustilo and Anderson) tibial shaft fractures who met the inclusion and exclusion criteria from January 2020 to June 2021 were selected. Group 1 was operated with antibiotic-impregnated cement-coated nails. Group 2 was operated with external fixators. Clinical and laboratory parameters were used to evaluate infection control. Final follow-up was taken at 6 weeks. Results: The infection rate after nailing was 10% in Group 1 (1/10) and 50% in Group 2 (5/10). Intraoperative time taken for soft tissue reconstruction procedures after primary fixation such as flap cover and skin grafting was comparatively less in Group 1 (mean time – 32 min ± 6.23) compared to Group 2 (51 min ± 5.83). Duration between primary and definite fixation was comparably less in Group 1 (mean duration 5.7 weeks ± 0.45) compared to Group 2 (6.3 weeks ± 1.004). Conclusions: Primary antibiotic-impregnated cement-coated nail is better than external fixator in terms of infection control and providing stability in compound fractures of shaft of tibia.
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Type of microbial flora in patients with bone and joint infections: Our experience at a tertiary care center of Eastern India p. 58
Anupama Singh, Ranjit Kumar Singh, Bimlesh Kumar Bimal, Ritesh Runu
Introduction: Bone and joint infections are very common in eastern India. Due to the lack of authentic data on the type of bacteriology in our region, this study was planned. Materials and Methods: After ethical clearance, retrospective data of 2 years from 2019 to 2021 were collected. Out of 115 patients, 77 patients were included in the study whereas 38 were excluded due to nonbacterial infections and incomplete data. Results: The average age of patients was 21.14 years. Pediatric patients were 58.66%. The common clinical condition was chronic osteomyelitis, followed by septic arthritis. The most common bone affected was femur, followed by tibia. The most common organism noted was methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative Staphylococcus aureus (CNSA). Gram-negative infections were also noted. Conclusions: Eastern India has a high incidence of bone and joint infection. MRSA followed by CNSA is the most common isolate affecting large bones such as femur and tibia.
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Clinical effect of morphological changes in bone tunnels after anterior cruciate ligament reconstruction p. 62
Abhijeet Subhash, Nishant Kashyap, Indrajeet Kumar, Ritesh Runu
Background: The effect of tunnel widening on clinical outcomes after anterior cruciate ligament (ACL) reconstruction has not been widely investigated. In this study, ACL reconstructions (ACL-Rs) were done by semitendinosus and gracilis tendon grafts and suspensory fixation on the femoral side. The aim was to study tunnel widening at the end of 1 year postoperative and correlate it with clinical outcomes. Materials and Methods: Fifty-five consecutive patients enrolled in the study underwent arthroscopic ACL-R. All were evaluated clinically using the Lysholm knee score and Tegner activity level preoperatively as well as during subsequent follow-up. Femoral and tibial tunnels were visualized with computed tomography scan which was performed at a mean duration of 1 year (range: 10–14 months). Results: The mean femoral tunnel diameter increased significantly (17.1%) from 8.03 ± 0.05 mm postoperatively to 9.04 ± 0.6 mm at 1 year; the tibial tunnel increased significantly (22.55%) from 9.04 ± 0.04 mm to 11.09 ± 0.8 mm at the same duration. No significant correlation could be established between tunnel widening and clinical evaluation scores. In both clinical evaluation scales, the overall improvement was noticed. Conclusions: Within a limit, neither femoral nor tibial tunnel widening affects the clinical outcome at 1 year of follow-up.
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Functional outcome of intramedullary interlocking nailing versus minimally invasive percutaneous plate osteosynthesis in distal tibia fracture p. 66
R Sahaya Jose, K Vivek, N Kattu Bava, M Syed Moosa
Aims: The aim of the study was to compare the functional outcome of patients with extra-articular distal one-third tibia fracture, treated with intramedullary interlocking nailing (IMILN) with those treated by minimally invasive percutaneous plate osteosynthesis (MIPPO). Settings and Design: This is a prospective study and nonprobability sampling technique. Subjects and Methods: In this study, 60 patients with distal third tibia fractures of AO classification Type 43 A1, A2, and A3 were selected, in which 30 of them were treated with IMILN and the remaining 30 were managed with MIPPO. The patients were regularly followed up, and functional outcome was measured at 4, 8, 12, and 24 weeks using a modified Klemm and Borner scoring system. Statistical Analysis Used: The data collected were subjected to data entry in MS Excel. The data were analyzed using SPSS version 20.0 using Chi-square test. Results: In our prospective study, the functional outcome of MIPPO has shown excellent outcome in 13 patients (43.3%) and good outcome in 13 patients (43.3%), fair outcome in three patients (10%), and only one patient had poor outcome (3.3%). However, in the IMILN group, excellent outcome was seen in 7 patients (23.3%) and good outcome in 15 patients (50%), fair in five patients (16.7%), and poor outcome in 3 patients (10%). Alignment of fracture was anatomical in 13 patients of MIPPO and 7 patients of IMILN. Complications such as nonunion and malunion were more in the IMILN group than MIPPO, whereas superficial wound infection and delayed union were comparable in both. Conclusions: Distal tibial fractures can be effectively treated by both intramedullary nailing and MIPPO with minimal soft tissue injury providing good-to-excellent results, whereas in our present study, we observed that MIPPO had excellent functional outcome when compared to IMILN. Although interlocking intramedullary nailing allows early weight-bearing in patients, malunion and nonunion were more frequently seen, which affects the functional outcome. Therefore, we recommend that MIPPO is considered a very effective modality of treatment in distal third tibia fractures.
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Modified tension band wiring of transverse patella fractures through cannulated cancellous screws: An analysis of functional outcomes and complications p. 73
Abhishek Gumaste, Prasanna Baindoor, Santosh Jeevannavar, Keshav Shenoy, Ranjan Gurudev
Introduction: The management of transverse patella fractures with modified tension band wiring using Kirschner wires, though routinely used is associated with complications such as implant loosening, wire migration, and infection. We hypothesized that using cannulated cancellous screws with tension band wiring through the screws will overcome these complications. Objective: The objective was to assess the functional and radiological outcomes following patellar fracture fixation with modified tension band wiring through cannulated cancellous screws. Materials and Methods: Twenty-four patients with transverse patella fractures fixed with modified tension band wiring through cannulated cancellous screws were included in this retrospective study. Surgical technique involved a vertical incision over the knee, reduction of the fracture initial fixation with Kirschner wires, replaced with cannulated cancellous screws. A stainless steel wire was passed through the lumen of the screws, and tension band was applied. Follow-up at 3, 6, and 12 months was done to assess the radiological union. Functional outcome was assessed with the Bostman scoring. Results: The study included 13 male and 11 female patients with an average age of 39.6 years, with 8 three-part and 16 two-part fractures. The average follow-up was 14 months, and the average time to union was 8.5 weeks. Twelve patients had an excellent, 11 patients a good, and one patient an unsatisfactory functional outcome as per the Bostman score. No infection or implant loosening was observed. Conclusion: The technique of patella fracture fixation with modified tension band through cannulated cancellous screws offers an enhanced stability, minimizing the complications such as implant migration, prominent implant, and refracture. As such, we recommend this technique in all transverse patella fractures.
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Joshi's external stabilization system fixator – A mini solution to avert major disabilities in hand injuries p. 78
Vijaya Kumari Thadiparthi, Kartheek Chinnapothula, Soma Sekhar Mecharla, Varun Kumar Paka, Jameer Shaik, Srivatsava S.D. M. Talluri, Ravi Sharma Pilaka
Background: Fractures of hand bones are often considered minor injuries and treatment is either delayed or neglected. These fractures are usually treated conservatively that leaves behind a residual functional deficit. Surgical intervention should be considered for open, unstable, multiple, comminuted, or intra-articular fractures. Standard surgical treatment includes the use of K-wire, plate, or mini-screws which are associated with unsatisfactory results and high complication rates. Joint stiffness is a commonly reported complication with most of the existing devices used for hand bone fractures. There is a deficit of data pertaining to the effectiveness of Joshi's External Stabilization System (JESS) in avoiding joint stiffness. Joshi's external fixator is a reliable treatment of phalangeal and metacarpal fractures of the hand. It is an economical, simple, lightweight, and stable contract. Patients and Methods: We report a prospective cohort study of 30 patients of hand bone fracture, 10–60-year age range, treated by JESS. Functional evaluation was made using the Duncan et al. scoring. Results: The results recorded were excellent in 31.58% of cases, good in 42.11% of cases, fair in 21.05%, and poor in 5.26% of patients. Conclusion: JESS ex-fix for hand is a useful construct that allows early mobilization of nearby joints. It can be considered a suitable choice for the management of phalangeal and metacarpal fractures of hand to deliver good functional outcome.
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Functional outcome of volar variable angle locking compression plate in distal end radius fractures: A retrospective case record analysis p. 84
KM Pawan Kumar, Sangamesh V Hawaldar, Manjunath Patil
Background: Distal end-of-radius fractures are one of the most common fractures seen worldwide, accounting for approximately one-sixth of all fractures. Closed reduction and cast immobilization have been the mainstay of treatment, but recently open reduction and plating with conventional plates have gained importance as they can be of great value in treating distal end radius fractures. This study is based on the latest innovation in this regard, the effectiveness of the volar variable angle locking compression plate in treating distal end radius fractures. Aim and Objectives: To evaluate the functional outcome associated with volar variable angle locking compression plate for distal end radius fractures and also to study the efficacy of the plate in capturing the fracture fragments. Materials and Methods: A retrospective study involving 30 patients with distal end radius fractures who were treated with open reduction and internal fixation using a volar variable angle locking compression plate. Patients admitted between November 2018 and November 2019 were included in this study. Clinical, functional, and radiological outcomes were used to assess the efficacy of the plate. Results were calculated using the Disabilities of the Arm, Shoulder and Hand (DASH) score questionnaire at the end of 1-year postsurgery. Follow-up data for all patients for 1 year were available in our medical records. The extent of the range of motion (ROM) at the wrist joint was noted. Results: 53.3% of patients had excellent results, 36.7% of patients had good results, while 10% of patients had fair results. Almost all the patients had good ROM postoperatively except two patients. One of them developed wrist stiffness and another patient had reduced ROM due to noncompliance to the treating doctor's advice. Conclusion: Our study signifies the importance fragment specific fixation of distal end radius fractures. Patients were mobilized sooner than other accepted modalities of treatment. We conclude that volar variable angle locking compression plates are superior to the other accepted modalities of treatment for distal end radius fractures.
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Open anatomical dual tunnel reconstruction of acromiao-clavicular joint using autogenous semitendinosus graft p. 90
Sai Venkata Sathwik Matta, Anil Kumar Nathi, Sivananda Pathri, Baladitya Sarma Sista, Varun Kumar Paka, Jameer Shaik, Chandana Pathri
Background: The primary constraint to the dislocation of an acromioclavicular (AC) joint is its ligaments. They prevent vertical and horizontal translations in the joint. Reconstruction of these ligaments is of prime importance for restoring the AC joint. There is uncertainty regarding the surgical treatment protocol for Rockwood's type III injury. Patients and Methods: We report a prospective cohort study on 20 patients aged between 15 and 45 years, presenting with Rockwood type III or higher rank of AC joint dislocation for open double-tunnel anatomical reconstruction of AC joint using autogenous semitendinosus graft. Patients were evaluated at the end of follow-up of 2 years using the Constant–Murley outcome scoring system. Results: Clinical and radiological evaluation performed revealed excellent results in 15, good in three, and fair in two, with no poor results recorded. Conclusion: Open double-tunnel reconstruction with semitendinosus graft is a vital technique for Rockwood type III or higher grade of AC joint dislocation management to deliver a pain-free shoulder with good strength, well-retained range of movements, and near normal regain of activities.
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Functional outcome of distal femur fractures managed by open reduction and internal fixation with locking compression plate p. 96
Surapaneni Suresh Babu, Nanda Gopal Velagapudi, Shaik Abdul Gani, Suprabha Surapaneni
Background: Distal femur fractures are one of the most frequent fractures seen in high-velocity trauma, and they are associated with substantial morbidity if not treated properly. Stiffness, secondary arthritis, shortening, and disturbance in the activity of daily living can occur as a result of this fracture. Open reduction and internal fixation with locking compression plates (LCPs) is the preferred treatment. The anatomic contoured LCP for the distal femur has been found to provide one of the best outcomes in terms of anatomical reduction with joint congruity, soft-tissue healing, fracture union, and functional ability. This study was done to evaluate the functional outcome of distal femur fractures managed with LCP. Materials and Methods: Thirty patients with distal femur fractures were treated at our institute using LCP were analyzed for the outcome in terms of clinical, radiological union, and functional results. Results: Twenty-one patients were male and nine were female. The average age was 41.55 years with a range of 21–60 years. In 22 patients, cause of fracture was road traffic accidents and in eight were fall at various occasions. Twenty-one patients had right-side fractures. The average time for radiological union was 14.2 weeks. The average flexion of the knee was 107.16°. Functional outcome was assessed using Sanders' Functional Evolution Scale. The outcome was excellent in 30%, good in 40%, fair in 17%, and poor in 13%. Conclusion: Locking compression plating is an excellent internal fixation option for both extra- articular and intra-articular distal femur fractures, and it is particularly helpful in osteoporotic metaphyseal fractures.
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A study of morbidity and mortality of surgically managed hip fractures in elderly patients in the 1st Year p. 101
TS Channappa, Manju Jayaram, HB Shivakumar, CL Karan
Background: Fractures of hip are one of the most common injuries sustained by the elderly. They occur predominantly in patients aged over 60 years. For many, this fracture is often a terminal event resulting in death due to comorbidities and cardiac, pulmonary, or renal complications. The incidence of morbidity and mortality after hip fractures was evaluated in this study. Methodology: We included 102 patients who were divided into two groups; 54 patients with fracture neck treated by hemiarthroplasty as arthroplasty group, and 48 with intertrochanteric fracture treated by internal fixation with proximal femoral nail or with dynamic hip screw as internal fixation (IF) group were followed up for 1 year. The preexisting medical comorbidities, intraoperative findings, and postoperative complications were documented. The final functional results were evaluated using Merle d'Aubigne score at the end of 1 year. Results: This is a descriptive cohort study from the local population. The mean age was 74.5 years. We noted a total mortality of 17.6%. Diabetes mellitus and anemia were the most common comorbidities. Binary logistic regression analysis was performed to predict the survival status among the study patients. We found that male patients with anemia to be most associated with mortality. Excellent results were noted in 39% of cases of arthroplasty and 60% of cases of IF. Morbidity experienced was greater in extracapsular fracture type, who were less mobile during the postoperative period. Conclusion: Hip fractures are on a rising trend in the elderly population, especially in the Indian subcontinent. Mortality and morbidity in elderly patients in the 1st year are significant. Age and preexisting comorbidities contribute to morbidity. Morbidity leads to loss of independence and requirement of social support. The goal of treatment in fractures of the hip must be the restoration of the patient to their preinjury status at the earliest possible time.
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Predictability of degenerative disc disease by lumbar sagittal alignment on conventional radiograph in comparison with cross-sectional magnetic resonance imaging p. 106
P Madhuchandra, KM Pawankumar, G Sunil Santhosh, KP Raju
Background: Degenerative disc disease (DDD) affects approximately 80% of the population. Changes in the magnitude of lumbar lordosis significantly change the weight-bearing patterns in lumbar facet joints and intervertebral discs. It is essential to understand the contribution of hypo and hyperlordosis toward the development of disc degeneration disease. Materials and Methods: A retrospective study of X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine of 200 patients with chronic low back ache. The lumbar lordotic angle was measured in a standing lateral radiograph using Cobb's method (between the lines drawn along the inferior end plate of D12 and the superior end plate of S1 vertebrae). DDD was assessed on MRI based on the Pfirrmann grading system. The correlation between the lordosis measured on the radiograph and DDD on MRI was assessed. Results: We analyzed the lumbar sagittal alignment effect on the degree of disc degenerative disease. Out of 200 patients, 70 had no disc degenerative disease (Grade I, II) whose Cobb's angle was 45°–75°. The remaining 130 patients showed disc changes (Grades III-V) on MRI and had Cobb's angle <45° or >75°. There was a statistically significant difference between Cobb's angle in normal and DDD patients with P = 0.009 (P < 0.05). Conclusion: DDD correlated with deviation from an optimal lumbar lordotic angle (Cobb's angle) of 45° to 75°. Deviation from optimal values would compromise the optimal weight-bearing conditions on the lumbar spine resulting in DDD. These results may well have implications for the diagnosis, prevention, treatment, and rehabilitation of DDD.
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Causes of revision after total hip arthroplasty in patients undergoing revision total hip arthroplasty younger than 50 years of age p. 111
Hemant Mathur, Kashyap Laxmanbhai Zala, Jimmy Jyotinbhai Chokshi
Background and Aims: Young patients undergoing revision total hip arthroplasty (THA) have different indications and causes of failure of THA. This retrospective cohort study examines the causes of failure of THA in a patient younger than 50 years. Subjects and Methods: Clinical and demographic data of 146 revision THA (130 patients) were gathered from case records of patients who underwent revision THA at our institute between January 1, 2018, and December 31, 2021. Fifty-two hips (46 patients) were younger than 50 years at the time of revision. Baseline characteristics, cause for revision, implants revised, and duration of survival were noted. Statistical Analysis: Chi-squared test was implemented to find a correlation, and P < 0.05 was considered statistically significant. Results: We had 52 hips, 46 patients (28 females), and the mean age at primary THA was 33.9 years, the mean age at revision THA was 44.5 years, and the mean survival of implants was 10.6 years. The most common diagnosis for primary THA was avascular necrosis of the femoral head (21 hips, 40.38%), followed by inflammatory arthritis. The most common cause of failure was aseptic loosening (27 hips, 51.92%). As compared to the overall population undergoing revision THA (60/146 hips, 41.09%), patients younger than 50 years having more frequency of aseptic loosening as a cause of failure of THA and less frequency of periprosthetic joint infection, instability, and fracture; but statistically significant difference was not found (P = 0.38). No correlation was found between the type of implants used (P = 0.84) and diagnosis at index THA (P = 0.78), with the cause of failure of THA. Conclusions: Aseptic loosening of THA is the most common mode of failure in patients younger than 50 years.
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Bone names and “ization” in orthopedics p. 115
Ganesh Singh Dharmshaktu
Various terms in orthopedics are formed using or incorporating the name of native bones and these terms then describe a clinical entity or a procedure. The term thus created, however, may or may not be directly related to the bone associated. There are a few interesting examples of such terms that are encountered in the orthopedic literature. A short recollection of those few notable terms that have the name of a known bone within their terminology is described here for general reading and knowledge.
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District residency program: seeking opportunity in the disruption p. 119
Ganesh Singh Dharmshaktu
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Vitamin D deficiency in proximal femur fractures: An observational, cross-sectional study p. 120
Mahmood Dhahir Al-Mendalawi
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