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   2019| January-April  | Volume 2 | Issue 1  
    Online since August 16, 2019

 
 
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ORIGINAL ARTICLES
A study - Incidence and pattern of musculoskeletal injuries among patients attending the emergency of tertiary health care center in Central India
Ashish Anand Gupta, Santosh Kumar Mishra, Suresh Uikey, Deepak Maravi
January-April 2019, 2(1):11-14
DOI:10.4103/2665-9352.263462  
Introduction: Trauma is the major cause of death and disability in developing country, is responsible for more years of life lost than most human diseases. This study aims to establish the value of a trauma registry by measuring, monitoring, and analyzing etiological factors of common musculoskeletal injuries caused due to several forms of trauma. Materials and Methods: This study has been conducted retrospectively. The patients attending the emergency department in tertiary care hospital were included in this study. Personal data and pattern of injuries sustained were extracted from the casualty admission register of emergency department and trauma unit, case records, and operation records. Results: A total of 6574 injured patients were seen in the emergency department. The most common injury was bony injury (65.38%, n = 4298) and soft-tissue injury 34.62% (n = 2276) and the most common sites were lower limbs in 41.39% of cases, amputation/crush injury in 7.82%, and 32.03% of cases (n = 1377) were of compound fractures. The most common soft-tissue injury was lacerated wound 45.21%. Most commonly associated injury was the head injury in 5.53% of cases. Maximum cases were in the age group of 30-59. Conclusion: Fractures were the most common pattern of injuries frequently associated with other injuries, especially head injuries, particular age group, and time period need special attention, and we need more such institutes near highways.
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Acetabulum reconstruction: A demanding surgery
Rajat Charan, Pankaj K Verma, Tushar Chaurasia
January-April 2019, 2(1):1-6
DOI:10.4103/jodp.JODP_2_18  
Introduction: Incidence of fracture in acetabulum is rising and requires anatomical reduction and fixation for proper functioning hip joint. Earlier majority of such fractures were treated conservatively with occasional satisfactory results. Its surgical management is technically demanding but is evolving fast. Material and Methods: Eighteen surgically managed patients in last 2 years were included in the study. On admission, patients were stabilized first the associated dislocation was reduced and maintained on traction. Surgery was planned as soon as general condition permitted after radiological evaluation. Surgical approach depends upon site and pattern of fracture. Postoperative radiological results were assigned according to the criteria described by Matta (Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996;78:1632-45) and functional results were evaluated using Merle d'Aubigne and Postel's system modified by Matta et al. (Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum: A retrospective analysis. Clin Orthop Relat Res 1986;230-40) after a minimum 6-month follow-up. Results: According to the Merle d'Aubigne and Postel scoring system modified by Matta, the clinical outcome was excellent in 9 cases (50%), good in 5 cases (27.7%), fair in 3 cases (16.6%), and poor in 1 case (5.5%). In our series, the overall incidence of sciatic nerve palsy was seen in 2 cases (11%), and other nerve damage was not seen. In our study, all patients received mechanical prophylaxis, and just one patient developed pulmonary embolism. This is in concordance with result of an Indian study. (Shrestha D, Dhoju D, Shrestha R, Sharma V. Acetabular fracture: Retrospective analysis of thirty three consecutive cases with operative management. Kathmandu Univ Med J (KUMJ) 2014;12:279-87.) In our study, deep infection was seen in one case, i.e., 5.5%, and two cases (i.e., 11%) had superficial infection. Conclusion: Nowadays open reduction internal fixation is the gold standard for the displaced acetabulum fractures. A good-to-excellent functional outcome was seen in more than 60% of the patients and a good-to-excellent radiological outcome was seen in more than 50% of the patients treated surgically.
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Study of musculoskeletal complications of hemophilia at a tertiary health-care center in Central India
Sujeet Mishra, Deepak Maravi, Santosh Kumar Mishra, Suresh Uikey
January-April 2019, 2(1):7-10
DOI:10.4103/2665-9352.264618  
Background: Hemophilia A, an X-linked recessive disorder of coagulation, caused due to the deficiency of coagulation factor-VIII and hemophilia-B caused due to the deficiency of factor-IX cause spontaneous and traumatic bleeding episodes, leading to various musculoskeletal complications. Materials and Methods: This study was conducted at the Department of Orthopaedics, Hamidia Hospital, Bhopal, for 2 years. After obtaining ethical clearance and consent from the participants, a total of 101 hemophiliac patients were clinically examined, and blood investigations and radiological evaluation were done. Their data were collected using a preformed pro forma. Results: Of the 101 patients, 91 (90.10%) patients had hemophilia A and 10 (9.90%) patients had hemophilia type-B. The mean age of the study population was 20.87 years. Severe (Grade III) hemophilia was more common, with 59.34% cases of hemophilia A and 60% cases of hemophilia B. Fifty-four (53.47%) patients were from rural area. The most common complication was hemarthrosis in 91 patients followed by hemophilic arthropathy in 64 patients, synovitis in 33 patients, and muscle hematoma in 18 patients. Among the 101 patients, 184 joints involved as target joints. Knee joint was the most commonly involved joint (51.09%) followed by elbow (25.54%) and ankle (15.76%). The most common muscle hematoma was psoas muscle hematoma in six (31.58%) patients followed by calf muscle hematoma in four (21.05%) patients. Conclusion: Hemophilia A is most common type causing bleeding in the knee joint and produces arthropathy. It needs prompt factor infusion and physiotherapy to reduce complications.
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CASE REPORT
Compartment syndrome: A rare complication of varicose vein surgery
Ritesh Runu
January-April 2019, 2(1):15-16
DOI:10.4103/JODP.JODP_5_19  
Varicose vein is a common surgical problem. It is commonly reported in surgery OPD and being treated by stripping. We report a case of 25year male who presented with cold, pulseless, pale and senseless left lower limb following stripping 4 days back. He had stitched wound up to groin on the medial aspect of leg and groin, patchy skin necrosis and swelling of whole lower limb. His urine output was reduced. Immediate fasciotomy was done. Urgent colour Doppler showed deep venous thrombosis and multiple large hematomas in the thigh. Due to development of septicemia and renal failure above knee amputation was done. Postoperatively the patient required two debridements and then closure was done. The patient improved gradually. We conclude that before doing venous stripping thorough preoperative evaluation is needed and post operative care should be taken to avoid complications.
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