Pub Date : 2021-10-01DOI: 10.33545/orthor.2021.v5.i4b.332
D. Jb, D. Jm, Dr. Rohan Natthuji Kumre
Background: Open fractures, osteomyelitis, peri-prosthetic infections whether impending or established are challenging situations in orthopaedic practice. Prevention and eradication of infections is a difficult task and incomplete treatment can lead to devastating complications. Treatment protocol involves wound debridement in cases of osteomyelitis and peri-prosthetic infections, primary internal fixation of the open fracture and application of calcium sulphate augmented with antibiotics, is a line of treatment in most of the cases. Aim: To study and analyse the effect of calcium sulphate augmented with antibiotics in orthopaedic practice. Materials and Methods: Patients were admitted in Mallya Hospital, Bangalore in between June 2018 to December 2019. Sample size of 30 was calculated based on the formula. Patients with diagnosis of osteomyelitis, peri-prosthetic infection and open fracture were included in the study. The patients were recruited to the study after due consent. Clinical history was taken and patients were examined, laboratory parameters (TC, ESR, CRP) were taken preoperatively and radiological examination done. Patients were followed up with laboratory parameters (TC, ESR, CRP), radiographs for resorption of calcium sulphate and bone healing at 6 weeks, 3 months and 6 months postoperatively. Results: Minimum age of the patient was 15 years and maximum 83 years, 2 patients were lost to follow up, 21 males and 7 female patients. Cases were divided depending on the type. Postoperatively laboratory parameters with statistical significant P values in cases of osteomyelitis, peri-prosthetic infection, open fracture seen in TC, ESR and CRP are as follows, osteomyelitis (0.016,0.011, <0.001), Periprosthetic infection (<0.001, <0.001,<0.001) and in open fractures (<0.001, 0,003,<0.001). Calcium sulphate resorption was assessed along with bone healing. Average Calcium sulphate re-sorption period was 6 weeks and average bone healing time was 6 months in fracture and cases with the bone void formation. There was statistically significant difference between all the groups when compared pre and postoperatively. Conclusion: We concluded that antibiotic impregnated Calcium sulphate plays an important role in tackling the infection when used locally at the site of infection; it helps in wound healing and bone healing.
{"title":"Study and analysis of effect of calcium sulphate augmented with antibiotics in orthopaedic practice","authors":"D. Jb, D. Jm, Dr. Rohan Natthuji Kumre","doi":"10.33545/orthor.2021.v5.i4b.332","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i4b.332","url":null,"abstract":"Background: Open fractures, osteomyelitis, peri-prosthetic infections whether impending or established are challenging situations in orthopaedic practice. Prevention and eradication of infections is a difficult task and incomplete treatment can lead to devastating complications. Treatment protocol involves wound debridement in cases of osteomyelitis and peri-prosthetic infections, primary internal fixation of the open fracture and application of calcium sulphate augmented with antibiotics, is a line of treatment in most of the cases. Aim: To study and analyse the effect of calcium sulphate augmented with antibiotics in orthopaedic practice. Materials and Methods: Patients were admitted in Mallya Hospital, Bangalore in between June 2018 to December 2019. Sample size of 30 was calculated based on the formula. Patients with diagnosis of osteomyelitis, peri-prosthetic infection and open fracture were included in the study. The patients were recruited to the study after due consent. Clinical history was taken and patients were examined, laboratory parameters (TC, ESR, CRP) were taken preoperatively and radiological examination done. Patients were followed up with laboratory parameters (TC, ESR, CRP), radiographs for resorption of calcium sulphate and bone healing at 6 weeks, 3 months and 6 months postoperatively. Results: Minimum age of the patient was 15 years and maximum 83 years, 2 patients were lost to follow up, 21 males and 7 female patients. Cases were divided depending on the type. Postoperatively laboratory parameters with statistical significant P values in cases of osteomyelitis, peri-prosthetic infection, open fracture seen in TC, ESR and CRP are as follows, osteomyelitis (0.016,0.011, <0.001), Periprosthetic infection (<0.001, <0.001,<0.001) and in open fractures (<0.001, 0,003,<0.001). Calcium sulphate resorption was assessed along with bone healing. Average Calcium sulphate re-sorption period was 6 weeks and average bone healing time was 6 months in fracture and cases with the bone void formation. There was statistically significant difference between all the groups when compared pre and postoperatively. Conclusion: We concluded that antibiotic impregnated Calcium sulphate plays an important role in tackling the infection when used locally at the site of infection; it helps in wound healing and bone healing.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121810394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.33545/orthor.2021.v5.i4b.334
Dr. Burhan Bhat, Dr. Sulaiman Sath, Dr. zameer Ali, Dr. Jabreel Muzaffar, Dr. AR Badoo, Dr. Ishtiaq Abdullah
Background: Fractures occur in individuals of all ages. The present study was conducted to record fracture reported in orthopaedics department. Materials and Methods: 148 patients with fractures reported in orthopaedics department underwent physical examination along with radiological investigation such as X- ray skull, upper limb, lower limb, CTR scan etc. was performed in each case. Etiology of fracture and associated injuries was also reported. Management of the patient was performed accordingly. Results: Out of 148 patients, males were 80 and females were 68. The most common cause of fracture among patients was road traffic accident seen in 102, fall in 40 and domestic violence in 6 cases. The difference was significant ( P < 0.05). Fracture of upper limb was seen in 60, fracture of lower limb in 30, fracture of spine and trunk in 25, fracture of skull, intracranial injury in 33. Associated injuries was contusion in 12, open wound of upper limb in 24, open wound of lower limb in 54 and superficial injury in 28 patients. The difference was significant ( P < 0.05). Conclusion: Common type of fractures among patients visiting orthopaedics department was fracture of upper limb, fracture of lower limb, fracture of spine and trunk.
{"title":"Profile of patients reporting with fractures in the orthopaedics department","authors":"Dr. Burhan Bhat, Dr. Sulaiman Sath, Dr. zameer Ali, Dr. Jabreel Muzaffar, Dr. AR Badoo, Dr. Ishtiaq Abdullah","doi":"10.33545/orthor.2021.v5.i4b.334","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i4b.334","url":null,"abstract":"Background: Fractures occur in individuals of all ages. The present study was conducted to record fracture reported in orthopaedics department. Materials and Methods: 148 patients with fractures reported in orthopaedics department underwent physical examination along with radiological investigation such as X- ray skull, upper limb, lower limb, CTR scan etc. was performed in each case. Etiology of fracture and associated injuries was also reported. Management of the patient was performed accordingly. Results: Out of 148 patients, males were 80 and females were 68. The most common cause of fracture among patients was road traffic accident seen in 102, fall in 40 and domestic violence in 6 cases. The difference was significant ( P < 0.05). Fracture of upper limb was seen in 60, fracture of lower limb in 30, fracture of spine and trunk in 25, fracture of skull, intracranial injury in 33. Associated injuries was contusion in 12, open wound of upper limb in 24, open wound of lower limb in 54 and superficial injury in 28 patients. The difference was significant ( P < 0.05). Conclusion: Common type of fractures among patients visiting orthopaedics department was fracture of upper limb, fracture of lower limb, fracture of spine and trunk.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117137226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.33545/orthor.2021.v5.i4a.319
Dr. T Ram Kalyan, Dr. Kalyan Kaushik Bharam, D. K. Verma
Background and Objectives: The unprecedented growth and development in the past decade of our country saw rapid growth and urbanization resulted in change in life style of the people and also increase in the sports and other occupational related activities by the individuals. This has led to the increased accidental injuries to the knee joint, a major contributing factor to Anterior Cruciate Ligament (ACL) injury. Arthroscopic ACL reconstruction using quadrupled semitendinosus and gracilis tendon autograft with using endobutton for femoral tunnel fixation and in the tibial tunnel with hybrid fixation using suture disc and anchored with a cancellous screw and washer or interferential screw is a relatively new technique. We have undertaken this study to analyze the postoperative outcome in our experience with this procedure. Methods: This was a prospective study of consecutive patients with ACL injury who underwent Arthroscopic ACL reconstruction in our institution using quadrupled semitendinosus and gracilis tendon autograft. Postoperatively, all patients were initiated on the same rehabilitation protocol. All patients were followed up for four to six months period at regular intervals using IKDC, LGS scoring systems and a subjective questionnaire. Functional assessment with hop test was done. Results: About 92% of the patients had a favourable outcome as per three scoring systems. All three scoring system had a very high correlation as evidenced by the Kendal-tau values ranging x from 0.464 to 0.923. Statistically, this was found to be highly significant (p value- 0.000 – 0.001). Using IKDC scoring, the results were normal in 14, nearly normal in 10 and abnormal 1. 4 patient (16%) presented with anterior knee pain. Sensory loss was noted in 3 patients (12%) at the end of 6 months following surgery. Swelling was present in 4 patients (16%).None were having any infection and FFD. Conclusion: We conclude that the functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis tendon autograft is excellent to good (92%). With proper patient selection and physiotherapy regimen, full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.
{"title":"A study on surgical management of anterior cruciate ligament injuries by arthroscopic reconstruction using semitendinosus and gracilis tendon","authors":"Dr. T Ram Kalyan, Dr. Kalyan Kaushik Bharam, D. K. Verma","doi":"10.33545/orthor.2021.v5.i4a.319","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i4a.319","url":null,"abstract":"Background and Objectives: The unprecedented growth and development in the past decade of our country saw rapid growth and urbanization resulted in change in life style of the people and also increase in the sports and other occupational related activities by the individuals. This has led to the increased accidental injuries to the knee joint, a major contributing factor to Anterior Cruciate Ligament (ACL) injury. Arthroscopic ACL reconstruction using quadrupled semitendinosus and gracilis tendon autograft with using endobutton for femoral tunnel fixation and in the tibial tunnel with hybrid fixation using suture disc and anchored with a cancellous screw and washer or interferential screw is a relatively new technique. We have undertaken this study to analyze the postoperative outcome in our experience with this procedure. Methods: This was a prospective study of consecutive patients with ACL injury who underwent Arthroscopic ACL reconstruction in our institution using quadrupled semitendinosus and gracilis tendon autograft. Postoperatively, all patients were initiated on the same rehabilitation protocol. All patients were followed up for four to six months period at regular intervals using IKDC, LGS scoring systems and a subjective questionnaire. Functional assessment with hop test was done. Results: About 92% of the patients had a favourable outcome as per three scoring systems. All three scoring system had a very high correlation as evidenced by the Kendal-tau values ranging x from 0.464 to 0.923. Statistically, this was found to be highly significant (p value- 0.000 – 0.001). Using IKDC scoring, the results were normal in 14, nearly normal in 10 and abnormal 1. 4 patient (16%) presented with anterior knee pain. Sensory loss was noted in 3 patients (12%) at the end of 6 months following surgery. Swelling was present in 4 patients (16%).None were having any infection and FFD. Conclusion: We conclude that the functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis tendon autograft is excellent to good (92%). With proper patient selection and physiotherapy regimen, full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128886090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.33545/orthor.2021.v5.i4a.320
Dr. Takshay J Gandhi, Dr. Harshlaxen A Rajpardhi, Dr. Raj N Patel
Introduction: The humerus diaphyseal fractures account for 3% all bone fractures. Humerus diaphyseal fractures occurs in young adults because of high velocity injuries like road traffic accidents, fall from height, assaults and heavy machinery injuries, humerus diaphyseal fractures occurs in old age patients because of simple falls due to osteoporotic bones. Methods: A retrospective review was conducted of patients with humerus diaphyseal fractures. In all 26 patients were enrolled in the study, of which 13(50%) were treated with anterolateral approaches and the 13(50%) with posterior approaches. In this study we treated diaphyseal humerus fractures with open reduction and internal fixation by two different approaches, anterolateral and posterior, and compared results and functional outcome. Results: Out of all the 26 patients with diaphyseal humerus fracture 13 patients were operated with open reduction and internal fixation by plate osteosynthesis by anterolateral approach 10(38.46%) patients had excellent result, 1(3.84%) patient had good result and 3(11.53%) patients had poor result. And Out of all the 26 patients with diaphyseal humerus fracture 13 patients operated with posterior approach 9(34.61%) patients had excellent result, 4(15.38%) patients had good result and none had poor result. Conclusion: in our study we conclude that both approaches are equally effective for diaphyseal humerus fractures treatment in terms of fracture union, functional outcome and complications. Posterior approach to shaft humerus fracture is beneficial because with mobilization of radial nerve 76% of humerus shaft is exposed. In preoperative radial nerve palsy with diaphyseal shaft fractures posterior approach is better choice for nerve exploration. And anterolateral approach is better option for upper third and middle third diaphyseal humerus fractures and posterior approach is better option for distal third diaphyseal humerus fractures.
{"title":"A comparative study of functional outcome in treatment of diaphyseal humerus fractures with open reduction and internal fixation by two different approaches, anterolateral and posterior","authors":"Dr. Takshay J Gandhi, Dr. Harshlaxen A Rajpardhi, Dr. Raj N Patel","doi":"10.33545/orthor.2021.v5.i4a.320","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i4a.320","url":null,"abstract":"Introduction: The humerus diaphyseal fractures account for 3% all bone fractures. Humerus diaphyseal fractures occurs in young adults because of high velocity injuries like road traffic accidents, fall from height, assaults and heavy machinery injuries, humerus diaphyseal fractures occurs in old age patients because of simple falls due to osteoporotic bones. Methods: A retrospective review was conducted of patients with humerus diaphyseal fractures. In all 26 patients were enrolled in the study, of which 13(50%) were treated with anterolateral approaches and the 13(50%) with posterior approaches. In this study we treated diaphyseal humerus fractures with open reduction and internal fixation by two different approaches, anterolateral and posterior, and compared results and functional outcome. Results: Out of all the 26 patients with diaphyseal humerus fracture 13 patients were operated with open reduction and internal fixation by plate osteosynthesis by anterolateral approach 10(38.46%) patients had excellent result, 1(3.84%) patient had good result and 3(11.53%) patients had poor result. And Out of all the 26 patients with diaphyseal humerus fracture 13 patients operated with posterior approach 9(34.61%) patients had excellent result, 4(15.38%) patients had good result and none had poor result. Conclusion: in our study we conclude that both approaches are equally effective for diaphyseal humerus fractures treatment in terms of fracture union, functional outcome and complications. Posterior approach to shaft humerus fracture is beneficial because with mobilization of radial nerve 76% of humerus shaft is exposed. In preoperative radial nerve palsy with diaphyseal shaft fractures posterior approach is better choice for nerve exploration. And anterolateral approach is better option for upper third and middle third diaphyseal humerus fractures and posterior approach is better option for distal third diaphyseal humerus fractures.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120846281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3a.285
Dr. Sunil Kumar Saharan, Dr. Kartikeya Sharma
Introduction: To evaluate the utility of a questionnaire in assessment of low back pain and disability and the correlation between disability score, clinical features and imaging findings in patients with low back pain. Methodology: Here, we included 25 consecutive patients with duration of low back pain for 1 month who were not responding to conservative OPD treatment, and also had no reason to suspect any underlying organic disease. Each patient was analyzed on the basis of history and physical examination and a base line X-ray was taken. Results: Here, mean age of patients is 39.8 years with female predominance. According to Q-score there are 13 out of 25 patients are of modrate category, 11 in severe cateogory and rest in extreme category. We further divide these patients into 2 types i.e concavity right side and concavity left side. There are 5 patient of former category and 1 of later. Conclusion: A back-pain questionnaire should be designed and framed according to the life style of the patient i.e. if the patient cannot read or understand the questionnaire than it should be framed in the local language and should be read by investigator. Clinical examination is also an important tool for assessment of patients especially to support and exclude destructive and compressive lesions and also neurological diseases.
{"title":"Evaluation of questionnaire in assessment of low back pain and disability and find correlation between disability score, clinical features and imaging findings","authors":"Dr. Sunil Kumar Saharan, Dr. Kartikeya Sharma","doi":"10.33545/orthor.2021.v5.i3a.285","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3a.285","url":null,"abstract":"Introduction: To evaluate the utility of a questionnaire in assessment of low back pain and disability and the correlation between disability score, clinical features and imaging findings in patients with low back pain. Methodology: Here, we included 25 consecutive patients with duration of low back pain for 1 month who were not responding to conservative OPD treatment, and also had no reason to suspect any underlying organic disease. Each patient was analyzed on the basis of history and physical examination and a base line X-ray was taken. Results: Here, mean age of patients is 39.8 years with female predominance. According to Q-score there are 13 out of 25 patients are of modrate category, 11 in severe cateogory and rest in extreme category. We further divide these patients into 2 types i.e concavity right side and concavity left side. There are 5 patient of former category and 1 of later. Conclusion: A back-pain questionnaire should be designed and framed according to the life style of the patient i.e. if the patient cannot read or understand the questionnaire than it should be framed in the local language and should be read by investigator. Clinical examination is also an important tool for assessment of patients especially to support and exclude destructive and compressive lesions and also neurological diseases.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122910744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3b.298
Guruprasath Arunagiri, Sathish Kumar Thangamani, L. Jagat, Tholgapiyan Thirueni
Background: Posterior cruciate ligament (PCL) is strongest of all ligaments around knee & its reconstruction remains a technically demanding surgery. Outcome of the surgery is multifactorial including graft material Selection, method of fixation etc. Our prospective study evaluates results of PCL reconstruction using quadripuled semitendinoses gracilis autograft, with 3 years follow up. Patients and Methods: 40 patients were included in the study which extended for 36 months. This was a prospective study and all cases which had PCL rupture during this period were considered for this study. Patients with isolated chronic PCL rupture as well as multi ligament injuries including PCL rupture were included in the study. Results: Physiotherapy was started on the second postoperative day and 40% had excellent outcome with Lysholm knee score whereas 60% had good outcome. Majority of the patients (95%)were men which implies that this kind of injuries common with RTA’s and worksite injuries. Conclusion: Reconstruction of PCL using quadripuled semitendinoses gracilis autograft improves the clinical outcome drastically.
{"title":"Functional outcome of arthroscopic posterior cruciate ligament reconstruction using quadrupled semitendinosus Gracilis graft: A prospective study","authors":"Guruprasath Arunagiri, Sathish Kumar Thangamani, L. Jagat, Tholgapiyan Thirueni","doi":"10.33545/orthor.2021.v5.i3b.298","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3b.298","url":null,"abstract":"Background: Posterior cruciate ligament (PCL) is strongest of all ligaments around knee & its reconstruction remains a technically demanding surgery. Outcome of the surgery is multifactorial including graft material Selection, method of fixation etc. Our prospective study evaluates results of PCL reconstruction using quadripuled semitendinoses gracilis autograft, with 3 years follow up. Patients and Methods: 40 patients were included in the study which extended for 36 months. This was a prospective study and all cases which had PCL rupture during this period were considered for this study. Patients with isolated chronic PCL rupture as well as multi ligament injuries including PCL rupture were included in the study. Results: Physiotherapy was started on the second postoperative day and 40% had excellent outcome with Lysholm knee score whereas 60% had good outcome. Majority of the patients (95%)were men which implies that this kind of injuries common with RTA’s and worksite injuries. Conclusion: Reconstruction of PCL using quadripuled semitendinoses gracilis autograft improves the clinical outcome drastically.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114160863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3a.317
Dr. Ajeet Hundekar, Dr. Santosh Mared, Dr. Prakash Wali
Introduction: Intertrochanteric (peritrochanteric) fractures include the fractures in the region extending from the extrascapular basilar neck region to the region along the lesser trochanter of femur. Usually occurs in the elderly age group as a result of low-Energy trauma such as accidental fall due to osteoporosis and poor bone quality but high velocity trauma in young individuals can also result in similar fracture. Epidemiological reports by (Gill esult JB, 2007) reported a life-time risk of hip fractures at 50 years of age as 5.6% for men and 20% for women. And, interestingly peritrochanteric fractures constitute around 34% of all hip fractures. Aim of the study: The aim of the study is to compare and analyze the functional outcome of patients with Unstable Trochanteric fractures managed with Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN) Objective of the study: Comparative analysis of functional outcome in the management of unstable trochanteric fractures by Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN).
{"title":"A comparitive & prospective analysis of unstable trochanteric fractures fixed with PFN and PFN AII","authors":"Dr. Ajeet Hundekar, Dr. Santosh Mared, Dr. Prakash Wali","doi":"10.33545/orthor.2021.v5.i3a.317","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3a.317","url":null,"abstract":"Introduction: Intertrochanteric (peritrochanteric) fractures include the fractures in the region extending from the extrascapular basilar neck region to the region along the lesser trochanter of femur. Usually occurs in the elderly age group as a result of low-Energy trauma such as accidental fall due to osteoporosis and poor bone quality but high velocity trauma in young individuals can also result in similar fracture. Epidemiological reports by (Gill esult JB, 2007) reported a life-time risk of hip fractures at 50 years of age as 5.6% for men and 20% for women. And, interestingly peritrochanteric fractures constitute around 34% of all hip fractures. Aim of the study: The aim of the study is to compare and analyze the functional outcome of patients with Unstable Trochanteric fractures managed with Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN) Objective of the study: Comparative analysis of functional outcome in the management of unstable trochanteric fractures by Proximal Femoral Nailing Anti-rotation II (PFN AII) against Proximal Femoral Nailing (PFN).","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117329172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3c.307
Dr. Subeg Singh, Dr. kapil kumar Bansal, Dr. Anshul Dahuja, Dr. Radhe Shyam Garg, Dr. Yugpreet Singh, D. R. Kumar
Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP). Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department at Guru Gobind singh Medical College and Hospital, Faridkot by MIPPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score. Results: There were 50 patients in the study including 36 males and 14 female of mean age 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non-union. There were 12 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. . According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100. Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.
{"title":"Minimal invasive percutaneous plate osteosynthesis (MIPPO) in treatment of distal tibial fractures: A prospective study of 50 cases","authors":"Dr. Subeg Singh, Dr. kapil kumar Bansal, Dr. Anshul Dahuja, Dr. Radhe Shyam Garg, Dr. Yugpreet Singh, D. R. Kumar","doi":"10.33545/orthor.2021.v5.i3c.307","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3c.307","url":null,"abstract":"Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP). Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department at Guru Gobind singh Medical College and Hospital, Faridkot by MIPPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score. Results: There were 50 patients in the study including 36 males and 14 female of mean age 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non-union. There were 12 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. . According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100. Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131724289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3c.309
Dr. Pradyot Basak, Dr. Rajib Debnath, Dr.Abhijit Sarkar, Dr. JM Datta
Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days posttrauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.
{"title":"Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique","authors":"Dr. Pradyot Basak, Dr. Rajib Debnath, Dr.Abhijit Sarkar, Dr. JM Datta","doi":"10.33545/orthor.2021.v5.i3c.309","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3c.309","url":null,"abstract":"Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days posttrauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"49 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131435300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.33545/orthor.2021.v5.i3b.291
D. Nayak, D. P. Dubey, Dr. Harshwardhan Dawar
Objective: To evaluate the outcome of the Olecranon osteotomy approach and TRAP (triceps reflecting anconeus pedicle) approach and comparing them, attributable to Mayo Elbow Performance Score, range of motion, duration of fracture union and duration of surgery. Method and Material: The study is a retrospective randomized control trial on patients with intercondylar and supracondylar fractures of humerus admitted and operated in Department of Orthopaedics, Government medical college and District Hospital, Ratlam from July 2019 to September 2020. Total of 30 patients was included in the study, 15 in each group viz. Group-A operated by TRAP approach and Group-B operated by olecranon osteotomy approach. Results: The difference in Mean duration for fracture union was not statistically significant, in group-A was 12.21 ± 1.621 weeks, while it was 13.46 ± 2.307 weeks in group-B. Duration of surgery was statistically significantly different, more in group B (1.42 ± 0.14 hours) compare to group-A (1.21 ± 0.21 hours). Comparison between ranges of motion of both groups was assessed by Average of extension lag, the mean elbow arc of motion and average of flexion. No significant difference was found between the parameters. The average of extension lag was 11.96 ± 9.26 degree in group-A and it was 16.77 ± 10.31 degree in group-B. The mean elbow arc of motion in group A was 98.34 ± 24.17degrees and in group B was 91.25 ± 21.84 degrees. Average flexion was 109.71 ± 16.65 degrees and 111.47 ± 20.37degrees in group-A and group-B respectively. The average Mayo Elbow Performance Score in group-A was 86.93 ± 12.42 and in group-B was 83.48 ± 15.93. P-value was >.05 show that there was no statistically significant difference between two groups Mayo elbow score. Finally, 25 patients (83.33%) out of 30 showed good and excellent results and hence concluding that there is no statistically significant difference between these two modalities when it comes to outcome. Conclusion: TRAP approach is comparatively better than osteotomy approach in terms of stable fracture fixation and better outcome, with the advantage of intact olecranon. However the approach demands fast rehabilitation.
{"title":"A Study comparing Olecranon osteotomy with Triceps reflecting anconeus pedicle approach (TRAP) for internal fixation of supracondylar and intercondylar fractures of the humerus","authors":"D. Nayak, D. P. Dubey, Dr. Harshwardhan Dawar","doi":"10.33545/orthor.2021.v5.i3b.291","DOIUrl":"https://doi.org/10.33545/orthor.2021.v5.i3b.291","url":null,"abstract":"Objective: To evaluate the outcome of the Olecranon osteotomy approach and TRAP (triceps reflecting anconeus pedicle) approach and comparing them, attributable to Mayo Elbow Performance Score, range of motion, duration of fracture union and duration of surgery. Method and Material: The study is a retrospective randomized control trial on patients with intercondylar and supracondylar fractures of humerus admitted and operated in Department of Orthopaedics, Government medical college and District Hospital, Ratlam from July 2019 to September 2020. Total of 30 patients was included in the study, 15 in each group viz. Group-A operated by TRAP approach and Group-B operated by olecranon osteotomy approach. Results: The difference in Mean duration for fracture union was not statistically significant, in group-A was 12.21 ± 1.621 weeks, while it was 13.46 ± 2.307 weeks in group-B. Duration of surgery was statistically significantly different, more in group B (1.42 ± 0.14 hours) compare to group-A (1.21 ± 0.21 hours). Comparison between ranges of motion of both groups was assessed by Average of extension lag, the mean elbow arc of motion and average of flexion. No significant difference was found between the parameters. The average of extension lag was 11.96 ± 9.26 degree in group-A and it was 16.77 ± 10.31 degree in group-B. The mean elbow arc of motion in group A was 98.34 ± 24.17degrees and in group B was 91.25 ± 21.84 degrees. Average flexion was 109.71 ± 16.65 degrees and 111.47 ± 20.37degrees in group-A and group-B respectively. The average Mayo Elbow Performance Score in group-A was 86.93 ± 12.42 and in group-B was 83.48 ± 15.93. P-value was >.05 show that there was no statistically significant difference between two groups Mayo elbow score. Finally, 25 patients (83.33%) out of 30 showed good and excellent results and hence concluding that there is no statistically significant difference between these two modalities when it comes to outcome. Conclusion: TRAP approach is comparatively better than osteotomy approach in terms of stable fracture fixation and better outcome, with the advantage of intact olecranon. However the approach demands fast rehabilitation.","PeriodicalId":151163,"journal":{"name":"National Journal of Clinical Orthopaedics","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115891869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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