Pub Date : 2017-01-01DOI: 10.4103/2319-2585.204724
D. Gautam, N. Wahal, R. Malhotra, Vijay Kumar
We present the case of a 55-year-old female who sustained avulsion of anterior cruciate ligament (ACL) from its tibial attachment while undergoing unicompartmental knee replacement (UKR). The fibers of ACL were intact. Realizing the paramount importance of ACL in a knee undergoing UKR, we promptly performed a primary repair of the ACL and continued with the surgery in the same sitting. At the latest follow-up, the patient is doing well both clinically and functionally and has no antero-posterior or varus-valgus laxity. We discuss the cause for ACL avulsion during UKR and precautions to avoid it.
{"title":"Simultaneous anterior cruciate ligament repair and medial unicompartmental knee replacement","authors":"D. Gautam, N. Wahal, R. Malhotra, Vijay Kumar","doi":"10.4103/2319-2585.204724","DOIUrl":"https://doi.org/10.4103/2319-2585.204724","url":null,"abstract":"We present the case of a 55-year-old female who sustained avulsion of anterior cruciate ligament (ACL) from its tibial attachment while undergoing unicompartmental knee replacement (UKR). The fibers of ACL were intact. Realizing the paramount importance of ACL in a knee undergoing UKR, we promptly performed a primary repair of the ACL and continued with the surgery in the same sitting. At the latest follow-up, the patient is doing well both clinically and functionally and has no antero-posterior or varus-valgus laxity. We discuss the cause for ACL avulsion during UKR and precautions to avoid it.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47156106","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}
M. Saini, Akshat Vijay, Mahesh Gupta, Hemeshwar Harshwardhan
INTRODUCTION AND AIM: Clubfoot is usually diagnosed immediately after birth; hence, most of the surgeons believes in an early initiation of treatment. Thus, our study was aimed to assess the efficacy of Ponseti technique in correcting congenital talipes equinovarus deformity of foot, to determine the type of clubfoot best suited for this technique and to find the lacunae and disadvantages of Ponseti technique, if any. MATERIALS AND METHODS: It was a prospective study of 50 cases with 76 feet of clubfoot in tertiary level hospital from September 2012 to October 2016. All these cases included were classical clubfoot deformities (idiopathic clubfoot), excluding syndromic and complicated cases with previous failed operative treatment. Children were evaluated by Pirani severity scoring system. All the patients were treated by Ponseti technique of corrective casting and achilles tenotomy. RESULTS: In the present study, about 84% of patients had good results, 4% had fair results, and 12% of patients had poor results showing failure with Ponseti technique. Overall, 88% of the patients presented with satisfactory results. Overall, mean Pirani score for all the feet was 5.01. There were thirty complications among all the patients, constituting 39% of total feet. CONCLUSION: The observations of the present study clearly showed that age at initial presentation, quality (mobility) of foot and Pirani score at presentation directly affects final results. Ponseti technique for the treatment of clubfoot is a simple and effective which is suitable in the Indian subcontinent as it is economical.
{"title":"Management of clubfoot by ponseti method: A prospective study","authors":"M. Saini, Akshat Vijay, Mahesh Gupta, Hemeshwar Harshwardhan","doi":"10.4103/joas.joas_33_16","DOIUrl":"https://doi.org/10.4103/joas.joas_33_16","url":null,"abstract":"INTRODUCTION AND AIM: Clubfoot is usually diagnosed immediately after birth; hence, most of the surgeons believes in an early initiation of treatment. Thus, our study was aimed to assess the efficacy of Ponseti technique in correcting congenital talipes equinovarus deformity of foot, to determine the type of clubfoot best suited for this technique and to find the lacunae and disadvantages of Ponseti technique, if any. MATERIALS AND METHODS: It was a prospective study of 50 cases with 76 feet of clubfoot in tertiary level hospital from September 2012 to October 2016. All these cases included were classical clubfoot deformities (idiopathic clubfoot), excluding syndromic and complicated cases with previous failed operative treatment. Children were evaluated by Pirani severity scoring system. All the patients were treated by Ponseti technique of corrective casting and achilles tenotomy. RESULTS: In the present study, about 84% of patients had good results, 4% had fair results, and 12% of patients had poor results showing failure with Ponseti technique. Overall, 88% of the patients presented with satisfactory results. Overall, mean Pirani score for all the feet was 5.01. There were thirty complications among all the patients, constituting 39% of total feet. CONCLUSION: The observations of the present study clearly showed that age at initial presentation, quality (mobility) of foot and Pirani score at presentation directly affects final results. Ponseti technique for the treatment of clubfoot is a simple and effective which is suitable in the Indian subcontinent as it is economical.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45897811","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}
T of back pain, sciatica, and claudication has changed due to understanding of anatomy, physiology of pain generators leading to change in access, philosophy, and equipment. I have tried to summarize what was the traditional past, why change is necessary and what has changed, and how the change is incorporated in Gore matrix for diagnosis and gore system for treatment in back pain, sciatica, and claudication by proposing spine surgery as stitchless and under local anesthesia in awake and aware patients.
{"title":"New emerging Gore Matrix: Basis of stitchless spine surgery under local anesthesia","authors":"S. Gore","doi":"10.4103/JOAS.JOAS_19_17","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_19_17","url":null,"abstract":"T of back pain, sciatica, and claudication has changed due to understanding of anatomy, physiology of pain generators leading to change in access, philosophy, and equipment. I have tried to summarize what was the traditional past, why change is necessary and what has changed, and how the change is incorporated in Gore matrix for diagnosis and gore system for treatment in back pain, sciatica, and claudication by proposing spine surgery as stitchless and under local anesthesia in awake and aware patients.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42187538","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}
{"title":"Luxatio erecta: A case series from a tertiary care centre in North India","authors":"G. Dharmshaktu, I. Khan, P. Singh","doi":"10.4103/joas.joas_34_15","DOIUrl":"https://doi.org/10.4103/joas.joas_34_15","url":null,"abstract":"","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44459775","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}
BACKGROUND: Blood transfusion is the cornerstone of therapy for many serious ailments, surgical and trauma patients. Patients undergoing orthopedic surgeries as elective procedure or emergency orthopedic surgery for trauma often experience excessive blood loss- requiring transfusions. However, preoperative placement of blood requests frequently overshoots the actual need resulting in unnecessary crossmatching, which can be reduced by formulating maximum surgical blood ordering schedule (MSBOS). It is a table of elective surgical procedures, which lists the number of units of blood routinely cross-matched pre-operatively. OBJECTIVE: The objective of this study is to audit the blood utilization in orthopedic surgeries so that unnecessary cross-matching, wastage of blood bank resources, and financial losses to the patients could be reduced. MATERIALS AND METHODS: A retrospective study was carried out in our tertiary care hospital over a period of 6 months to determine the utilization of blood during different orthopedic procedures and to recommend an appropriate blood ordering schedule. The data collected include patient's requests, patient's transfused, type of surgical procedure, number of units crossmatched and transfused, crossmatch to transfusion ratio (CTR) and transfusion indices (TI's); according to them, MSBOS was proposed. RESULTS: A total of 478 units of blood were crossmatched for 273 patients and only 243 units were transfused to 183 patients. About 50.8% of the crossmatched units and 67% of the total patients were transfused. Seven out of the thirteen procedures had a CTR higher than 2, low TI ≤0.5 and blood utilization ≤50%. Fracture forearm and unilateral total knee replacement have the transfusion probability of ≤30%, so implementation of type and screen policy was recommended for these two procedures. CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.
{"title":"Proposed maximum surgical blood ordering schedule for common orthopedic surgeries in a Tertiary Health - Care Center in Northern India","authors":"Sonam Kumari, R. Kansay, Sandeep Kumar","doi":"10.4103/JOAS.JOAS_24_16","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_24_16","url":null,"abstract":"BACKGROUND: Blood transfusion is the cornerstone of therapy for many serious ailments, surgical and trauma patients. Patients undergoing orthopedic surgeries as elective procedure or emergency orthopedic surgery for trauma often experience excessive blood loss- requiring transfusions. However, preoperative placement of blood requests frequently overshoots the actual need resulting in unnecessary crossmatching, which can be reduced by formulating maximum surgical blood ordering schedule (MSBOS). It is a table of elective surgical procedures, which lists the number of units of blood routinely cross-matched pre-operatively. OBJECTIVE: The objective of this study is to audit the blood utilization in orthopedic surgeries so that unnecessary cross-matching, wastage of blood bank resources, and financial losses to the patients could be reduced. MATERIALS AND METHODS: A retrospective study was carried out in our tertiary care hospital over a period of 6 months to determine the utilization of blood during different orthopedic procedures and to recommend an appropriate blood ordering schedule. The data collected include patient's requests, patient's transfused, type of surgical procedure, number of units crossmatched and transfused, crossmatch to transfusion ratio (CTR) and transfusion indices (TI's); according to them, MSBOS was proposed. RESULTS: A total of 478 units of blood were crossmatched for 273 patients and only 243 units were transfused to 183 patients. About 50.8% of the crossmatched units and 67% of the total patients were transfused. Seven out of the thirteen procedures had a CTR higher than 2, low TI ≤0.5 and blood utilization ≤50%. Fracture forearm and unilateral total knee replacement have the transfusion probability of ≤30%, so implementation of type and screen policy was recommended for these two procedures. CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42530235","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}
N. Kumar, J. Mukhopadhaya, C. Yadav, Sumit Anand, Swapnil Singh
Total knee Arthroplasty is the most common and successful surgery world wide. Foundation of TKA is based on three pillars soft tissue balancing, bone cuts and cementing. All these factors are equally important and mistake at any level will lead to failure. We here would like to add the fourth pillar 'Joint line Restoration' for successful TKA.
{"title":"Joint line restoration in total knee arthroplasty","authors":"N. Kumar, J. Mukhopadhaya, C. Yadav, Sumit Anand, Swapnil Singh","doi":"10.4103/JOAS.JOAS_10_17","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_10_17","url":null,"abstract":"Total knee Arthroplasty is the most common and successful surgery world wide. Foundation of TKA is based on three pillars soft tissue balancing, bone cuts and cementing. All these factors are equally important and mistake at any level will lead to failure. We here would like to add the fourth pillar 'Joint line Restoration' for successful TKA.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43157053","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}
Patients who suffer from spinal cord injury because of their permanent mobility and/or cognitive impairment will usually face difficulties in reentering into the community. The aim of this paper is to review the relevant architectural and attitudinal barrier, transportation difficulties in the current Indian scenario. MEDLINE®, Embase™, the Science Citation Index, and Google™ Scholar were used to look for relevant articles published in English literature. Rehabilitation should promote the full inclusion and participation of people with disabilities in the physical and psychosocial environment. The past two decades have seen a renewed interest in India to improve services for spinal injured. Although there are number of barriers to successful community reintegration in India; a holistic and empathetic approach to prioritize this issue is the need of the hour. Recent initiatives taken by the government, namely, “Sugamya Bharat Abhiyan - Accessible India” and Person with Disability Act 1995 are welcome steps in this direction.
{"title":"Community reintegration postspinal cord injury: Indian scenario","authors":"Roop Singh, Sidharth S Yadav, V. Meena","doi":"10.4103/JOAS.JOAS_2_17","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_2_17","url":null,"abstract":"Patients who suffer from spinal cord injury because of their permanent mobility and/or cognitive impairment will usually face difficulties in reentering into the community. The aim of this paper is to review the relevant architectural and attitudinal barrier, transportation difficulties in the current Indian scenario. MEDLINE®, Embase™, the Science Citation Index, and Google™ Scholar were used to look for relevant articles published in English literature. Rehabilitation should promote the full inclusion and participation of people with disabilities in the physical and psychosocial environment. The past two decades have seen a renewed interest in India to improve services for spinal injured. Although there are number of barriers to successful community reintegration in India; a holistic and empathetic approach to prioritize this issue is the need of the hour. Recent initiatives taken by the government, namely, “Sugamya Bharat Abhiyan - Accessible India” and Person with Disability Act 1995 are welcome steps in this direction.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44520469","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}
Mukesh Kumar, K Chandrabau, V. Bhaskaran, R. Jindal
Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road). Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.
{"title":"Unusual proximal femur fracture in children treated with PHILOS plate and review of literature","authors":"Mukesh Kumar, K Chandrabau, V. Bhaskaran, R. Jindal","doi":"10.4103/JOAS.JOAS_32_16","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_32_16","url":null,"abstract":"Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road). Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43302893","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}
INTRODUCTION: Intertrochanteric fractures (ITF) are of intense interest globally. These fractures are most frequently operated type having the highest postoperative fatality rates and hence have become a serious health resource issue. AIM: The aim of this study is to assess the risk factors and their effect on the outcome of intertrochanteric fractures treated by sliding hip screw fixation. SETTINGS AND DESIGN: This is a retrospective and prospective observational study of all the intertrochanteric fractures treated by sliding hip screw fixation at our institute between January 2013 to August 2015. MATERIALS AND METHODS: A total of 78 intertrochanteric fractures have met the inclusion criteria proposed for the study. Preoperative and intraoperative risk factors were assessed for all the cases and treated by sliding hip screw. The Radiological outcome was assessed after a minimum follow-up of 3 months for all the cases. RESULTS: When comparing all the preoperative and intraoperative variables independently with the outcome, P value was found to be statistically significant only in displacement, reverse obliquity, inadequate lateral wall thickness, and reduction. We devised a scoring system to assess the risk outcome in the treatment of trochanteric fractures based on local fracture factors. Least score of zero and a maximum score of eight was seen in the study participants. CONCLUSION: Trochantric severity score is a useful tool to assess the outcome of management of intertrochanteric fractures. Sliding hip screw may not be an ideal implant for, trochantric fractures with inadequate lateral wall thickness (failure rate of 63%), reverse oblique type of trochanter fractures (failure rates of 50%), and displaced comminuted fractures (failure rate of 13%).
{"title":"Trochantric severity score a useful tool to assess outcomes after intertrochantric fractures","authors":"S. George, B. Rai, Abhishek Mannem","doi":"10.4103/joas.joas_9_17","DOIUrl":"https://doi.org/10.4103/joas.joas_9_17","url":null,"abstract":"INTRODUCTION: Intertrochanteric fractures (ITF) are of intense interest globally. These fractures are most frequently operated type having the highest postoperative fatality rates and hence have become a serious health resource issue. AIM: The aim of this study is to assess the risk factors and their effect on the outcome of intertrochanteric fractures treated by sliding hip screw fixation. SETTINGS AND DESIGN: This is a retrospective and prospective observational study of all the intertrochanteric fractures treated by sliding hip screw fixation at our institute between January 2013 to August 2015. MATERIALS AND METHODS: A total of 78 intertrochanteric fractures have met the inclusion criteria proposed for the study. Preoperative and intraoperative risk factors were assessed for all the cases and treated by sliding hip screw. The Radiological outcome was assessed after a minimum follow-up of 3 months for all the cases. RESULTS: When comparing all the preoperative and intraoperative variables independently with the outcome, P value was found to be statistically significant only in displacement, reverse obliquity, inadequate lateral wall thickness, and reduction. We devised a scoring system to assess the risk outcome in the treatment of trochanteric fractures based on local fracture factors. Least score of zero and a maximum score of eight was seen in the study participants. CONCLUSION: Trochantric severity score is a useful tool to assess the outcome of management of intertrochanteric fractures. Sliding hip screw may not be an ideal implant for, trochantric fractures with inadequate lateral wall thickness (failure rate of 63%), reverse oblique type of trochanter fractures (failure rates of 50%), and displaced comminuted fractures (failure rate of 13%).","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47686986","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}
Avascular necrosis can develop secondary to a traumatic or atraumatic interruption of blood supply to a bony region. We present an unusual case of femoral head osteonecrosis in a patient who concomitantly suffered a complete delamination injury to the articular surface and ultimately underwent progressive degenerative changes in the femoral head requiring total hip arthroplasty (THA). A 57-year-old man without significant medical comorbidities presented for orthopedic evaluation in the outpatient setting complaining of left hip pain. The patient reported a slip and fall onto his left hip 4 months prior with no preexisting discomfort. Since then, the progressively worsening pain has centered on the left groin with radiation into the lateral aspect of the hip. Physical examination is negative for focal deficits, but provocative maneuvers for intra-articular pathology were positive. X-rays demonstrated mild degenerative changes while magnetic resonance imaging (MRI) showed a complete delamination injury to the articular surface with associated femoral head collapse. Nonoperative treatment failed to provide pain relief, and so the patient ultimately underwent surgical intervention. Treatment consisted of left uncemented THA with cable augmentation. Postoperatively, the patient was monitored with periodic follow-ups while undergoing postsurgical rehabilitation. Interval improvement was demonstrated and patient overall did well.
{"title":"Femoral head chondral delamination injury and associated osteonecrosis: A case report of treatment","authors":"Vince W. Lands, A. Malige, C. Reddy","doi":"10.4103/JOAS.JOAS_19_16","DOIUrl":"https://doi.org/10.4103/JOAS.JOAS_19_16","url":null,"abstract":"Avascular necrosis can develop secondary to a traumatic or atraumatic interruption of blood supply to a bony region. We present an unusual case of femoral head osteonecrosis in a patient who concomitantly suffered a complete delamination injury to the articular surface and ultimately underwent progressive degenerative changes in the femoral head requiring total hip arthroplasty (THA). A 57-year-old man without significant medical comorbidities presented for orthopedic evaluation in the outpatient setting complaining of left hip pain. The patient reported a slip and fall onto his left hip 4 months prior with no preexisting discomfort. Since then, the progressively worsening pain has centered on the left groin with radiation into the lateral aspect of the hip. Physical examination is negative for focal deficits, but provocative maneuvers for intra-articular pathology were positive. X-rays demonstrated mild degenerative changes while magnetic resonance imaging (MRI) showed a complete delamination injury to the articular surface with associated femoral head collapse. Nonoperative treatment failed to provide pain relief, and so the patient ultimately underwent surgical intervention. Treatment consisted of left uncemented THA with cable augmentation. Postoperatively, the patient was monitored with periodic follow-ups while undergoing postsurgical rehabilitation. Interval improvement was demonstrated and patient overall did well.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42961697","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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