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Kampa Avinash, Cd Deepak
International Journal of Orthopaedics Sciences, Volume 7, pp 520-522;

The PFN required significantly shorter incisions, less blood loss and operative times. The DHS group required 16sec less fluoroscopy time. Post operative complication in both group included malunion and infection, 5 malunion in DHS while 1 in PFN, 2 wound infections in DHS while 1 in PFN and 1 screw back out in DHS. Patients treated with PFN had a significantly lower pain score at the sixth month of follow up. Patient treated with DHS had more limb length shortening as compared to those treated with PFN. The outcomes of the stable fractures treated with either DHS or PFN were similar. Unstable intertrochanteric fractures, treated with PFN, had significantly better outcomes with all patients having good results. Though both PFN and DHS have similar functional outcome in stable fracture and PFN has better function outcome with unstable fractures, PFN requires shorter operative time and a smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fracture.
Varun Gbs, Sunil N, Gurucharan S, Srikanth En, Nagacharan Gowda, Sumith Jm
International Journal of Orthopaedics Sciences, Volume 7, pp 437-443;

Spondylolisthesis is the anterior translation of cephalad vertebra, in relation to the adjacent caudal vertebra with an intact neural arch. The majority of low-grade listhesis be treated conservatively in the early stages of the disease. In the end, the problem is further compounded by the development of secondary spinal canal stenosis, which leads to the operating room. Therefore, it is necessary to conduct a study to compare the functional and effectiveness of a decompression, with or without instrumentation, for a low-grade, single-level degenerative spondylolisthesis with canal stenosis. Purpose: The study was carried out to compare the functional and clinical outcome of low-grade degenerative spondylolisthesis with a secondary canal stenosis, with or without the instrument. Methods: 40 patients were enrolled and assigned into instrumented or non-instrumented group, 20 patients in each group. The outcome measures were (1) The visual analogue scale to assess the clinical outcome and (2) the Modified Oswestry Disability Index to assess the functional outcome. Results: The improvement in VAS for low back ache was greater in the instrumented group than in the non-instrumented group (91.3% vs 90.5%) with no significant differences (p
Umang Sanghvi, Dishant Bharatbhai Mehta, Pranay Bhatt
International Journal of Orthopaedics Sciences, Volume 7, pp 392-394;

Background and Aim: Open fracture of tibia is one of the most common injuries seen in ortho pedic practice. The appropriate treatment of open tibial fractures is one of the priority problems in modern era of traumatology. Present study was done with an aim to assess functional and clinical outcome after intramedullary locking nail fixation of open fracture shaft of tibia. Material and Methods: This prospective study was conducted in the Department of Orthopaedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. 40 patients were treated over a period of 16 months with gentamicin coated tibia interlocking nail after taking written and informed consent. Antibiotic coated tibia interlocking nail with property of sustained release of gentamicin was used. The coating contains combination of gentamicin and biodegradable polymeric carrier Poly. An average size nail carries 100 mg (1 mg/cm2) gentamicin drug. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Results: The most common cause of injury was found to be due to road traffic accident. Fibula fracture was associated with 92.5% of patients. Time taken in wound healing in majority of patients was less than 5 weeks (45%). Majority of patents (47.5%) had RUST score 8 at six months of duration. Two cases got infected in this study and in one case there was non-union. Average duration of hospital stay was 15 days. Large numbers of patients had fair outcome 45%. Conclusion: In this study we showed that use of antibiotic coated nail to treat open tibial fracture was associated with an absence of deep wound infections. Antibiotic coated tibia interlocking nail is a good treatment option for open tibial fractures, yields good functional outcome with less complications in these fractures and should be used whenever indicated.
Anshul Sethi, Aditya Kumar Mishra, Mohd. Bilal Kaleem, Navneet Badoni, Amish Bhandari, Pankaj Singh, Vishal Haldar, Raunaq Saxena, Sulabh Maheshwari
International Journal of Orthopaedics Sciences, Volume 7, pp 404-407;

The femur is prone to fracture when struck by strong external forces, such as in motor vehicle accidents, falling from height. Intramedullary nailing (IMN) has achieved good results in the treatment of adult femoral shaft fractures. However, poor blood supply and severe soft tissue damage often result from inappropriate surgical operations or deep infection, leading to delayed union or bone non-union. The incidence of non-union of femoral fractures after trauma is 5%–10%. The treatment options available to deal with NON-UNION include Exchange Nailing, removal of the nail, and Re-osteosynthesis with plating +/- Bone grafting, or Ilizarov fixation. We present our experience of plate augmentation with Exchange nailing +/- bone grafting for non-union at junction of proximal 2/3rd and distal 3rd of femoral fractures. It is an efficient technique, which provides additional rotational stability at the non-union site, the additional advantages of this technique are that it can be done with minimally invasive technique, allows early rehabilitation of the patient, and carries lesser morbidity.
Narendra Joshi, Premsagar C Desai, Rakesh Kumar Dhukia, Abhijit Shetty, Krishan Murari Sharma, Manpreet Singh
International Journal of Orthopaedics Sciences, Volume 7, pp 572-577;

Aims: In this study we are evaluating the outcome in management of distal radius fracture by closed reduction and percutaneous 5 k-wire fixation in both young and elderly patients in most types of distal radius fracture types where closed reduction is possible and where ulna is intact or reconstruct able.Material and Methods: A total of 50 patients with distal end radius fractures associated with or without other fracture were treated in in the department of Orthopaedics at all hospitals attached to SMS Medical College & Hospital, Jaipur. The patients were treated with closed reduction and 5 k-wire (1.8mm) fixation under anaesthesia. Clinical scoring system of green and o’brein modified by Cooney and Sarmiento’s modification of Lindstorm criteria was recorded.Results: The most commonly encountered complications were superficial pin tract infection (25.5%) and extensor tendon tethering (6.4%) which were less serious complications and resolved completely on removal of k –wires. Cooney modification of Green and O‘ Brien‘s score was showed higher excellent case (84%) than good (10%) and fair (6%)Conclusion: According to our study perfect closed reduction and five k-wire fixation technique is a versatile tool which provides functional outcomes better than conventional k-wire fixation and volar plating in distal end radius fractures.
Jitendra Aloria, Paras Meena, Rp Meena
International Journal of Orthopaedics Sciences, Volume 7, pp 432-436;

Background and objectives: The treatment of humeral shaft fractures might include plate osteosynthesis or intramedullary nailing. The fracture hematoma is maintained using intramedullary nails because they are placed in a closed way, allowing for early fracture consolidation and decreased infection rates. Interlocking provides rotational stability, allowing nearby joints to mobilize more quickly. Antegrade nailing, on the other hand, has the side effect of tightening the shoulder. in this study, we wanted to see how humeral shaft fractures treated with closed Antegrade Intramedullary nailing fared in terms of time to union, functional results, and comorbidities. Methods: Twenty adult patients with acute humeral shaft fractures were treated using antegrade closed intramedullary nailing. With an average age of 38.4 yrs., there had been 17 men and 3 females (21-65 yrs.). These patients had tracked for two years as well as the outcomes were assessed. Results: 1 (5%) fracture failed to union after an average consolidation time of 13.78 weeks (11-16 weeks). There were three occurrences of intraoperative fracture comminution (15%) that had no impact on fracture healing. 2 (10%) of the patients experienced nail impingement, 1 (5%) had shoulder stiffness, and 1 (5%) had a superficial infection. Functional outcomes were good in 17 (85%), moderate in 2 (10%), and poor in 1 (5%). Results: 1 (5%) fracture failed to union after an average consolidation time of 13.78 weeks (11-16 weeks). There were three occurrences of intraoperative fracture comminution (15%) that had no impact on fracture healing. 2 (10%) of the patients experienced nail impingement, 1 (5%) had shoulder stiffness, and 1 (5%) had a superficial infection. Functional outcomes were good in 17 (85%), moderate in 2 (10%), and poor in 1 (5%).
Deepak Mantri, Kumar Rahul, Ankit Thora
International Journal of Orthopaedics Sciences, Volume 7, pp 504-507;

Introduction: The posterolateral tibial plateau fractures remain a challenge and usually a tough nut to crack even for experienced surgeons. The proximity of the neurovascular structures and difficulty owing to the presence of the fibular head demands surgical skills and expertise. The purpose of this study is to understand the technical difficulties such as difficult exposure, limitation of distal extension of approach, limited implant choices. Material and Methods: 14 consecutive cases of isolated posterior fractures of the posterolateral tibial plateau were operated with a modified posterolateral approach without exposing the CPN between September 2016 and September 2019. Articular reduction quality was assessed according to the intraoperative fluoroscopy and immediate postoperative radiographs. Patients were followed up at 2 weeks, 4 weeks, 2 months, 4 months and 6 months. International knee score was assessed online, at the end of 6 months. Results: All patients were followed up, with a mean period of 8 months (range 25–40 weeks). Bony union was achieved in all patients. The average range of motion arc was 126° (range 110°–135°) and the mean postoperative IKS was 94.2 (range 81–97) at 6 months follow-up. None of the patients sustained neurovascular complications. Conclusions: The modified posterolateral approach could help to expand the surgical options for optimal treatment of this kind of fracture, and plating of posterolateral tibial plateau fractures would result in restoration and maintenance of alignment. This approach demands precise knowledge of the anatomic structures of this region but the results are gratifying.
Pratik Khare, Tribhuwan Narayan Singh Gaur
International Journal of Orthopaedics Sciences, Volume 7, pp 511-515;

Background: Midclavicular fracture are most common type of clavicular fracture and there are recent trend to Fixtion of this factures. this is prospective study to evaluate the result of tens in midclavicular fractures. Material and Methods: Study of 33 (23 male & 10 female) consecutive patient of midclavicular fracture treated by tens and follow up done for radiological and functional evaluation at 4, 8,12, 16 weeks. Result: The average follow up of 13 weeks and union achieved in all 33 cases. length of incision, hospital stay, blood loss, operation time were less significant. there medial Protusion of nail in 4 patient that requires medial trimming of nail, one case of open reduction was got infected treated by early implant removal. no other significant complication were observed. Conclusion: In our hand tens provide good restoration of Clavivular length and allow early mobilization of extremity to got normal range of movements also good cosmetic appearance.
Ravindra Prasad, Lb Manjhi
International Journal of Orthopaedics Sciences, Volume 7, pp 500-503;

Introduction: Fractures of the proximal humerus constitutes 7% of all fractures and approximately one-half of all humerus fractures. In the elderly population above 65 years of age, these are second most frequent upper extremity fracture and third most common non vertebral osteoporotic fractures. Management of proximal humerus fracture with various treatment modalities has always been a topic of debate and draws much controversy and confusion with it because of the complexity of these injuries with fracture displacements. Moreover, even good anatomical results achieved with operative fixation may lead to poor results unless supported by a meticulous postoperative rehabilitation. Aim: To assess and compare the functional outcome with different modalities of the fixations in proximal humerus fractures. Method: a prospective study comprising of 23 patients with proximal humerus fractures classified through Neer’s classification. Modalities of treatment employed included (1) Closed reduction and Percutaneous K-wire fixation (2) Open reduction and Internal fixation with Locking Compression Plate (PHILOS) (3) Closed reduction and Internal fixation with Intramedullary Nail and (4) Shoulder Hemiarthroplasty. Functional outcome was evaluated using Constant Murley score and American Shoulder and Elbow Surgeons Shoulder Score (ASES) based on pain, function, strength and range of motion. Result: Higher incidence of these fracture was seen in (61%) females as compared to males. Most of the fractures (43%) occurred in the age group 50-60 years. Fall from a standing height was the most common mode of trauma in elderly patients while in younger patients, these fractures were mostly a result of RTA or sporting injuries. Two part and three part fractures were found to be commoner of all fractures constituting 39% and 34.8% respectively. Functional outcome evaluated using Constant Murley Score shown Excellent outcome in 13% cases, Good outcome in 34.8% cases and Fair outcome in 39.1% cases while in 13% patients, outcome was poor. The unsatisfactory results in our series was seen mostly in elderly patients who were reluctant or not compatible for rigorous rehabilitation program. Conclusion: Fractures of the proximal humerus have varied patterns and are complex injuries to manage. Reconstruction of the articular surface with restoration of the anatomy, achieving stable fixation, with minimal soft tissues damage and preservation of blood supply remains the key for attainment of optimal functional outcome.
Avinash Gc, Manjappa Cn, Mahendra Kumar Kl, Shivaprakash Ss
International Journal of Orthopaedics Sciences, Volume 7, pp 447-449;

Reporting a case of traumatic, simultaneous right anterior and left posterior hip dislocation with associated fractures, due to an impact of high velocity traffic accident in a 68 year old male. Closed reductions of both hips were successfully performed. The mechanism of this injury is discussed.
Ravi Varma, Darshan Ck, Ravi Gr, Manohar Rao Hr
International Journal of Orthopaedics Sciences, Volume 7, pp 103-107;

Aim: In spine surgery, it is common practice to thoroughly exhaust all conservative measures before surgery. With the increasing popularity of injection procedures, significant number may still require surgery post epidural steroid infiltration (ESI). We aim to study the incidence of such patients who eventually go in for surgery after a failed ESI. We also studied and compared the functional outcomes of transforaminal (TF) versus interlaminar (IL) procedures in intervertebral disc prolapse (IVDP) patients. Materials and Methods: 150 patients with lumbar disc prolapsed were subjected to epidural steroid infiltration after 6 weeks of failed conservative management, of which 101 underwent IL and 49 TF procedure according to surgeon's preference, and followed up for 6 weeks. Those with persisting (or worsening) Visual analogue scale (VAS), Modified Oswestry diability index (ODI) and with progressive neurological deficits, underwent lumbar discectomy and all were followed up for 6 months.Results: Out of 150 patients, 45 patients underwent discectomy (30 %) after total 6 months follow up, and out of the remaining 105 patients, 40 (81.6%) from TF group and 65 (64.4%) from IL group improved. In total, 62% of females went to surgery, Minimal disability in ODI score was seen in 77.8% in surgery group and 98.1% in epidural group at final follow up.Conclusion: Our study observed a much smaller crossover rate (30%) to surgery, and a significant difference in outcomes of the two injection methods and concludes that TF is a better procedure than IL.
Rajaneesh B, Varun Gbs, Sujith
International Journal of Orthopaedics Sciences, Volume 7, pp 86-91;

Introduction: Spinal fusion has become one of the most popular methods of treating spinal diseases such as trauma, deformity and degenerative disc disease. Ideally, in order to promote fusion, the bone graft or bone substitute should have both osteoinductive and osteoconductive properties. The demineralized bone matrix (DBM) of demineralized allosteric bone is processed by comprehensive decalcification procedures. These procedures include chemical and radiological steps to reduce the immune response and the risk of infection. The bone inductive activity of demineralized bone matrix (DBM) has been well demonstrated. DBM also appears to support new bone formation through bone conduction mechanisms. Case reports and analyzes of several retrospective non-randomized clinical series indicate that DBM in combination with autologous marrow or bone marrow demonstrate similar performance characteristics to autograft in posterior lumbar spinal fusion. The purpose of this study is to access radiological outcomes of PLF in lumbar spine using demineralized bone matrix (DBM).Purpose: To see Radiological Outcome of PLF (posteriolateral Fusion) Surgeries In Lumbar Spine Using Demineralized Bone Matrix (DBM).Methods: 30 patients were included in the study Patients were followed up postoperatively at one year follow up. The participants were evaluated for Radiological Outcome in the study group was assessed by using Lenke Classification of Posterolateral Fusion Surgeries In Lumbar Spine Using Demineralized Bone Matrix (DBM).Results: All patients followed up for one year. Radiological evaluation of Lumbar fusion rates assessed with Lenke fusion Classification for PLF at the end of one year was 83.33% Grade. A fusion rates which is excellent. Younger patients of either sex had better outcomes compared to the older age group patients.Conclusions: The average improvement across the board was 81.40% which is excellent. The available literature shows similar results compared to an iliac bone graft which is the gold standard for spinal fusion. DBM can be considered a reliable alternative to the autograft when used as a graft expander in combination with the autograft.
Roshan Kumar Bn, Prasanna Ty, Neel Pasrija
International Journal of Orthopaedics Sciences, Volume 7, pp 75-78;

Purpose: To investigate the incidence and location of meniscal tears in relation to complete vs partial anterior cruciate ligament (ACL) injury.Subjects and Methods: We collected MRI of 114 patients (114 knees) diagnosed with combined ACL and meniscal injury at a follow up 3 months to 2 years of knee injury at our center in last 3 years. The subjects comprised 68 males and 46 females ranging in age from 20 to 55 years. The patients were divided into two groups: Meniscal tears with Partial ACL injury and Complete ACL injury and the results were compared between this two groups.Results: The incidence of complete ACL injury diagnosed with MRI was 52.63% (60 of 114 knees) and partial ACL injury was 47.36% (54 of 114 knees). Regarding the locations of meniscal tears, in complete ACL injury (60 knees), medial meniscal tear was found in 60% (36 of 60 knees), lateral meniscal tear in 31.66 % (19 of 60 knees), and bilateral meniscal tears in 8.33 % (5 of 60 knees). In Partial ACL injury (54 knees), medial meniscal tear was found in 46.29 % (25 of 54 knees) and lateral meniscal tear in 42.59 % (23 of 54 knees) and bilateral (including medial and lateral) meniscal tears in 11.11 % (6 of 54 knees). Bucket handle tear was observed in 11 knees (medial: 8 knees, lateral: 3 knees) in complete ACL injury, and 4 knees (medial: 3 knees, lateral: 1 knee) in partial ACL injury.Conclusion: Incidence of medial meniscus tear was more than 50% in complete ACL injury. Lateral meniscus tear was more associated with partial ACL injury compared to complete ACL injury.
Nagesh Desai, Anshul Gupta, Ashish Parmar, Dipnesh Rathwa
International Journal of Orthopaedics Sciences, Volume 7, pp 46-49;

Osteoarthritis (OA) of the knee joint is a chronic, degenerative disease associated with pain, decreased range of motion, and deformity in the affected joint. Proximal fibular osteotomy (PFO) works on the principal that by removing proximal part of Fibula, medial and lateral compartment of the knee are evenly loaded on weight bearing and hence the medial joint pain and Arthritic changes resolve. This study was undertaken to study outcomes of Proximal fibular osteotomy (PFO) in the Population of South Gujarat attending our hospitals with medial compartment Osteoarthritis of The knee.Materials and Methodology: This is a prospective study of patients who attended the orthopedic out pateint Department in our hospital between September 2018 to November 2019. .In our orthopedics department 42 patient operated for medial compartment Osteoarthritis of the knee with proximal fibular osteotomy. In the follow up Period 5 patient lost follow up in the covid 19 pandemic and 2 patient expired Due to covid 19. So that this patient excluded from the study.Results: In our study, in terms of improvement, two significant differences were found in terms of pain relief, the mean VAS before surgery was 8.00 ± 0.79, which Improved to 2.25 ± 0.792; that was significant in terms of patient relief of pain. Similarly, in terms of comparison of function, the mean preoperative knee Clinical score was 42.75 postoperatively it improved to 83.25 and mean knee Functional score preoperative was 72.5 and postoperatively was 94.37. All These findings, i.e., VAS, and knee score and functional score, were all Suggestive of the beneficial effects of PFO in terms of pain relief and function. Mean HKA angel pre-operative was 173 and postoperatively 173.87 Suggested minimal alignment of mechanical axis.Conclusions: Proximal fibular osteotomy is a simple, safe, less time consuming, and Effective procedure for pain relief and functional recovery. It requires little Rehabilitation and is associated with little or no complications. After a review of the results of our study it was revealed that this procedure is reasonably good both clinically and radiologically, and can be recommended for Medial compartment OA of the knee joint
Sunil Gottipati, Y Siva Sai Kumar Reddy
International Journal of Orthopaedics Sciences, Volume 7, pp 99-102;

Supination-external rotation type of fracture is the most common pattern of ankle fractures. Anatomical reduction of ankle is always desired and poor reduction usually leads to shortening of fibula, or alter the biomechanics of ankle leading to chronic pain as a result of failure of fixation always. Both lateral and antiglide plating of fibula achieve in accurate anatomical reduction of these fractures. But, maintaining the reduction until bony union is also required to avoid failure of hardware or non union. Antiglide construct enhances biomechanics strength of the fixation device due to its anti gliding effect of the applied plate upon weight bearing and thereby is more favourable. This study evaluated clinical outcomes and complications seen in fixations done by antiglide technique done during 2018-2021 among patients admitted with SER pattern injuries at our institute. A total of 24 patients were included in the study. Mean operative time in the study group was 57.5 ± 27.4 (range 20–120) minutes. The most commonly used plates were five-hole plates in 10 (42%) patients, six holed plates in 10 (42%) patients and seven holed in 4 (16%) patients. The median number of screws distal to the fracture line in the antiglide plate was 0.5 (range 0–2); 10 (50%) fibulas with no fixation, 8 (40%) with one and 2 (10%) with two screws. The AOFAS in the antiglide group performed at one year after surgery was 94.5 ± 6.0 (range 85–100).We conclude that the use of the antiglide plate in a posterolateral position, without using unreasonable distal screws, is an appropriate method of fixation in every short oblique lateral malleolus fractures occurring as a part of SER pattern injury of ankle.
Sharath Kr, Dinakar Reddy, Mahesh M
International Journal of Orthopaedics Sciences, Volume 7, pp 225-228;

Background and Objectives: Total knee arthroplasty (TKA) is an effective and terminal surgical treatment for arthritis of knee joint. The aim of this study was to evaluate the influence of Posterior Condylar offset (PCO) ratio on range of motion after posterior cruciate ligament (PCL) retaining TKA and PCL substitution TKA. Methods: This was a prospective trial, comparing PCL-substitution TKA with PCL-retaining PKA in patients requiring primary TKA. The study subjects were randomly allocated into two groups, 32 each. Baseline and endpoint Knee Society scores (KSS) were used to assess functional outcomes. Follow up assessments were conducted at baseline, 1 month, 3 months and 6 months after surgery. Results: The mean age of study subjects was 61.52 ± 7.48 years. In the cruciate substituting group, 61.29% (19) were men. In the cruciate retaining group 60.61% (20) were women. The posterior condylar offset ratio was significantly lesser in the cruciate substituting group (p
Navneet Krishna Saxena, T Sankaralal
International Journal of Orthopaedics Sciences, Volume 7, pp 169-174;

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to visit Orthopaedist. Though most patients recover quickly with minimal intervention, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 40 patients of low back pain between the age group of 21-85 years of both sexes who were admitted and treated at Department of Orthopaedics from August 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, osteoarthritis and any history of trauma. The clinical diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A thorough neurological examination was also performed. Results: The author tabulated 40 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (12) is observed in the age group of 51-60 years (40%) and the lowest number of cases (2) is observed in the age group of 71-80 years (6%). All patients were inquired about (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a clinical examination and a series of investigations. In 40 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively). The research found association between low back pain and various factors. Prevention is the key for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large percentage of the population and is difficult to diagnose. Orthopaedist must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and various risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of devitalizing back pain.
Bula Ratna Kumar, Aravind Jd, Hiranya Kumar S
International Journal of Orthopaedics Sciences, Volume 7, pp 116-124;

Introduction: Anterior cruciate ligament injury is a common injury, frequently occurs in sport. Anatomic ACL reconstruction with autograft or allografts remains a technically demanding procedure. Fixation of replacement graft can be classified into direct and indirect methods. Graft fixation continues to be a weak link in the early rehabilitation process. Our study aimed to compare clinical and functional results between aperture fixation and suspensory fixation of hamstring graft on femoral side.Methods: It is a prospective cohort study conducted on 30 patients, 15 patients in each group with at least 1 year follow up, who underwent ACL reconstruction with autogenous hamstring graft at Vydehi Institute of Medical Sciences and Research Centre, Bangalore from January 2018 to May 2019. Patients aged between 20-46 years of both genders were included in study. The aperture fixation group underwent interference screw fixation at both femoral and tibial tunnels. The suspensory fixation group underwent endobutton fixation on the femoral side and interference screw on tibial side. Patients in both the groups were examined prior to surgery and regularly till 12 months post-surgery. They were compared for clinical and functional outcome with Tegner Lysholm knee score.Results: There was statistically significant improvement in Tegner Lysholm knee score from pre-operative to 12 months post-operative with p value
Vedant Bajaj, Suraj Kumar, Clamson Kamei, Nongmaithem Bikananda Singh
International Journal of Orthopaedics Sciences, Volume 7, pp 378-381;

Monteggia fractures account for less than 1% of all paediatric elbow dislocations, with a peak age of 4 to 10 years. Although rare, they receive considerable interest because they are often missed, resulting in poor outcomes. There have been numerous reports of Monteggia equivalents including the three most common- isolated radial head dislocation, fracture of the proximal ulna with fracture of the radial neck and both bone proximal third fractures with radial fracture more proximal than the ulnar fracture. We present a case of 6 year old boy with minimally comminuted metaphyseal fracture of ulna extending to proximal diaphysis with anterior dislocation of radial head managed by closed reduction and fixation by percutaneous Kirschner-Wires.
Ranganatha Babu Kurupati, Atithi Vijay Kv, Kumar Vinay Gurusiddappa Karindi, Sujai S
International Journal of Orthopaedics Sciences, Volume 7, pp 17-20;

Introduction: Management of unstable comminuted proximal humeral fractures has remained controversial since ages. Open reduction and internal fixation have resulted in devastating complications like stiffness of shoulder joint, avascular necrosis, infection, etc. This study was undertaken to see the functional outcome in management of unstable comminuted proximal humerus fractures treated by a novel method of percutaneous pinning with multiple k wires. Materials and Methods: In this prospective study conducted at MVJMC&RH, 20 patients with unstable comminuted proximal humerus fractures were treated with percutaneous pinning with multiple k wires from June 2018 to November 2020 Results: According to the Constant scoring system, two patients (10%) had an excellent score, fifteen patients (75%) had a good score, and two patients (10%) had a fair and 1 patient (5%) had poor score. Conclusion: In view of the results obtained from our study, percutaneous pinning is a safe and novel method of management of unstable comminuted proximal humeral fractures with fewer complications.
Sushant Ghumare
International Journal of Orthopaedics Sciences, Volume 7, pp 261-263;

Poliomyelitis has created devastating complications and altered the physical, socioeconomic lives of patients suffering from it. Commonly it causes flaccid paresis or paralysis. Osteoarthritis can develop in knees of these patients over the years. Generally absent Quadriceps function is contraindication for total knee replacement. Here, we describe a case of middle aged female patient who underwent knee replacement using hinged implant for severe osteoarthritis of knee joint. At 6 month follow up patient reported excellent painless mobility.
B Sahithya, Gopal Arunkumar
International Journal of Orthopaedics Sciences, Volume 7, pp 246-253;

Back pain is a major issue in our country and its effective management remains a challenge. Prolapsed intervertebral disc is one of the major cause of illness leading to low back ache which is mostly affecting adults in their fourth decade of life. We have selected a study group of 120 people with single and double level disc bulges and prolapses, who underwent MRI for their low backache and managed them with ESI by different approaches, among which 63 patients were given interlaminar approach, 21 transforaminal approach and 36 caudal approach at the end we got fair to good results in our study, by this the time interval for surgical intervention has been increased.
Ramesh R, Yogarakshith Ar, Jayanth B, Pradeep Hullatti
International Journal of Orthopaedics Sciences, Volume 7, pp 161-164;

The AO/ASIF proximal femoral nail (PFN) is a new device designed for the treatment of the unstable intertrochanteric femoral fracture. This study reports the outcome in such fractures treated using the short PFN (proximal femoral nail). All patients presenting to our department with unstable trochanteric femoral fractures were treated operatively using the short proximal femoral nail. A total of 40 patients were included in the study and were followed-up at regular interval of 1, 3, 6 and 12 month. The functional outcome of the patients was assessed by modified Harris hip score at regular intervals.Results: All 40 patients treated with short pfn. In this study first follow up was at 4 weeks, radiological union was noted in 9(22.5%) patients. At second follow up at 12 weeks, clinical union was noted in 85% of patients and radiological union noted in 90% patients. At 6 month follow up all 40 patients showed signs of clinical and radiological union. Post-op 1 patient has superficial wound infection and 3(7.5%) patients operated with short PFN showed varus deformity. Patient were functionally evaluated by modified Harris Hip Score at regular follow-ups. In our study 87.5% of cases showed good to excellent results and rest 12.5% of cases showed fair results.Conclusions: It is concluded from our study that short proximal femoral nail is an stable and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging.
Vijayakumar S Kulambi, Raghukumar, Subodh Shetty, Sabarish K
International Journal of Orthopaedics Sciences, Volume 7, pp 165-168;

Introduction: The majority of tibial plateau fractures are secondary to high velocity road traffic accidents. Hence the management of high-energy proximal tibial fractures will need very good care of the soft-tissue envelope as the surface of the proximal tibia is covered only with skin and subcutaneous tissues The main goal of surgical treatment of proximal tibial fractures in this study is to restore and preserve normal knee function by using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique. Method: 32 cases of proximal tibial fractures from Chigateri General Hospital and Bapuji Hospital attached to J.J.M Medical College, Davangere during the study period were included in study and cases were followed up for a minimum period of 12 months. At 4, 6, 9, 12, 16 weeks and then two monthly follow up till 12 months. Inability to take part in post operative rehabilitation & those with Open fractures were excluded from the study. Result: Based on Modified Rasmussen criteria for clinical assessment in our study we achieved 71.88% excellent results, 15.62% good results (with overall of 87.% excellent to good results) and 12.5% fair results.
Rajesh K Ambulgekar, Mrityunjay P Sharma
International Journal of Orthopaedics Sciences, Volume 7, pp 07-13;

Spinal subdural abscess/empyema is uncommon but serious condition with significant morbidity and mortality. Till date very few cases of spinal subdural abscess has been reported. Prognosis of Spinal Subdural Abscess is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI) findings should be properly considered and thoroughly evaluated. Symptoms include fever, back pain, and neurological symptoms, but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. In few cases there may be no organism isolated as in our case, possible reason being prior usage of antibiotics before surgery. Treatment should include prompt surgical exploration and decompression combined with appropriate prolonged antibiotic treatment with regular follow up and physiotherapy.
Hemjit Das, Harikrishnan Ng, Siddharth Kumar
International Journal of Orthopaedics Sciences, Volume 7, pp 194-197;

A 25 years old female with limp and a gradually progressive flexion deformity at the knee, being able to walk only on crutches, following septic arthritis of the knee joint during childhood had a fixed flexion deformity of 70 degrees at the knee with a limb shortening of 7cm with evidence of multiple healed previous sinuses and secondary deformities of spine, pelvis and ankle. The soft tissue over the posterior aspect of knee joint was scarred with a degenerated and ankylosed knee joint. A supracondylar anteriorly based closing wedge osteotomy of the femur at the CORA was done to correct the deformity gradually using a long spanning Ilizarov’s ring external fixator with corticotomy and sequential lengthening done later. At final follow up at 12 months after completion of treatment apart from pin tract infections the patient had no other complications like residual or recurrence of deformity, delayed consolidation, non-union, refracture, peroneal nerve injury or hardware failure. Also with satisfactory hip and ankle range of motion and a limb that was pain free and in functional position unaided ambulation was possible. Hence, wedge resection and gradual correction with Ilizarov’s technique can achieve desired results without causing any neurovascular complications or soft tissue procedure requirement in a chronic severely flexed ankylosed knee.
J Raja Purushothaman, F Abdul Khader
International Journal of Orthopaedics Sciences, Volume 7, pp 186-188;

Aim: Evaluating the outcome of computed tomography (CT) guided percutaneous radiofrequency ablation in the treatment of osteoid osteoma in unattainable region. Material and Methods: 12 patients between 12 - 30 years of age with osteoid osteoma were selected and treated by percutaneous CT guided radio-frequency ablation. All the patients had complained of pain. Evaluation done with x-ray, CT, MRI and bone scintigraphy. The lesion is heated to 900 C for a minimum of 6 minutes by Radiofrequency ablation under general anaesthesia. Results: All patients had complete relief of pain after radiofrequency ablation and was fully weight bearing without any support. Local erythema was noted in 6 patients, paresthesia was observed in 2 patients, 1 patients had a small cortical chip fracture at entry site of needle which healed spontaneously and 3 cases of minor thermal injury of skin were noted which required dressing with 0.2% Silver Nitrate ointment. Patients were followed up for 2 years (24 months), and no recurrence was reported. Conclusion: CT guided percutaneous radiofrequency ablation is an effective, minimally invasive and economic treatment method for osteoid osteomas.
K Hari Krishna Reddy, Shaik Nawaz Shareef
International Journal of Orthopaedics Sciences, Volume 7, pp 313-319;

Background: Tibial fractures are the most common long bone fractures, while distal tibial fractures are even more complicated due to their proximity to the ankle and the close relationship with thin, soft tissue envelope and severe comminution. Objectives: To assess and compare fractures' functional outcomes in Group A (treated with plating) versus Group B (treated with intramedullary nailing). To assess the efficacy, advantages, and disadvantages of the treatment modalities and their complications. Materials and Methods: This is a comparative study done from October 2019 to March 2021 in the Department of Orthopaedics, Narayana general hospital, attached to Narayana Medical College, Nellore. In this study period total of 40 patients were taken for study as per inclusion criteria. The patients are randomized into two groups of 20 cases each. Group A treated with plating, and Group B was treated with intramedullary nailing. Results: In our study, good results were observed in Intramedullary nailing groups (51.43%) when compared with the plating group (40.3%). These differences were statically significant with a p-value (p
Kavita Avinash Patil, Kv Mahendra Prashanth, A Ramalingaiah
International Journal of Orthopaedics Sciences, Volume 7, pp 108-115;

Osteoporosis is a silent bone disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones and decreases in bone strength which increases the risk of fractures.It is more common in women rather than men. DEXA that is Dual Energy X-ray Absorptiometry is a model to diagnose osteoporosis although its low-availability, expensive, and high radiation exposure. The CAD (Computer-Aided Diagnosis) has enhanced the analysis to a higher level. The advanced learning paradigm that is Deep-Learn, Machine-Learn and Artificial Intelligence has exposed a turning point in the medical field which leads to accurate diagnosis of osteoporosis. The review is based on various anatomical sites such as lumbar spine, hip, forearm, calcaneus, and dental are assisted and examined based on validation, pre-trained networks, and accuracy. The combination of clinical data and images are fed to deep leaning models specifically CNN-Convolutional Neural Network, RNN-Recurrent Neural Network may result in completely automatic detection and diagnosis of osteoporosis.
Siddaling Narasangi, Anuj Manjunath
International Journal of Orthopaedics Sciences, Volume 7, pp 578-580;

The proximal tibia is involved in body weight transmission though the knee joint and leg, it plays a vital role in the knee joint function and stability. Fractures of proximal tibia have historically been difficult to treat because of its subcutaneous location of the anteromedial surface of the tibia. Severe bone and soft tissue injuries are not infrequent and there is high incidence of open fractures compared to other long bones. This study was a prospective study done on 20 consenting cases of closed tibial plateau fractures who were admitted with posteriomedial plate with inclusion or exclusion of anteriolateral and have come for follow up during the study period chosen based on the inclusion and exclusion criteria. In our study Average time for union of fracture was 18 weeks (range from 16-24 weeks). In our study two patients developed knee stiffness One patient with knee joint stiffness is due to lack of postoperative mobilization .Second patient developed knee stiffness due to patella fracture treated with TBW and physiotherapy and regain 900 of flexion.
Alshebromi Ash, Badghish Ems, Alzahrani Basim, Elyousfi Abdulhamid
International Journal of Orthopaedics Sciences, Volume 7, pp 402-403;

Fusion of carpal bones a rare and it is extremely rare to have ipsilateral lunotriquetral coalition, pisiform hamate coalition. In this report, we present a case of a 20-year-old male, with an incidental finding of ipsilateral lunotriquetral coalition, pisiform hamate coalition after a fall on outstretched hand. In such cases if a patient is not complaining of any persistent symptoms, we prefer to treat conservatively with no requirement of operative intervention. It is important to be aware of such anomaly to be part of you differential diagnosing and not to mistaken it for other unrelated abnormalities.
Dhakal Rabi Mohan, Shrestha Rabeendra Prasad, Parajuli Prabhakar
International Journal of Orthopaedics Sciences, Volume 7, pp 455-459;

Background: Malleolar fractures are the most common type of ankle fractures. These intra-articula fractures need to be managed properly as they have high chance of non-union and are usually treated operatively. Open reduction and internal fixation with malleolar screw or tension band wiring (TBW) are mostly used treatment modalities for medial malleolus fracture. The objective of this study was to compare the functional and radiological outcome of patient who underwent TBW or malleolar screw fixation. Methods: It was a prospective comparative study conducted in 40 patients at Gandaki Medical College over the period of 24 months. Patients fulfilling the inclusion criteria were included in in the study. 20 patients were randomly selected in either group of malleolar screw and TBW which were followed for six months postoperatively. Functional outcome was measured using Olerud and Molander scoring system. Radiological outcome, adverse radiological outcome, range of motion and complications were studied and compared. Results: The mean age of TBW group was 41.3± 14.76 while in malleolar screw group it was 39.65±15.34. Male to female ratio in TBW group and malleolar screw group was 0.82 and 0.66 respectively which is not statistically significant. Mode of injury, fracture type pre and postoperative hospital stay and duration of surgery were statistically similar in both the groups. Most common mode of injury was RTA (50%) and twisting of ankle (35%). Higher rate of smoking was seen in malleolar screw group(40%) than in TBW group(20%) while alcohol consumption was seen in 40% TBW patients and 15% malleolar screw patients. Average duration of bony union was significantly higher in TBW group (8.32±1.61 weeks) compared to malleolar screw fixation group (10.69±3.35weeks) (P=0.008), however there is no significant difference in term of functional outcome score, radiological outcome and complication rate. Conclusions: There is no significant difference in term of functional outcome and complication rate between TBW or malleolar screw fixation for medial malleolar fracture however, patients treated with TBW fixation tend to show earlier radiological union.
Sriphani Kumar K, Srikanth Scv, Sreenivasa Chowdary J
International Journal of Orthopaedics Sciences, Volume 7, pp 523-532;

Background and Objectives: To study the functional outcome following total knee replacement in primary osteoarthritis patients with varus deformity.Method: In our study, we had analysed the functional outcome of patients with chronic osteoarthritis of knee between the ages of 50-76 and had undergone total knee replacement in Dr PSIMS & RF, Chinnaoutpalli. Out of 26 patients who had undergone knee replacement 15 were female patients and 11 were males. We had evaluated the functional outcome using American knee society score and documented the complications.Results: In our study, 58% of the patients comprised of females and 42% of males. In this study 57% of patients of patients had excellent results, 33% of patients had good results, 10% of patients had fair results. Relief of pain was excellent in most patients: 86% had no pain or very mild pain postoperatively. The average post- op anatomical alignment of tibiofemoral angle was found to be 4.10 valgus on radiographic evaluation.Conclusion: In our study, we found that total knee replacement in symptomatic primary osteoarthritis is a very effective procedure in management of pain and in regaining good range of movements. We also conclude that American Knee Society Score is a very useful tool to assess the outcome of the surgery. In our series, cemented total knee arthroplasty has demonstrated well to excellent results. Further follow-up studies are required to see if this performance is maintained in the long term results.
Pavan Kumar Patted, Md. Sadiq, Vivek V
International Journal of Orthopaedics Sciences, Volume 7, pp 542-544;

Background: The study was conducted to assess functional outcome and complications of Proximal Humerus Inter Locking System (PHILOS). Plating in displaced proximal humeral fractures by Constant-Murley (Subjective and Objective) score.Materials and Methods: The study was conducted on 60 patients with displaced proximal humeral fractures operated with Proximal Humerus Inter Locking System. Among 60 patients 24 females, 36 males; mean age 50.64 years range (26-70yrs). All patients were put on same physiotherapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radio graphically at regular intervals of 6 weeks, 12 weeks and 6 months. Functional outcome was assessed using the Constant- Murley score. Complications during the follow-up period were recorded.Results: In our series of 30 patients 2-part fractures were more common accounting 60 % compared to 3-part (20%) and 4-part (20%). Fractures united in all patients. The most frequent complication seen was shoulder stiffness in 6 patients. Excellent functional outcome seen in 18 (30%) cases, good 24 (40%) cases, fair 12(20%) cases, poor 6(10%) casesConclusion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part and 4 part fracture. The complications are high in four part fractures and old age. Good surgical skills and surgeon’s experience are of utmost importance for successful operative treatment.
Dhaval Gotecha, Akshat Mittal
International Journal of Orthopaedics Sciences, Volume 7, pp 460-462;

Aim: The aim of this study was to evaluate the therapeutic effect of platelet-rich plasma (PRP) injections in the treatment of Patellar Tendinopathy. Methods: The study group comprised of 39 patients comprising mainly athletes with patellar tendinopathy for more than 6 months. PRP was obtained from the patients’ own blood and injected in a single dose. Peppering technique was used for injecting the doses in the patients. Results were calculated using pre-injection and post-injection Visual Analog Scale (VAS) and Victorian Institute of Sport Assessment (Patellar, VISA-P) at baseline, 6 weeks and 6 months. Results: All patients enrolled in the study completed a 6 month follow-up. There were no complaints of any side-effects to the administered platelet-rich plasma. No infection or any other complications were reported at the end of 3 months. The outcome was seen in terms of VAS and VISA-P. Conclusion: PRP therapy proves to be effective in relieving pain in a long term for treatment of Patellar Tendinopathy.
Prince Solomon, Siva Swaminathan Santhanam, Gopi Kumarasamy, Ponnilavan Krishnan, Antony Albert, Brinda Ramanujam
International Journal of Orthopaedics Sciences, Volume 7, pp 399-401;

The optimal timing of debridement of open fractures has been a debatable topic for many years. The purpose of the present study was to evaluate the relationship between the timing of initial debridement and the development of subsequent infection in open long bone fractures of lower limb presenting to our institution. We did a retrospective cohort study in 89 cases of open long bone fractures of lower limb who had underwent wound debridement and fracture fixation. Patients were grouped as Group A (44 patients) in which debridement of open fractures were done within 12 hours of injury and Group B (45 patients) wherein debridement was carried out after 12 hours of injury. Out of 44 patients in group A, 21 patients had infection and 23 had no signs of infection at the end of 1 year. In group B, out of 45 patients, 19 were infected and 26 had no signs of infection at 1year follow-up. Statistical analysis showed that there was no significant relationship between the timing of debridement and infection rate (p value – 0.6). Hence open fractures can safely be debrided even after 12 hours of injury without increasing the chances of infection provided the antibiotics are started on time and the surgery is carried out by adequately rested and trained surgical team.
Gurram Venkata Siva Naga Raja, Ram Bhupal Varma R
International Journal of Orthopaedics Sciences, Volume 7, pp 395-398;

Background: The goal of treatment of distal fracture of radius is restoration of normal function and prevention of complication like malunion, joint stiffness, and deformity but achievement of desired outcome is always a challenge in fracture of distal end of radius. As there is variability in the conclusion of various literature present study has been conducted to evaluation of outcome of surgical management of unstable comminuted fracture of distal radius using external and internal fixation in our clinical conditions. Method: Patients with unstable comminuted fracture of distal radius admitted in the department of orthopaedics and trauma are enrolled for this study based on inclusion and inclusion criteria. For functional assessment of outcome, we used DASH (Disability of the Arm, shoulder and hand) Method. Result:The mean of DASH score was16.24±4.62 in external fixation group and 14.65±3.98 in internal fixation group. Both groups are comparable to each other as it is not statistically significant (P˃ .05). There is no incidence of compressive neuropathy, Sudeck’s osteodystrophy, iatrogenic rupture and nerve injury. Discussion: From present study we can conclude that fracture of distal end of radius is common fracture with male predominance. Injury is more common on right side and fall from height is common mode of injury. DASH score was less in internal fixation group. Post-operative infection was high in infernal fixation group. Functional outcome was better in outcome was better in internal fixation group.
Sujanatheja Js, Pavan Kumar Patted
International Journal of Orthopaedics Sciences, Volume 7, pp 545-547;

Background: The study was conducted to assess the functional outcome of hook plate for displaced lateral end clavicle fractures using Constant Murley score. Materials and Methods: This study include total of 15 cases with displaced lateral end clavicle fractures satisfying the inclusion criteria treated with hook plate. Patients were followed up at 1st month, 2nd month and 6th month, the functional outcome was assessed using Constant Murley score and the radiological outcome was also assessedResults: In our study, 15 cases treated with hook plate 26.7% of patients had excellent outcome and 73.3% had good outcome and postoperative shoulder impingement seen in 13% of patientsConclusion: Hook plate has a good functional outcome for lateral end clavicle fractures. Hook plate is an absolute indication for commenuted lateral end clavicle fractures. Hook plate has implant-related complications, hence implant removal should be advised.
Pramod Singh Chahar, Ravinder Kumar Lamoria, Amit Kumar Gupta, Gyanendra Singh Chauhan, Mahesh Chand Bansal
International Journal of Orthopaedics Sciences, Volume 7, pp 470-474;

Background: Depending on the severity of your ACL injury, treatment may include rest and rehabilitation exercises to help you regain strength and stability or surgery to replace the torn ligament followed by rehabilitation. Methods of femoral fixation in arthroscopic ACL reconstruction surgery are widely discussed in the literature. The cortical suspension technique is a popular option with a variety of adjustable loop and fixed closed loop devices available in the market. Aim: To evaluate short term outcome of arthroscopic ACL reconstruction using fixed closed loop fixation (CLF) and adjustable loop fixation (ALF) techniques. Study Design: Hospital based Prospective randomized comparative interventional study. Materials and Methods: 60 cases were included in this study, in which 30 cases were treated arthroscopically by using CLF and remaining 30 cases were operated arthroscopically by using ALF. Clinical outcome was assessed using Lachman and pivot shift, and results were graded using the International Knee Documentation Committee. Functional outcome was evaluated by using Lysholm score up to 8 months. Result: Lachman grading (mm) pre-operative in CLF group was 2.84±0.35 mm and in ALF group was 2.72±0.31. Maximum patients were from IKDC 2+ grade. 70.00% in CLF group and 56.67% in ALF group. Lysholm score pre-operative in CLF group was 63.00±1.29 and in ALF group was 62.90±1.86. Lachman grading (mm) post-operative in CLF group was 0.31±0.02 mm and in ALF group was 0.35±0. 16.67% patients belong IKDC 2+ grade in CLF group and in 10.00% patients in ALF group. Lysholm score post-operative in CLF group was 92.36±0.95 and in ALF group was 91.9 ± 0.91There were no statistically significant differences. Conclusion: We concluded that in femoral fixation of ACL graft both CLF and ALF techniques may provide secure fixation, equal reduction of graft laxity, and similar functional outcome in ACL deficient knee.
Chetan Giroti, Akshat Mittal, Dhaval Gotecha
International Journal of Orthopaedics Sciences, Volume 7, pp 463-466;

Aim: The aim of this study was to evaluate the therapeutic effect of corticosteroid and platelet-rich plasma (PRP) injections in the treatment of De Quervain Tenosynovitis. Methods: The study group comprised of 49 patients with 50 hands divided into two groups. In the corticosteroid group (Group A; n=28), 1 ml of methylprednisolone (40 mg/ml) was injected along with 1 ml of 0.5% bupivacaine. In the PRP group (Group B; n=22), PRP was obtained from the patients’ own blood and injected in a single dose. Patients were evaluated using Visual analogue scale (VAS), the shortened disabilities of the arm, shoulder and hand questionnaire (DASH) at baseline, one and three months after the injection. Results: Overall, 44 females and 5 males were included with 28 hands in Group A and 22 hands in Group B. The CS group had better pain relief, hand function tests at 1 month and at 3 months follow-up, the PRP group had better pain relief, hand function tests than CS group. Conclusion: PRP therapy proves to be more effective in relieving pain than corticosteroid injections in treatment of De-Quervain Tenosynovitis.
Joyance James Mammen, Anupam Mahajan, Rajesh Paul
International Journal of Orthopaedics Sciences, Volume 7, pp 373-377;

External fixators have been used for temporary stabilization as a part of damage control orthopedics. Watson et al in 2000 described “traveling traction”, a simple external fixator for provisional stabilization of pilon fractures. We have tried to analyze the wide applicability of this simple external fixator and its modification (Ez-fix) for provisional stabilization of all tibial fractures: proximal, diaphyseal and distal tibial. This was a 18-month prospective hospital based study in which 91 skeletally mature patients with tibial fractures (proximal, middle, distal 1/3rdand pilon) provisionally stabilized with Ez-fix external fixator application were enrolled. Ez-fix, with one distal femoral/ proximal tibia pin and other calcaneal pin was applied. Posterior splint was given for added stability. The patients were followed up till a definitive fixation or trans-fixation cast was applied. Out of 91 fixators 56 were shaft, 28 proximal and 7 were distal tibial fractures. The average duration in the Ez-fix across all the fracture patterns was 22 days. 71 of the 91 fractures had associated fibula fractures too. 25 Ez-fixes were applied in the ER/ICU. Satisfactory initial reduction in the Ez-fix was achieved in 92% of the proximal, 71% distal and 57% shaft fractures. The place of external fixation did not affect the initial reduction as there were comparable rates of satisfactory reduction in Ez-fixes applied in OT and ER/ICU. There was a significant association between duration and loss of reduction with p-value of
Sunil N, Sujith Patil B, Sumith Jm
International Journal of Orthopaedics Sciences, Volume 7, pp 79-85;

Introduction: Closed fractures of leg are common following RTA, which requires immobilization and leg elevation above heart level to reduce oedema formation and increase of compartment pressure leg elevation is routine in pre operative and post operative period to reduce intra compartment pressure whereas optimum height of elevation has not been standardized till now. Inadvertent elevation of leg decreases venous oedema whereas chances of muscle ischemia increases with prolonged and inappropriate elevation of leg. So determination of appropriate level of leg elevation above heart level by invasive method by white side’s method will help reduce muscle ischemia and discomfort to the patient. Purpose: To determine optimum height of leg elevation above heart level to reduce intra compartmental pressure.Methods: Patients at KLES Dr. Prabhakar Kore Hospital with closed fractures of leg. Anterior compartment pressure measured with Whiteside’s invasive method .Patients were randomly divided into two groups Group A: 15 cm of leg elevation and Group B:30 cm of leg elevationResults: In this study 60 patients with closed fractures of tibia were selected for intra compartmental pressure monitoring and randomised for different weights of leg elevation i.e., Group A 15 cm above heart level and Group B 30 cm above heart level. The mean age of leg fractures in our study was 40.1 years. Male subjects were 85% (mean = 53) and female were 17% (mean = 7) of total of 60 patients.The measurement of compartment pressure of normal leg was 9.4 ± 2.5 mm Hg. Pressure were measured within 5 cm of fracture site at 0 hr, 12 hr, 24 hr and 48 hr interval using Whiteside’s method. The mean values at 0 hr were 29.17 ± 5.95 mm Hg, at 12 hr interval it was 29.97 ± 5.46 mm Hg, at 24 hr interval it was 23.36 ± 3.8 mm Hg and at 48 hr interval it was in Group A. The mean values at 0 hr were 32 ± 7.8 mm Hg, at 12 hr interval it was 32.33 ±57.65 mm Hg, at 24 hr interval it was 26.48 ± 3.5 mm Hg and at 48 hr interval it was in 25.19 ± 2.56 mm Hg in Group B. In our study 5 patients out of 60 underwent fasciotomy. All patients had differential or delta pressure below 30 mm Hg before fasciotomy.Conclusion: Tibia fractures are commonest cause of compartment syndrome of leg. Whiteside’s method is a reliable and safe method of measuring intra compartment pressure when sophisticated methods are not available. Inappropriate levels of leg elevation causes muscle ischemia. Elevation of leg to 15 cm leads same clinical results as 30 cm with the advantage of avoiding muscle ischaemia. There is further need for evaluation of different heights of leg elevation and review about our practice of leg elevation.
Faizal Ali Aa, V Sumesh Shanker, Hijas Hameed, Govind Karunakaran
International Journal of Orthopaedics Sciences, Volume 7, pp 125-129;

Tibial plateau fracture have been a challenge to treat as these fractures are associated with severe damage to the soft tissue envelope and significant communition and bone loss. This may be due to high speed velocity accidents or fall from height. There exist no gold standard approach in treating these fractures, each case may vary in terms of soft tissue injury, communition and association of neurovascular status. This study was conducted by department of orthopaedics at Government Medical College Ernakulam from February 2018 to January 2020, during this period 30 patients managed by internal fixation was evaluated for their functional outcome. The patients were assigned into two groups; those treated with locking plate and another being the Non locking group. Follow up range was 10-24 months, average being 17.4.This study revealed locking plates to be superior in terms of knee scores, radiological outcomes and post-operative pain.
Balakrishnan Sushant, E Kaizar Ennis
International Journal of Orthopaedics Sciences, Volume 7, pp 232-235;

Background: Tibial diaphyseal fractures are one of the most commonest fractures in young adults around the world. It is usually managed surgically by using interlocking intramedullary nails. The present study is aimed to evaluate the Clinico-Radiological Healing of Diaphyseal Fractures of Tibia Treated by Interlocking Intramedullary Nail. Materials and Methods: The study was done in the Department of Orthopaedic Surgery, SUT Academy of Medical Sciences, Vattapara, Kerala over a period 18 months from October 2019 to March 2021. Twenty-eight patients were included in the study based on the inclusion and exclusion criteria. All the patients were explained regarding the procedure, study and informed consent was obtained. Demographic, clinical data and 12th month results was recorded. The collected data was analysed by SPSS (20.0) version software. Results: Half of the study group were aged between 21-30 years (n=14) with male female ratio was 14:1. Fourteen patients had closed type of fracture. Oblique type of fracture pattern was the most commonest compared to others. Twenty-three patients had fracture due to road traffic accident and middle third was the most commonest site of fracture. Most patients underwent surgery within 36-48 hours of injury. At 12th month of assessment, 24 patients had fracture union while 2 patients had delayed union and 2 patients had non-union. Functional grading showed excellent results in 19 patients and good results in 5 patients. Conclusion: Interlocking intramedullary nailing is still a valid technique for the management of tibial diaphyseal fractures since its inception.
Manish Patel, Kishan Patel, Swati Kapadiya, Rahul Patel
International Journal of Orthopaedics Sciences, Volume 7, pp 198-200;

Background: Ankle injuries gain importance because body weight is transmitted through it and locomotion depends upon the stability of this joint. Trimalleolar fractures are one of the most complex fracture around ankle. As with all intra articular fractures, Trimalleolar fractures necessitate reduction and stable internal fixation [2]. The purpose of this study is to assess the functional outcome and results of surgical treatment of Trimalleolar fractures to attain a proper anatomical alignment and stability of ankle joint [2]. Material and Methods: A Prospective study was conducted for 30 patients with trimalleolar ankle fracture. Open reduction and internal fixation was done. Patients were evaluated with functional scoring by Biard and Jackson. The functional outcome of ORIF by subjective, objective and radiological assessment were recorded. Results: In the present study of 30 patients with trimalleolar ankle fractures treated by open reduction and internal fixation. Excellent results were achieved in 17 (56.67%) patients, good in 8 (26.67%), fair in 3 (10%) and poor in 2 (6.67%) patient. Excellent results were observed young patients with close trimalleoluar fractures. More severe injuries, compound fracture and severely osteoporotic fractures were followed by least satisfactory results. The patient with poor result had mild pain with activities of daily living, diminution in the abilities to run and to do work, reduced motion of ankle and narrowing of joint space. Conclusion: This fracture pattern was classified under Lauge-Hansens on basis of different injury mechanisms, and were treated according to it. After anatomic reduction and stable fixation through the specific operative approach and methods, the short-term outcome was good and complications were reduced to minimum. The operative results were eminently satisfactory in 83.33% of patients.
Md Qamar Abdul Azeez, Gompa Parameswara Rao, G Venkatesh, Chinni Ganesh
International Journal of Orthopaedics Sciences, Volume 7, pp 175-180;

Scaphoid fractures are common, but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole, and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This study gives us a radiological and functional outcome of 10 cases operated by pronator quadratus based muscle pedicle bone graft for scaphoid non unions at waist level.
Nitin Chaudhari, Dipnesh Rathwa, Ashish Parmar, Ankur Mali, Part Darji
International Journal of Orthopaedics Sciences, Volume 7, pp 42-45;

Introduction: Osteoarthritis is thought to be the most prevalent chronic joint disease. Total knee arthroplasty is now s reliable treatment for severe arthritis and is commonly done for end stage arthritis of knee. The results of TKA are predictable in majority of cases, but with geriatric population, arthritis is often associated with other co-morbid condition along with age, which makes the results of TKA less predictable. So the present study was conducted to evaluate the clinical and functional outcome of TKA in this subset population.Materials and Methods: This prospective study was done at a tertiary center of new civil hospital surat. A total of 25 Consecutive patients who consented and underwent TKA were assessed clinically, functionally using the knee society score at 6 months.Results: The average pre-op knee Functional score was 65.8 which improved to an average post-op score of 83.68 At 6 month follow up, 19 patients (76%) had excellent, 2 patients (8%) had good, 2 patients (8%) had fair, and 2 patients (8%) had poor results as per KFS. The average pre op knee Clinical score was 47.4, which improved to a post op score of 83.84. At 6 month follow up, 18 patients (53%) had excellent, 5 patients (20%) had well, 1 Patient (4%) had fair and 1 patient (4%) had poor results as per KCS. Conclusion: Total knee arthroplasty improves the functional ability of the old patient above 60 years and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post op knee clinical score and knee functional score.
Sagar V Kakatkar, Aditya P Apte, Akshaj Sharma
International Journal of Orthopaedics Sciences, Volume 7, pp 96-98;

Objective: The knee joint is one of the most commonly affected joints of the body and this can be attributed to its exposure to external forces and the high functional demands placed on the joint. Meniscal root tears have conventionally been treated with menisectomy and in this study we evaluate the effects of repairing the torn posterior medial meniscal root. We also study the effects of age and body mass index on the postoperative outcome of the patient. Methods: 35 patients with posterior horn medial meniscus root tear were operated with root repair with either a fibre wire/ fibre tape or their pre and post-operative tegner lysholm scores were evaluated. Results and Conclusions: The evaluation was suggestive that medial meniscus root repair improved outcomes. Additionally, a relationship was established between the body mass index and patient age with that of the post-operative function.
Vimal Singh, Vidya Bhushan Singh, Shubham Mishra, Pankaj Kumar Lakhtakia
International Journal of Orthopaedics Sciences, Volume 7, pp 310-312;

COVID-19, caused by SARS-CoV-2, is affecting many people worldwide. Huge numbers of people are being killed due to the virus. Although many patients are recovering from COVID-19, there may be possible complications after convalescence, including unfavorable non-pulmonary effects. One of these complications is avascular necrosis (AVN), which may lead to negative outcomes and bone collapse if missed. AVN was seen frequently in SARS and may also be common in COVID-19 infection. It should be kept in mind that the threat of AVN remains with patients recovered from COVID-19 infection, like SARS. The recent outbreak of coronavirus disease 2019 (COVID-19) has become a global pandemic. Corticosteroids have been widely used in the treatment of severe acute respiratory syndrome (SARS), and the pathological findings seen in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those observed in severe acute respiratory syndrome-related coronavirus (SARS-CoV) infection. However, the long-term use of corticosteroids (especially at high doses) is associated with potentially serious adverse events, particularly steroid-induced avascular necrosis of the femoral head. In today's global outbreak, whether corticosteroid therapy should be used, the dosage and duration of treatment, and ways for the prevention, early detection, and timely intervention of steroid-induced avascular necrosis are some important issues that need to be addressed. This review aims to provide a reference for health care providers in COVID-19 endemic countries and regions.
Amit Dhond, Parth Agarwal, Pratik Dhabalia, Abhineet Chand
International Journal of Orthopaedics Sciences, Volume 7, pp 28-36;

Background: US FDA defines non-union as fracture bone that has not completely healed in 9 months since injury and which has not shown any signs of healing over 3 consecutive months on serial x-rays. The operative treatment depends on the type of non-union. There are one-step or two-step procedures according to the principles of the ‘diamond concept’. This involves the improvement of the mechanical situation (in most cases with a re osteosynthesis) and vascularization, local application of osteoconductive carriers e.g. tricalcium phosphate, vial cells from autologous bone and osteoinductive substances like bone morphogenic proteins (BMP-2 or BMP-7). Aim: To study the principles and method of fixation of non-union of distal femur with lock plates. Material and Methods: It was a prospective study including patients with non-union of distal femur admitted and examined according to protocol after obtaining informed consent from the patient and permission from the institutional ethics committee. 40 cases satisfying the inclusion criteria admitted in tertiary healthcare centre of Navi Mumbai since May 2018 to March 2020 with minimum 1 year of follow up were included in the study.Results: Patients were also evaluated as per non-union scores. The average non-union score was 19 (range 11 to 27). All of the non-unions united, at an average of 19 weeks. The average arc of knee motion improved from 85° preoperatively to 114° postoperatively. The average Neer’s score improved from an average of 60.4 points (range 16 to 44 points) preoperatively to 89 points post operatively. The knee society score (Part 1) improved from an average of 51.87 points (range 36 to 68) preoperatively to 81.725 points (range 74 to 93) post-operatively. Conclusion: The operative technique respecting the biology and biomechanical principles has shown the influence of success of treating these fractures with locking plates.
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