International Journal of Orthopaedics Sciences

Journal Information
ISSN / EISSN : 2395-1958 / 2395-1958
Published by: AkiNik Publications (10.22271)
Total articles ≅ 2,532
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Aravind Subramanian, Amlan Dash, Konchada Srikant, Berikai Venkat Aditiya
International Journal of Orthopaedics Sciences, Volume 7, pp 265-269; doi:10.22271/ortho.2021.v7.i2d.2641

Abstract:
Fractures of the tibial plateau usually result from high energy trauma. Fractures of the tibial plateau change the knee kinematics, alter joint stability, and cause joint incongruity. Fractures range from simple lateral condyle fractures to severe comminuted metaphyseal fractures. Various surgical modalities like open reduction internal fixation with cannulated Screw fixation, Condylar plate with or without bone graft, AO/ASIF Buttress plate (T/L) with or without bone graft, Proximal tibial locking plate have been practiced. To study the functional outcomes of various modalities of treatment of internal fixation of tibial condylar fractures schatzkers type V and type V1. To find out the basis of selecting the mode of treatment of tibial condylar fractures to bring out the best functional results. 35 patients of age group 18-70 yrs who presented with X-ray based Schatzker Type V and VI proximal tibia fractures were selected for the study. All the patients underwent Open Reduction and Internal Fixation with locking compression plating. The functional outcomes were assessed using knee society score. Complications were observed and treated accordingly with an average follow-up of 12 months. It was observed that the mean duration of the union was 14-16 weeks. Most of the patients (19) showed excellent results with a good range of motion of 122⁰. The combination of dual approaches with dual fixation and with fixed angle locking plates is a safe and effective way to have direct reduction and satisfactory fixation for complex tibial plateau fractures.
Abhay Patil, Rupesh Kadam, Nitin Dawre, Prashant Munde
International Journal of Orthopaedics Sciences, Volume 7, pp 161-170; doi:10.22271/ortho.2021.v7.i2c.2626

Abstract:
ACL is important for maintenance of knee movement. ACL do not heal itself because of its intrinsically poor healing potential and surgery required. Autografts like quadriceps, hamstrings, patellar tendon and allografts of achilles, tibialis anterior and Hamstrings tendon are used. Anatomic placement of ACL tunnels in its native footprint to better restore knee kinematics conventional transtibial reconstruction or its modifications were compared with the anatomic single bundle ACL reconstruction. Reconstruction with single bundle bone-tendon-bone autograft with interference screw fixation. Methods: Study includes 100 patients undergoing arthroscopic Single Bundle ACL Reconstruction, Age between 18 to 40 yrs. Demographic, Clinical, radiological data used for functional assessment of arthroscopic anatomical single bundle ACL reconstruction. Results: Comparable distribution of age between groups based on tear grades which suggests that age is unrelated to tear grades (all p values>0.05). Average preoperative Lysholm knee Score was 75.4± 8.2. Average Lysholm knee Score Before Surgery in grade II tear patient group (78.3 ±8.4) was significantly higher than grade III tear patient group (74.12 ±9.1) (p=0.03) After 3 months of surgery, Lysholm knee score was good (84-90) in majority (62%) of the patients. It was found excellent (91-100) in 24% of the cases. After 3 months of surgery Lysholm knee score was fair (65-83) among 6% patients and was unsatisfactory i.e. (
Siddharth Bhaginath Jadhav, Rahul Ajit Damle, Janmajay Dalal, Saumitra Dubey, Abhijeet Nalkar, Prasad Bhimbarwad
International Journal of Orthopaedics Sciences, Volume 7, pp 350-358; doi:10.22271/ortho.2021.v7.i2e.2651

Abstract:
As the life expectancy has increased in recent years, the incidence of proximal femoral fractures is on rise. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilitation & thus decreased medical complications. PFNA-II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Prospective observational study was conducted on 49 patients. All fractures were classified by AO/OTA classification system. Patients were followed up at 4, 8, 12 and 16-weeks. Functional outcomes were assessed according to pain assessment by numeric rating scale, Parker Palmer mobility score, Harris hip score. Fracture union and mechanical failure were assessed radiologically. Mean age of the entire group was 71.84years. Male to female sex ratio was 0.81:1.00. 32.7% had A1 type, 61.2% had A2 type and 6.1% had A3 type fracture. Mean OT time was 49.29mins and mean blood loss was 117.14ml. Mean pain score at 16-weeks was significantly lower compared to that at 4, 8 and 12-weeks post-op follow-up. Distribution of mean Palmer Parker mobility score and Harris hip score at 16-weeks post-op follow-up was significantly higher compared to that at 4, 8 and 12-weeks post-op follow-up. 38.8% had excellent, 40.8% had good, 12.2% had fair and 8.2% had poor functional outcome. Helical blade back out, cut-out and medial migration was seen in one patient each. 95.9% cases had maintenance of reduction and fracture union. Mean time for fracture union was 14.26 weeks. Use of the PFNA-II to treat intertrochanteric fractures has the following advantages: quick procedure with small incision, less operative time, minimal blood loss, few complications, early weight bearing, less union time, good clinical efficacy and very few cases of complications. Good functional outcomes can be achieved, when the radiological parameters are restored. We conclude that PFNA-II is an effective treatment modality for intertrochanteric fractures, with excellent functional outcome and regaining back the pre-fall ambulatory status with minimal mechanical complications.
Meet Kamal Singh Wadi, Sonia Garg, Lovjot Singh, Ramneet
International Journal of Orthopaedics Sciences, Volume 7, pp 359-363; doi:10.22271/ortho.2021.v7.i2e.2652

Abstract:
Introduction: The management of infected nonunion of the tibia is challenging, particularly with segmental bone loss, multiple draining sinuses, poor soft tissue cover, osteopenia, adjacent joint stiffness, limb deformity, or multidrug-resistant polymicrobial infection. The Ilizarov method permits early rehabilitation and addresses all the problems such as non-union, infection, shortening, soft tissue loss and deformity simultaneously at single stage. Ilizarov ring fixation technique has its own advantages as well as associated complications. Methods: The present study was a prospective randomized open study in which aim was to evaluate Complications with Ilizarov ring fixator in open tibial fracture. The study was conducted in 30 skeletally mature patients in Department of Orthopaedics, SGRD University of health sciences, Amritsar from July 2017 to May 2019. The patients were assessed clinically based on history and physical examination. Radiological evaluation using plain antero-posterior and true lateral radiographs of the involved leg was done and evaluated by complications.Results: Mean age was 37.7 years. Out of 30 cases 24(80%) were male and 6(20%) were female. Right tibia was involved in 24 cases out of 30 cases. 29 cases had history of road side accident and 1 had history of fall from height. In present study following complications were noted, limp in 12 cases(40%), ankle stiffness in 7 cases(23.33%), pin site infection in 9 cases(30%), limb oedema in 7 cases(23.33%), knee stiffness in 3 cases(10%), loosening of pins in 2 cases(6.67%), deformity in 2 cases(6.67%) and refracture in 1 case(3.33%). There was no complication of neurovascular injury, malunion, breakage of wires, axial deviation or limb length discrepancyConclusion: Limp and Pin tract infection were the most common complications. Most complications can be prevented by diligent post-operative care. Complications if diagnosed early can be managed effectively. As such advantages of Ilizarov ring fixator outweigh the associated complications.
Sreehari Sreedhar, Tk Jeejesh Kumar, Jacob Mathew, Kumaran Chettiyar K, Puneeth K Pai, Priyavrata Rajasubramanya
International Journal of Orthopaedics Sciences, Volume 7, pp 369-375; doi:10.22271/ortho.2021.v7.i2e.2654

Abstract:
Introduction: Medial compartment osteoarthritis is a common entity leading to significant morbidity in geriatric population. High tibial osteotomy is a time tested knee preserving operation. The fixation methods vary from internal fixation like plates and screws, to external fixators like dynamic uniaxial fixators and Ilizarov.In this study we have analysed the outcomes of medial opening wedge osteotomy using a unilateral dynamic external fixator (Orthofix) using the principle of hemi-callostasis.Method: We conducted a prospective cohort study involving 20 patients with medical compartment osteoarthritis. Medial HTO was performed using OrthofixTM external fixator in 20 patients (20 knees) and were followed up between January 2019 to February 2021.Functional and radiological outcomes were assessed using the KSS and KOOS scores and the alignment xrays respectively.Results: Out of 20 patients included in the study, the majority (18) were females the mean age in the group was 50.75 years (+6.06years) at time of surgery. The involvement of right knee was seen in 12 patients and left knee was involved in 8 patients. The average improvement in th HKA was 13+1.2 degrees. The Average corrected HKA was 183.05+4.2 degrees. There was significant improvement in the mean KSS score at 2years, from (44.15 ± 6.13) pre-operatively to (86.15 ± 6.41) post-operatively and was statistically significant (p
Jv Modi, Pratik Vala, Nishil Patel
International Journal of Orthopaedics Sciences, Volume 7, pp 364-368; doi:10.22271/ortho.2021.v7.i2e.2653

Abstract:
Atlanto-axial segment is made up of Atlas (c1) and axis (c2) vertebrae. This segment is responsible for rotational movement in the region of the cervical spine. Instability and damage to this segment can occur due to various reasons and can lead to abnormal motion with neurological consequences. Here we describe a case of 21 year old male with traumatic Atlanto-axial dislocation with odontoid process fracture with left upper limb weakness with gait instability treated with posterior vertebral fixation using pedicle screws with its clinical as well as radiological outcome.
Shreesh Kadur Jm, Sharvani S, Hareesh Babu M
International Journal of Orthopaedics Sciences, Volume 7, pp 05-08; doi:10.22271/ortho.2021.v7.i2a.2605

Abstract:
Calcific tendinitis of shoulder is a disorder common in middle aged women. It goes through a cyclical course to leave a residual stiffness. Several therapies such as sonography, acetic acid iontophoresis,shockwave lithotripsy, and percutaneous aspiration of the calcifications have been tried. Surgical treatment has been used as last option. Among these, percutaneous needle aspiration under ultrasonography with a modified technique has been successful in a 48 year female with dramatic relief of symptoms in few weeks to months. Hence this technique which is minimally invasive and painful can be used widely for this common disorder as a therapeutic method.
Siddhant Sanjay Gandhi, Santosh S Nandi, Sandeep Naik, Shreepad Kulkarni, Gireesh Khodnapur
International Journal of Orthopaedics Sciences, Volume 7, pp 53-58; doi:10.22271/ortho.2021.v7.i2a.2613

Abstract:
Introduction: Unstable, Comminuted intertrochanteric fractures continue to pose a challenge to the orthopaedic surgeon because of severe osteoporosis and medical disorders that increase the risks associated with surgery and anaesthesia. To overcome problems like lateral wall impingement and prominence of the proximal end of the nail, the PFNA-II was introduced in 2008. The PFNA II design modifications include the flat lateral shape of the proximal portion and a decrease in the mediolateral bending angle from 60 to 50. The purpose of the study is to confirm that the PFNA II eliminates the problem of lateral wall impingement experienced with previous intramedullary nailing systems and provides stable fracture fixation with positive functional outcome.Materials and methods: This study was conducted on 52 patient of which 32 were available till follow up of 6 months. All patients we were diagnosed with unstable intertrochanteric fracture of femur and underwent closed reduction internal fixation with proximal femoral nail anti-rotation system II. Functional outcome was assessed with Modified Haris Hip Score and radiological outcome was assessed with TAD score and implant related complications. Results: Fracture union was appreciated on an average 4 months of postoperative period. 4 patient had superficial infection while 1 patient had deep infection. Only 1 patient had cut off of helical blade. According to modified Harris hip score, excellent to good outcome was noted in more than 80% of patient. Conclusion: From our study, we conclude that PFNA II can be a reliable and implant of choice for the management of unstable intertrochanteric fracture with high rates of union, restoring the anatomical alignment with less chances of implant failure and reduced chance of implant failure.
Amlan Dash, Aravind Subramanian, Debasish Mishra, Amit Kumar, Ravindran Vt, Devanshi Desai
International Journal of Orthopaedics Sciences, Volume 7, pp 260-264; doi:10.22271/ortho.2021.v7.i2d.2640

Abstract:
Fractures of the tibial plateau usually result from high energy trauma. They change the knee kinematics, alter joint stability, and cause joint incongruity. These fractures range from simple lateral condyle fractures to severe comminuted metaphyseal fractures. Various surgical modalities like open reduction internal fixation with cannulated Screw fixation, Condylar plate with or without bone graft, AO/ASIF Buttress plate (T/L) with or without bone graft, Proximal tibial locking plate have been practiced. The aim of this Prospective Observational Cohort is to introduce a computed tomography-based ‘‘three-column fixation’’ concept; and evaluate the functional outcomes of treatment of internal fixation of tibial condylar fractures .35 patients of age group 18-70 yrs who presented with X-ray based Schatzker Type V and VI proximal tibia fractures were selected for the study and a three column CT-based classification was done. All the patients underwent Open Reduction and Internal Fixation with locking compression plating. The opted surgical approach depended on the assessment of injury by CT-based reconstruction of the fracture. The functional outcomes were assessed using oxford knee score. Complications were observed and treated accordingly with an average follow-up of 12 months. It was observed that the mean duration of the union was 14-16 weeks. Most of the patients (19) showed excellent results with a good range of motion of 122⁰. The combination of posterior and antero–lateral approaches is a safe and effective way to have direct reduction and satisfactory fixation for complex tibial plateau fractures. The three-column classification seems to be an efficient method to characterize and classify fractures of tibial plateau, particularly multiplanar fractures involving the posterior column.
Sachin Onkar Phirke, Ravindra Patil, Yash P Oza, Shreyansh D Mehta, Ashwin Lokapur, Suraj Deshmukh
International Journal of Orthopaedics Sciences, Volume 7, pp 102-107; doi:10.22271/ortho.2021.v7.i2b.2618

Abstract:
Objective: The aim of our study was to evaluate the functional outcome using the HSS knee scoring system and complications of tibia plateau fractures in the Indian population treated with the Locking Anterolateral plate with the MIPO technique. Method: A prospective study was carried out in our institute at Kolhapur. A total number of 57 patients with tibia plateau fracture (AO/OTA type 41-B, C) were studied between March 2019 and Jan 2021. All were treated with an anterolateral locking plate via anterolateral approach and MIPO technique. A mean follow-up of 12 months was carried out, and evaluation was done with the help of the HSS (Hospital for special surgery) Knee scoring system. Result: The mean radiological union time was 16 weeks. The outcome was measured using HSS knee scoring. The average follow up period was 12 months with good patient satisfaction. A total of 11 patients out of 57 reported complications like Non-union (2%), Delayed union (7%), Infection (5.20%) and hardware irritation (5.20%). No case of peripheral neuropathies reported in any of the patients. Conclusion: Locking anterolateral plating via the MIPO technique is a good treatment option showing good clinical outcome in the treatment of tibia plateau fracture (AO/OTA type 41-B, C). It offers a more stable fixation and good functional recovery after the surgery.
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