International Journal of Orthopaedics Sciences
ISSN / EISSN : 2395-1958 / 2395-1958
Current Publisher: AkiNik Publications (10.22271)
Total articles ≅ 2,284
Latest articles in this journal
International Journal of Orthopaedics Sciences, Volume 7, pp 04-09; doi:10.22271/ortho.2021.v7.i1a.2451
Background: Congenital idiopathic clubfoot is a complex deformity which occurs in an otherwise normal child. The Ponseti method of clubfoot management has been shown to be effective, producing better results and fewer complications than traditional surgical methods. Weekly manipulation and plaster casting reduce the deformity. Most feet also require a percutaneous Achilles tenotomy. The correction is maintained by a foot abduction brace (Dennis Browne splint). Recent studies suggest that the Ponseti method can be successful in up to 98% of feet. Objective: The purpose of this study was to assess the results of correction of idiopathic clubfoot by Ponseti method and its complications in children below 2 years of age. Methodology: It is a prospective study in 37 children below 2years of age with idiopathic clubfoot treated by Ponseti method. The study was conducted from august 2016 to august 2018 in Yashoda Superspeciality Hospital, Hyderabad. Observation and Analysis: The mean age of the patient’s was 35 weeks (0-120). Of 37 patients, 25 children presented between 0-6 months, 6 between 6 to 12 months and 6 between 1- 2 years. Among 37 children, 29 were male and 8 were female. Most children had grade III and grade IV (Dimeglio et al. grading) deformity. The average number of casts was 5.1, 5.5 and 7.4 for the age groups 0-6 months, 6 months to 1 year and 1-2 years respectively. The mean number of casts required was 5.76 (4 to 10). Tenotomy was required in 51 feet (100%). The scores for the entire group ranged from 4.0 to 7.0 (of 10) and 4 to 19 (of 20) in the Dimeglio classification. Pirani scores for the age group 0- 6 months were 4.46, 6 months to 1 year were 5.36 and 1-2 years were 5.75 respectively. The results were excellent in 88.3% and good in 11.7%.The mean of initial and final Pirani score is 3.52083 with a ‘ p’ value is 0.000 which is less than 0.01 hence they are statistically significant. Conclusion: Congenital talipes equinovarus (C.T.E.V) is the commonest of all the foot deformities being commoner in male children and bilateral in 66% of cases, idiopathic type being the commonest form. We conclude that the Ponseti method is safe and effective treatment for congenital idiopathic clubfoot in children up to 6 years of age.
International Journal of Orthopaedics Sciences, Volume 7, pp 10-12; doi:10.22271/ortho.2021.v7.i1a.2452
Failure of ACL reconstruction is very common and may be due to technical failure or new traumatic injuries. The graft options in these cases are very limited and may include taking graft from opposite leg or allograft. The allograft availability is very limited in our country and is also very expensive. The use of graft from opposite leg gives morbidity to other side also. We describe our experience of using ipsilateral peroneus longus graft for failed ACL reconstruction cases. Methodology: six patients with failed ACL reconstruction with age less than 40 years old and having normal knee ROM were included in the study. Clinical tests and Lysholm score were used to evaluate the outcome. Graft site morbidity was assessed using AOFAS Score and ankle disability test. Results: Lachmann test and Pivot shift test was positive in all the six cases while these tests were negative at one year follow up with no signs of instability. The average Lysholm score pre-op was 66+/- while it was of 87 +/- 5 at the end of one year follow-up. There was no case of graft failure and reoperation after one year. Donor site Mean pre- and postoperative AOFAS scores were 100.0 ± 0.0 and 96.0 ± 9.6, respectively at 6-month follow-up (p = 0.06). Conclusion: Ipsilateral peroneus longus graft can be used for reconstruction in failed ACL cases with minimal morbidity at donor site and good clinical outcome
International Journal of Orthopaedics Sciences, Volume 7, pp 13-17; doi:10.22271/ortho.2021.v7.i1a.2453
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.
International Journal of Orthopaedics Sciences, Volume 7, pp 01-03; doi:10.22271/ortho.2021.v7.i1a.2450
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.
International Journal of Orthopaedics Sciences, Volume 7, pp 98-103; doi:10.22271/ortho.2021.v7.i1b.2466
Background and Objectives: Medial malleoli fracture is one of the common fractures in ankle joint mainly due to road traffic accident in which transverse fracture of medial malleolus accounts for significant morbidity and mortality. Tension band wiring (TBW) is an accepted modality of treatment which enables early mobilization of the patients than any other methods of treatment at present. TBW converts a tensile force into compressive force there by improves fracture healing, early mobilization and improved functional outcome of medial malleoli fracture of ankle joint.Materials and Methods: A longitudinal cohort study of transverse fracture of medial malleolus requiring surgical treatment, 20 patients were selected by convenient sampling technique and were operated by tension band wiring technique. In our study we use Lauge- Hansen classification pronation –abduction and pronation- eversion type, patients were evaluated for functional outcome by using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle – Hind foot scale. All data were analyzed using SPSS software v 20.0.Results: The result of our study shows the effectiveness of the procedure for medial malleolus where good to excellent results were obtained in 75% of cases, fair results were in 15% of cases and poor results in 10%.Conclusion: TBW is a simple, inexpensive technique and effective means of fixing medial malleolus fracture based on biomechanical principle with minimum complications. Long term complications of prolonged immobilization like joint stiffness, muscle wasting, pressure sores and osteoporosis are avoided. TBW for medial malleolus helps by achieving compression at fracture site, the fracture heals faster and helps in early rehabilitation.
International Journal of Orthopaedics Sciences, Volume 6, pp 152-157; doi:10.22271/ortho.2020.v6.i4c.2333
The best modality for management of correctable triggering of fingers has remained controversial. This study focuses on the outcome of 2 minimally invasive techniques, the percutaneous release of A1 pulley and the local Corticosteroid injection. Aim of this Prospective study is to compare the functional outcome in terms of pain, remnant and recurrent triggering over a period of 6 months, in patients of trigger finger, treated with percutaneous release and steroid injection. For this study, 100 patients of grade 2 and 3 triggering of fingers underwent percutaneous release or steroid injection (50 each) randomly, and they were assessed repeatedly over a follow up period of 6 months. The analysis was done using a Green’s grading, Roles-Maudsley score and VAS Score. Results were analysed with graphical representation. Percutaneous release gave an excellent relief from triggering with no recurrence, and 98% success rate. Steroid injection had only 56% success rate with 22% recurrence at the end of 6 months (higher with grade 3). The roles Maudsley score was almost equal at the end of 6 months, with 98% patients having good and excellent results in both groups. Pain relief was immediate after the steroid injection but there was a relapse in a few patients by the end of 6 months (14% developed VAS Score 4 and higher). It took 1 month for pain to get relieved in the percutaneous group, but the relief was well sustained (96% had absolute relief in percutaneous group vs 66% in steroid group). The percutaneous release should be the preferred modality in all grade 2 and 3 trigger fingers with adequate analgesia for the 1st week post- procedure.
International Journal of Orthopaedics Sciences, Volume 6, pp 139-144; doi:10.22271/ortho.2020.v6.i4c.2330
Introduction: Total knee Arthroplasty (TKA/TKR) is frequently performed surgery in patients with osteoarthritis, above 50 years age. TKR decreases pain, increases patient ability to walk independently. This decreases dependency on others in elderly age. This will help them to carry-out daily activities of living, at times daily activities of earning in that old age.Aim: To study variability of alpha angle post-operatively in knee, with same preset 5o valgus cut angle. Null Hypothesis: We propose that preset 5o valgus cut angle (distal femur cut) will have same alpha angle of 95o in all knee post-operatively. Materials and methods: Patients admitted into BIRRD (T) Hospital for TKR during the March 2017 to March 2018 were included into study, after satisfying inclusion and exclusion criteria. Radiological evaluation was done pre and post-operatively. Varus (pre and post-operative), alpha angle and other angles were calculated. Results were tabulated and statistical evaluation done. Results: Sixty-two patients were included in the study. Average age was 60 years. There were twenty six male and thirty six female patients. Average pre-operative Varus was 183o and post-operative correction obtained was 177o. Average alpha angle was 94.9o, beta angle 89.4o. Alpha angle varied from 90o-99o while beta angle varied 80o-94o in our study. Conclusion: Preset 5o valgus distal femur cut cannot determine alpha angle. Alpha angle is dependent upon many factors like entry-point of intramedullary guide, over-reaming of entry point, isthmus diameter of femur, cutting difference of medial and lateral condyles in distal femur cut. Null hypothesis remains rejected.
International Journal of Orthopaedics Sciences, Volume 6, pp 82-84; doi:10.22271/ortho.2020.v6.i4b.2322
Objective: A common cause of shoulder pain in the young athletic male is Acromioclavicular (AC) joint separations, so reconstruction measures may be designated for efficient enhancement. A multitude of surgical reconstruction techniques exist. Material and method: 15 patients of AC joint dislocation with type IV and V injury were treated by a technique using a Palmaris longus autograft in reduction and fixation of the joint. Result: Postoperatively, pain and deformity was vanished, no superior relocation was noted even after three years of primary surgery, no infection and no restricted range of motion was noted. Conclusion: The anatomic reconstruction of the coracoclavicular ligaments with grafts validates promising clinical and biomechanical effects.
International Journal of Orthopaedics Sciences, Volume 6, pp 97-99; doi:10.22271/ortho.2020.v6.i4b.2326
Purpose: Our study aims to report the functional and cosmetic results of the patients with Sprengel’s shoulder who were operated using the Woodward procedure. Materials and methods: Five children were operated at a mean age of 6.2 years and the children were reviewed at an average follow up of 24 months. Cosmesis was assessed using Cavendish score pre-operative and post- operatively. Functional outcome was assessed by measuring shoulder range of abduction clinically using goniometer. Results: The mean pre-operative Cavendish score was 2.6 which reduced to 1.2 at final review. The range of shoulder abduction on the involved side increase from 102.2 degrees to 135 degrees at follow up, thus showing an improvement of 32.8 degrees. Conclusion: The Woodward’s procedure is a reliable procedure for correcting Sprengel’s deformity and to achieve good cosmesis and functional outcome.
International Journal of Orthopaedics Sciences, Volume 6, pp 73-76; doi:10.22271/ortho.2020.v6.i4b.2320
Introduction: Osteochondromas are the most common benign bone tumors and represent 20-50% of all benign bone tumors and 10-15% of all bone tumors. The incidence of primary bone tumor in the fibula is 2.5%. Most osteochondromas are asymptomatic and are seen incidentally during radiographic examination. The most common symptom related to osteochondroma is a nontender, painless cosmetic deformity related to the slowly enlarging exophytic mass. Additional complications that cause symptoms include osseous deformity, fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Case Series: In a series of two cases, we document the occurrence of osteochondromas involving the fibula in two adult males. While, these benign tumors were located at either ends of the bone, both patients had similar symptoms of swelling with restriction of joint movement and pain. Neither had neurovascular involvement in either limbs and there was no joint instability on examination. They both improved dramatically following surgical resection of these tumors without any recurrences. Conclusion: The two cases of fibular osteochondromas reported here illustrate their rare and atypical locations at the same time coincidentally possessing similar presentations of impingement due to their bulky sizes.