International Journal of Orthopaedics Sciences

Journal Information
ISSN / EISSN : 2395-1958 / 2395-1958
Current Publisher: AkiNik Publications (10.22271)
Total articles ≅ 2,418
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Ankur Agarwal
International Journal of Orthopaedics Sciences, Volume 7, pp 178-181; doi:10.22271/ortho.2021.v7.i1c.2478

Abstract:
Introduction: Accurate location of the physes is important in many pediatric orthopaedic operative procedures. Pre-operatively the physis can be identified by a simple plain radiograph, while intra-operatively a C-arm Image Intensifier serves as an essential equipment for localizing the physis. The physis is visible as a radiolucent area sandwiched between the epiphysis and the metaphysis. However, due to unavailability of C-arm, per-operative accurate localization of the physis was a challenge. The purpose of this case series was to assess the usage of Henna (Mehndi) as a radio-opaque marker for pediatric orthopaedic operations for localization of the physis. Methods: A preoperative true-size marker film was taken after drying of applied henna paste. Henna is radio-opaque and also stains the skin, the marks of which persist for several days. The marks of henna on the skin were intra-operatively used to correlate with the markings on the radiographic film for accurate localization of the physis in a series of cases of surgical correction of the uniplanar deformity around the knee at a tertiary level pediatric institute between October 2017 and December 2018.Results: There were eleven cases in the study. Mean age at presentation was 9 years (range 7 to 12 years). Three cases had unilateral affection, while eight cases had bilateral affection. Average follow up period was 30 months. All cases had their deformity corrected till the last follow up.Conclusion: Varieties of intra-operative skin markers have been used for past several years, details of which are available in literature. Henna is a near ideal pre-operative skin marker as it is easily available, inexpensive, visible even after vigorous surgical skin preparation and normally has no untoward side effects. Our use of henna in pediatric orthopaedic surgeries for localizing the physis has not been reported in literature as of date.
Sanatan Behera, Sn Mohanty
International Journal of Orthopaedics Sciences, Volume 7, pp 13-17; doi:10.22271/ortho.2021.v7.i1a.2453

Abstract:
This is a prospective, non-randomized, single-blind study conducted in twenty-three patients of both sexes, with either L5 or S1 or both L5 and S1 radiculopathy, secondary to disc pathology at L4L5 and L5S1 suffering from chronic leg pain for three months or more. The objective of this study was to analyze the difference in the efficacy of administering caudal epidural corticosteroid in the patients with single and double level disc pathology, in terms of improvement of walking distance and relief of leg pain-decrease in Visual Analog Score (VAS). All the patients were evaluated clinically and radiologically, including magnetic resonance imaging of the spine. The patients were divided into two groups i.e., Group I – with single level pathology at either L4L5 or L5S1 and Group II – with double level pathology. Injection Dexamethasone 8mg mixed with injection Bupivacaine 0.5% and distilled water was injected by the caudal route to all patients under fluoroscopy. The pre-injection, 3 weeks, 3 months and 6 months post-injection Visual Analogue Score (VAS) and walking distance were analysed. There was significant reduction of VAS & improvement of walking distance at 3 weeks, 3 months and 6 months post Caudal Epidural Steroid Injection (CESI) in both the groups. There is no statistical correlation in both the groups in terms of clinical efficacy of the corticosteroid with respect to the number of levels of disc pathology. No major adverse event was reported in this series. Caudal Epidural Steroid Injection is a safe and reproducible modality for the treatment of lumbosacral radiculopathy. We would recommend CESI in L5 and S1 radiculopathy, secondary to disc pathology and maybe repeated after 3 months.
Het Patel, Ashish Somani, Prafulla Herode, Ankit Gabani
International Journal of Orthopaedics Sciences, Volume 7, pp 01-03; doi:10.22271/ortho.2021.v7.i1a.2450

Abstract:
Calcinosis cutis is very rare disorder characterized by the deposition of calcium in the skin and subcutaneous tissue. Idiopathic calcinosis cutis has only rarely been reported in the literature. Here, we report cases of two healthy females 40 year old and 55 year old who presented with multiple asymptomatic hard nodules on the fingertips of their hands. Histopathological, radiological, and extensive blood investigations confirmed the diagnosis of idiopathic calcinosis cutis.
Rohan Navalkar, F Abdul Khader, S Raghul Raj
International Journal of Orthopaedics Sciences, Volume 7, pp 408-411; doi:10.22271/ortho.2021.v7.i1g.2519

Abstract:
It was seen that Proximal fibular osteotomy (PFO) is a very simple to perform and a very low-cost surgery when compared to knee arthroplasty and high-tibial osteotomy and was seen to be useful in treating low socio-economic populations that cannot afford expensive surgical treatment methods. The literature available currently consists of mainly of case series and finds PFO useful in symptomatic improvement of medial compartment osteoarthritis. However, there is a lack of consensus regarding the functional outcome of this surgery and also the exact mechanism that is in action. This study was hence conducted to analyse all the evidence on proximal fibular osteotomy which is available, to know its benefits and the mechanisms in action. The theories like non-uniform settlement, slippage phenomenon, the too-many cortices theory, dynamic fibular distalization theory, the concept of competition of muscles, ground reaction vector readjustment theory are various mechanisms have been proposed previously. We have discussed these mechanisms and proposed directives for future research. However, to be sure of the benefits of this procedure when compared to other established treatment modalities, large trials and long-term follow-up studies are required.
Abhijeet Kadam, Rahul Kadam, Abhay Challani, Akshay Shah, Gaurav Sharma
International Journal of Orthopaedics Sciences, Volume 7, pp 140-142; doi:10.22271/ortho.2021.v7.i1c.2470

Abstract:
Background: This study was conducted to compare the results of radial head excision versus radial head open reduction and fixation in Type 2 and Type 3 Mason fracture of radial head using Quick Dash scoring system. This study suggested better Quick Dash score was associated with radial head fixation as compared to radial head excision.Methods: Out of 40 participants who underwent surgery for Type 2 and 3 Mason radial head head fracture, 20 patients had undergone radial head excision and 20 patients had undergone open reduction and internal fixation. Patients were followed up post-operatively upto 6 months and were evaluated on the basis of Quick Dash scoring system.Results: Out of 40 patients, 27 were males and 13 were females. The Mean age group of this study population was 38.8 years with SD of 12.5 years. Even though, the elbow range of motion was comparable between two groups, those who had undergone radial head excision had an average score of 52.5% where bas those who had undergone radial had fixation had an average score of 60%.additionally patients those who had undergone radial head excision had complaints of elbow instability.Conclusion: Mason Type 2 stable, displaced fractures can be treated satisfactorily with radial head excision, but in the presence of ligamentous injury, there are likely chances of elbow instability and patient may require long term use of orthosis whereas unstable, displaced type 2 Mason fracture and Type 3 communited fracture are better treated with open reduction and internal fixation with either k-wires, screws or plates with fewer complications.
Sv Shiv Sandeep, Ravi Kiran Kakumanu
International Journal of Orthopaedics Sciences, Volume 7, pp 625-630; doi:10.22271/ortho.2021.v7.i1j.2552

Abstract:
Introduction: Fracture of both bones forearm in adults occupy a large field of modern traumatology. Maintenance of radial bow, regaining length, good apposition and alignment without malrotation is essential to restore good range of motion of forearm. Aim: to compare functional and radiographic results of plate osteosynthesis to IM nailing in treatment of diaphyseal forearm fracture in adults.Method: A prospective study comprising of 32 patients. 16 patients treated with open reduction and internal fixation using 3.5 mm DCP and 16 patients by IM nailing using 316L SS Talwarkar square nailing by closed or mini open reduction.Result: Mean age of patients was 36.4 years (range 20 to 58 years), Maximum number of patients in this study are middle age group and mean age is 48 years most fractures were of type 22A3 as per AO/OTA classification. Average operative time was 83 minutes and 64 minutes in plating and nailing respectively. Out of 16 patients in each group in our present study we encountered complications like restriction of movements at elbow in 5 (31.25%) plating cases and 3 (18.75%) nailing cases; restriction of movements at wrist in 1(6.25%) plating case and 0 nailing cases and loss of supination or pronation or both were observed in 6 (37.5%) each in nailing and plating cases. Localised bursitis were observed in 2 (12.5) nailing cases alone & wound healing and superficial infections were observed in 2 (6.25%) plating cases alone. We had 1 (6.25%) Non-Union is case of Plating and all fractures united in cases operated with nailing. Out of the 32 sample cases, taking into the account of our functional grading we have observed that about 9 (56.25%) cases have been graded with excellent outcome in plating group and 10 (62.5%) in nailing group, similarly about 5 (31.25%) have been graded with good outcome in plating and 3 (18.75%) in nailing group respectively and satisfactory outcome in 1 (6.25%) in plating group and 3 (18.75%) in nailing group. This has been only 1 (6.25%) case which had a Poor outcome in plating group in our study.Conclusion: We conclude that open reduction and internal fixation with dynamic compression plating is gold standard for treating diaphyseal forearm fracture in adults as it provides rigid fixation, restores forearm stability earlier and has negligible complications.
F Abdul Khader, Pratheesh Mohanraj, Sanjai B
International Journal of Orthopaedics Sciences, Volume 7, pp 663-666; doi:10.22271/ortho.2021.v7.i1k.2554

Abstract:
Background and Aim: Distal third tibia fractures accounts for about 7-9% of all lower extremity fractures. The treatment of distal tibia fractures is challenging, because of limited soft tissue coverage and poor vascularity. In the present study our aim is to assess the clinical and functional outcome of distal third tibia fractures treated by Minimally invasive percutaneous plate osteosynthesis. Materials and Methods: A total of 40 patients with distal tibia fracture was treated in this study from December 2018 to January 2020. TWS Scoring system was used to evaluated the functional outcome. Results: Majority of the study population (21, 52.5%) were belonging to the excellent outcome category, followed by good category among (14, 35.0%). Discussion: MIPPO technique offers biological advantage by preserving periosteal blood supply and it provides good stability to fracture site. Complication rate is less compared to other procedure.
Mithun Shetty, Shashi Kumar Ms, Shree Krishnananda Sagar, Anusree Anil Kumar
International Journal of Orthopaedics Sciences, Volume 7, pp 684-690; doi:10.22271/ortho.2021.v7.i1k.2560

Abstract:
Background: Achieving reduction prior to fixation is a key aspect in successfully managing intertrochanteric fractures. In this study of proximal femoral nailing for intertrochanteric fractures, a novel technique of utilizing pre-fixation compression screw was introduced to achieve and maintain reduction of femoral neck shaft angle. Materials and Methods: The current prospective study was conducted over a period of six months between July 2018 and January 2019 among patients who underwent surgical fixation by PFN for intertrochanteric fractures of femur. Pre-fixation compression screw was used in all the cases to achieve and maintain correction of varus. Pre-operative, intra-operative and post- operative neck shaft angles were documented. Data was analysed by using Statistical Package for Social Sciences (SPSS). The results were expressed as percentages and graphs.Results: There is significant improvement in correction of varus (average increase of neck shaft angle =14.04 degrees) with the use of pre-fixation screw technique. This procedure did neither increase the blood loss (average blood loss = 34.67 ml) during the procedure nor the duration (average duration = 19.46 min) of the procedure.Conclusion: Pre-fixation compression screw can be used as an effective alternative for varus correction in cases of simple intertrochanteric fractures undergoing PFN fixation with added intra-op and post-op advantages compared to other methods of reduction.
Vijay Shankar Sharma, Narendra Joshi, Rakesh Dhukia, Vishal Shekhawat
International Journal of Orthopaedics Sciences, Volume 7, pp 691-702; doi:10.22271/ortho.2021.v7.i1k.2561

Abstract:
Objective: The purpose of our study is to describe our experience with the non-vascularised fibular autogenous grafts that was used for the treatment of nonunion of long bones including tibia, femur & humerus and to analyse and compare the results in terms of postoperative wound infection, radiographic evidence of union, postoperative pain and functional disability, success rate of procedure etc. with conventional iliac crest bone grafting and plating, at a tertiary care centre.Methods: The study was conducted in department of Orthopedics SMSMC, Jaipur from September 2017 to June 2019 and included 80 cases of nonunion of long bone. Amongst these, 40 cases were treated with fibular strut grafting and 40 cases were treated with iliac crest bone grafting, and all cases were followed postoperatively to compare the results in terms of demographic parameters, union time, postop complications.Result: Amongst 32 cases of nonunion of long bones treated with fibular strut 31 cases (96.9%) showed complete union in mean time interval of 17.77 weeks while only 29 (85.3 %) amongst 34 cases treated with iliac crest bone graft showed union in mean time of 18.41 weeks.Graft site pain was noted in 20.6% cases of iliac crest graft while no cases of fibular strut graft had this problem; EHL weakness was noted in 34.4% of cases and all of them recovered fully at the end of follow up.Conclusion: According to our study fibular strut is a better option in treatment of nonunion long bones as maximum cases showed complete union in less time interval and with very few postoperative complications than iliac crest bone grafting.
Sandeep Sriram, Nishant Jajee, Prashant Dhanraj, Sunkoj Krishna Sai
International Journal of Orthopaedics Sciences, Volume 7, pp 738-741; doi:10.22271/ortho.2021.v7.i1l.2563

Abstract:
Background: Tibial shaft fractures are third most common type of long bone fractures in children after femur and forearm.Aim: The purpose of the study is to evaluate the functional and radio logical outcome results of Closed reduction or open reduction of tibial fractures and fixation using locking plate as supra cutaneous external fixator in children.Methods: In this observational study 32 children with tibial fractures having soft tissue injury underwent external fixation with locking plates. There were 22 male and 10 female children with mean age of 10.59years (range 6 to 15 years) who sustained fracture in RTA. 84.4% cases had closed fractures, and 15.6% cases had open fractures. Out of the cases with open fractures, 60% had grade 1 injury, and 20% each had grade 2 and grade 3b injury respectively. Results: 7, 9, 11, 13 Holed LCP were used in 34.4%, 25%, 25% and 15.6% patients respectively. Screw tract infections were observed in two patients who had serious discharge and was relieved with oral antibiotics. No deep infections were reported. All the fractures united by the end of 24 weeks after bone grafting. In all most all the patients skin condition was found to be good in follow up.Conclusion: The present study though in small number (32) shows that use of LCP plate as supra cutaneous external fixator is an effective method in terms of stability of fixation, utilisation as permanent fixation method and less complication rate.
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