National Journal of Clinical Orthopaedics

Journal Information
ISSN / EISSN : 2521-3466 / 2521-3474
Published by: Comprehensive Publications (10.33545)
Total articles ≅ 243
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Dixit Chaudhary, Vinod Gautam, Nehal Sha, Sumit Jain, Vishal Mehta
National Journal of Clinical Orthopaedics, Volume 6, pp 04-09; https://doi.org/10.33545/orthor.2022.v6.i1a.340

Abstract:
Purpose: To determine functional and radiological outcome of various surgical modalities for treating malleolar fractures. Materials and Methods: The present prospective observational study was conducted among 40 admitted in the department of Orthopedics, Sir T Hospital, Bhavnagar with Ankle Fracture. Standardized clinical and functional evaluation at 2 weeks (suture removal), 3 months and 6 months were done. Surgical technique used were open reduction and internal fixation of the lateral malleolus with semi tubular plate; medial malleolus with cancellous screws or tension band wiring ; posterior malleolus with cancellous screws. Radiological assessment of each patient was done. The outcome measures were calculated using the Karlsson and Peterson functional scoring system at 3 and 6 months postoperatively. Similarly radiological outcome was calculated using Kristenson’s Radiological criteria at 6 month. Results: In our series, most of the patient affected by the fracture belongs to age group of 41- 50 years which was16 (40%). The commonest mode of injury is fall (50%) and road traffic accident (32.5%). 23 were male patients (57%) and 17 were female patients (43%). 23 cases involved the right ankle and 17 cases involved the left ankle. The mean duration of stay was 4.5days. In the present study out of 40 patients, 5 patients presented with persistent swelling, 8 patients presented with residual pain while 9 patients presented with both of the complaints In our study of 40 cases, 29 cases (72.5%) achieved good results and 7 cases (17.5%) achieve fair results and 4 cases (10%) achieved poor results at 6 months follow up.1 patients develops superficial infection postoperatively and treated by dressing and antibiotics. Conclusion: Ankle fractures are among the most common injuries treated and these are best managed by open reduction and internal fixation. Anatomical reduction is essential in all Tri-malleolar fracture to achieve good functional outcome and to avoid complications like arthritis and loss of range of movements. Immobilization for 6 weeks doesn’t reduce the final functional outcome. Good physiotherapy is recommended for adequate range.
Neelanagowda Vp Patil, Arun Gr, Deepak Mk, Arun Mohan
National Journal of Clinical Orthopaedics, Volume 6, pp 22-25; https://doi.org/10.33545/orthor.2022.v6.i1a.344

Abstract:
Background and Objectives: Fractures of the distal tibia, especially complex open fractures have been historically difficult to manage due to the poor soft tissue envelope around the bone and the precarious blood supply. In this study, we aim at devising an economical model of a hybrid external fixator for complex distal tibia fractures by using reused Ilizarov rings and A O rods after adequate methods of sterilization and study the functional outcome, time to union and complications associated with it.Objectives: To devise an economical model of hybrid external fixator for the management of complex distal tibia fractures and to study the Functional outcome, Time to union and associated complications.Methods: Total 16 patients with complex distal tibia [AO type 43(A1-A3, B1-B3, C1-C3)] fractures were treated in our institution with an economical model of hybrid external fixator using reused Ilizarov rings and A O rods after adequate methods of sterilization between June 2019 to December 2021. Patients were followed up every 6 weeks till 6 months and then at the end of 1 year. Patients were evaluated for functional and radiological outcome using the Ovadia and Beals scoring criteria. Time to union and Immediate and late complications were analyzed.Results: Total 16 patients were evaluated postoperatively for functional and radiological outcome using Ovadia and Beals criteria which showed 3 patients (18.75%) had well to excellent and 13(81.25%) patients had fair outcome. The average duration for fracture union was 33.25 weeks. 6(37.5%) patients had pin tract infection which was treated with adequate antibiotics and pin tract care. No deep infections were noted. There were 7(43.75%) cases of joint stiffness, 5(31.25%) cases of mal union and 2(12.5%) cases of delayed union. Reusing the non invasive components of the fixator helped us in reducing the overall operating cost of the surgery by 35-40%.Interpretation and Conclusion: In our study, we found that reusing the non invasive components of a hybrid external fixator is an economical treatment option for complex distal tibia fractures when combined with minimal internal fixation of fibula fracture, adequate antibiotic coverage, wound and pin tract care and aggressive physiotherapy.
Neelanagowda Vp Patil, Arun Gr, Deepak Mk, Jyothishlal Mk
National Journal of Clinical Orthopaedics, Volume 6, pp 17-21; https://doi.org/10.33545/orthor.2022.v6.i1a.343

Abstract:
Aims: To prospectively study the functional outcome of extra articular and intra articular distal femur fractures treated with minimally invasive percutaneous plate osteosynthesis using modified Rasmussen criteria and correlation with radiological outcome described by Handolin et al.Materials and Methods: Total 25 patients with distal femur fractures [A1 A2 A3 B1 B2 B3] were treated in our institution. They were operated with minimally invasive percutaneous plate osteosynthesis [mippo] lcp between december 2019 to june 2021 and examined according to protocol clinically and radiologically. Followed up regularly by clinical examination, rasmussens clinical scoring and xrays taken immediately after operation, at 6weeks, 12 weeks, and 24 weeks after surgery and ct scan in 3rd to 5th postoperative day or at immediate follow up.Results: Total 25 patients were evaluated postoperatively thoroughly for functional and radiological outcome using modified Rasmussen’s criteria and criteria described by Handolin et al. which showed excellent and good results of functional outcome in 65% (16) and 35% (9) patients respectively and no poor results. Coronal and sagittal alignments were satisfactory in 92% and 96% of subjects. Rotational alignment was satisfactory in 56% of patients. According to Handolin et al. classification excellent results in 16% (4) of patients good in 40% (10) fair in 32% (8) poor in 12%(3) of subjects. Leg length discrepancy was satisfactory in 92% (23) of patients. Conclusion: Minimally invasive percutaneous plate osteosynthesis (MIPPO) showed an excellent option in treating the distal femoral fractures due to minimal soft tissue distruption. But regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after mippo for distal femoral fractures whereas satisfactory alignment is obtained for coronal and sagittal alignments and limb length.
Janak Rathod, Dhruv Patel, Sanjay Modi, Yogesh Kucha, Ronak Patel
National Journal of Clinical Orthopaedics, Volume 6, pp 26-30; https://doi.org/10.33545/orthor.2022.v6.i1a.345

Abstract:
Introduction: The treatment of ankle fractures with involvement of the posterior tibial margin remains a subject of debate. We have evaluated the clinical, radiological, and functional outcome of such fractures in 25 patients, all of which were managed surgically over an average follow- up period of 6 months. The treatment options available for malleolar fractures, to attain a proper anatomical alignment and stability of ankle joint, can lead to rewarding outcome for the patient.Materials and Methods: 25 patients with posterior malleolus fractures were managed surgically between June 2019 to November2021 were included in this series. The mean age, gender ratio, mode of trauma, fracture union time, and complications were noted. The AOFAS Hindfoot scores were used for assessing the Ankle function.Results: Of the 25 patients in the study, 21 were males and 4 were females. The mean age was 38.12 years. The mean fracture union (radiological) time was 14.04 weeks (range: 10–18 weeks). However Ankle function was excellent in 17 cases (68%) on the AOFAS hindfoot score with a average AOFAS score of 94.8. Also platting gives a better result than using cannulated cancellous screws. Better syndesmotic stability is observed after surgically treating posterior malleolus fractures.Conclusion: Fixation of the posterior malleolus to reduce persistent fragment displacement, regardless of size, as well as to restore syndesmotic stability, may lead to improved outcomes. We conclude that posterior malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness and have achieved excellent clinical and functional outcomes of surgically fixing the posterior malleolus fractures.
Abhishek Kumar Rai, Vijay Sarukte, Ketan Kodare, Dixit Bansal
National Journal of Clinical Orthopaedics, Volume 6, pp 40-43; https://doi.org/10.33545/orthor.2022.v6.i1a.348

Abstract:
Background: Elderly patients with a minor fall can sustain a fracture in this area because of debilitated bone due to osteoporosis or pathological fracture and this account for 90%. Benefits of intramedullary devices like PFN include preserved blood supply to the bone fragments, less operative blood loss and less disruption of the environment. The study was conducted to determine the union rate, functional outcome and the complication in intertrochanteric fractures treated by PFN. Materials and Methods: A prospective observational study on 30 patients with intertrochanteric fractures were done at a tertiary care centre between April 2018 to March 2019. All patients were managed by proximal femoral nail. The patients were evaluated radiologically and functionally. The radiographic evaluation was done for a minimum of three cortices union on anteroposterior and lateral views. The functional evaluation was done on the basis of Harris Hip Score (HHS).Results: The results of the treatment of stable intertrochanteric fractures using Proximal Femoral Nail were assessed by Harris Hip Score system. Most of the patients were having fair to excellent outcome.Conclusion: we consider that the PFN is a highly accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon, careful surgical technique and selection of the patients should further reduce its complication rate. Early post-operative ambulation and physiotherapy improves the results of PFN.
Janak Rathod, Viraj Banker, Sachin Patel
National Journal of Clinical Orthopaedics, Volume 6, pp 76-79; https://doi.org/10.33545/orthor.2022.v6.i1b.350

Abstract:
Background: To evaluate radiological and functional outcome in fractures of the distal end radius treated by K-wire fixation in post menopausal women.Methods: Fifty patients with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary block or general anaesthesia. Anatomical restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 70% (n=35) of our patients had excellent to good outcome while as 20% (n=10) had fair outcome and 10% (n=5) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.
Janak Rathod, Suny Patel, Vikram Jasoliya, Ronak Patel, Kirti Sonaviya
National Journal of Clinical Orthopaedics, Volume 6, pp 70-75; https://doi.org/10.33545/orthor.2022.v6.i1b.349

Abstract:
Introduction: Osteoarthritis is a multifactorial disease but abnormal stress produced by biomechanical alteration is one of the major accelerating factors. Medial compartment osteoarthritis refers to the excessive loading of weight onto the medial femoral condyle and medial tibial plateau. If mechanical axis is realigned in correcting varus in open wedge high tibial osteotomy to unload the medial compartment, patient gets significant pain relief and surgery adds life to the knees. Material and Methods: This is a prospective study of patients who attended the Orthopaedics outpatient clinic in tertiary care hospital. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. During this period 21 patients were selected and were included in study. Results: Major group of patients in our study belong to age group 46-50 years (62%). The mean age of patients in our study is 48.38 years, the mean time of union is 4.04 months. As far as complications are concerned there were 3 complications we encountered 1 among them was superficial infection 1 had lateral tibial condyle involvement due to higher correction angle 1 patient had under correction noted on post operative HKA axis scanogram. The average JOA Knee score preoperatively was 52.6 which improved postoperatively with average score of 82.9.average. Functional knee society score was 70.80 preoperatively which improved postoperatively to 90.57. VAS score preoperatively was 6.95 which reduced considerably to an average score of 2.09 postoperatively. We got excellent results in 18 patients (86%), good results in 2 patients (9.5%) and fair results in 1 patient (4.5%). Conclusion: In our study medial opening wedge high tibial osteotomy with osteosynthesis is a physiologically better surgery in medial compartmental primary osteoarthritis knee in early stages. Early results are gratifying for Indian patients, who cannot afford the costlier surgery and implant and also are reluctant to change squatting habits & job profile. Though complications are there but they are avoidable & treatable.
Prasad Bhimbarwad, Siddharth Jadhav, Aakash Gaurav
National Journal of Clinical Orthopaedics, Volume 6, pp 13-16; https://doi.org/10.33545/orthor.2022.v6.i1a.342

Abstract:
Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.
Abhishek Kumar Rai, Dixit Bansal, Bhushan Sunil Hadole, Geekesh Kumar K G
National Journal of Clinical Orthopaedics, Volume 6, pp 31-34; https://doi.org/10.33545/orthor.2022.v6.i1a.346

Abstract:
Background: The shoulder complex is one of the most mobile joints in the human body allowing a great freedom of motion to the upper limb. The present study was conducted to assess the role platelet rich plasma in supraspinatus tendinitis. Materials & Methods: 60 grade 1 and grade 2 patients of supraspinatus tendinopathy of both genders. Clinical symptoms, pain, side, history of trauma etc. was recorded. Patients were subjected to USG and MRI of the involved shoulder. PRP was prepared and 2-3 ml of PRP was injected with needle no 24 into site of tendon. Constant Murrey Score was evaluated at baseline, 1 month and 3 months follow up. Results: Out of 60 patients, males were 43 and females were 17. Side was left in 10% and right in 90%. Etiology was traumatic in 24% and non- traumatic in 76%. Pain intensity was mild in 8%, moderate in 70% and severe in 22%. Investigation for diagnosis was USG in 90% and MRI in 10%. Constant Murrey Score at 0 month was 33.4, at 1 month was 27.5, at 3 months was 21.3, at 6 months was 22.7, at 12 months was 21.4 and at 18 months was 21.1. The difference was significant (P
Suhail Shabnum Wani, Inam Ul Haq, Shariq Hussain
National Journal of Clinical Orthopaedics, Volume 6, pp 10-12; https://doi.org/10.33545/orthor.2022.v6.i1a.341

Abstract:
Introduction: Volar Barton's fracture is fracture-dislocation of radiocarpal joint with the intra-articular fracture involving the volar lip. Open reduction and internal fixation is the preferred method as this allows reduction under direct vision, stable internal fixation, shorter period of immobilization, and fast return of function. Materials and Methods: The study consisted a total of 20 patients who were operated in the Department of Orthopaedics, Government Medical College Srinagar during the period of 2019-2021. All the patients were managed by volar locking plating. Inclusion criteria were: age 18-60 years, both sexes, patient consenting for surgery and patients fit for anaesthesia. Exclusion Criteria were: associated factures of ipsilateral limb, delayed presentation more than 2 weeks, pathological fractures and open fractures. Results: Mean age of our patients was 27.3 years. The average palmar flexion was 72.5 degrees and the average dorsiflexion was 80.4 degrees. The mean supination was 82 degree and mean pronation at final follow up was 78 degrees. In the present study, the average radial inclination at final follow up was 17 degrees. All the 20 patients in this study had less than 5 mm radial shortening. Average palmar tilt at final follow up was around 7.5 degrees. 75% of the patient had excellent outcome based on Gartland and Werley score. Conclusion: Anatomical reduction of volar barton fractures is important to achieve good procedural outcomes. Volar locking plates have shown promising results in volar barton fractures.
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