International Journal of Orthopaedics Sciences

Journal Information
ISSN / EISSN : 2395-1958 / 2395-1958
Published by: AkiNik Publications (10.22271)
Total articles ≅ 2,651
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Sumit Chawla, Mallika Gupta, Vaishali Grover
International Journal of Orthopaedics Sciences, Volume 7, pp 92-96; https://doi.org/10.22271/ortho.2021.v7.i4b.2869

Abstract:
Background: Cephalomedullary nailing for peritrochanteric femoral fractures is widely popular owing to low risk for perioperative morbidity. The evaluation of outcomes of peritrochanteric fracture fixation has usually relied upon objective measures. The purpose of the present study is functional and clinical evaluation including complications after intraHeal™ Proximal Femoral Nail Advanced for fixation of peritrochanteric fractures. Methods: We conducted a single center study through our post market surveillance project including 468 patients (range 26-93 years, mean age 81 years) with unstable peritrochanteric fractures (AO/OTA 31-A2, 31-A3) treated with intraHeal™ Proximal Femoral Nail Advanced. Functional evaluation was done using Harris hip score, parker score, range of motion, leg length, body mass index, neck-shaft angle and grade of osteoarthritis hip at various stages of follow up. Clinical assessment of bony union and complications in perioperative and postoperative period was also considered. Results: Radiographic union was achieved at an average 3 months in 94.5% of cases, with satisfactory reduction in 84.6% of cases. According to the Harris Hip Score 83% had excellent or good results. Parker score averaged 6 (between 6 and 8). In 36 cases postoperative complications were recorded, of which 13 required major or minor surgical procedure. 38 Patients were excluded from study due to death within 1 year of surgery. Conclusion: The intraHeal™ Proximal Femoral Nail Advanced is an excellent alternative in treatment of all types of unstable peritrochanteric fractures. This study emphasizes the importance of acceptable anatomical reduction in anteroposterior and the lateral projection in reducing the risk of cut-out failure.
Mruthyunjaya, Arunodhaya S, Avinash Chandra
International Journal of Orthopaedics Sciences, Volume 7, pp 14-17; https://doi.org/10.22271/ortho.2021.v7.i4a.2859

Abstract:
Giant cell tumor (GCT) of bone is common type of osteolytic tumor being benign involving epiphyseal aspect of long bones like femur, tibia, humerus. In contrast, GCT of hand bones are relatively rare incidence of around 1-4%. Despite being benign in nature, they may be locally malignant with significant bone destruction, local recurrence. The diagnosis is based on the clinical, radiological, and histopathological findings with primary treatment being surgical. Each case should be assessed individually to ensure adequate treatment, aiming to prevent recurrences and functional limitations. Resection with reconstruction using iliac crest graft can be considered as alternate modality instead of ray amputation in terms of functionality and cosmesis.
Pradeep Choudhari, Utkarsh Goyal, Bikramdeep Singh
International Journal of Orthopaedics Sciences, Volume 7, pp 26-29; https://doi.org/10.22271/ortho.2021.v7.i4a.2861

Abstract:
Background: The patella is the biggest sesamoid bone of the human frame located in front of the knee. Patellar fracture account for about one percent of all fractures and are most common within the age group of 20–50 years. Modified tension band wiring is the excellent for displaced transverse fractures. The principle of TBW is that tension forces at fracture site are converted to compression force. Materials and Method: This is a prospective study. This study was carried out at Sri aurobindo medical college and Pg institute during the period of January 2020 to May 2021. The functional status of the knee was analyse. Open reduction and internal fixation of the fractures were done by modified tension band wiring within 1week of fracture. Result: The mean age of the patients was 33.70 ± 6.73 years with a range from 23 to 49 years. There were 8 (40%) females and 12 (60%) males i, showing a male predominance. In 8 (40%) patients sustained injury due to fall and in 12 (60%) patients sustained injury due to road traffic accident. Conclusion: The modified tension band wiring is simple with a short period of learning curve, safe, inexpensive and effective technique in transverse fracture of patella because of good stability of implant, early joint mobilization with minimum complications and with easier post-operative rehabilitation.
Rajesh K Ambulgekar, Virendra Ramesh Khandekar
International Journal of Orthopaedics Sciences, Volume 7, pp 01-05; https://doi.org/10.22271/ortho.2021.v7.i3m.2856

Abstract:
A 38 year old male presented with a painful non mobile, bony hard swelling of lower end of Right femur of 6 month duration. The swelling was present since 6 months with progressive increase in size of the swelling, size of swelling was peanut shape when the patient noticed it 1st time and it gradually increased to lemon size over the period of 6 months. Initially the swelling was painless nut since last 2 months patient started having pain which was aggravated by knee movements over anterior aspect of distal third of thigh.Clinical examination revealed a bony hard swelling arising from anterolateral aspect of lower end of femur away from the knee joint. The swelling was painful on knee movements.MRI revealed rounded bony outgrowth on anterior aspect of distal femur of size 20*12mm having mass effect on quadriceps tendon. A diagnosis of benign exostoses lower end femur was made. In view of sudden increase in size of the lesion and associated pain on knee movements, and mechanical obstruction Patient underwent surgical excision of the exostoses. Histopathology revealed osteochondroma & no malignant transformation.
Shobhit G Taneja, Nadeem A Lil, Vaibhav V Pathria, Viren A Umrethiya, Tirthraj Dave, Kishor Chaudhary, Nihar Parmar
International Journal of Orthopaedics Sciences, Volume 7, pp 71-78; https://doi.org/10.22271/ortho.2021.v7.i4a.2866

Abstract:
Aims: To investigate the association of being overweight or obese with the presence, extent, and severity of lumbar disc degeneration and lumbar spinal stenosis on magnetic resonance imaging (MRI) in adults in the Indian population.Study Design: Level 4, Cross-sectional studyPlace and duration of study: Department of Orthopaedics, SVP Hospital, Ahmedabad between February 2019 and October 2019. Methodology: A population-based cross-sectional study of 500 Indian volunteers was conducted. Subjects underwent radiographic and clinical assessment, and weight and height were measured. T2-weighted MRIs of the lumbar spine were obtained. The presence, extent, and severity of disc degeneration and additional radiographic and clinical parameters were assessed. Asian-modified body mass index (BMI) (kg/m2) categories were used.Results: The study included 305 men and 195 women (mean age 50.59 years). Disc degeneration was noted in 450 (90%) subjects. BMI was significantly higher in subjects with disc degeneration (mean 29.18 kg/m2) than in subjects without degeneration (mean 23.66 kg/m2). A significant increase in the number of degenerated levels, global severity of disc degeneration, and end-stage disc degeneration with lumbar spinal stenosis was noted with elevated BMI, in particular in overweight and obese subjects. End-stage disc degeneration with disc space narrowing was significantly more pronounced in obese subject.Conclusion: Our findings, to systematically assess lumbar disc degeneration and lumbar spinal stenosis on MRI, indicated a significant association between the presence, extent, and global severity of disc degeneration and lumbar spinal stenosis with BMI (>23 kg/m2) in overweight and obese adults.
N Vishnu Vardhan, Yg Raghava Naidu
International Journal of Orthopaedics Sciences, Volume 7, pp 06-08; https://doi.org/10.22271/ortho.2021.v7.i4a.2857

Abstract:
Background and objective: Wounds are a major source of morbidity, lead to considerable disability, and are associated with increased mortality; therefore, they have a significant impact on public health and the expenditure of healthcare resources [1]. Vacuum-assisted closure (VAC) uses negative pressure to assist wound healing. Negative pressure drains fluid from the wound, thus removing the substrate for growth of microorganisms. Negative pressure may also accelerate granulation tissue formation and promote angiogenesis. The mechanical stimulation of cells by tensile forces may also play a role by increasing cellular proliferation and protein synthesis. Negative pressure wound therapy (NPWT) involves the use of a negative pressure therapy or suction device to aspirate and remove fluids, debris, and infectious materials from the wound bed to promote the formation of granulation tissue. Materials and Methods: A total of 30 post-operative infected wound cases presented in between December 2019 to August 2021 were taken for study. Each case was examined clinically in systematic manner as per the proforma drafted. VAC dressing was done and all cases were followed up to discharge and subsequently for a follow up on 10th day. Results: In our clinical study of 30 cases managed by VAC dressing, 30% of the cases were of post-operative infected wounds of radius & ulna, 13.3% humerus, 23.3% femur, 23.3% tibia, 3.3% spine, 3.3% calcaneum, 3.3% metatarsals. By the completion of VAC therapy none of the cases required a revision surgery or implant removal. There is a progression of healthy healing in all the cases (100%). Commonest organisms isolated were Staphylococcus, Pseudomonas and Proteus. Interpretation and conclusion: In our study VAC therapy enhanced granulation tissue formation leading to better wound healing, and faster recovery. VAC is thus a promising new technology in the field of wound healing with multiple applications in a variety of wounds and can be used in both acute and chronic wounds, salvage procedures or as an adjuvant therapy to improve the results of various surgical procedures.
Ranganatha Babu Kurupati, Anil V, Ashok Kumar Reddy K, Dilip Kumar Pillay T, Sujai S, Shridhar S
International Journal of Orthopaedics Sciences, Volume 7, pp 30-33; https://doi.org/10.22271/ortho.2021.v7.i4a.2862

Abstract:
Objective: The objective of the study is to evaluate the functional outcome of both bone forearm fractures with locking compression plate.Methods: This prospective study was conducted in the department of orthopedics, MVJ Medical College and Research hospital, Bengaluru from June 2019 to January 2021. The patient’s age group ranging from 18-60 years with closed both bone forearm fractures treated with locking compression plate for radius and ulna. Post operatively patients were evaluated using the Criteria of Anderson et al.Results: A total of twenty patients were evaluated in our study of which there were 14 males and 6 females. Nineteen patients had complete fracture union and one patient had non-union. 17 patients showed excellent results, 2 patients had satisfactory results and 1 patient had a failure of the procedure.Conclusion: Open Reduction and Internal Fixation of both bones forearm fracture with Locking Compression Plate is a safe and effective option in the fixation of closed both bone forearm fractures.
Mohamed Nazir Ashik, Adnan Qamar, Prabaharan C, Gokul Raj Dhanarajan, Nithya Dharani Vp, Nivetha R
International Journal of Orthopaedics Sciences, Volume 7, pp 85-91; https://doi.org/10.22271/ortho.2021.v7.i4b.2868

Abstract:
Background: Total knee arthroplasty being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants & in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of LOS yet improving the functional outcome with better patient satisfaction. The purpose of this study is to identify the perioperative risk factors increasing the LOS of patients, by quantifying them, efforts can be done to manage those risks providing better satisfaction to patients.Materials and Methods: The study design is a retrospective analysis of 1022 patients of primary elective total knee arthroplasty, performed in our institution. The potential factors recorded were: age, sex, hemoglobin levels, albumin levels, BMI calculated with patients height and weight, ASA grading, smoking alcohol status, diagnosis for which TKA was done and comorbids were analysedResults: We looked at 1022 patients and found the average length of stay is 6 days, with age, comorbids, BMI, ASA, Diagnosis, blood transfusion, hemoglobin and albumin all played a role to influence Length of stayConclusion: Our study showed that LOS after TKA is multifactorial. Various risk factors are present at the time of presentation, some of which are modifiable and some non-modifiable. It is important to acknowledge all the factors that increase the in-hospital LOS & to do one's uttermost use of medical resources.
N Vishnu Vardhan, T Dhorababu
International Journal of Orthopaedics Sciences, Volume 7, pp 09-13; https://doi.org/10.22271/ortho.2021.v7.i4a.2858

Abstract:
Background: In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. Materials and Methods: This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures) treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, Narayana Medical College and Hospital, Nellore from October 2019 to August 2021. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis). 15 cases were in right femur (60%) and 10 cases were in left femur (40%). Results: 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. Conclusion: LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.
N Vishnu Vardhan, Kr Radhik
International Journal of Orthopaedics Sciences, Volume 7, pp 18-25; https://doi.org/10.22271/ortho.2021.v7.i4a.2860

Abstract:
Background: Hip femoral neck fracture (FNF) accounts for 50% of all geriatric patient's hip fractures. Elderly femoral neck fractures are common with a significant health concern. PPF surgical care can be physically demanding due to severe inflammation, dislocation, and intraoperative fractures, with a high risk of complications. There were some prosthetic designs recorded. Aim and Objective: The aim of study was to evaluate the clinical and radiological outcome of intracapsular fracture neck of femur in elderly treated with cemented bipolar prosthesis Methodology: A prospective study to analyze the outcome of management of intracapsular fracture neck of femur in elderly treated with cemented bipolar prosthesis. Twenty cases of elderly patients with fractured neck of the femur above the age of 56 years with management of intracapsular fracture neck of femur in elderly treated by cemented bipolar prosthesis in the Department of Orthopaedics between September 2018 to April 2020. The short-term functional results were analyzed by using a modified Harris hip scoring system. Results: The patients considered were in the age group of 56 to 78 years with a mean average age of 65.25. The majority of the fractures were sub capital fractures. Our study recorded all the research participants with prosthesis as Cemented bipolar. However, even after using a Cemented bipolar prosthesis, the majority of the study participants (70%) did not experience any complications after the surgery. The medication of choice for femoral neck fractures in patients older than 60 years is cemented bipolar prosthesis. The minimal utility of bipolar hemiarthroplasty has been shown. The cemented bipolar prosthesis should be carried out in a decent setting with a medium to wide trauma or orthopedic center by a professional surgeon. The utilization of an anterior solution to the hip encourages the patient to use it. Conclusion: We conclude that management of intracapsular fracture neck of femur is a good option in elderly treated with cemented bipolar prosthesis. No mortality was observed during the study. The morbidity is not high; the operative procedure is simple, complications are less disabling.
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