Indian Journal of Orthopaedics最新文献

Background: The implementation of the standard Ponseti technique (SPT) in management of idiopathic clubfoot can be challenging due to the need for frequent travelling and long duration to achieve correction. The one week accelerated Ponseti technique (OWAPT) reduces the duration of correction to seven days and has been reported to be effective and safe. However, children still need to travel for change of cast.

Methods: A randomized controlled trial was conducted to compare the SPT and OWAPT for their effectiveness, safety and treatment expenditure. Children under one year of age with untreated idiopathic CTEV were included. Those undergoing correction with OWAPT were hospitalized till tendo-achillis tenotomy. The relevant data was collected and analyzed using appropriate statistical methods.

Results: Forty six children (68 feet) were enrolled with 22 (33 feet) in OWAPT group and 24 (35 feet) in SPT group. The mean age at treatment in OWAPT and SPT group was 1.55 months and 2.91 months, while their mean Pirani score was 4.59 and 4.70 respectively. The Pirani score improved significantly within both groups without any significant difference between the two groups. The total number of casts required to achieve correction were also comparable (p = 0.779). The OWAPT was observed to be more economical (p < 0.001) but had more minor complications.

Conclusion: The OWAPT is equally effective, achieves faster correction and is more cost-effective than SPT. Its implementation by hospitalizing the children avoids travelling issues and achieves 100% compliance during correction phase. Hospitalization also ensures better plaster care and monitoring for complications.

Introduction: Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis.

Materials and methods: This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathologic fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24 months.

Results: The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21 weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy.

Conclusion: Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome.

Background: Rickets is a common metabolic bone disease in children, primarily caused by vitamin D deficiency. This study aimed to compare the efficacy of oral weekly vitamin D supplementation and injectable stoss therapy in treating nutritional rickets in Indian children.

Methods: This prospective, randomized, controlled trial was conducted over 18 months at a tertiary care center. Forty children aged 6 months to 16 years with clinical, biochemical, and radiological evidence of nutritional rickets were enrolled and randomly assigned to receive either oral vitamin D3 (60,000 IU weekly for 10 weeks) or a single intramuscular injection of vitamin D3 (600,000 IU). Clinical, biochemical, and radiological assessments were conducted at baseline and at 3 weeks, 6 weeks, 3 months, and 6 months post-treatment.

Results: Both treatment regimens significantly improved vitamin D, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels, with no significant differences between the groups. Radiological healing, assessed by Thacher's score, was achieved in both groups by 6 months. While both treatments were effective, injectable stoss therapy resulted in a more sustained increase in vitamin D levels and may offer better compliance due to its single-dose administration. No cases of local skin complications or vitamin D toxicity or symptomatic hypercalcemia were observed.

Conclusion: Oral weekly and injectable stoss therapies are both effective and safe for treating nutritional rickets. Injectable stoss therapy may be more suitable for the Indian population due to its cost-effectiveness and lower compliance demands. Serum parathyroid hormone (PTH) levels emerged as a useful early marker of rickets severity as well as treatment response. Early diagnosis and treatment are crucial to prevent long-term skeletal deformities.

Background: Non-union of fracture of tibia is often associated with multiple problems like infection, deformity, bone loss, and soft tissue loss. Ilizarov is a worldwide accepted treatment for infected non-union of tibia, but correlation of patient-rated outcome measures with surgeon-assessed clinical and radiological outcomes is not being done in the literature.

Objectives: To analyze the variables affecting clinical and radiological outcomes and patient-reported outcomes (EQ5D5L) and to assess correlation between patient-reported outcome measures and ASAMI scores during management of infected nonunion of tibia with Ilizarov ring fixator.

Patients and methods: Thirty three patients aged between 18 and 70 years, both sexes, presenting with infected non-union tibia.

Results: The mean age was 39.51 ± 14.94 years ± SD, pre-operative EQ5D5L score was > 20 in 87.9%, patients mean value is 21.061 ± 3.508 SD, mean non-union severity score was 51.7 ± 15.7 SD, mean Infection Severity Score is 44.485 ± 18.755 SD. The correlation of the variables affecting the ASAMI radiological score: Distal 1/3rd and midshaft, Smoking, Alcohol, Non-union severity score, Infection severity score had negative correlation, with significant p value and EQ5D5L score immediate post-operative score and EQ5D5L follow up had positive correlation with ASAMI radiological score. Gap / bone loss score had negative correlation, p value being 0.058+. EQ5D5L immediate post-operative score and EQ5D5L follow up had positive correlation with significant p value with ASAMI clinical score.

Conclusion: Ilizarov fixator is an excellent tool in managing infected nonunion of tibia with bone loss with good patient rated outcome and ASAMI clinical and radiological score.

Backgrounds: Breech presentation, family history, and physical examination are the most recognized risk factors for DDH, which form the basis of selective screening. However, this approach can lead to late diagnosis, invasive treatments, and complications. This study analyzes the effectiveness of selective screening and identifies additional factors related to DDH.

Methods: A retrospective case-control analytical study is designed, including children who are assessed through screening between 2012 and 2019. The variables examined include clinical and gestational characteristics, as well as examination findings. Descriptive analysis is conducted, followed by univariate analysis using Chi-squared, Fisher's exact, or Student's T tests. For multivariate analysis, the "all set" user command is employed. Sensitivity, specificity, and ROC curve are calculated, with a significance level set at p < 0.05. StataIC 16 and SAS System 9.4 are used.

Results: 762 children are included in the study, of which 33 are diagnosis with DDH. A total of 8,191 models are developed to predict DDH. The best logistic regression model identified the following independent predictors of dysplasia: newborn weight (OR 1.2, 95% CI 1.1-1.4), female sex (OR 3.9; 95% CI 1.4-10.9), cephalic presentation (OR 17.8; 95% CI 2.3-137.3), primiparity (OR 2.6; 95% CI 1.1-5.7), and examination (OR 149.6; 95% CI 18-1121.4). This model correctly classifies 83.6% patients (ROC curve 0.86). In selective screening, examination is the only identified risk factor for DDH, yet its sensitivity does not exceed 10%.

Conclusions: This study proposed a total of 8191 models to predict DDH. The identified predictors include female sex, birth weight, cephalic presentation, and primiparity. While physical examination is the primary risk factor, it detects only decentred hips. The low sensitivity of selective screening raises questions about whether it remains the most appropriate method for identifying DDH in current practice.

Background: Untreated cubitus varus results in cosmetic deformity as well as posterolateral rotatory instability at the elbow if longstanding. French osteotomy with its modifications is the most commonly done osteotomy and relies on a medial intact hinge and these osteotomies fail to address the lateral prominence. Intraoperative fixator assistance to adjust the translation and fine tune the osteotomy is a novel method to address the lateral prominence. This prospective study analyses the efficacy of the same.

Materials and methods: A total of 16 consecutive patients presenting with unilateral cubitus varus resulting from mal-united supracondylar fracture of humerus were included. The humero-ulnar angle correction required, size of lateral closing wedge and amount of translation required were calculated. After a lateral surgical approach, one Schanz pin of size 2.5mm-3.5mm depending on age, was passed just above the level of distal humerus physis, lateral to medial; a second pin was inserted in the shaft of humerus, again lateral to medial. Pre-calculated wedge of bone was removed, angular correction as well as translation done; fine tuning of the osteotomy was achieved using fixator assistance. Rotational and hyperextension deformities were corrected simultaneously. Fixation of the osteotomy was done by multiple K wires or plates, depending on the age of the patient.

Observation and results: The mean carrying angle corrected to 10.4 degrees valgus from a preoperative value of 19.8 degrees varus. The mean humero-ulnar angle corrected to 9.6 degrees valgus from a preoperative value of 19.6 degrees varus. The mean lateral prominence index reduced to - 3.8% from a preoperative value of - 5.5%. The mean cosmetic correction score was 9 (Max 10) from a preoperative value of 1.9. No patient had an 'S' shaped deformity in the operated elbow. No nerve palsies were observed in any of the operated patients.

Conclusions: Fixator assistance during surgery allows angular, translation and rotational control of the fragments to fully correct the deformity. It also allows fine tuning of the osteotomy during surgery.

Background: Pediatric diaphyseal both-bone forearm fractures are one of the most prevalent fractures in orthopedic practice.

Purpose of the study: To assess the anatomical and functional outcomes of hybrid fixation (radius nailing and ulna plating) in treating closed proximal radius and ulna fractures in adolescents.

Methods: This prospective cohort study was performed on 41 patients between the ages of 10 and 16 years, both sexes, with recent trauma (less than 2 weeks) suffering from closed proximal diaphyseal radius and ulna fractures. Functional outcomes were assessed according to the price score grading criteria, along with the radiological assessment of the union.

Results: Regarding Price score grading, 28 (68.29%) cases had an excellent function, 8 (19.51%) had a good function, 3 (7.32%) had a fair function, and 2 (4.88%) cases had a poor function. The mean union time was 7.41 ± 2.65 weeks. Four patients complained of prominent hardware, three cases developed neuropraxia resolved, and two cases had nonunion of both bones and one of them had nail migration.

Conclusion: The hybrid fixation technique could be effectively used in the treatment of adolescent proximal both-bone forearm fractures.

Background: This single center-based prospective cohort study was conducted, on 157 patients over 60 years old patients requiring major orthopedic surgery, from June 2019 to June 2021. Frailty was assessed using the Edmonton Frailty Scale pre-operatively. Post-operative complications, ambulatory status, readmission rates, and mortality were monitored up to three months post-surgery, and statistical analysis was performed.

Materials and methods: With India's elderly population projected to reach 324 million by 2050, the prevalence of orthopedic surgeries among this demographic is increasing. frailty, a measure of decreased strength, endurance, and physiological function with aging, may significantly affect surgical outcomes. This study aimed to evaluate the correlation between frailty, as measured by the Edmonton Frailty Scale, and postoperative outcomes in elderly patients undergoing major orthopedic surgeries.

Results: The study found that 60% of patients were categorized as either vulnerable or frail. Surgical site infection (15.9%) was the most common postoperative complication across all frailty levels. Cardiac complications and deep vein thrombosis were significantly associated with higher frailty levels. At discharge, 78% of patients were ambulatory, improving to over 91% at the three-month follow-up. However, frailty significantly delayed recovery to ambulatory status. The incidence of death during the study was 3.2%, and readmission within 30 days post-surgery was 3.8%. Statistical analysis revealed significant differences between frailty levels and post-operative complications, ambulatory status, and, to a lesser extent, readmission, and mortality rates.

Conclusion: The study demonstrates a significant correlation between frailty and adverse postoperative outcomes in elderly patients undergoing major orthopedic surgeries. It underscores the necessity of incorporating frailty assessment into preoperative evaluations to tailor care plans and improve surgical outcomes. Tailored rehabilitation programs and preoperative optimization may mitigate the risks associated with frailty, enhancing recovery and reducing the burden of postoperative complications and readmission.

Aim: The aim of the examination was to determine which of the three measurement methods Cobb (CB), Ferguson (FR), and Centroid (CN) has the best repeatability and reliability when the measurements are made by inexperienced researchers.

Methods: Three researchers (from the student research group) measured the angle of spine curvature on X-rays of the entire spine in standing anteroposterior view in 50 patients with severe idiopathic scoliosis qualified for surgery. Cobb, Ferguson, and Centroid methods were used. One of the researchers repeated all examinations twice at 3-week intervals. The measurements were compared with each other using the intraclass correlation coefficient (ICC) method. Values less than 0.5 are indicative of poor reliability, values between 0.5 and 0.75 indicate moderate reliability, values between 0.75 and 0.9 indicate good reliability and values greater than 0.90 indicate excellent reliability.

Results: The ICC (inter-rater) between the researchers' measurements was 0.9387 for CB, 0.9169 for FR, and 0.9061 for CR. Whereas the ICC (intra-rater) between measurements taken by a single researcher was 0.9824 for CB, 0.9088 for FR, and 0.9546 for CR.

Conclusions: The above results show that Cobb angle measurement method is the most reliable for measuring the curvature angle of the spine for novice researchers. Although it seems to be difficult to measure, it provides the most repeatable results.