International Journal of Orthopaedics Sciences

Journal Information
ISSN / EISSN : 2395-1958 / 2395-1958
Published by: AkiNik Publications (10.22271)
Total articles ≅ 2,973
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Muneeb Ul Islam, Mudasir Nazir Bhat, Marouf Aslam, Numan
International Journal of Orthopaedics Sciences, Volume 8, pp 31-34; https://doi.org/10.22271/ortho.2022.v8.i2a.3113

Abstract:
Introduction: A reverse oblique fracture is an unstable fracture that really is not a true classic hip fracture, because of its complications. The fracture starts from medial proximal to lateral distal and extends to include the lateral cortex distally. In reverse oblique fractured patients the early surgical treatment is required to avoid major complications as mortality. Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. Aim and Objective: Comparison between dynamic condylar screw (DCS) and proximal femoral nail (PFN) for the treatment of patients in reverse oblique fractures. Materials and Methods: This prospective study was done on 45 patients with reverse oblique fractures admitted during the period of June 2020-May 2021 in the Orthopedics Department, Govt. Medical College Srinagar. Among 45 patients with reverse oblique fractures 25 patients were treated using proximal femoral nail (PFN), and the remaining 20 patients were treated using dynamic condylar screw (DCS). Results: The study comprised of 45 patients in age group of 20-75 years, including 26 males and 19 females with a mean age of 53.15. Mechanism of injury was road accidents, fall from height and fall from standing height. Among 45 patients 19 (42.22%) belonging to age group of 61-75 years. In elderly patients with presence of significant osteoporosis a simple fall accounted fractures. Conclusion: The patients treated using PFN showed improved functional outcome as compared to the patients treated using DCS.
Savsaviya Ram Gordhanbhai, Vipin Gupta, Mahipal Ajitsinh Padhiyar, Avinash Kumar Singh, Kartik Dua, Kuldeep Prakashchandra Pindaria, Dhamelia Dhyey Shambhubhai, Ahir Vipul Kumar Dayanand, Mahipal Singh Sidhu
International Journal of Orthopaedics Sciences, Volume 8, pp 177-179; https://doi.org/10.22271/ortho.2022.v8.i2c.3131

Abstract:
The utilization of transforaminal epidural steroid injections (TFESIs), an elective diagnostic and therapeutic spinal procedure, has risen dramatically over the past decade. Fluoroscopic guidance is important during lumbar epidural injection to increase certainty of correct needle placement, thus minimizing the risk of complications. Patients with radiculopathy, who did not respond to physical therapy, anti-inflammatories, or analgesics confirmed by magnetic resonance imagining received fluoroscopically guided lumbar transforaminal epidural steroid injections at the presumed symptomatic nerve root. This study included 32 individuals with lumber radiculopathy and followed at 1, 2 and 4 after injection.
Viswanath H Chavali, Ravikumar N Desai, Jaydeep Kansara
International Journal of Orthopaedics Sciences, Volume 8, pp 170-176; https://doi.org/10.22271/ortho.2022.v8.i2c.3130

Abstract:
Open fractures are a well described entity in the literature of Orthopaedics. However review of literature and patients attending fracture clinics and hospitals around the world indicates that the fracture epidemiology (in general) is changing very quickly [2, 3, 4, 5, 6, 7, 8, 9]. The same is true for open fractures as well. Worldwide literature is deficient in determining the changing characteristics, pattern and outcome of open fractures. With the intention of improving our hospital approach towards open fractures, we felt the need to audit our current management and outcome of such injuries. This study was conducted to assess the characteristics and outcome of surgically treated open fractures in our set-up. Aims and Objective: To study the clinical profile and outcome of open fractures treated surgically with reference to general health, limitations of activities, physical health problems and social activities and upper and lower limb involved. Also assess the union (by x-ray) and health of patient at the end of 6 month by SF-36 questionnaire. Methods: This observational prospective cohort study was carried out at the Department of Orthopedics, at a state run 1500 bedded tertiary care hospital attached to post-graduate teaching institute located in central Gujarat, from July, 2019 to November, 2020 with due permission from Institutional Ethics Committee. During this period, 60 patients with open fractures were treated surgically under one unit. This study being a surveillance, all patients included were closely observed for a period of 6 months from the date of presentation, while they were being treated. No study specific alteration was done in the management which was decided on individual merits by the treating surgeon. All subjects were evaluated with respect to the demographic data, history of fracture being treated, presenting symptoms and signs, current management and outcome as outlined in the Performa (see Annexure). The outcome was considered favorable if the fracture united at final follow up and unfavorable if otherwise and also assessed according to SF - 36 questionnaire. Results: Out of 57 fractures in our study, 41 open fractures showed union at final follow up and the remaining 16 ended in non-union. 76% of Open Grade I fractures united at final follow up where as 38.8% of Open Grade II fractures united at final follow up and 90% of Open Grade IIIA fractures united at final follow up. Among OG IIIA fractures 50% of fractures were small bones of Hand and Feet. All those fractures showed full union at final follow up. 33.33% of Open Grade IIIB fractures united at final follow up. In our study all upper limb fractures showed union compared to lower limb fractures of which 60% showed union at final follow up. In our study, Patella fractures showed 60% of non-union at final follow up. Average age of patients was 40 years. Male to female ratio was 4:1. Most patients (66.6%) were from the active phase of their life. Most patients were operated within 5 days of admission. A statistically significant association was seen between grade of open fractures and duration of Hospital stay. As grade of open fracture increased duration of Hospital stay also increased. Tibia was the most common bone fractured (43.85%) followed by Radius-Ulna (15.78%), Small bone of Hand and Feet (14.03%), Femur (12.28%), Patella (8.77%) and Humerus (5.88%). In our study 50% of Open Grade III fractures had complications like infection, failure of fixation and limb length discrepancy. In our study 50% of patients with Open Grade III fractures showed less than 65 score of SF-36 questionnaire at final follow up and 51.16% of patients with Open Grade I & II fractures showed more than 80 score of SF-36 questionnaire at final follow up. However no statistically significant association between score of SF-36 and grade of open fractures was elicited. Conclusion: We justified from our results that we should continue surgical fixation of open fractures as per our Hospital protocol so as to decrease the duration of Hospital stay and improve the outcome in relation to activities of daily living. However, more intensive treatment is advocated for open fractures of lower limb especially the severe variety. Bone grafting as a adjuvant to fracture healing may timely improve the outcome in such fractures.
Sanjeev Kumar Gupta
International Journal of Orthopaedics Sciences, Volume 8, pp 132-135; https://doi.org/10.22271/ortho.2022.v8.i2b.3126

Abstract:
Introduction: In extra-articular distal radius fractures closed reduction and casting has been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome in comparison to closed reduction and casting.Aim: To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, a volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system.Materials and Methods: Prospective study was conducted on 60 patients attending the Department of Orthopaedics, from December 2013 to May 2015 with extra-articular fractures (AO type 23-A2 and 23-A3) of distal radius and fulfilling all the inclusion and exclusion criteria. The cases were randomly divided into two equal groups of 30 patients, the first group treated by closed reduction and below elbow cast application, while the second group were treated by closed reduction percutaneous K-wire application and below elbow cast application. The radiological outcome of both groups were evaluated by measuring the Volar inclination, Radial inclination and Radial height, while the functional outcome was evaluated by the demerit scoring system of Gartland and Werley.Results: The Cast application group had 13 excellent, 9 good, 7 fair and 1 poor result the mean outcome score of the group was 5.2. The K wiring group had 11 excellent, 13 good, 5 fair and 1 poor result, the mean score of the group was 5.17. The unpaired student’s t-test on the values obtained from both groups yielded a p-value of 0.9816. The mean radial height in the Cast application group was 8.033mm while the mean in the k wiring group was 11.783mm. The mean volar tilt was 4.867 degrees and 7.5 degrees respectively. The mean radial inclination was 14.23 degrees and 19.1respectively. Unpaired student’s t-test on the values revealed a p-value of 0.0001 for all three.Conclusion: We concluded that closed reduction with percutaneous K-wire fixation under C-arm for treatment of extra articular fractures of distal radius gives statistically significantly better radiological outcome than treatment with closed reduction and casting alone, but there is no statistically significant difference in functional outcome.
Ayouba G, Bakriga B, Akloa Kek, Kombate Nk, Dellanh Yy, Towoezim Th, Abalo A
International Journal of Orthopaedics Sciences, Volume 8, pp 161-164; https://doi.org/10.22271/ortho.2022.v8.i2c.3127

Abstract:
The purpose of this study is to present our surgical strategy and describe the advantages and outcomes of the Ilizarov method in the treatment of bilateral tibia nonunion in an adult with OI. The major of bone fracture fixation drawback is the difficult placement of nails due to abnormal bony anatomy, non-linear and imperforate canals, marked bowing and unusually short limbs. A female adult aged 18yo with bilateral tibia nonunion affected with OI type V was treated with the Ilizarov method. The tibia was in varus (15° at left, 14° at right) and recurvatum (18° on left, 27° on right). Surgical technic was same for both tibia in one-time procedure and it's compounded: primary fibula osteotomy, tibia and osteotomy taking out interfragmentary fibrosis, reduction and fixation by Ilizarov frame. Full weight-bearing was allowed at 3 months. The complications that occurred were minors. Bone's consolidation was obtained at 5 months and the frames were removed at 6 months in the office without anesthesia. At the follow-up visit 5 months after removal, the ASAMI functional and radiological score was excellent on the left side and good on the right side. The use of the Ilizarov method for treating a tibia bilateral nonunion in an adult patient with moderate OI provides good stability. This technic ensures early weight full bearing, above joint motion, recovery functional necessary to bone tissue regeneration normal. This is an alternative to avoid difficulties and complications due to internal fixation in deformities correction in adults with acquired bone-weakening conditions.
Kshitij Mody, Aashay Mody
International Journal of Orthopaedics Sciences, Volume 8, pp 91-94; https://doi.org/10.22271/ortho.2022.v8.i2b.3118

Abstract:
Purpose: This prospective study aims to evaluate clinical results of arthroscopic repair of meniscal tears using clinical scores and functional outcome measures while establishing clinical evaluation as a dependable method of evaluating the healing process of a repaired meniscus.Methods: From June 2019 to October 2020, 203 patients with a mean age of 24 (range, 18-54) years with 203 meniscal tears underwent arthroscopic all-inside meniscal repair using a pre-loaded suture anchor. All tears were located in either red-red or red-white zone. Simultaneous anterior cruciate ligament reconstruction was performed in 170 (84%) of the patients. Postoperatively, patients were evaluated based on clinical examination using Barrett’s criteria wherein presence of locking, joint-line tenderness, swelling or positive McMurray test were considered to indicate clinical failure. Further, we also used the International Knee Documentation Committee score, Lysholm score and Short-Form 36 score for post-operative evaluation.Results: At average of 1.2 years follow-up, the success rate of arthroscopic meniscal repairs in this series was 94% (191 clinically healed menisci out of 203) according to the criteria of Barrett et al. The IKDC, Lysholm and SF-36 scores had significantly improved postoperatively.Conclusions: Arthroscopic all-inside repair using pre-loaded suture anchor (FastFix 360) is a safe and effective procedure for the treatment of meniscal tears, and clinical evaluation was found to be a dependable method of evaluating the results of a healed, repaired meniscus.
Bekir Karagoz, Mustafa Erdem
International Journal of Orthopaedics Sciences, Volume 8, pp 01-06; https://doi.org/10.22271/ortho.2022.v8.i2a.3107

Abstract:
Background: To evaluate the functional recovery at six months postoperatively in elderly patients with hip fractures and to determine the risks of not regain to the pre-fracture level of mobility.Materials and Method: In this retrospective observational cohort study, 281 patients over the age of 65 who underwent surgery for hip fracture were included in the study. The patients were divided into two groups (mobil without an aid and mobil with an aid) according to their pre-fracture level of mobility, and three groups according to their postoperative 6th month mobility level (mobil without an aid, mobil with an aid and immobile). In addition, motor-Functional Independence Measure (mFIM) scores were calculated to evaluate activities of daily living (ADL). Risk factors for not regain pre-fracture mobility and worsening of ADL were identified.Results: The rate of patients who could not regain their pre-fracture ADL after 6 months postoperatively was 34.1%. Patients with intertrochanteric fractures or those with an intraoperative proximal femoral nail (PFN) implanted were less likely to regain their pre-fracture mobility and ADL (p=0.006, p=0.005, respectively). The most important risk factors for not regain to pre-fracture mobility and worsening of ADL were advanced age, high ASA score, cardiovascular disease or malignancy among comorbidities, intertrochanteric fracture as fracture type, and PFN use as implant type.Conclusion: Advanced age, high ASA score, cardiovascular disease or malignancy among comorbidities, intertrochanteric fracture as fracture type, and use of PFN as implant type were the main risk factors for not regain to pre-fracture mobility and ADL.
Nitha Shajith, Yeshwanth Subash
International Journal of Orthopaedics Sciences, Volume 8, pp 13-16; https://doi.org/10.22271/ortho.2022.v8.i2a.3110

Abstract:
Introduction: CTS (Carpal tunnel syndrome) is characterised by compression of the median nerve at the wrist joint and is quite commonly seen in orthopaedic practice. Surgical management with release of the transverse carpal ligament is the most commonly performed modality of treatment and this study was performed to assess the functional outcome after open release of the carpal tunnel. Methods: This study included 30 patients with CTS managed by open carpal tunnel release done between January 2014 to January 2017. The patients were evaluated for functional outcome using the DASH (Disabilities of arm, shoulder and hand) and GSS (Global symptom score) scores. Results: There were 14 males and 16 females with the left wrist involvement seen more as compared to the right side. The patients age was a mean of 42.4 years (33-54 years). The average duration of the surgical procedure was 36 minutes (22-48 minutes) and the mean blood loss was 20.2 ml (18-28 ml). There was a good improvement in the DASH and the GSS scores postoperatively which were statistically significant. We were able to provide good functional outcomes to the patients with minimal complications. Conclusion: Open surgical carpal tunnel release facilitates release of the carpal ligament under direct visualization and hence complications such as iatrogenic median nerve injury which can be associated with minimally invasive methods can be avoided. It offers good resolution of symptoms to the patients and provides a good functional outcome enabling a faster return to work related activity as well as day to day living.
Ramesh Chandra Vadapalli, Vijay Harinath Reddy, Lavanya Butti
International Journal of Orthopaedics Sciences, Volume 8, pp 35-40; https://doi.org/10.22271/ortho.2022.v8.i2a.3114

Abstract:
Avascular necrosis of the femoral head (ANFH) is a debilitating disease most commonly affecting young and middle-aged people. Most often leading to a significant articular disability ultimately needing total hip replacement. Early diagnosis and effective joint-preserving surgical treatments are urgently needed for patients with early stage ANFH. We would like to report a minimally invasive modified technique of percutaneous core decompression using flexible reamers and percutaneous iliac bone graft harvesting for treatment of early stage of femoral head osteonecrosis.
Janak Rathod, Dhaval Prajapati, Dhruvit Vora
International Journal of Orthopaedics Sciences, Volume 8, pp 07-09; https://doi.org/10.22271/ortho.2022.v8.i2a.3108

Abstract:
Background and Objectives: The purpose of this study was to evaluate the clinical and functional outcomes of MPSS for Aneurysmal bone cysts. Methods: In the Department of Orthopedics, a study of 16 patients with Aneurysmal bone cysts treated with Injection Methyl Prednisolone was conducted. Information on the patients was compiled from clinical details, case files, and procedure records. This was a prospective study. Patient follow-up was for a minimum of 6 months to a maximum of 24 months (2 years). Results: Excellent or good pain relief and function were obtained in 16 patients after percutaneous intra-lesional MPSS injection.Conclusion: Present study suggests that Patients treated with Inj. MPSS for Aneurysmal bone cysts can provide good clinical and radiological results after an intermediate duration of follow-up. The study was free of complications, the overall functional and clinical outcome showed excellent results.
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